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Dismantling systemic racism and improving health equity must address the role of security and law enforcement at healthcare organizations

A message from Bonnie Fryzlewicz, Vice President and Chief Nursing Officer for Seattle Children’s

If you visit one of Seattle Children’s locations, you’ll see that we’ve worked hard to make the experience safe, welcoming and comfortable – especially as families navigate their child’s care.

You might see kids’ art on display or a box of Play-Doh® for your child to take on their way out. You pass through doors without metal detectors.

You’re also greeted by members of our security team who are dedicated to keeping our patients, families and members of our staff safe, just like you would in many settings.

But unlike many settings, our security team operates differently than you might expect. For example, unlike many other hospitals they do not carry firearms. Neither do they carry handcuffsor other restraining devices. They are also trained in de-escalation techniques and strategies that promote advocacy and safety for the whole care environment. In other words: They are diverse and compassionate employees whose expertise is an extension of our mission and values.

That said, as healthcare professionals, we know that ineffective interactions with police or security can potentially cause children and their families physical, cognitive, emotional and social trauma.

Potentially avoidable confrontations continue to occur at healthcare organizations throughout the United States, including the Seattle area. At Seattle Children’s, we have sought to learn more about – and improve – interactions between security and our patients and their families.

Part of our work has involved understanding the practice of initiating a “Code Purple.” A Code Purple is called when a member of our team perceives threatening or unsafe behaviors, and a response team made up of security team members and behavioral support clinicians arrives to de-escalate the situation.

We examined who was calling Code Purples, why they were requesting them and – crucially – which patient-family populations were more likely to have a Code Purple called. While it may be called something other than a Code Purple, this practice exists in every medical institution.

After reviewing data from the last three years, we found what has become tragically not surprising: Code Purples were disproportionately called on patients and families who identify as Black or African American.

That discovery was simply unacceptable. The findings made clear that we had to create a better system to eliminate this disparity and its impacts, especially for Black or African American families.

Earlier this year, Seattle Children’s adopted a new Code Purple policy. Our new policy aims to set expectations and guide our team on when to call a Code Purple, to clarify the roles and responsibilities of the response team, and to create a space to debrief with an equity and anti-racism framework each time a Code Purple is called.

The policy also includes de-escalation training; equity, diversity and inclusion training; and a consistent data review process to support our efforts to decrease the disparity. Our goal is to strengthen our ability to create an environment of equity, trust, healing and partnership.

Revising our Code Purple policy is an important step, and we are not stopping there. We are dedicated to reviewing our data through an anti-racist and equitable lens to help improve decision-making regarding all security and law enforcement engagements at Seattle Children’s. We’re also working to enhance learning for our team through rigorous diversity, equity, bias and inclusion training. No health system can achieve equity without an intentional organization-wide commitment to learning, action and accountability.

In addition to the work actively underway, we also look forward to the findings and recommendations from Covington & Burling’s independent assessment of systemic racism, diversity, equity and inclusion at Seattle Children’s. Their assessment will help inform our efforts, and lead to greater equity not only for our Black and African American patients and families, but also for our team and every family who depends on us for care. We expect to learn more from the assessment this summer. In the meantime, our work continues as we advance our efforts to become an anti-racist organization.

After 36 years as a registered nurse and healthcare leader, I can tell you two things for certain. The first is that nothing is more important to me than the health and safety of our patients, their families and our team. The second is that change is a force for good, and it’s one that we welcome.

Transforming ourselves to become the anti-racist organization we’ve promised to become – the one our patients, families and community need and deserve – is a journey we will be on for years to come. That’s why we are listening to, learning from and engaging our community in our Anti-Racism Organizational Change plan. Reducing disparate outcomes and experiences for patients and families who identify as Black, Indigenous and people of color is essential to our ability to help every child live the healthiest, most fulfilling life possible.

Seattle Children’s is committed to this work not only because it is the right thing to do, but also because the work of dismantling systemic and institutional racism in healthcare must be as critical to medical professionals as curing cancer, sickle cell disease, diabetes or heart disease. It will be achieved by embracing change and relentlessly questioning the status quo.

About Seattle Children’s

Seattle Children’s mission is to provide hope, care and cures to help every child live the healthiest and most fulfilling life possible. Together, Seattle Children’s Hospital, Research Institute and Foundation deliver superior patient care, identify new discoveries and treatments through pediatric research, and raise funds to create better futures for patients.

Ranked as one of the top children’s hospitals in the country by U.S. News & World Report, Seattle Children’s serves as the pediatric and adolescent academic medical center for Washington, Alaska, Montana and Idaho – the largest region of any children’s hospital in the country. As one of the nation’s top five pediatric research centers, Seattle Children’s Research Institute is internationally recognized for its work in neurosciences, immunology, cancer, infectious disease, injury prevention and much more. Seattle Children’s Foundation, along with Seattle Children’s Guild Association – the largest all volunteer fundraising network for any hospital in the country – works with our generous community to raise funds for lifesaving care and research.

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