Table 4 Case discussion

Here, we provide a case discussion loosely based on a case provided by a participant in this study. In this example a healthcare professional (the case presenter, Alex) reflects on a diversity-related moral challenge with one other healthcare professional (Ezra) by means of the deliberation structure proposed in the Diversity Compass. Before engaging in dialogue, they critically examined the seven recommendations. The diversity-related moral challenge at hand concerns Alex reflecting on how to approach his colleagues whom he had overheard joking about a transgender patient who is transitioning.

1. What is the situation?

 Alex: Since recently we care for a transgender patient who is transitioning. Last week two colleagues of mine left their room and I overheard them making a joke about this patient’s body

2. Wat are your feelings about the situation? What is so difficult about this situation?

 Alex: I think that this is disrespectful! I get angry and disappointed at my colleagues for talking this way. I also don’t find this professional behavior. What I find particularly difficult is how I ought to talk to my colleagues about what I heard. I think that healthcare professionals should not discriminate or laugh about others based on their gender identity. I want to have a serious and open conversation with them, but am not sure how I can do that in a good and constructive way. I am also a bit scared about damaging my relationship with my colleagues if I address this situation

3. What is your specific question?

 Alex: How can I address this situation and my feelings about their behavior with my colleagues in a good way?

4. What are the feelings of the others? (Your conversation partner(s) and other stakeholders involved in this conversation, for instance your patient, colleague or manager. Ask them for their feelings, or try to put yourself in their shoes if they are not present during the dialogue)

 Alex: Although the patient was not present in this situation, I think that they would be very hurt by my colleagues’ comments. I also got the impression that my colleagues did not really understand why they were transitioning which they masked with humor and laughing. Regarding my manager, I am not sure what her feelings would be about this situation. We never really address situations like that in our team

Ezra: This is so terrible to hear. My first reaction is that the comments of the colleagues are unprofessional and unsuitable, this situation frustrates me. I can also only imagine how denigrating and painful it may be for the patient to be talked about in this way

5. What is important to you? How does your social background influence what you find important? Where and how you grew up, your age, cultural background, spiritual beliefs, sexuality and gender identity, etc

 Alex: I think that this situation is so difficult for me because I grew up with the notion that you have to be open towards each other and treat each other with respect. My parents always said: treat others as you want to be treated. From personal experience I know what it is like to be ridiculed or bullied because of who you are. It was only when I got older and moved to a larger city that I really felt accepted. That is why it is so important to me that all my patients are and feel respected and that my colleagues do not make these kinds of discriminatory ‘jokes’. It is difficult for me to work with people that talk in this way. I really want my colleagues to reflect on their behavior

6. What is important to the others? Also inquire and reflect on their background

 Alex: I think that it is important to the patient that they are respected for who they are. And that they receive good and professional care without being discriminated against. And my colleagues probably want to openly share their opinion with each other. Actually, I am curious to know what they really find important, what inclined them to make this joke and what the perspective of my manager is on this situation

Ezra: I am wondering whether your colleagues are actually aware of their behavior and its consequences and if they know how difficult the transitioning process is and how much discrimination there is. In general, I think it is really important that the whole team makes clear and concrete agreements about what they perceive as a good way to talk about patients. And that discrimination is never okay. Having an open discussion in your team where you critically reflect on this and similar situations in the future could help with this, if it is done in a good way and facilitated by someone who makes sure that it is a safe and respectful conversation. I think that this may really contribute to better and more inclusive care

7. What do you learn from this exploration?

 Alex: I realized that my colleagues might act like this based on discomfort and a lack of knowledge and insight into the situation. And they might not have thought about how hurtful their comments may be to the patient and to others. Most importantly, I learn that I really have to talk to my colleagues and manager about this

8. What will you do? If you go through these steps with others, first ask them what they would do in your place

 Ezra: I would talk about this with your colleagues at a moment where there is enough time. You should also set the ground rules for the conversation by discussing the seven recommendations with them, before starting with the actual subject and really focus on your own perspective. You can also ask a colleague you trust to support you. Or your manager

Alex: I will use this conversation method with my colleagues tomorrow. I think that colleague D may help me here. She is a good friend and has experience with guiding dialogues. She can help me when I am uncertain about what to say and will make the conversation feel safer. Through the dialogue I want to know more about my colleagues’ true motivation, to share my feelings and really reflect on the situation together

Evaluation:

 Through this dialogue I realized that sometimes people may not be aware of the fact that they see someone else, or their behavior, as different or even inferior. These ‘blind spots’ are important to talk about so that you can treat each other respectfully – not only those that ‘are like you’. I will address this specific situation with my colleagues, and I also want to talk about social justice issues more regularly in my team. My manager may also help, for instance by making diversity and inclusion a regular topic in team meetings. I will also have a look if there are any people in my organization who can help with these conversations