Equality, diversity, inclusion and belonging (EDIB) are key elements underpinning the provision of fair, inclusive, welcoming, holistic and equitable healthcare.

What do we mean by equality, diversity, inclusion and belonging?

• The Osteopathic Practice Standards
• Professionalism and the law
• Patient access to healthcare
• Respect for individuality
• Communication
• Speaking up
• Tips for supporting equality, diversity, inclusion and belonging in practice
• Resources to support continual professional development

People, including our patients, are all different. Individuals have a diversity of identities, backgrounds, experiences, needs, and communication styles. The Osteopathic Practice Standards (OPS) can help osteopaths provide care for different people in different contexts.

Applying the OPS and ensuring that we promote equity, value diversity, support inclusion and belonging does not mean treating everyone the same. It means providing care that meets an individual’s needs.

Being clear about how the standards embed the principles of equality, diversity, inclusion and belonging will enable osteopaths to reach a judgement as to whether they have the knowledge, skills and experience necessary to meet the specific needs of a patient and, if not, be able to refer appropriately or signpost to further support or resources (which are mentioned below).

Why is this important?

People understand our communications to them based on their own different experiences, backgrounds and identities. This means that what we intend to communicate, and what is understood and received by the person we are communicating with, can be very different, creating misunderstanding.

Continual learning about EDIB can support more holistic and inclusive practice and better communication with our patients. It is therefore an essential part of osteopathic practice and continual professional development.

Over time, embedding EDIB in osteopathic practice will ensure that we are able to serve diverse communities and patients.

What do we mean by equality, diversity, inclusion and belonging?

• Equality: ensuring equal opportunities for all. Removing barriers and providing opportunities: no discrimination
• Diversity: welcoming, recognising and valuing different experiences and views, demonstrating that we respect difference
• Inclusion: creating spaces which are accessible to all and where people feel they can participate fully, because their experiences, views and identity are valued. Belonging: where people feel valued and empowered to contribute as equals.

Further information about equality, diversity and inclusion can be found in this video by Yinka Fabusuyi and Jerry Draper-Rodi.

The Osteopathic Practice Standards

Osteopaths are required to meet the Osteopathic Practice Standards, many of which address issues that centre around providing inclusive, individualised care, tailored to the needs of the patient.

Professionalism and the law

Meeting the law at all times is essential for any registered healthcare practitioner, and for osteopaths is referenced in the following standards.

D7. You must uphold the reputation of the profession at all times through your conduct, in and out of the workplace.

This standard states that your professional and personal conduct must not undermine the public’s trust and confidence in the profession, that you must act within the law at all times and show compassion to patients. In relation to EDIB, it is important to remember that the public and patients are diverse and the way that they are treated will determine if they have trust and confidence in the profession.

D6. You must treat patients fairly and recognise diversity and individual values. You must comply with equality and anti-discrimination law.

The guidance to this standard states:

• You should be familiar with the requirements that apply to you under equality law.
• It is illegal to refuse a service to someone on the grounds of their age, disability, gender reassignment, marriage or civil partnership, pregnancy or maternity, race, religion or belief, sex or sexual orientation. Relevant legislation includes the Equality Act 2010 in England, Wales and Scotland, and similar legislation in Northern Ireland.

The Equality and Human Rights Commission publish guidance for businesses (2019) which can help osteopaths to understand their legal obligations to ensure that they provide services in accordance with the law.

Patient access to healthcare

Equalities legislation requires that reasonable adjustments are made to support people with disabilities in accessing health care. These protections apply where patients have:

• a physical impairment
• sensory impairment
• long term mental health condition
• long term health condition
• learning disability

Reasonable adjustments might include:

• ensuring that there is wheelchair access to your clinic, or having another arrangement for patients in these circumstances
• adjustable plinths
• providing patient information in easy read formats.
• allowing longer appointments for patients with particular needs (at no extra cost)

B3. You must keep your professional knowledge and skills up to date.

This standard specifies that you should keep up to date with factors relevant to your practice including legal requirements and changes to the law in relation to equality issues.

Respect for individuality

These standards put the patient and their identities at the forefront of effective care.

A1. You must listen to patients and respect their individuality, concerns and preferences. You must be polite and considerate with patients and treat them with dignity and courtesy.

A7. You must make sure your beliefs and values do not prejudice your patients’ care.

Communication

A2. You must work in partnership with patients, adapting your communication approach to take into account their particular needs and supporting patients in expressing to you what is important to them.

A3. You must give patients the information they want or need to know in a way they can understand.

People’s interpretation of what we say and what we do can be shaped by their background and identity (for example their education, heritage, family, work experiences, social origins and experiences, their sex, gender, sexuality, religion, ethnicity, race, whether they are disabled as well as other matters).

It is also important to be aware that our own beliefs and biases can impact and influence how we interpret the health needs of others, because it is easy to make assumptions about people. The more we know about equality, diversity, inclusion and belonging, the more we can begin to ensure accessible and holistic practice, try to avoid assumptions, supporting better communication between osteopath and patient.

C1. You must be able to conduct an osteopathic patient evaluation and deliver safe, competent and appropriate osteopathic care to your patients.

Take account of the patient’s individual needs and sensitivities by adapting your communication style when taking and recording a patient’s history.

Speaking up

C4. You must take action to keep patients from harm.

Applying the Osteopathic Practice Standards to ensure that we promote equity, value diversity, support inclusion and belonging also means speaking up or taking action against discrimination.

This Merseycare video about Just and Learning Culture: Respect and Civility Awareness can support speaking up in different ways.

Further sources of support about speaking up can be found at:

• Protect (a speaking up charity operating across the UK),
• the National Guardian in England
• resources for speaking up in Wales
• resources for speaking up in Scotland
• resources in Northern Ireland
• How to raise a concern using the General Osteopathic Council website

Tips for supporting equality, diversity, inclusion and belonging in practice

There are a number of ways in which osteopaths can make sure that their practice meets EDIB best practice. For example:

Do:

• Review patient information, marketing material and website content to see if this can be made more accessible, welcoming and inclusive for diverse patients. Maybe ask patients for feedback to help with this. This video provides useful hints and tips about creating a gender inclusive environment.
• Be clear in your practice information that you aim to provide an equitable and inclusive practice that respects and supports the diversity of patients. Ask patients to let you know if they have additional needs, or if there is anything they need by way of a reasonable adjustment to their care.
• Use people’s preferred names and pronouns. Check how to pronounce names if you are unsure and make a note to ensure you get it right next time.
• Consider using our patient resources to help patients think about what is important to them before the consultation and to explain what’s important to them to you during the consultation.
• Develop the skills to sensitively ask about cultural factors which may be relevant to a patient’s care.
• Think about your language when communicating with patients – might what you say be confusing for some patients? Do you use particular metaphors or similes to explain your diagnoses that might be hard to understand for patients for whom English is a second language?
• Does your appointment system allow for flexibility in how patients are booked, for example, if they may need a longer appointment?
• Is your patient population representative of the area in which you work? It can be helpful to review patient characteristics from time to time to consider who you are not seeing as patients, and whether this could be addressed in some way.
• Talk directly to and include patients who are communicating through a translator.
• Work in partnership with patients to remove barriers to your practice.

Don’t

• Don’t make assumptions about the sex or gender of a patient.
• Don’t make assumptions about partners
• Don’t use microaggressions. This resource from Imperial College provides examples of behaviour which can make people feel different, excluded or othered, and which should be avoided.
• Don’t comment on appearance or attractiveness
• Don’t make assumptions about how people from different cultures feel pain or how they may describe pain. For example, this article Conceptions of pain among Somali women (2006) discusses some Somali cultural attitudes to expressing pain.
• Don’t speak directly to translators, excluding the patient in front of you.