WASHINGTON — Physicians, research scientists, and leaders of the TIME’S UP Healthcare movement called for a more proactive approach to ending sexual harassment in medicine and academia, during a panel discussion at the Academy Health Annual Research Meeting on Monday.
Victor Dzau, MD, president of the National Academy of Medicine, recalled a situation during his time as chair of medicine at Harvard where a powerful division chief faced a number of claims of sexual harassment. When the claims were substantiated, the institution’s core focus was its own liability and reputation, and so it agreed to the non-disclosure agreement requested by the division chief’s lawyer and the individual “left voluntarily,” Dzau said.
A female physician hired in his place changed the division’s climate; but in retrospect, Dzau said, the non-disclosure agreement should never have been signed. Allowing such problems to remain hidden is a barrier to ending sexual harassment, he said.
As Dzau’s example illustrates, institutions historically have had little motivation to address sexual harassment, explained Esther Choo, MD, MPH, an emergency medicine physician and health services researcher at the Oregon Health & Science University in Portland, the co-founder of Equity Quotient, and a founding member of TIME’S UP Healthcare.
Typically, health systems and academic institutions only responded to sexual harassment or discrimination complaints out of fear of lawsuits or negative publicity, and not because it was morally the right thing to do, Choo said.
If cancers were treated the same way healthcare deals with sexual harassment and discrimination are, she said, “we would wait until they were widely metastatic before we addressed them, we would not be screening at an early stage where they are most amenable to intervention.”
She added, “If you’re waiting till the lawsuit or [for] the person to get to the media because they have harassed dozens if not hundreds of women then it is so late to fix the careers that he has devastated.”
Treating sexual harassment as isolated incidents has meant that as soon as perpetrators are identified, confirmed, and compelled to leave — in some fashion — institutions return to “business as usual,” Choo said.
But keeping such cases hidden from view makes it even more difficult to address them, she added.
“How do we address a problem that is not seen, spoken of, quantified? We only hear of cases of egregious sexual harassment at our own institutions when it is in the news,” said Choo.
“How can we really begin to be productive around these problems when we have no idea what’s going on?”
This lack of transparency — use of non-disclosure agreements, institutions’ eagerness to keep matters quiet — encourages a sense of “shame and fear,” Choo said.
“What else in healthcare do we solve by not talking about it and trying to look away?” Choo said.
Even the most effective and confident institutional leaders “fall like a puddle at your feet with helplessness” when it comes to the problem of sexual harassment. Because of their own fears and uncertainties, they often adopt a reactive rather than a proactive response.
Choo then laid out concrete solutions for re-framing the way institutions and health systems address sexual harassment:
First, it’s important to “multiply the levers” — i.e., the resources, institutions, and channels that individuals experiencing harassment can turn to when they need support.
“This cannot be one office and one institution tackling this problem, but really everybody needs to be all in,” she said. That includes funding agencies, private philanthropic institutions, licensing boards, societies, and unions.
Choo said the TIME’S UP Healthcare movement is actively working with other groups including the National Academies of Sciences, Engineering and Medicine’s Action Collaborative on Preventing Sexual Harassment to establish a “unified message.”
Secondly, Choo said it’s important to “routinize” conversations about sexual harassment and not treat them as “icky.” There should be structured community-wide solutions-building, she said.
By talking about both the micro- and macro-aggression on a daily basis, in time people will become more comfortable with those discussions, she said.
Third, she stressed the importance of “community accountability.”
When she meets with organization leaders, she asks how much the institution has been affected by sexual harassment — how many reports have there been, how many lawsuits. The response is always the same, Choo said.
“Nobody ever knows. And we would never do that for any other problem. If I asked you to improve hemoglobin A1C at a clinic, the first thing you’d say is, ‘Well, what is the average number now and how many patients are on their recommended diabetic therapy?'” she said. “What if I told you, ‘I want you to improve it, but you don’t get any of those numbers.’ … And that’s kind of how we treat sexual harassment. Nobody gets any metrics, the community is not watching for trends, and yet we all hope this will get better.”
Choo said she imagines a dashboard where organizations publicly track certain metrics including the number of reports of sexual harassment and discrimination claims and investigations. The community should then expect to see these metrics improve over time.
In addition to establishing a unified message, bringing conversations out of the shadows, and beginning to document and measure the problem, Choo believes institutions can borrow frameworks used in other parts of the healthcare system.
“We don’t need to make up new stuff,” stressed Choo. Working at a stroke center, “if I don’t make my door-to-CT time I know about it the next day,” she said. “Our ability to track metrics and meet our target outcomes is incredible in many, many other domains. I think we could do this for sexual harassment as well.”
One particular framework worth leveraging is the Donabedian model, Choo said, which requires assessing the structure, human resources, procedures, and process measures that are needed in order to ensure that a policy is properly implemented and that it meets intermediate markers of success. There also must be clearly defined outcomes.
The National Academies released a report on sexual harassment in these fields in 2018. A consensus study on this issue is due out in the fall of 2019. The academies also announced on Monday that members can be ejected if allegations of misconduct are reported and confirmed.
For more on sexual harassment in medicine, check out MedPage Today’s recent “#MeToo in Medicine” investigation.