Danielle Gibbs Koenitzer examines how healthcare institutions manage anti-racism through policy and process while avoiding the structural changes required to protect marginalized patients and professionals.

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Healthcare systems are fluent in the language of equity. Hospitals, professional bodies, unions, and regulators issue anti-racism statements, land acknowledgements, and policies that promise safety and inclusion. On paper, this suggests progress.

For many marginalized patients and health care professionals, however, lived experience tells a different story. This gap between what institutions say and what people experience is where performative anti-racism takes hold, not through open hostility, but through symbolic actions that signal virtue without shifting power, resources, or protection.

Image Description: An AI generated photo of healthcare workers in scrubs and lab coats representing different races and genders.

Performative anti-racism is not inaction, but action that stops short of accountability.

These upcoming examples are not abstract second-hand anecdotes. They are experiences I have directly encountered, and if this is what is visible within such a small circle, it raises an unavoidable question: how many similar cases exist beyond it, unrecorded and unseen?

• A 65-year-old man with a history of heart disease and stroke presented to the emergency department with leg pain and was discharged without an assessment. He later died from a cardiac event that may have been preventable.
• A mother brought her 18-year-old son to the hospital during a sickle cell crisis. He was stable when she briefly left to get him a change of clothes. Shortly after, she received a call from the emergency department informing her that he had died.
• A nurse was reported to HR after colleagues falsely claimed she was unfit to practice because they did not want to work with a Black nurse. She ultimately left her role due to ongoing bullying and harassment.
• When I experienced ovarian torsion, a time-sensitive gynecologic emergency, my pain was questioned, and the urgency was minimized as I fought to save my ovary through pain and distress. My clinical knowledge and professional status offered no protection. I include my own experience not as an exception, but as part of the same pattern.

What unites these examples is not the absence of policy, but its presence. Institutions proclaim commitments to equity and anti-racism, yet protection is absent.

Land acknowledgements offer a similar example. They are often delivered on stolen land while Indigenous communities continue to experience dispossession and underfunding. The land remains colonized, and power does not shift. Black History Month events and Pride celebrations follow the same pattern: visibility without power, recognition without change.

Hospitals, unions, and professional organizations often insist that all complaints are handled fairly through standardized processes. Yet treating all concerns as equivalent ignores power, history, and bias. Racism is not simply interpersonal conflict; it is structural and cumulative.

For many marginalized patients and health care professionals, raising concerns about discrimination leads to heightened scrutiny.

• For patients, pain or symptoms are questioned, reframed as anxiety, non-compliance, or exaggeration.
• For health care professionals: concerns about bias are redirected into evaluations of competence or professionalism.

In both cases, Harm is reframed, shifting the question from “where did the system fail?” to “how did you fail the system?”

Institutions frequently defend these processes by pointing to intent: investigators are trained, policies exist, and committees are active. But ethics is not measured exclusively by intent but impact is important as well. When patients leave care feeling dismissed, or professionals leave processes feeling isolated, blamed, or silenced, something has failed.

The ethical failure of performative anti-racism is that it allows effort to stand in for effectiveness.

Silence is not success. It is data. When patients stop advocating because they have been dismissed, institutions mistake that silence for satisfaction. When health care professionals stop reporting discrimination out of fear of retaliation or career harm, organizations assume systems are working.

A process cannot be fair if people are afraid to speak within it, and a policy cannot be protective if those it claims to support do not believe it will.

Genuine anti-racism is not a statement, an event, or a committee. It requires recognizing that neutrality is not fairness, that equal treatment does not produce equitable outcomes, and that some harms demand different responses. Systems built without marginalized voices will continue to fail them.

Ethical anti-racism asks uncomfortable questions:

• Who benefits from current processes?
• Who is protected, and who is assessed?
• Who feels safe seeking support, and who does not?
• What happens when policy meets reality?

Until institutions move beyond performance and confront these questions honestly, anti-racism will remain symbolic. Ethical practice is not proven by intent or declarations alone, but by accountability to those most vulnerable.

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Danielle Gibbs Koenitzer is a Clinical Nurse Educator at London Health Sciences Centre and a Part-Time Professor at Fanshawe College, committed to advancing equity in healthcare.

The views presented are the author’s personal perspectives and do not reflect the positions of any affiliated institutions.