Ethical Impacts of DEI Efforts on the Quality of Care in Emergency Services

Diversity, Equity and Inclusion (DEI) has been a significant trend in emergency services (ES). “Even though many people are beginning to acknowledge the benefits and necessity of DEI, there is still the question of what ethical obligations companies have to implement and enhance diversity in their workforce.” (Sloan, n.d., para. 1). This paper discusses how DEI is relevant to ethical bases for DEI principals and some areas where DEI is applied in ES. The paper also includes recommendations for goals and standards suitable for DEI in ES and various ways of setting benchmarks for continuous improvement. 

ES are ethically obligated to “impose and enforce rules fairly and impartially to ensure justice” (Langton et al., 2016, p. 432). The Canadian Human Rights Act (CHRA) is a contemporary list of ethical Canadian cultural norms. The CHRA empowers us by stating people cannot be “hindered in or prevented from doing so by discriminatory practices based on race, national or ethnic origin, colour, religion, age, sex, sexual orientation, gender identity or expression, marital status, family status, genetic characteristics, disability or conviction” (Government of Canada, 1985, p. 1). 

By definition, the inclusion of diversity is ethical and the law. Studies toward understanding elements that have inhibited diversity in ES have revealed systemic institutional barriers to overall inclusion. “By implementing DEI best practices into an organization’s value-based leadership, culture, strategy, and self-regulation, there is an observable connection to an increase/addition to an ethical organizational culture” (Cole, 2020, p. 2).

Foundations of Ethics for ES 

In addition to the rights afforded by the CHRA, Mayor Amarjeet Sohi stated, “our citizens deserve to feel safe” (2022). The physical and psychological safety of employees and the community are an ethical concern and consideration for diverse cross-sections of the entire population, many of which have generational and traumatic experiences, for example, indigenous, refugees, and immigrants. 

Bureaucratic structures of ES and labour unions are duty-bound to uphold ethical standards deliberated and prescribed by Collective Bargaining Agreements (CBAs). Employee justice and institutional ethics are deeply rooted in the jurisprudence of employment law, labour relations and natural justice contained in CBAs. DEI practices lead us toward restorative justice examinations.” The moral obligation for organizational justice or fairness regards the distribution and use of power to bestow benefits or impose burdens on those within the organization” (Sloan, n.d., para. 6).

CBAs will need to adapt to increased social pressure. “The City of Edmonton and Edmonton Police Service recognize the Government of Canada’s National Day for Truth and Reconciliation on September 30 as a paid day of leave for staff” (The City of Edmonton, 2021, para. 1). These new observances will require documentation into CBAs.

Anecdotally, ES is widely regarded as trusted professionals in North America. As such, there is a higher expectation of representing the community they serve. ES must “go beyond what it is obligated to do and choose to do so because of some popular social need and does what it can to help improve society because it is the right thing to do” (Robbins et al., 2016, p. 111). 

DEI Applications 

DEI utilization does apply across the entire span of an emergency service organization but requires an intentional focus. There are tools to help acquire a base perspective of DEI. “GBA Plus, an analytical process used to assess how different women, men and gender diverse people may experience policies, programs and initiatives” (Government of Canada, 2022, para. 2). The following are some examples of DEI applications.

Diversity principles and practices are relevant in emergency medical care. Employees from different backgrounds add on-scene capacity in terms of communication and cultural nuances. For example, “caring for Muslims in the healthcare setting requires knowledge of their cultural and spiritual values. Important differences include diet, ideas of modesty, privacy, touch restriction, and alcohol intake restriction” (Atum et al., 2022, para. 1). A diversified workforce is an important contributing resource helping the organization build understanding, knowledge and skills in working with different communities, thus increasing the quality of care.  

Equity practices are often applied to recruitment efforts. Studies show multiple barriers to people from underrepresented communities, which hinder success in recruitment processes. Barriers must be eliminated to ensure only tangible bonafide occupational requirements and qualities sought after. “Atlanta Fire Rescue Department created a nine-step hiring process that does not require any experience, training, or certification in fire or ES” (Plumb Research Services, 2021, p. 21). Obtaining prerequisite certifications requires access and financial resources that not all have access to. Therefore, disqualifying potentially good, ethical, talented, and representative applicants. 

Inclusion principles apply to employee experience. ES has “tight-knit groups that have many positive benefits for those that are included; those that do not fit in are often isolated from the group and can face backlash as an outsider” (Plumb Research Services, 2021, p. 8). Normalizing open dialogue and an honest environment where feedback is solicited and appreciated allows people to contribute their true selves. Inclusion means we all contribute. Providing opportunities for people to get involved, celebrating traditions, extracurricular activities, and recognition programs help build cultural strength in the organization. These efforts translate into happy, engaged employees who put total effort into the quality of care.

Standards and Goals.

Standards must align with providing exceptional quality of care and setting goals that will continually improve those standards. Current trends in recruitment are acknowledging and “aimed at removing barriers for those who want to have a career as a firefighter” (Pearson, 2016, para. 3). As these efforts reduce prerequisite qualifications, fire departments must ensure all firefighters are trained to established industry standards before the commencement of duties. 

The goals of recruiting people from underrepresented communities should not merely be about increasing demographics but about attracting people of the highest moral and ethical calibre. “A fire fighter’s personality reflects his/her work ethics. It shows how they love the job, how concerned they are in helping other people’s lives and properties in jeopardy” (Administrator, 2012, para. 3). Over time as more ethical people are hired, the entire organization increases the quality of care delivered.

Benchmarking 

Benchmarking is an essential practice in ES. “Benchmarking helps your business establish an internal or external standard to measure itself against the purposes of continual improvement” (Fallon, 2021, para. 8). As benchmarking through the lens of DEI is emerging, it is difficult to compare against external agencies. However, the intent is to have continuous internal improvement. We must measure DEI’s impact on the quality of care within the community. The following are possible areas to establish benchmarks. 

Community risk reduction has a public education component. Diverse staff and inclusive tactics such as literature available in multiple languages can help increase connections within multicultural communities to educate about hazards. We can use response data for “cultural, geographic areas which most societies share many traits in common” (Pauls, 2009, para. 1), such as China-towns in most major cities. Optimism would anticipate a reduction in emergency events for cultural areas where robust efforts to connect with the community have occurred. These metrics can be correlated to dispatch data.

Language barriers are common challenges for emergency dispatch services. Integrating rapid and extensive translation capabilities will reduce those difficulties. “first responders are taking advantage of new technology to breach the language barrier (Kolb, 2016, para. 23).  Several translation services are available to 911 systems compatible with Computer Aided Dispatch (CAD). Dispatch has another advantage of being technology-driven, which makes developing metrics and accessing data sets easy. A simple benchmark could include the time it takes to access translation services and dispatch resources. 

Conclusion 

DEI efforts in ES are often misunderstood. Misunderstanding is replaced with resistance if concepts are too abstract. Communication to employees should echo the justification and ethics behind DEI integration. The groundwork must be relatable. Applications must become operational norms, linking DEI practices to” building community and organizational resilience to more frequent and intense emergency events, organizations need to change from working for communities to working with them (Young & Jones, 2019, p. 38). Es must meet their obligations to high standards and set goals that will facilitate continuous improvement using benchmarks that have a DEI lens. It is indisputable that DEI Efforts in ES are ethical.

References

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