One of Nikki McGruder’s favorite sayings is, “If you have a brain, you have a bias.” To prove her point, McGruder begins her education sessions on implicit bias with MU Health Care employees by revealing one of her own.
A few years ago, McGruder took a test that showed she had a bias against people with darker skin. She explains that it probably stemmed from her childhood, when she was often the only Black student in her class and she wanted to fit in. She wonders if she passed along her bias as an adult when she acted disappointed that her daughter’s skin tone darkened after a day at the swimming pool.
“I would say things to her like, ‘What happened to my little caramel-colored cutie? Now, you’re chocolate,’ ” McGruder said. “I was thinking it was funny, but I realize upon further reflection that subliminally I was telling her that my preference was for her to have lighter skin.”
When McGruder — MU Health Care’s director of diversity, equity and inclusion — admits that she is working on her own biases, she notices the people in the training sessions start to open up and more seriously examine their own thoughts, words and actions.
“Implicit bias is my favorite topic to discuss, because of the aha moment people have when they realize that this isn’t a conversation we need to shy away from,” McGruder said. “Typically, when people hear ‘bias,’ they don’t want to talk about it. They’re afraid of being called a racist or being accused of any of the ‘isms.’ They would rather you just believe they are a good person. Well, they are good people, but well- intentioned people do harm every day when they have not checked their biases.”
McGruder’s expertise is helping people identify their prejudices without coming across as judgmental.
“When we talk about diversity and inclusion, a lot of walls go up, because people think we’re just talking about race,” said Laura Henderson Kelley, MD, a practicing internal medicine pediatric physician and the MU School of Medicine’s associate dean for diversity and inclusion. “It’s important to broaden that initially to let people know that bias affects everybody and talking about it is not meant to single out a specific group. And it’s not just about race. Bias exists within many identities — gender, gender identity, ability, class. Nikki does a really effective job of breaking down that wall initially and getting people to open up.”
The idea of contributing to a more tolerant, healthy community for everyone is what inspired McGruder to devote her professional life to diversity and inclusion work. She spent five years leading two mid- Missouri nonprofit organizations devoted to equality for all races, genders, sexual orientations and religions before coming to MU Health Care.
“Investing in diversity and inclusion programs is just the right thing to do,” MU Health Care CEO Jonathan Curtright said. “As our employees embrace their differences, it will be easier for us to recruit outstanding staff and physicians, and MU Health Care will be an even better place for them to work. That translates to better patient care.”
One of McGruder’s first moves after starting the job in August 2020 was to meet regularly with MU Health Care’s four employee resource groups — The African Heritage Group, The Women of MU Health Care, The Pride Network and Bienvenidos for Hispanic employees — to give group members a formal way to connect with each other and with leaders of the organization.
Being a more welcoming health care system doesn’t always mean big changes. It can be simple things that come from seeing a clinic visit from someone else’s point of view.
For example, Ashley Millham, MD, the medical director of MU Health Care’s new Battle Avenue Medical Building, treats many transgender and nonbinary patients, so she posted signs in the clinic’s waiting room giving directions to the nearest all-gender, single-stall restroom. She also changed the clinic’s bandages from beige to neon colors so patients don’t get the impression that light skin tones are preferred.
“Having advocates and allies like Dr. Millham is so important,” McGruder said. “It’s just a matter of considering the needs of all humans rather than a one-size- fits-all approach.”
MU Health Care’s ultimate goal is that a more diverse and inclusive workforce will translate into a better experience and better long-term health for patients, particularly those from minority groups. Across the nation, Black, Hispanic and Native Americans live shorter lives than white people and have higher rates of heart disease, high blood pressure and diabetes.
McGruder knows from her own experiences, particularly during pregnancies while she lived in St. Louis, how frustrating it can be to feel you aren’t being listened to as a patient.
“When I would ask questions and be very clear that I didn’t feel well, I would just be given more blood pressure pills or different blood pressure pills, not really feeling like my pain and my experiences and my challenges were really being heard,” she said. “I can remember having conversations with my parents saying, ‘I just don’t feel like they’re hearing me.’ I didn’t have the language or the data or the understanding that this wasn’t just my story but it was a common story across the country.”
Now that she is working for MU Health Care, McGruder has a platform to have those difficult conversations and chip away at those perceptions. Her main message won’t change: There’s no shame in having a bias; the shame is not acknowledging and correcting the bias.
“We have to cultivate an environment of grace where we can make mistakes while we’re trying to learn and we’re not going to be cut off at the knees and canceled because of our mistakes,” McGruder said. “We’re going to use mistakes as learning opportunities and provide a road to reconciliation. We have to all be a part of that if we’re talking about creating sustainable change.”