Unconscious Bias in Maternity Care: Providence Response to the New York Times
Providence takes any concern about safety, quality or discrimination incredibly seriously. The experience Ms. Tozay shared with the New York Times is absolutely heartbreaking and is not the experience we strive to deliver. The language used with the patient and her husband was completely unacceptable and outside our core values. It does not reflect the excellent, compassionate work our caregivers deliver every day.
Having received a signed HIPAA consent form from Ms. Tozay, Providence was able to confirm with the New York Times that Ms. Tozay contacted us by phone on Nov. 6, 2017 to file a complaint about an inappropriate comment made by one of our caregivers.
We want Ms. Tozay to know that we took her complaint seriously and are grateful that she shared her important feedback with us. The comment made was not the compassionate communication we expect of ourselves, and we are deeply sorry Ms. Tozay had to experience it, especially during such a stressful and difficult time in her life.
In response to questions from the New York Times about how we specifically followed-up on the complaint, we shared that the leader of our childbirth center met with the nurse 1:1 on Nov. 14, 2017 to discuss the comment. The leader reinforced our appropriate communications practices, which is an important way that high reliability organizations show respect for patients and foster a safe and compassionate environment.
The caregiver was provided with and completed educational resources around communicating with positive intent and listening with empathy and intent to understand. The leader also sent a written response to Ms. Tozay, dated Nov. 16, 2017, expressing our deepest condolences for the loss of her son and our sincerest apologies for the inappropriate comment that was made.
The patient complaint only referenced one comment from a nurse. It did not reference any physician comments chastising the patient, which the New York Times also alleges, so we were unable to provide information about that specific concern.
In addition, Ms. Tozay shared with the New York Times that she was not seen by an M.D. when she came to OB triage just a few days before losing her son. From our records, we can tell that a physician was actively engaged in her care, ordering tests, reviewing results and developing a plan of care. However, because this case happened so long ago, we could not confirm whether or not a doctor was physically present in the room.
At Providence, we recognize that systemic racism is prevalent in health care and creates inequities in birth outcomes, including an alarming national rise in maternal mortality. We are doing several things to address this. In 2020, we committed $50 million to help improve health equity in our communities. Systemwide, we are taking steps to continue to reduce maternal mortality and improve outcomes, such as working to reduce Cesarean section rates among patients of color, rolling out the JUST Birth doula program and implementing the TeamBirth tool to ensure the patient is the decision maker of their birth experience. We have also rolled out comprehensive education around anti-racism, implicit bias and historical harm. We are using cultural navigators to help ensure culturally competent care, and we are incorporating assessments of racial bias into our review of adverse outcomes.
This is an important national issue that we believe deserves urgent attention and action on the part of all U.S. health systems. Providence is proceeding with humility and focused determination to continuously improve. Recognizing the human dignity in every person we serve is central to the Mission of Providence. Though we are by no means perfect, we are deeply committed to ensuring we serve all people according to our values of compassion, excellence, justice, dignity and integrity.
