Interviewer: With all the inequities that persist in healthcare today, what do you personally do or imagine can be done to improve trust between medical institutions and historically marginalized communities?

Dr. Maria Small: This is a big question. It is multileveled. there are a lot of different parts to that. First, there needs to be a statement that it is a priority. I think that is something that in 2020 when George Floyd was murdered, a lot of institutions realized that they needed to look at every level of the institution and see where structural racism existed. It’s not easy and it is an ongoing process, but what does that look like in a healthcare system? You have people that look like the people you are serving. You have people from the community involved in how the system is run or involved in many of the community engagement groups. You have a group, like what we have – even though it is modest as is – where we come together to talk about issues that are of concern to us as a community, as healthcare providers, as stakeholders. You have ongoing education for nurses, front desk workers, physicians, and everyone who comes into contact with people in the community or who you are serving to talk about racism, to talk about bias, to talk about implicit bias. We need to train on these issues and it has to keep going. We need a way to keep checking the pulse of the people you are serving. It can’t just be one and done. It has to be part of the fabric of the institution. Part of the groundwater, part of the system. And like we say, the system did not start overnight and we can’t dismantle it overnight. So, it takes persistence. But the first step is to admit there is a problem and to have a desire to change it. At Duke, there are now signs that say what our beliefs are. That we are an inclusive equitable institution. That we won’t tolerate patients being abusive to our staff, other providers, or any staff or providers being abusive to patients. That can change the climate