Introduction
The AcademyHealth’s Annual Research Meeting (ARM) is a great time to catch up with old colleagues and meet new ones. It’s also an opportunity to implement policies that advance diversity and inclusion in the field. A core value in AcademyHealth’s Strategic Plan is diversity and inclusion, with a goal to “develop and sustain a diverse workforce to respond to the changing needs of stakeholders who need evidence to advance health and health care improvement.” Scientific conferences such as ARM are opportunities to build inclusion, but conferences have a history of contributing to an exclusionary environment with lack of representation by women and other historically marginalized groups among speakers, committees, and other leadership roles. Fields proximal to health policy have raised concerns about the adverse experiences, including sexual misconduct, that arise from the imbalance in representation.
Prior to this year’s ARM, we engaged AcademyHealth leadership in a conversation about how professional codes of conduct can help address that exclusionary environment. That conversation spurred an updated AcademyHealth Professional Code of Conduct.
A Code of Conduct is one way to address these concerns, but not the only way. This blog aims to expand the conversation and equip our members with tools so that we can all begin to take action to create a more inclusive work environment.
The importance of identifying sexual misconduct
Sexual misconduct – an encompassing term for a continuum of sexual behaviors performed without consent that have a harmful, threatening and/or intimidating effect on the person against whom such conduct is directed – stifles efforts to advance equity goals within health policy and related fields. All harm is harm, however, the severity or burden associated with sexual misconduct is on a continuum (Figure 1) and occurs as a function of power differentials as made clear by a 2023 National Academies report, “Preventing Sexual Harassment and Reducing Harm by Addressing Abuses of Power in Higher Education Institutions.”
Figure 1. Examples of Behaviors within the Continuum of Sexual Misconduct
Self-Identifying Opportunities for Improved Conduct
Assessing our day-to-day conduct for harmful verbal expressions, microaggressions, and attitudes and beliefs is a means for preventing harms across the sexual misconduct continuum (Table 1). Using the pyramid of violence as a useful framework (Figure 2), we can see how the less severe but more prevalent types of harm such as these verbal expressions contributes to a climate where the extremely harmful but more rare actions at the top of the pyramid (including sexual and physical assault) are more likely to happen or less likely to be taken seriously when they occur Even if we are not perpetrating forms of physical aggression, when we fail to think critically about the implications of our thoughts, words, and actions, we risk bolstering an unsafe, inequitable professional environment.
Acting as an Effective Bystander
We also have the capacity to redirect harmful conduct of others by directly or indirectly addressing other’s concerning behavior (Table 2). Inaction is rarely the best way to approach sexual misconduct as it implicitly communicates:
- to the affected person that they deserve to be treated this way.
- to other bystanders that we do not see a problem, and there is no reason for them to act either.
- to the person displaying the concerning behavior that their conduct is acceptable.
When taking action, a bystander should:
- Prioritize safety: One of the greatest responsibilities of a bystander is to make a situation safer, which requires being mindful of one’s own short- and long-term safety, and that of the affected person.
- Consider the positionality: Pause to account for the observable identities of the person you are concerned for (i.e., junior professional standing, gender, race, etc.) and then try to anticipate what sources of support might make them feel safest.
- Engage the affected person: Whenever possible, engaging the person affected by the conduct to understand how they experienced the situation and how they’d like to proceed is ideal. In extreme circumstances, there may be a need to engage official channels for support and recourse even when an affected person is not comfortable with that. Should this occur, letting the affected person know your intentions to proceed with a report is important.
- Consider a combination: The bystander approaches listed are not mutually exclusive. Making use of a combination of strategies may well be the best path forward, particularly if indirect interventions are the only pathways available.
Identifying Support and Recourse Options
Resources exist to support individuals that experience sexual misconduct within the community (e.g., Rape, Abuse, and Incest National Network [RAINN]) and employer (e.g., Employee Assistance Program [EAP]). Sexual misconduct that is severe and/or frequent enough to create a hostile or offensive work environment or yield an adverse employment decision (e.g., demotion or firing) is a form of employment discrimination prohibited by Title VII of the Civil Rights Act. For students at academic institutions, sexual misconduct can be classified as a form of discrimination that impedes an individual’s educational opportunities, and therefore is prohibited by Title IX of the Civil Rights Act, with further improvements being released for implementation in August 2023. While these supports and protections are in place, there are often institution-specific rules and reporting requirements that put the burden on the victim, which makes taking action time consuming and even harmful if no action is taken by an institution.
AcademyHealth is leading the way by ensuring their Professional Code of Conduct creates and upholds expectations for professionals engaging with this community. The code is of no value if our members are not taking action in their own institutions to prevent sexual misconduct and creating an inclusive environment. In this blog, we identified individual actions that can be taken, but systemic changes are necessary to ensure processes are in place to prevent sexual misconduct. This starts with a review of whether your institution has a statement of professional conduct with clear means of enforcement, as well as current practices and policies that support equity in advancement, and being a champion for creating a safe and inclusive environment.