Is Hand Hygiene More Important Than Racism?

Do you know how to wash your hands? I thought I did. Yet every year, hospitals spend thousands of dollars on handwashing campaigns, and every hospital orientation blocks out time to “teach” grown adults how to wash their hands. As with any patient-facing safety risk, there are metrics. Audits. Compliance checks.

As a member of the global majority, I have experienced racism — as a patient, and as a healthcare worker. I have never seen the same systems built for racism prevention.

Is it because racism is less important?

If racism contributes to poor maternal and mental health outcomes — and it does — where are the standardized patient-reporting measures for discriminatory treatment? Why aren’t racial disparities tracked as a routine quality indicator? Why isn’t pain management audited across demographics the way infection rates are audited across units?

Instead of building systems to recognize and eliminate racism, we task the people harmed by it with dismantling it themselves:

Black women are told to advocate for themselves.
Clinicians are told to reflect on their biases.

Both are individual fixes for a systems problem. And for those of us who sit inside both groups — Black and a physician — that burden lands twice. Advocacy itself gets read as aggression by anyone who subscribes to the strong-Black-woman stereotype. The population most harmed by inequity is also the one asked to carry the cost of correcting it.

A physician can sincerely believe they treat every patient the same while still making different assumptions — about pain compliance, about substance use, about emotional stability, about parenting, about credibility. That gap between intention and pattern is exactly why the literature on clinician bias refers to it as unconscious. Which means self-awareness training was never going to close it. You don’t fix an unconscious pattern by asking someone to notice it in real time, any more than you’d fix a hospital’s infection rate by asking nurses to think harder about their hands.

That’s the point of the hand-hygiene comparison, and it’s not a metaphor — it’s a model. Racism in healthcare is a morality issue, but morality is not how we’ve ever governed patient safety. Every other problem that touches patient outcomes gets protocols, audits, and accountability structures, precisely because we don’t trust morality alone to protect patients. Racism is the one exception we’ve carved out — the one harm we still leave to individual conscience.

That’s the system failure. Not that clinicians are uniquely unwilling to confront bias, but that healthcare has refused to build for racism the infrastructure it builds for every other threat to patient safety. The effect of racism is just as pervasive as unwashed hands, and it deserves the same attention. It will only get it when we demand it.

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If you’re a patient who has felt this gap — between being heard and being believed — Inclusive Health Match exists because self-advocacy shouldn’t be the only tool you have.

If you’re a provider who wants your practice held to the same accountability standards as your infection-control protocol, listing on Inclusive Health Match is a good place to start — it puts the burden of finding culturally concordant care back on the system, not the patient.