Creating Ripples of Change: The Pillars of Anti-Oppressive Practice

Healthcare is full of ripples—small moments that can shift outcomes for patients, families, and the workforce. A missed conversation, a quick assumption, or a courageous act of advocacy can all create waves that either sustain or disturb the balance across care systems.

Anti-oppressive practice (AOP) offers clinicians a framework to understand and intentionally influence those ripples. Rooted in social-work theory and expanded across disciplines, AOP equips practitioners to identify systemic power imbalances and build cultures of equity, safety, and respect for every person they serve.¹

Understanding anti-oppressive practice

Anti-oppressive practice extends beyond cultural awareness or interpersonal kindness—it’s an ethical stance that recognizes how structural inequities and implicit power dynamics shape care delivery. In healthcare, these imbalances can appear through coverage gaps, inequitable access, or the subtle biases that influence decisions.

AOP is grounded in five interlocking pillars: cultural humility, implicit bias, racial equity, social justice, and anti-racism practices. Together, these elements empower clinicians to deliver care that is both ethical and equitable, ensuring every person has access to the same quality of treatment and respect across all settings.

The five pillars of anti-oppressive practice

Each pillar of anti-oppressive practice supports the others. Together, they create a framework for ethical, inclusive, and equitable care—one that challenges us to reflect, respond, and lead with intention.

1. Cultural humility

Cultural humility isn’t a skill you check off or a training you complete. It’s a lifelong process of reflection and self-awareness—one that asks you to examine how your own values, assumptions, and social position shape the way you deliver care. It also means staying open to learning from the people and communities you serve.^2,3

Let’s pause and reflect: How often do you intentionally ask questions to understand a patient’s perspective before assuming what they need? That curiosity lies at the heart of humility.

You’ll also see cultural humility reflected across professional ethics. The 2025 ANA Code of Ethics calls on nurses to address structural oppression and protect human dignity. The AOTA (2020), APTA (2023), and ASHA (2023) each embed diversity, equity, and inclusion into their core principles—reminding us that humility isn’t optional; it’s part of ethical care.

This sentiment is echoed by the NASW Code of Ethics (2021), which also highlights how dignity and the worth of each person should be embedded within every social workers’ interactions across patients, their families, and colleagues.

2. Implicit bias

Bias is universal—formed by experience, socialization, and context—but it becomes dangerous when it clouds assessment, communication, or decision-making. Left unchecked, bias can compromise safety and expose both patients and organizations to harm.

Let’s reflect on a training scenario that illustrates how bias can subtly influence care decisions. A patient of color presents to the emergency department with abdominal pain and is dismissed as “drug-seeking,” while another patient with identical symptoms receives appropriate testing and care. The first patient later returns with a serious obstruction requiring surgery—a preventable outcome rooted not in clinical error, but in bias.

Research confirms these patterns: patients of color who advocate for themselves are more likely to be labeled “aggressive,” while White patients demonstrating the same behavior are described as engaged.^4,5 Recognizing and interrupting these reflexes is foundational to ethical practice and equitable outcomes.

3. Racial equity

Racial equity means building a system where race no longer predicts outcomes. It’s not about treating everyone the same—it’s about addressing the conditions that make care unequal in the first place. Achieving equity requires organizational commitment to inclusive hiring, diverse leadership, community partnerships, and transparency around outcomes.⁶ 

Ask yourself: Are your organization’s data, policies, and workflows designed to identify disparities—or do they unintentionally reinforce them? True equity requires redesign, not just awareness.

4. Social justice

Social justice takes anti-oppressive practice beyond awareness and into action. It’s the call to use your professional voice to challenge inequities, advocate for policy change, and build systems that reflect fairness and respect.^7,8 

In practice, that might mean addressing insurance barriers, joining a diversity council, mentoring clinicians from underrepresented backgrounds, or volunteering with advocacy groups. Every action, no matter the scale, helps realign healthcare with its core purpose: to serve all people equitably.

5. Anti-racism practices

Anti-racism is more than awareness—it’s sustained, intentional action to dismantle racist structures in healthcare and beyond.^9,10

It involves an ongoing commitment to reflection and change—personally, professionally, and institutionally. That might include examining hiring and promotion patterns, revising practice standards, advocating for inclusive policies, or simply calling out inequities when you see them.

Each step, no matter how small, strengthens the collective impact of anti-oppressive care.

Psychological safety: A foundation for equity

Anti-oppressive care begins with psychological safety—the ability for patients and professionals alike to speak up, share concerns, and admit mistakes without fear of punishment or humiliation.¹¹ Creating this kind of safety opens space for honesty, curiosity, and growth, allowing both care and collaboration to thrive.

Psychological safety isn’t abstract—it’s visible in how you make eye contact, read the room, listen to understand, and avoid assumptions like “I know how you feel.”

When patients and families feel heard and respected, they become partners in care. When teams communicate openly, they innovate faster, solve problems more effectively, and experience less burnout.^12,13

Every discipline carries an ethical responsibility to foster this kind of environment. The AHRQ SHARE Model provides one practical framework for building psychological safety in patient interactions:

1. Seek the patient’s participation.

2. Help them explore options.

3. Assess their values and preferences.

4. Reach a shared decision.

5. Evaluate the outcome together.

Now, think about how those same principles might apply to your team. Establish ground rules. Assume positive intent. Approach mistakes as opportunities to learn rather than occasions to assign blame. Consensus isn’t the goal—respectful disagreement is.

When clinicians and leaders model these behaviors, they set the tone for equity to take root. Psychological safety becomes not just an interpersonal skill, but a cornerstone of anti-oppressive care.

Trauma-directed practice and leadership

Trauma affects everyone in healthcare—patients, families, and clinicians alike. Whether it stems from illness, loss, systemic inequities, or the pressures of the profession itself, trauma shapes how people think, feel, and interact. Recognizing that reality is the first step toward creating safer, more compassionate systems of care.

Trauma-directed practice builds on foundational trauma theory to move a step beyond trauma-informed care.^14,15 Being trauma-informed means acknowledging trauma’s presence; being trauma-directed means intentionally integrating that understanding into every interaction.

Let’s pause here for reflection: How might trauma be influencing your patients’ engagement—or your team’s communication—right now?

Trauma-directed practice is deliberate. It centers on four key principles:

• Safety: Ensuring both emotional and physical security.

• Trust and transparency: Explaining the “why” behind care decisions.

• Inclusion and collaboration: Inviting people to participate in choices that affect them.

• Empowerment and support: Validating lived experiences and reinforcing strengths.

These principles protect not only patients but also clinicians, who frequently experience moral injury, workplace violence, or burnout in the course of care.

Trauma-directed leadership

Leadership grounded in trauma awareness goes beyond day-to-day management. It’s about guiding through connection, curiosity, and compassion. The National Council for Mental Wellbeing describes trauma-directed leaders as those who balance advocacy with inquiry, distinguish discussion from dialogue, and “get on the balcony” to see the broader system.

Sustaining this kind of leadership takes consistency and commitment. Data, reflection, and collaboration drive progress over time. Consider these strategies for building a trauma-directed culture:

• Use retention, survey, and well-being data to make the case for change.

• Maintain a long-term view—anti-oppressive transformation is never “one and done.”

• Celebrate small successes to sustain momentum and engagement.

• Encourage staff to “take 10” for self-regulation and reflection, fostering resilience and connection.

Trauma-directed leadership reminds us that equity and compassion are inseparable. When you lead with awareness of trauma’s impact—on both patients and professionals—you help build the foundation for truly safe, inclusive care.

Integrating the pillars: From awareness to action

Anti-oppressive practice is not a single moment of awareness but an evolving process—one that grows as evidence, language, and understanding change. 

The five pillars of AOP, together with psychological safety and trauma-directed care, create a shared foundation for equitable practice. Each reinforces the others: anti-racism deepens psychological safety; psychological safety enables trauma-directed leadership; and trauma-directed systems sustain equity over time.

Let’s take a moment to reflect on what this looks like in your own setting.

• Where might bias surface in your documentation, communication, or assumptions?

• How does your organization demonstrate cultural humility in its policies, not just in training?

• What structures exist to protect both staff and patients from psychological harm?

The goal of this work isn’t perfection—it’s progress. Every action, every conversation, and every question brings you closer to equity. When clinicians commit to continuous reflection, awareness becomes accountability—and care becomes safer, more compassionate, and more just for every patient, provider, and population.

Continuing the journey toward equity

Every action in healthcare creates ripples of impact. Guided by equity and compassion, those ripples become waves of lasting change—shifting how care is delivered, how teams connect, and how systems evolve. By grounding our work in anti-oppressive principles, fostering psychological safety, and embracing trauma-directed leadership, clinicians can help build a more just, compassionate future for every patient, provider, and population.

If you’re interested in exploring these concepts further, my Medbridge course series The Pillars of Anti-Oppressive Practice offers a deeper look at how to apply these frameworks across disciplines and care settings:

• Part 1: Anti-Racism Practices — Explore the foundations of anti-oppressive practice, including cultural humility, implicit bias, social justice, and racial equity.

• Part 2: Intercultural Effectiveness — Learn strategies to strengthen inclusive communication and collaboration through intersectionality and the 7 Pillars of Inclusion.

• Part 3: Racial Equity — Examine how systemic discrimination and intersecting identities influence care, and how to implement equity-driven change.

References

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2. Tervalon, M., & Murray-García, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9(2), 117–125. https://muse.jhu.edu/article/268076

3. Agner, J. (2020). Moving from cultural competence to cultural humility in occupational therapy: A paradigm shift. The American Journal of Occupational Therapy, 74(4), 7404347010p1–7404347010p7. https://research.aota.org/ajot/article-abstract/74/4/7404347010p1/8449/Moving-From-Cultural-Competence-to-Cultural

4. Commonwealth Fund. (2024, February 15). Revealing disparities: Health care workers’ observations of discrimination against patients. https://www.commonwealthfund.org/publications/issue-briefs/2024/feb/revealing-disparities-health-care-workers-observations

5. Commonwealth Fund. (2025, January 27). Health care workers in Canada, the U.K., and the U.S. report racial and ethnic discrimination in the health care system. https://www.commonwealthfund.org/blog/2025/health-care-workers-canada-uk-and-us-report-racial-and-ethnic-discrimination-health-care

6. Kendi, I. X. (2019). How to be an antiracist. One World.

7. Horton, R. (Ed.). (2021). Critical perspectives on social justice in speech-language pathology. IGI Global.

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9. Hassen, N., Lofters, A., Michael, S., Mall, A., Pinto, A. D., & Rackal, J. (2021). Implementing anti-racism interventions in healthcare settings: A scoping review. International Journal of Environmental Research and Public Health, 18(6), 2993. https://www.mdpi.com/1660-4601/18/6/2993

10. Iheduru-Anderson, K., & Waite, R. (2022). Illuminating antiracist pedagogy in nursing education. Nursing Inquiry, 29(4), e12494. https://onlinelibrary.wiley.com/doi/10.1111/nin.12494

11. Lee, E. H., Pitts, S., Pignataro, S., Newman, L. R., & D'Angelo, E. J. (2022). Establishing psychological safety in clinical supervision: Multi-professional perspectives. The Clinical Teacher, 19(2), 71–78. https://asmepublications.onlinelibrary.wiley.com/doi/10.1111/tct.13451

12. Kim, S., Lee, H., & Connerton, T. P. (2020). How psychological safety affects team performance: Mediating role of efficacy and learning behavior. Frontiers in Psychology, 11, Article 1581. https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2020.01581/full

13. Fukami, T. (2023). Patient engagement with psychological safety. Patient Safety in Surgery, 17, Article 34. https://www.sciencedirect.com/science/article/pii/S2772653323000576?via%3Dihub

14. Harris, M., & Fallot, R. D. (2001). Envisioning a trauma-informed service system: A vital paradigm shift. New Directions for Mental Health Services, 2001(89), 3–22. https://onlinelibrary.wiley.com/doi/10.1002/yd.23320018903

15. van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.