Equality, Diversity and Inclusion in the Pathology Laboratory: From Principle to Daily Practice

Why EDI belongs at the laboratory bench

Equality, diversity and inclusion are sometimes treated as subjects for a yearly course. In biomedical science, they are part of scientific quality and patient safety.

A fasting instruction that a patient cannot read may lead to an unsuitable sample. A reference interval selected from an incorrect assumption may lead to a misleading interpretation. A trainee who cannot distinguish colours on a QC chart may miss a trend unless the display is adjusted. A dismissive comment can stop a colleague from raising a safety concern. Each example affects the reliability, accessibility or safety of the service.

The HCPC requires equality, diversity and inclusion to be embedded across professional practice. It is not an optional addition to technical competence. This article turns the IBMS Registration Training Portfolio module on Equality, Diversity and Inclusion into practical NHS pathology behaviours, supported by learning in professional development, genetics, physiology, clinical laboratory science and research.

Learning outcomes

Knowledge: what you should understand

After reading this article, you should be able to explain:

• equality, equity, diversity and inclusion in plain language;
• the protected characteristics in the Equality Act 2010;
• how intersectional experience, culture, disability, poverty, isolation and digital exclusion can affect access to pathology services;
• how personal values and conscious or unconscious bias can influence laboratory decisions;
• what reasonable adjustments are and why they are a professional and legal responsibility;
• why dignity, autonomy, mutual respect, safeguarding and power matter even when contact with patients is limited; and
• how inclusive leadership improves staff wellbeing, speaking up and patient safety.

Competence: what you should be able to demonstrate in practice

With local training, support and assessment, you should be able to:

• recognise a potential barrier and respond respectfully;
• ask about an individual’s needs without making assumptions;
• make or support a reasonable adjustment through the correct route;
• use patient demographic information accurately and only for a legitimate purpose;
• adapt laboratory information and communication to improve access;
• challenge discriminatory behaviour safely and escalate serious concerns;
• protect confidentiality when interpreters or communication supporters are involved; and
• reflect on your own bias and show a change in behaviour or service.

1. Four related ideas

Equality

Equality means that people have equal rights and are not unlawfully discriminated against. It does not always mean giving everyone exactly the same thing.

Equity

Equity means recognising that people begin with different needs and barriers, then providing proportionate support so that they can participate or receive a safe service. A person who needs information in large print is not receiving an unfair advantage; the format enables equitable access.

Diversity

Diversity describes the range of people, identities, experiences, knowledge and perspectives in a group or population. Diversity can strengthen problem-solving, but only if people are able to contribute safely.

Inclusion

Inclusion is the active creation of an environment in which people are respected, can access what they need and can take part. A diverse team is not automatically inclusive. Inclusion is shown by design, behaviour and decisions.

2. The Equality Act 2010 in everyday practice

The Equality Act 2010 protects people in Great Britain from unlawful discrimination connected with nine protected characteristics:

• age;
• disability;
• gender reassignment;
• marriage and civil partnership;
• pregnancy and maternity;
• race;
• religion or belief;
• sex; and
• sexual orientation.

Equivalent arrangements in Northern Ireland are contained in different legislation. Staff must follow the law and organisational policy that apply where they work.

Discrimination can be direct, indirect, associated with another person, or connected with disability. Harassment and victimisation are also prohibited. A rule that appears neutral can create a particular disadvantage. For example, providing all mandatory learning only as fast-moving online video without captions may disadvantage some people with hearing, language, concentration or connectivity needs.

Professional practice should also respond to difference beyond protected characteristics. Literacy, housing insecurity, caring responsibilities, digital access, health anxiety and previous experience of services can all affect a person’s ability to follow instructions or engage with care.

3. Intersectionality: people do not live one characteristic at a time

Intersectionality describes how different aspects of a person’s identity and circumstances can combine to create a particular experience. An older person with visual impairment who does not read English may face different barriers from another older person. A pregnant trainee with a disability may require adjustments related to both pregnancy and disability.

Do not turn intersectionality into a checklist or prediction. It is a reminder to ask, listen and respond to the individual rather than relying on stereotypes.

4. Bias and the scientific mindset

Bias is not limited to openly prejudiced behaviour. It can influence whose explanation we trust, how we interpret uncertainty, who receives development opportunities and whether we notice a system designed around only one group.

Common patterns include:

• affinity bias: feeling more comfortable with people who seem similar to us;
• confirmation bias: noticing evidence that supports an early view and overlooking evidence that challenges it;
• name or accent bias: making assumptions about competence from a person’s name or speech;
• status bias: giving more weight to a senior voice when a junior colleague has identified a valid risk; and
• automation bias: trusting a demographic field or algorithm without checking whether it is complete and appropriate.

Scientific training helps because it encourages us to examine assumptions and evidence. However, being a scientist does not make anyone free from bias. A professional response is to slow down important decisions, use agreed criteria, invite challenge, review patterns in data and act on feedback.

A short bias check

Before a decision about a person, ask:

1. What evidence am I using?
2. What assumption have I added?
3. Would I respond the same way if a different person presented the same facts?
4. Whose perspective is missing?
5. Can an objective criterion or second review improve fairness?

5. Clinical Chemistry example: demographic data and reference information

Many laboratory reports use demographic or physiological information to select a reference interval, calculate an estimate or support interpretation. Some tests are influenced by age, pregnancy, hormonal state, muscle mass or other biological factors. These variables are clinically relevant, but they must be handled carefully.

Safe principles

• Use recorded information and a locally validated rule; never infer sex, gender identity, pregnancy or anatomy from a name, voice or appearance.
• Recognise that administrative fields may not contain all clinically relevant information.
• Do not change patient demographics to make a result “fit”. Corrections must use the approved identity and data-quality process.
• If the available information does not support a safe interpretation, seek advice through the authorised route. A clinical scientist or duty biochemist may need to liaise with the requesting team.
• Use respectful language and the person’s recorded preferred name and pronouns where systems and circumstances permit, while still completing required identity checks.
• Treat demographic information as confidential and access it only for a legitimate work purpose.

Example

A testosterone result is presented with a reference interval that appears inconsistent with the clinical details on the request. The safe response is not to make an assumption about the patient. Check the request and LIMS data, confirm that the result itself is analytically valid, and refer the interpretive issue according to the local SOP. The requesting clinician may need to provide relevant physiological and treatment context. Record any authorised action clearly.

The same principle applies to pregnancy-related interpretation, paediatric ranges and calculated results. Inclusive care and scientifically appropriate interpretation support each other.

6. Reasonable adjustments: removing avoidable disadvantage

A reasonable adjustment is a change that removes or reduces a substantial disadvantage experienced by a disabled person. What is reasonable depends on effectiveness, practicality, resources, risk and the circumstances. The starting point is a respectful conversation, not a guess.

Inclusive practice is a cycle: ask what works, test the adjustment and improve it with the individual.

Adjustments for service users

Clinical Chemistry services may contribute by providing or supporting:

• 24-hour urine, fasting or timed-sample instructions in an accessible format;
• clear language, large print, easy-read material, audio or translated information;
• an appropriate interpreter rather than using a child or untrained colleague;
• a communication need or reasonable adjustment being recorded and shared through approved systems;
• more time or a quieter setting for a collection procedure where available;
• accessible routes to phlebotomy or point-of-care services; and
• alternatives for people who cannot use a digital-only booking or information route.

The NHS Accessible Information Standard describes a practical cycle: identify needs, record them, flag them, share them appropriately, meet them and review them. NHS organisations are also implementing the Reasonable Adjustment Digital Flag; staff should follow the current local process.

Adjustments for trainees and staff

Examples may include:

• an accessible bench layout or sit–stand workstation;
• adaptive pipettes, grips or other ergonomic equipment following risk assessment;
• written steps alongside verbal training;
• screen magnification or compatible software;
• labels, symbols or line styles in addition to colour on QC charts;
• protected time, a quieter assessment area or planned breaks;
• phased training or adjusted sequencing without lowering the required safety standard; and
• an agreed communication approach for dyslexia, hearing loss, neurodivergence or mental health needs.

An adjustment changes access to training or work; it does not remove essential competence requirements. Occupational health, human resources, the training lead, disability services and the individual may all contribute. Share health information only with those who need it.

7. Daily practice example: colour is the only warning

A QC dashboard displays acceptable results in green and unacceptable results in red, with no symbol or text label. A trainee with colour-vision deficiency explains that the difference is difficult to see.

An inclusive response is to thank the trainee for raising the risk, prevent reliance on colour alone and arrange an effective adjustment. Options might include symbols, labels, contrast changes or an alternative approved display. The change should be tested with the user and controlled through the laboratory’s IT or quality process.

The wrong response would be to say that “everyone else manages” or to tell the trainee to ask a colleague every time. The underlying design creates a foreseeable safety barrier. Improving it may benefit many users, including staff working under glare, fatigue or poor screen conditions.

8. Daily practice example: accessible patient instructions

A patient is asked to collect a 24-hour urine specimen for a specialist biochemical test. The leaflet uses dense technical language and assumes that the patient can read small print, store the container safely and understand when to start and stop the collection.

Errors can produce an incomplete collection and a misleading result. Good practice is to use approved plain-language instructions, identify communication needs, offer an accessible format and provide a route for questions. Information should explain the collection times, what to do with the first specimen, how to store the container, any preservative-related precautions and how to return it. The laboratory should not give unapproved clinical advice; questions outside its remit should be directed appropriately.

If an interpreter is needed, use an approved service and maintain confidentiality. Check understanding without being patronising: “To make sure I explained it clearly, could you tell me when you will begin and end the collection?”

9. Dignity, autonomy and power

Laboratory staff hold access to sensitive information and specialist knowledge. This creates a power imbalance even when there is no face-to-face contact. Misusing access to look at records out of curiosity, making jokes about a diagnosis or dismissing a patient’s concern breaches trust.

Respecting autonomy means recognising the service user’s role in decisions about their care. Biomedical scientists may support that role by ensuring results are accurate, explaining laboratory processes within their competence, providing accessible information and routing clinical interpretation to an appropriate professional.

Do not use expertise to pressure, shame or frighten. Be clear about what you know, what you do not know and who can help.

10. Mutual respect in the laboratory team

Respect is not avoiding disagreement. Safe teams challenge ideas while treating people fairly.

Inclusive team behaviours include:

• pronouncing and using colleagues’ names correctly;
• avoiding stereotypes, “banter” and repeated interruptions;
• making rotas, training and development opportunities transparent;
• inviting a trainee or quiet colleague to contribute without putting them on the spot;
• crediting the person who raised an improvement;
• using objective competency criteria consistently;
• providing feedback about behaviour and performance, not personality; and
• responding seriously when someone reports exclusion or harassment.

Psychological safety matters in pathology because a person who expects ridicule may stay silent about a near miss, analyser problem or uncertainty.

11. Challenging barriers and discrimination

You do not need to be the most senior person to challenge a barrier. The response should be proportionate to risk and safe for those involved.

Options include:

• addressing a comment calmly at the time: “That language is not appropriate here”;
• checking on the person affected and asking what support they want;
• raising a recurring design barrier with the training, quality or service lead;
• using the organisation’s equality, dignity-at-work, Freedom to Speak Up or incident route; and
• escalating immediately where behaviour creates danger, abuse or a safeguarding concern.

Keep a factual record where policy requires it. Do not investigate serious allegations yourself or promise complete secrecy. Explain that information may need to be shared with the people responsible for responding.

12. Safeguarding in a laboratory context

Safeguarding means protecting children and adults at risk from abuse, neglect and exploitation. Most Clinical Chemistry staff have limited direct patient contact, but safeguarding still matters in phlebotomy, point-of-care work, telephone contact, service-user visits and information handling.

Possible concerns should be noticed and passed through the local safeguarding process. A laboratory result alone rarely proves abuse, and biomedical scientists must not make unsupported accusations. If information, behaviour or a pattern creates concern, preserve relevant facts, seek advice and share necessary information through the authorised route. An immediate danger requires urgent escalation.

Confidentiality is important, but it is not a reason to ignore a serious safeguarding need. Share only what is necessary, proportionate, relevant, accurate, timely and secure, and record the decision.

13. Inclusive leadership is everyday leadership

Leadership is not limited to managers. A trainee shows leadership by noticing an inaccessible instruction and suggesting a solution. A biomedical scientist shows leadership by challenging biased allocation of training, supporting a stressed colleague or asking whose needs were considered in a service redesign.

Useful inclusive leadership behaviours are:

• curiosity rather than assumption;
• listening before solving;
• transparent decisions and criteria;
• willingness to admit and correct a mistake;
• fair access to information, training and recognition;
• active invitation of different perspectives; and
• follow-through after a concern is raised.

Measure inclusion through experience and outcomes, not good intentions alone. Review complaints, incidents, access problems, training completion, progression and feedback for patterns, while protecting confidentiality and avoiding simplistic conclusions from small numbers.

14. What competent practice looks like

A competent trainee or biomedical scientist:

• knows the protected characteristics and applies equality principles in daily work;
• treats every person with dignity and avoids assumptions;
• can explain how a laboratory process may create an access barrier;
• uses accurate demographic data and seeks advice when context is insufficient;
• supports reasonable adjustments without lowering patient-safety requirements;
• adapts information and communication appropriately;
• notices their own bias and uses checks to reduce its effect;
• responds appropriately to discrimination, harassment or safeguarding concerns; and
• demonstrates inclusive leadership at a level appropriate to their role.

15. Common mistakes and better alternatives

16. HCPC Standards of Proficiency covered

The following standards are mapped to the IBMS Equality, Diversity and Inclusion module. The wording is summarised in plain English; use the current HCPC publication for the authoritative wording.

17. Portfolio and supervision prompts

Keep examples anonymised and agree evidence with your training officer.

1. Identify one barrier in a laboratory process, training resource or patient instruction. Who may be affected and how?
2. What adjustment was made, or what controlled change would you propose? How would you test whether it works?
3. Describe a time you noticed an assumption or bias in your own thinking. What check did you introduce?
4. How does your laboratory select reference information when demographic or physiological context matters?
5. Where are the local equality, reasonable-adjustment, safeguarding and speaking-up routes?
6. What inclusive leadership behaviour can you practise during your next shift?

Key takeaways

• EDI is part of scientific quality, access and patient safety.
• Equality does not always mean identical treatment; equity and reasonable adjustments remove avoidable disadvantage.
• Demographic and physiological data must be used accurately, respectfully and without assumption.
• Inclusive design often improves safety for everyone.
• Bias should be expected, examined and controlled rather than denied.
• Every biomedical scientist can challenge barriers and demonstrate inclusive leadership.

Suggested references

• Health and Care Professions Council. Standards of proficiency: Biomedical scientists (effective 1 September 2023)
• Health and Care Professions Council. Standards of conduct, performance and ethics (effective 1 September 2024)
• Institute of Biomedical Science. Registration Training Portfolio V5: Module Descriptors, version 1.1, May 2025
• Institute of Biomedical Science. Good Professional Practice in Biomedical Science, updated 2025
• UK Government. Equality Act 2010
• NHS England. Accessible Information Standard requirements
• NHS England. Reasonable Adjustment Digital Flag