Strengths, not deficits: A blind low vision perspective on working in healthcare

In this episode Sally Britnell, a disability advocate and senior lecturer, discusses the challenges and barriers faced by disabled people in the healthcare sector.

Sally shares her personal journey of working in health and the importance of representation in the health workforce.

She reflects on the current state of inclusivity, experiences of discrimination, and explores the need for universal design in workplaces.

Also, the role of digital tools in enhancing accessibility, the support employers can provide, and the importance of education in fostering understanding among health staff.

Transcript

Rebecca McBeth (00:05)
Kia ora koutou, welcome to eHealth Talk NZ. I'm Rebecca Macbeth, I'm the media editor at HINZ, and this episode is part of a collaborative podcast series with Blind Low Vision New Zealand. And today I'm joined by Dr. Sally Britnell. Sally is a disability advocate and senior lecturer in the School of Nursing at Auckland University of Technology. With a PhD in computing and mathematics alongside extensive nursing qualifications,

She champions an interdisciplinary approach integrating technology with clinical expertise. She's also a fellow of Health Informatics New Zealand and sits on the board. So welcome on the show, Sally, great to have you. Can you just start by telling our listeners more about yourself? What drew you to working in the health sector and what kind of roles have you been involved in over the years?

Sally Britnell (00:56)
So I, at school, wanted to be a nurse and was told by the Dean of my school, you don't see very well, you can't be a nurse, take four lots of transition. So I didn't do university entrance, and came into academia as an adult and decided I was going to study nursing anyway. Since then I've worked in a lot of places, I've worked adult rehab, adult surgical, practice nursing, in the ambulance for a while, both paid and volunteer. Children's Emergency, I stayed there for eight years and then I've been teaching nursing for about the last 14. I still keep my hand in with a lot of other things, so disability advocacy and bits and pieces like that. 

I've just finished working with Whaikaha on the new disability strategy 2026 to 2030. And that's been an interesting process and good community consultation.

So I was born three months prem and the retina in my right eye didn't develop at all. And I've always had very poor vision in that eye. If not none, I can see a little sliver of light about five millimeters out of the right one. And the left one has been
interesting throughout the years. I've had multiple retina detachments and cataracts, glaucoma, And I also have retina atrophy. So with all of those things, my eye doesn't work as it should. I've got a connective tissue disorder as well, which means healing's a bit dodgy. and the pressure can change quite a lot during the day, over a day, and it can go quite high and quite low. It's what they call volatile.

Rebecca McBeth (02:32)
and you obviously were told at a young age that you wouldn't be able to enter nursing, but you decided that you would go ahead. I guess when people talk about accessibility in healthcare, we usually are thinking about patients, but what does it mean for people working in healthcare or wanting to work in healthcare?

Sally Britnell (02:38)
No

That's an awesome question and I'm really passionate about this because there's actually a lot of discrimination in health, it or not, from my perspective. There's pockets of really good accessibility and really good inclusion and belonging, but there's also pockets where people just can't seem to think differently to make it work for somebody, So the story I normally tell is the reason why I left clinical work in the end.

And that's because I was told you can't use a magnifying glass in the drug room because it would decrease the public perception of our department. What I should have done is turn around and said, what's the difference between a magnifying glass and your reading glasses to the person who said it? But at that time, I didn't really have the resilience to do that. So there's a lot of people who just make judgments. 

And health and nursing is a profession where you've actually got to use your own professionalism. So I'm not going to put any of my patients in a dangerous position. I'm actually going to be even more careful, but people just don't seem to think that you can do that. There's a lot of assumptions out there. So a lot of assumptions like if you're blind, I'm partially deaf as well, so I'm considered deaf-blind. If you don't do things in the exact normal way, that you can't be a health professional. And I worry a lot that the patients don't see themselves in the people looking after them, So if you have a disabled person interacting with the healthcare system, they might not see themselves within that.

Rebecca McBeth (04:25)
It's interesting when people talk about bringing more diversity into the health workforce. It's not always disabled people who are highlighted in that. It's more like showing the ethnic diversity of the community in the health workforce. yeah, disability is one that's obviously interacting a lot with health, but like you said, not seeing themselves there.

Sally Britnell (04:47)
It's, I think in society, that disability, because of the health models, has always been seen as a deficit. And since it's been seen as a deficit with the medical model, then the community still think of it that way and hasn't moved on to use other models like the social, the collective, the functional and things like that.

It's kind of like we're already not seen and we're only ever seen in a deficit light. ⁓ but we actually bring a hell of a lot of expertise, empathy, and knowledge with us that people don't see as being as valuable

Rebecca McBeth (05:15)

What would the impact be, do you think, for disabled people to see more people like themselves in workforces like health,

Sally Britnell (05:32)
To me it would be absolutely amazing to see our community being A, included and B, showing their skills and expertise. So in other countries there's a lot of things like some countries even mandate you must hire X amount of disabled people and they have the infrastructure in place to be able to work with that, whereas in New Zealand we don't have, don't a lot of the time have the infrastructure to back things up. 

So people talk about reasonable accommodations for students and reasonable accommodations for this, that and the other. A lot of workplaces don't think that way. They just think you can't do the job, we won't hire you. But forget about a lot of the other things. So I have friends who work in ministry, I have friends who work in health-related and disability-related fields that have a lot of knowledge and input, but it just doesn't get seen by the rest of society or doesn't get valued in the same way.

Rebecca McBeth (06:28)
So I think you've probably answered this, but how inclusive do you think the health workplaces are right now for people who are blind and have low vision or live with other disabilities?

Sally Britnell (06:39)
I think there's pockets that are really good and there's pockets that aren't. And in mainstream, if I went to work back clinically, I don't think I would be welcomed. I did apply for one job in health not long ago and it was actually a really good experience. This was a few years ago now. ⁓ I had my old guide dog.

And I had been an infection control nurse specialist in a previous life. So I thought, OK, if I'm made redundant because there was some redundancy rounds a while ago, I'll give this a go. And so I went into the interview and it was a charged nurse that had moved from England to New Zealand where accessibility is streaks ahead, both in the workforce and in the infrastructure.

And I felt very welcomed. She said, I'm wanting to get the right person for the job. I'm so glad you came in. I know we're not allowed to touch, interact with service dogs, but welcome the seats in front of you that was just amazing.

But then there's other times where a lot of people just get, I say desk rejected because that's what happens when you submit an article and they just go desk reject, send it back, go to another journal. But it's the same in interviews. You get desk rejected, people don't actually look and see if the person is actually right for the job. 

They'll just look at the piece of paper in front of them. So there's a lot of people out there who have a dilemma of actually... whether they will apply for a job or not, or whether they'll disclose that they're disabled and when they'll disclose it. So there's quite a stigma around that. I did disclose it in this case and they were very welcoming, but other times I've had interviews over my career, which is quite long, I haven't had that experience.

Rebecca McBeth (08:17)
Yeah, you mentioned the time, you know, being told that you can't use a magnifying glass, but do you have any other personal examples or examples from I know that you field calls from other people working in health of being discriminated against in the health workforce?

Sally Britnell (08:27)
Yeah.

⁓ I do and lately, this year I've had a few phone me that have actually been pretty good just wanting to know where to go next. So I know of nurses who are working in theatre with some accommodations. They might not be able to last a long, time but they've put accommodations such as magnification equipment and things like that so that they can use the instruments.

And that kind of thing in the workplace is actually actively helping this nurse to find a new job if she needs to and when she needs to, it's on her terms. I've also had people who are struggling to navigate the system and By system, mean, even getting assessed for disability is quite challenging. People seem to make assumptions that if someone's disabled, they automatically get benefits and get looked after by the government. Not quite so true in the sense that a lot of people think, A, it's tested, but B, some people can't even get a diagnosis and people who don't have a diagnosis therefore find it hard to interact with the systems because they don't have a diagnosis. Another example I can give is that I'm across two sectors. 

So I come under Te Kura Trust for blindness and deafness, but because I have a connective tissue disorder as well, that doesn't come under them, it comes under your local DHB hospital. And so there's a tension there that sends you between one and the other and they send each other back and forward and that happens for other people in the workforce as well. So a lot of people just don't know where to go and where to get help from. And I don't think that...

in the health system and disability system that it's advertised well enough that you can go here for help. I feel like in my own experience, it's more if you know the right person and know the right questions to ask, you get some sort of help or support. But if you don't know the right questions to ask and you don't know where to ask, then you're kind of left.

There's actually all sorts of little rules and regulations which actually are systemic barriers and that's in society in general. It seems there is even less understanding in my view in the workforce. One really good place is Whaikaha, since I've been down there. Their building is amazing the way they've got it set up. As a blind person, I walked in there and got braille on everything.

They've got things like dark contrasted carpet and contrasted chairs So you can easily navigate the environment and that takes off a lot of cognitive load There's a lot of small things that workplaces can do, like the low hanging fruit that actually help everybody. So, for example, a lift that talks helps everybody.

Having high contrast signage helps anybody and there's a lot of good lighting or adjustable lighting helps everybody but those kind of things are seen as extras but they're not extras they'll actually help everyone

Rebecca McBeth (11:28)
yeah, that's often the case in health actually. Yeah, if you build it for the most vulnerable or the people who are going to have the most challenges, then everybody benefits at the end of the day. So yeah, it's a lesson to be learned, I think.

Sally Britnell (11:41)
But it's really interesting - with the systems. I'm going to skip ahead a bit. With the systems. So things are built for process. So hospital might be built with some accessibility features there, but the staff don't understand it. So they don't use them in the right, well, use them in a constructive way. So for example, you can set up a room so that it's easy for a wheelchair to navigate.

It's easy for a person with mobility aids, it's easy for someone else, but often things aren't set up in that way and it's just because somebody hasn't thought about it. It's not that they don't want to, it's they haven't asked or thought. So again, it's universal design from that perspective and it will help everyone. I skipped ahead a bit.

Rebecca McBeth (12:26)
Mm.

So we've talked about some of the barriers disabled people face when trying to get a job in health and the, yeah, just sending off the CV and having the interview for a start, but what about, you know, for those who are in the system but want to build a career and want to move ahead, are there barriers there as well?

Sally Britnell (12:46)
There are and it's quite challenging. One of the things that a lot of people don't realize you end up doing as someone disabled in the workforce is that I would spend probably six hours a week making my job accessible so that I can do it. It would be converting files. It would be just chasing things up to make sure I get things that I can use or setting up meetings and places that work for me and things like that. So there's a lot of things that

you end up doing on top of it that you don't ever get paid for, if that makes sense, to make the job accessible. But you don't really have the forum to be able to tell workplaces a lot of the time. So if there were more forums for people to tell how it's going for them and what could be improved, then I think it might

Rebecca McBeth (13:30)
What about digital tools and technology? That's obviously your passion. How can they help make working and health more accessible?

Sally Britnell (13:33)
Yep.

So there's a lot out there of digital tools. There's a lot actually built in. So I keep thinking of the ward environments I used to work in where people have desktop computers that everybody uses and they log in and out to use it. And a lot of times your settings didn't go from one computer to another. But if IT set that up, the settings for large print or voice or things like that would follow you from one system to another.

It would actually reduce barriers immensely and make it a lot easier. Other things are the vendors. If the vendors could build in accessibility and not have it as an add-on, that would also be awesome. Because so often, if you're developing software, accessibility isn't usually an afterthought unless it's something that's being specifically made for disabled people.

Rebecca McBeth (14:27)
Yeah, and like we spoke about before, guess, again, most people would think about the accessibility of a system in terms of a patient interacting with it, as opposed to the health workforce themselves interacting with the system.

Sally Britnell (14:42)
And that's something that I have a bit of a bugbear about actually because there's a lot out there for patients. So some of the patient portals have built-in access, large print voice, things like that. You can hook up buttons and switches for anybody, that kind of stuff. So that's all there. But when you're a healthcare professional, you've got, in my case, you've got little icons. So I couldn't read the writing on any of the icons, so I'd go by the color and click on that. And if somebody moved the icons around on the screen, then it was challenging. But if it was built on high contrast using design principles, it would be great. I mean, the user experience include people who are disabled in your user experience, and then that will filter through.

Rebecca McBeth (15:26)
So it sounds like there's a lot of potential there, but would you say at the moment the technologies you have to interact with as a health professional are more disabling than enabling?

Sally Britnell (15:36)
Yes,

I would, to be quite honest. thinking about practice management systems, I'm thinking about blood test systems. They're already siloed, all of the systems. They already don't talk to each other. So getting them, talking to each other and B, being accessible to the same standards would be great. And I know that Neil talked in his podcast a lot about standards. He's the standards guru.

But I think that we need to be doing better in New Zealand. So there's companies in New Zealand like

There's Access Advisors with Chandra who do help companies with accessibility. They do user testing with disabled people and there's also the New Zealand Disability Employers Network Collective, and they work with companies as well They give an accessibility tick, but it's something, somewhere that companies can start if that makes sense.

Rebecca McBeth (16:27)
You said before, you know, accessibility often involves extra effort from the employee, you in that case. So what kind of adjustments or supports can the employers provide that make a real difference in the workplace, especially for blind, low vision staff?

Sally Britnell (16:33)
Yes.

Yeah, absolutely.

it took me rather a long time to get my hands on a monitor arm. And that's a simple thing that anyone can really have, but the processes to get one were quite challenging. And it ended up being a year and there were processes in place, go and buy yourself and get reimbursed. That's quite frustrating. So if they'd have just said, like some companies do,

How would you like your workstation set up? Would you like a monitor arm? I could have said yes, that would be great. Some of the other things I've done to help myself are get the light moved from above my desk to the other side of the room because glare is a bit of an issue for me. I have a bed for my guide dog who's asleep in the background. So that's quite cool. Digital wise, I also ask to use a Mac because I prefer voiceover. There are many screen readers. I have used JAWS. I don't like it very much. It's Windows and it costs a lot of money. There's NVDA, which is Windows and is free. And then I use voiceover on the Mac. 

What I have found as someone who's been losing my vision over time is that the Mac monitors and the Mac screens give better resolution and I can see better. And it's just quite easy to use the large print features. So some of the other things I have asked for here is an office that doesn't have windows, so it's not glary.

Some of the other things that people can do are, for example, not using the chat when you're in Zoom meetings, because there's a competition between the chat and the screen reader and what the person's saying on the screen and you can never hear both.

There's a lot of little things like that that people can set up to make it work really well and the same in health. Telehealth, looking at telehealth, a lot of things are beginning to be accessible in telehealth for patients. I am not 100 % sure how far they've come for staff. And ⁓ the other thing I want to talk about is AI because...

What would be really cool for me to get around at work and to read signs and things like that is for the Metaglasses to work in New Zealand. I have a pair that I've used overseas and they're amazing. They can describe a scene, so this is using AI, describe a scene, they can read out signs, they can read whole documents to you, but New Zealand just doesn't have the AI in place yet, so they're not really available here.

Rebecca McBeth (19:06)
did mention there, you know, you work at the university. So we've talked about what the health system can do, but what about universities or professional programs? What can they do to better prepare and include disabled students who want to enter health as a career?

Sally Britnell (19:16)
Great.

Awesome.

So that's a really good question. And I've worked here for 14 years and I've seen it change a bit over the years. People are a lot more accepting. So I'm thinking primarily of the neurodiverse community. It's actually now that it's more out in the open and now that that's being talked about as well as mental health and some of the other things, it's quite good that people will bring it up. There are still some...

barriers. For example, a lot of people will automatically still say you be blind and work in a clinical field. However, that's changing. I often get students ringing me up and going, how do you do it? Or prospective students, how did you do it? What kind of things would stop me doing it? So it's having the people there that they can actually talk with.

and having the lived experience there. Because it's not all about, can you see, can't you see? It's about the nuances and how the person can actually problem solve themselves.

So it's about what roles can you go into that adapt and help the rest of the health system.

Rebecca McBeth (20:27)
What about the teams and the health system themselves? How do you build more understanding and confidence amongst health staff to be inclusive?

Sally Britnell (20:35)
And that's the real hard part, I think, because...

A lot of people would come out of university and go into a team that's really stretched. And as we know, the health staff are stretched and a lot of it's due to hiring freezers and things like that. So if we want to make change in the health system, I think A, we need to start at education, but B, we also need to give the new staff and the older staff time to actually assimilate information. When I worked in ED, we used to be so busy that we would sometimes cancel things like, educational seminars and the short things that were on, we'd cancel them because of patient need. And I think that's, talking to my friends, that happens a lot still now. So if we can get the staffing and the infrastructure better in health, I think that it would actually be better for disabled employees

Rebecca McBeth (21:26)
And you spoke earlier about moving from a deficit focus to a strengths-based or holistic what impact would doing that have on disabled staff and the organization as a whole and the health provider, do you think?

Sally Britnell (21:40)
I'm doing some work on this in research I'm looking at deafblind identities in an international study So there is no definition of deafblindness so people don't see the intersection of the ⁓ two disabilities, if that makes sense. So if you have a hearing impairment and a sight impairment you might have less of a sight impairment than one person and less of a hearing impairment put them both together and you might actually function worse. So that's what they call a functional assessment and a functional model when they look at function rather than diagnosis and deficit. But that doesn't cover things like collectiveness. So if a person who is Māori Pacific and is using a collective model of health, if that person's family actually helps mitigate their disability, then they won't consider themselves disabled. 

So that's the collective model of health, but it also shows that our data is probably flawed. I've done an analysis of some of the census data from 2023, and I've tried correlating to look for the intersection. And it comes up that a lot less Māori Pacific people are saying that they're disabled, but it comes on at a much younger age. So I'm actually thinking, well, if it's mitigated, people aren't necessarily counting themselves as disabled or having challenges. 

So there's that one. There's also the social model, which is what New Zealand subscribes to, or the social model of disability. It's where it's the society that disables the person. And you could say that in digital, it's the infrastructure and the way things are made that disables people as well. give ⁓ an example that's not digital because it's kind of obvious. A lot of the shops that I've been visiting don't have a footpath way in. They only have a driveway. So people, only people who drive are expected to use the shops. So there's one just down the road from my house. 

And if I want to go to PB Technology, I have to walk through a very, very busy car park entrance and places like that because there's no footpath. So a lot of things have just been designed without thinking it through thoroughly. the social model would be it's society's needs to fix that. The medical model or the deficit-based model is it's the person's problem, not society's.

Rebecca McBeth (24:03)
So what would you most like to see to help make the health sector a more accessible place for everyone to work?

Sally Britnell (24:10)
I would love us to look at more than just deficit model because the health system is predominantly based on medical model deficit. Then the workforce in it kind of subscribes to that as well. You've got your allied health staff like OTs and people like that who subscribe to functional, but they're not the predominant.

I think health needs to be structured differently and I think it needs to take into account all of the different models, collective, functional, social, medical, and they all have their part but they need the same value put on them, So say it's not all about this person's sick, I diagnose them, I fix them and it goes away. It's about

How do we make this person as well as they possibly can be?

Rebecca McBeth (24:58)
Well, thank you so much for joining me today, Sally. That's all we have time for, but we will be exploring further themes related to the experience of blind and low vision people in the health and social care system in future episodes. So be sure to like and subscribe to this podcast to learn more.

Ma te wa.