The Echo Chamber Problem — Why Culture Change in Healthcare Feels So Hard
At Surviving in Scrubs, we talk a lot about culture — probably more than most people realise. Yes, we are deeply concerned about the prevalence of sexual harassment and sexual assault within the healthcare workforce. And yes, we are actively campaigning and educating to tackle this issue head-on.
But if we want to create lasting change, we have to take a step back and ask the deeper questions:
– How are perpetrators allowed to keep harming their colleagues?
– What is it about our systems, our hierarchies, our culture — that allows this to happen?
This was one of the core questions we set out to answer when we launched Surviving in Scrubs. What is going on here? Why are people who sexually harass and assault colleagues still working in healthcare?
Or more accurately: Why are they not challenged long before their inappropriate beliefs and behaviours escalate into something so harmful?
We know there is a culture of tolerance toward these behaviours. We know there are blind spots around particular individuals — those who are protected by status, seniority, or institutional convenience.
But we will not stop.
We will continue to deliver training, education, and talks to raise awareness, advocate for survivors, and push for systemic change.
The Echo Chamber Problem
One of the most frustrating — and disheartening — parts of this work is this: We are often speaking into echo chambers. The people who attend our sessions, follow our work, and share our posts are usually those who already get it. They’ve seen the harm. They’ve felt the harm. They want to make things better — not just for themselves, but for the people around them.
But here’s the truth:
Culture isn’t upheld by the people who care. It’s upheld by the people who look away.
And unfortunately, when our sessions aren’t mandatory or compulsory, they are often boycotted — either passively or deliberately — by the people with the most influence, those with positional, professional, or social power. These people are often shielded from the discomfort of experiencing sexual misconduct by their status. They don’t see the problem. They don’t feel the need to change the culture, the systems that we work in, because the system often works for them.
This is why echo chambers are dangerous.
They can give us the illusion of progress, by giving speakers positive reassurance in the moment, but in reality the structures that allow harm to persist remain untouched.
What we really need
Real culture change isn’t just about support. It’s about disruption. Culture doesn’t shift by adding a checkbox to induction. It shifts when people in power are willing to interrupt the norm — even when it’s uncomfortable, even when it’s unpopular, even when it means challenging a colleague, mentor, or friend. Disruption requires courage.
We need to see people in positions of power taking this seriously, and doing something about it. It is no longer enough for senior leaders to issue vague statements of “zero tolerance” or express passive concern when allegations surface. We need those with influence — clinical directors, trust executives, senior consultants, board members — to move from awareness to action. That means putting policies into practice, showing up to training themselves, backing staff who speak up, and holding their peers accountable when lines are crossed.
In reality, it is not enough for the already-converted to care. These supporters are not the ones contributing to harm — but they’re also not always the ones with the authority to change the systems that enable it. We need those who sit at the decision-making tables to stop assuming someone else will handle it. The time for passive allyship is over.
We need to bring these conversations to those who resist them most. This means no more optional attendance. No more quiet avoidance. No more whisper networks protecting “repeat offenders.” The people who need to hear these messages most are often the ones most resistant to engaging — and yet, they’re the ones with the power to dismantle the status quo.
We need this work to be compulsory, no more opting out. Attendance should be expected, and enforced. We need to stop valuing reputation over true safety, enabling people to speak up and not being silenced.
Nothing changes, when nothing changes. The culture will not shift, without some movement from leadership to make this a priority.
This work is hard. It’s relentless. It often feels like we’re not making much progress, but we will keep pushing.
Because those harmed by the system can’t afford for us to stop.