Abstract Background Experiences of racial discrimination during healthcare encounters have increasingly been recognised as a source of health inequity. Narrative accounts by racialised healthcare users have dominated research in the field but it is equally important to capture the perceptions and practices of professionals to understand how racism operates in healthcare provisioning. This presentation asks: how does racism manifest in the German inpatient healthcare system (hospitals, rehabilitation facilities), and are there areas or phases of healthcare provisioning where racism is observed more frequently? Methods Problem-centred expert interviews (Döringer 2021) with 20 healthcare professionals from medicine, nursing, and therapeutic professions working in hospitals or rehabilitation facilities across three German federal states. Data were analysed using documentary method (Bohnsack 2002). Results Racism occurs widely in German inpatient settings. It manifests both structurally, e.g. in the absence of professional translators for healthcare users with limited German skills, and interpersonally, e.g. in the form of microaggressions and stereotyping but also the witholding of treatment and verbal abuse. Targets of racism are both patients and staff, especially internationally recruited healthcare workers. Respondents thereby identify night shifts, psychiatric settings and the emergency ward as contexts where racism is more likely to occur. The hierarchical nature of and pervasive power asymmetries in hospitals thereby prevent effective interventions against racial discrimination. Conclusions Racism in German healthcare institutions requires multiscalar public health interventions, particularly at the level of the institutions themselves. These include the establishment of a robust and low-threshold complaints structure, spaces for self-reflection for professionals, and mandatory anti-racism training rather than a focus on diversity-sensitive competence. Key messages • In future research approaches, structurally determined reproductions of racism should be investigated using a multi-method approach. • Experiences of powerlessness are reported by both those affected by racism and those professionals who observe racism and should be addressed by the institutions.
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