Symbolic sexism: superficial or serious bias? An investigation into images on patient call bells.

Objectives: To determine whether gendered symbols on patient call bells are restricted to our hospital or are examples of an international practice that perpetuates gender stereotypes and occupational segregation.

Setting: Multicentre, international study of hospital equipment, 2018.

Main Outcome Measure: Types of symbols on patient call bells.

Results: We received 56 responses from 43 hospitals in eight countries across five continents: 37 devices included female-specific images, nine included gender-neutral images, and ten did not use imagery (for example, button-only devices). No call bells included male-specific images.

Conclusion: Female symbols on patient call bells are an international phenomenon. Only female or gender-neutral images are used, indicating bias in their design, manufacture, and selection. Female symbols may reinforce gender stereotypes and contribute to occupational segregation and reduced equity of opportunity. We suggest alternative symbols. Individual action with coloured marker pens may provide a pragmatic short term, albeit provocative, solution. While call bell design has only a minor impact on patients, everyday bias affects all staff and society in general.