Small Great Things, Picoult's first adult novel since 2014 (see the cover exclusively below), follows an African-American nurse who is asked to be removed from caring for the sick child of two white supremacists. The nurse then has to make a choice between saving the child and disobeying the parents' objection to a black woman caring for their child. When things "go south," as Picoult tells PEOPLE, she finds herself on trial – and counseled by a white public defender.
"It's really about all of these three characters facing their own beliefs about privilege, power and race," says Picoult. "And hopefully their journey will encourage readers to do the same."
The author says this was "one of the hardest" books she's ever written, for several reasons.
"I really had to explore my own beliefs and my own biases and learn a lot about myself and privileges that I've had that I'd never noticed before," she said. "It's been a story I've wanted to tell for a long time and I didn’t know the right way to tell it. And when I finally felt like I cracked that, it was the right time."
While her books often deal with difficult subjects, Picoult says Small Great Things goes beyond those tough conversations.
"I talk all the time in my books about subjects that people don't really want to talk about," she says. "But to me, this feels different. I think racial awareness is one of the most pressing conversations that we really need to have in our country, and it's something that a lot of people don't want to talk about because it makes them uncomfortable."
"You can't turn on the news or open Facebook or Twitter without seeing some evidence of the fact that racism and racial awareness in our country are very important and contentious issues," she says. "This is not only a topic in the news, but a topic that is weighing pretty heavy on a lot of people's hearts. And although I am not the one who's going to come up with an easy answer to solve it, I know that a lot of my research for this book reminded me that racism is both systemic and institutional, but it's perpetuated and dismantled in individual acts."
"And that's one of the reasons that I think it's so important to have this conversation with my readers. Because even the things that feel the most overwhelming to us, in terms of issues, are often things that we can make personal adjustments about and somehow, in doing that, make the world a slightly better place."
Small Great Things will be available Oct. 11.