Children's Hospitals Today - Spring 2023 - 20

FEATURE / SIMULATION
PROFESSIONAL ACTORS
Mitigating bias at the bedside
Over the past two decades, mounting
evidence has revealed a pattern of implicit
bias and inequities in health care.
Though the detrimental effects of bias
have been demonstrated,
its unconscious
nature makes it difficult to address
and overcome. " No one shows up
to the bedside planning to treat people
differently, but the data shows that does
happen, " says Vora.
While children's hospitals have
committed to improving this issue, it
was brought to the forefront of
Children's Minnesota's mission in 2020
when George Floyd was murdered in
the neighborhood of the hospital's
Minneapolis campus. As an organization,
Children's Minnesota pledged to advance
equity across the hospital system
through a variety of strategies.
One facet of this work includes simulation-based
training to help health
care professionals reduce bias in patient
experiences. " We started looking to see
if there were things already being done,
maybe not even in health care, that we
know influence and change behaviors, "
says Vora. " And that's what simulation
is perfect for. "
Vora and Brittany Dahlen, clinical
education specialist at Children's
Minnesota in Minneapolis, created the
Role of Bias at the Bedside simulation
course. The four-hour program runs two
to three times a week with groups of
six to eight employees, clinicians and
providers. It's a live, interactive playpause
course that uses actors and
scenarios to learn about and mitigate
personal biases.
" We've built these cases and the
course with actors from our community
and partnered with a lot of stakeholders
across Children's Minnesota, " says
Dahlen. " We wanted this work to be
in line with the framework that the
20
organization put forth, but also what
our employees see at the bedside. "
To build the course, Vora and Dahlen
pulled information from community
partners and employee resource groups,
such as the Nurses of Color group at
Children's Minnesota. Employees voiced
a need for more resources on subjects
such as de-escalation, bias mitigation
and validation tactics.
Using the hospital's data stratified
by race allowed the education team to
home in on specific areas to start building
their course. One scenario includes a
Black mother in the neonatal unit who
feels left out of the care decision making
process. Participants then work with
the mother, played by an actor, to validate
and understand her feelings and
agree on a path forward.
" When they interact, we're having
them focus on evidence-based, implicit
bias mitigation strategies, " says Dahlen.
" The facilitators are helping them identify
what the concerns are that this
caregiver is wanting to share. "
Another important consideration
was the makeup of each group, including
the participants, actors and facilitators.
For example, they had to balance
the power dynamics of each group
to support everyone's emotional
safety, particularly people of
color. The demographics of
the group, based on managerial
level, gender or
race, can influence the
way an individual may
navigate the course.
" This work requires a lot
of emotional labor, " says
Vora. " So, it's important
to debrief often throughout
and at the end of the sessions. The
facilitators also go through over 16
hours of training. "
CHILDREN'S HOSPITALS TODAY Spring 2023
The play-pause simulation format
means that participants can pause the
scenario to discuss the situation and
how to move forward with input from
the group. " We also let the actors regroup
their thoughts and they come back
to provide feedback to our learners, "
says Vora.
Vora and Dahlen have committed
to finding actors from the Twin Cities
community. They'll visit local theatre
productions or work with acting troops
to find individuals willing to offer their
expertise and commitment to reducing
bias. " They're from our community and
their feedback is so critical to the work, "
says Vora. " Despite initial recruitment
challenges, when we started looking
in the right places, that is where we go,
which has been incredible. "
In launching the course, Vora and
Dahlen worked with leaders across the
organization and the nurses' collective
bargaining unit to start with specific
areas or teams. " We wanted this to be
a shared language that people can use
across
the organization and within
their teams, " says Dahlen.
The results have been overwhelmingly
positive. Since 2020, more than
300 staff have completed the bias
mitigation
training.
Participants
MAKING HEADWAY
Since 2020, 300 staff
have been trained,
with 95% approving
and applying what
they learned.
take a situational judgment
test where they respond
to different scenarios,
and their scores show
significant improvement
after taking the course.
Through pre- and postsurveys,
95% of participants
said they found it
beneficial, and learners
pointed out that they consistently
use the strategies they learned
during the course even three to six
months later.
Children's Hospitals Today - Spring 2023

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