Role of bias at the bedside: Children’s Minnesota pioneered a course for employees to practice implicit bias mitigation strategies

As part of our commitment to health equity, Children’s Minnesota pioneered and developed an interactive simulation training course called “The Role of Bias in De-escalation” which began to roll out to employees in 2020. This course provides an opportunity for employees to practice implicit bias mitigation strategies and de-escalation skills in a simulated environment with actors.

Important: This video shows scripted scenarios that are actor-portrayed.

About the course

This program puts health care providers face-to-face with live actors portraying parents of kids in high-stress medical situations. Actors are recruited from our community and represent Children’s Minnesota’s diverse patient population.

Throughout each course, participants – including clinical staff and our organization’s leadership – have the opportunity for self-reflection and to identify personal biases during a live interactive simulation with the actor. As a group, participants also engage in guided practice with facilitators to learn and use new techniques to provide equitable care to all patients.

How it’s going

Over 300 Children’s Minnesota employees and professional staff have attended the course from January 2020 through May 2022 with 95% of participants saying they would recommend the course to others. In addition, preliminary course data has shown improved outcomes regarding respect, dignity and sustained use of bias mitigation strategies at the bedside – that means that the training is positively impacting the experience of our patient families.

How and why did this course start?

Data is showing gaps in health disparities across the country. We are seeing those same gaps in our organization and we are committed to addressing those inequities. This course is part of our efforts to improve and work toward health equity.

We learned through staff that there was a desire for hands-on practice and continuing education on implicit bias mitigation skills. So that’s where Brittany Dahlen, MSN, RN, NPD-BC, CPN, clinical education specialist, and Dr. Samreen Vora, MHAM, FACEP, medical director of simulation came in. In 2020, they identified the opportunity to use simulation to allow participants to practice implicit bias mitigation strategies and began to develop a curriculum to offer this opportunity to all of our employees. The course piloted in our St. Paul NICU in 2021.

What do participants learn during the course?

Participants have the opportunity to practice each of the implicit bias mitigation skills:

Counter-stereotyping imaging: The participant, recognizing bias, purposely identifies members of a group who counter the stereotypical image of the group, and replaces the automatic biased image with the positive image.
Emotional regulation: The participant reflects on “gut feelings” and negative reactions (dislike, fear, frustration) to patients from vulnerable groups. Nurse then intentionally strives to be empathetic, patient and compassionate.
Habit replacement: The participant frames recognized biases as bad habits to be broken. They develop and use a personal toolkit of self-interventions to replace the bad habit of biased thinking with the good habit of accepting and caring about each patient as an individual.
Increasing opportunities for contact: The participant seeks to develop relationships with members of a group to which the nurse does not belong, with the goal of dissolving stereotypes.

Individuation: The participant mindfully seeks seeing patients as individuals instead of as members of a stigmatized group.
Mindfulness: The participant purposely takes time to calm thoughts and feelings by being mindful of the present moment, which can help the nurse act compassionately toward the patient.
Partnership building: The participate intentionally frames the clinical encounter as one in which the nurse and patient are equals, working collaboratively toward the same goal.
Perspective taking: The participate purposely and empathetically thinks about what the patient is thinking and feeling, stimulating feelings of caring and compassion.
Stereotype replacement: The participate reflects on negative reactions to members of vulnerable populations, acknowledges stereotypical responses, considers reason for the feeling and commits to respond with compassion in the future.

Thank you to all who helped make this course happen, and to all who participate in expanding our knowledge and becoming better health care workers each and every day.