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How U-M Health Got 27K Staff Members in Implicit Bias Training

U-M Health’s implicit bias training aligned with state-mandated training for clinicians, compelling more provider staff to complete the courses.

It’s not every day that a health system can boast of achieving 112 percent of its goal for anything, but that’s where Michigan Medicine finds itself with its implicit bias trainings.

In just a year, the health system has gotten 27,000 of its staff members, from patient-facing clinicians to environmental/custodial staff, to complete basic implicit bias training, a core tenet of its overall health equity strategy.

That exceeds an already ambitious goal.

When Michigan Medicine started the training last year, it wanted to get 24,000 of its staff members to complete the sessions. But the 27,000 trained employees figure is 112 percent of that goal, putting the organization well on its way to an overarching health equity and anti-racism journey.

U-M Health is like a lot of organizations as it pursues equitable healthcare. In 2020, when COVID-related health disparities were front and center and George Floyd’s murder sparked a national racial reckoning, the health system joined its peers in prioritizing anti-racism in medicine.

The implicit bias training, titled Building Toward Belonging (BTB), is a part of that anti-racism mission. Developed by U-M Health’s Office for Health Equity and Inclusion (OHEI), these trainings fulfill the “Belonging” part of the organization’s overall BASE strategic priorities.

“In the Office for Health Equity and Inclusion, we knew that we wanted to push forward something around creating this more inclusive environment, recognizing that that was going to be individual work that would impact the collective,” Blaire Tinker, a part of OHEI and one of the primary facilitators for the implicit bias training, said in an interview with PatientEngagementHIT.

That endeavor also happened to align with a statewide mission from Michigan’s Licensing and Regulatory Affairs (LARA), which licenses medical practitioners. As OHEI started to conceptualize its implicit bias training, it clocked a new mandate from LARA stating that all licensees need to complete a one-hour, facilitated basic implicit bias training.

The OHEI team saw an opportunity for coordination and built out U-M Health’s mandatory training to also fulfill the LARA requirements. To start, that meant the U-M Health program was going to be 60 minutes and be facilitated by a trained instructor, per LARA specifications.

According to Tinker, who joined the OHEI team after the implicit bias training curriculum was set, that LARA alignment was integral to the training’s success. Because U-M Health clinicians knew they needed to fulfill LARA training, the U-M Health course became an opportunity to accomplish two things at once.

That alignment was a big draw for the clinicians who needed to complete the training modules, but the OHEI team also knew they had to make the program accessible. Clinicians are busy and work irregular schedules, Tinker pointed out, so OHEI needed to host some meetings as early as 5 a.m. in addition to the sessions that took place during regular office hours.

And to reach the other U-M Health staff members who maybe aren’t patient-facing—meaning folks who may not perceive their roles as integral to the health equity mission—OHEI knew it’d need a stronger approach.

To be clear, the implicit bias training was mandatory, Tinker pointed out, but that doesn’t mean it had to feel compulsory. OHEI started an internal marketing campaign featuring organization leadership outlining the importance of the entire healthcare organization being on the same page in terms of anti-racism.

The Office also kept in close contact with department leadership. If the data showed a certain department had low training attendance, the Office connected with leadership to help get the word out.

Still, Tinker said it soon became clear that OHEI would need to develop more modalities to ultimately reach its end goal of 80 percent course completion within a year.

“We also came out with our 25-minute asynchronous module in early March because we recognized that not everyone needed those 60 minutes,” Tinker said. “And then it gave us the option to allow people who are not patient-facing, who did not need LARA licensure, to get that training done.”

OHEI got an assist again when LARA announced that practitioners could maintain licensure if they, too, attended an asynchronous module. The sessions still needed to be 60 minutes, so OHEI adapted the 25-minute course it already hosted to add in more details for those seeking LARA licensure.

“Our main goal was numbers, numbers, numbers,” Tinker emphasized. “We need to get at least 80 percent of our population to finish this training by June 2023. So this asynchronous module and the ability to even work towards that was instrumental as far as getting us to our numbers well before our deadline for the end of this month.”

But as any implicit bias program instructor probably knows, not every participant is eager to be a part of the program. Implicit bias training sessions can often be uncomfortable for participants, Tinker acknowledged. And while most healthcare practitioners want to do right by all of their patients, some might believe already treat their patients equitably or bristle at the thought of being biased.

“It didn't happen often because I think we did a really great job as far as setting up parameters and letting people know that this is going to be a respectful space,” Tinker noted. “And if you're not in this space to make it respectful, then there are other sessions you can attend when you're in a better mood.”

“But when I've had people who've willingly shared something that deviates from an inclusive mindset or that deviates from the direction that we want the training to go in, I always challenge people to consider the fact that we're coming from different spaces,” she added. “We all have work to do and lean into cultural humility, which is really about exploring the fact that we need to constantly and consistently learn about ourselves and be in the space to learn about other people.”

Tinker stressed the importance of hiring the right people to facilitate training sessions for this very reason. Implicit bias training does not work when the instructor simply parrots off a slide; rather, organizations need to consider individuals who are trained in conflict resolution.

Implicit bias training at U-M Health won’t be over after this year, Tinker reported. OHEI has been approved to host similar trainings for next year that will focus specifically on the LGBTQIA+ community, a population the Office prioritized because of the adverse outcomes and patient experiences reported for this group.

After that, Tinker said she hopes OHEI at U-M Health will be able to continue conducting implicit bias training focusing on other groups, like individuals with disabilities, and even summary trainings. Moreover, she hopes to see specific departments at the organization host immersive exercises around implicit bias.

After all, a one-hour training isn’t going to change the course of health equity at any organization, Tinker said, citing evidence that it can take up to 50 hours to reverse some biases.

“But again, thinking about that foundational like that math problem and how our learning is developmental, we introduced the strategies to mitigate bias and got people to think about maybe what biases they particularly have,” she concluded. “And then now we're going to step up and think about specific communities.”

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