Implicit Bias Training Helps Eliminate Healthcare Disparities

Implicit Bias Training Helps
Eliminate Healthcare Disparities
Crystal Anderson
People Operations Business Partner
Vivian Anugwom
Manager, Health Equity at Allina Health

© 2020 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Implicit Bias Training Helps Eliminate
Healthcare Disparities
From hospitals and clinics to data
warehousing companies, data is the key
to all sorts of improvements.
As hospitals and clinics identify
opportunities to improve provider
performance that will lead to better
patient care.
While private-sector companies identify
opportunities to improve team member
performance that will lead to better
overall company performance, implicit
biases can be a stumbling block on the
path to improvement.

Implicit Bias Training Helps Eliminate
Healthcare Disparities
Implicit bias occurs when people act on
the basis of preconceived prejudices and
stereotypes without intending to do so.
Everyone has implicit biases, however,
African Americans, women, and the
LGBTQ+ community are more likely to
be negatively impacted.
In the world of healthcare, the effects of
implicit biases can be even further
reaching—such as preventing a patient
from receiving the right care.

Implicit Bias Training in Healthcare Combined with
Data Identified Disparities in Care and Performance
Allina Health, a not-for-profit health system in
Minneapolis, and Health Catalyst, a leading
provider of healthcare data and analytics
technology headquartered in Salt Lake City,
used data to identify potential areas of bias and
intervene to ensure equitable treatment for all.

At Allina Health, these implicit biases proved
to be a barrier to patient care. They negatively
impacted patient access to important
resources like hospice care.
Similarly, at Health Catalyst, CEO Dan
Burton, identified an opportunity to increase
the number of women in leadership positions.
This opportunity is consistent with the general
lack of diversity in the technology sector.

Leadership teams in both organizations
understood the value of addressing implicit
biases to improve patient outcomes for
Allina Health and improve gender
representation at Health Catalyst.

Allina Health Increases Access to Hospice for
African Americans
In 2018, Allina Health’s Health
Equity Leadership team reviewed
a list of the 35 top identified
disparities based on data within
the health system and prioritized
the hospice referrals disparity to
improve in 2019.
Data revealed that the African
American populations receiving
care at Allina Health were not
enrolling in hospice programs
when they were eligible.

African Americans
As improvement teams dug deeper into the data
to understand the root cause behind the lack of
awareness, they realized that hospitalists weren’t
referring African Americans who were eligible for
hospice at the same rate as other populations.
The team at Allina Health—led by Vivian
Anugwom, Program Manager of Health Equity,
and Emily Downing, MD, VP of Medical
Operations at Allina Home Care Services—
presented the data to different provider groups to
increase awareness of the disparities.

African Americans
Seeing the data first-hand prompted thoughtful
discussion between all members of the care
team about the reasons behind the disparities
and the steps to fix it.
The data showed the disparities and prompted
discussion about why the disparities exist and
what measures the Allina Health team could
implement to address the disparities.
In the discussion groups, providers said things
like, “I’ll be honest, I’m probably not going to
bring hospice up because in the past, I had a
negative experience.”

African Americans
Through provider discussion
groups that fostered honest
discussions and feedback and
reviewing existing research
around potential barriers to
accessing end-of-life care for
African Americans, the team
realized that implicit biases were
preventing providers from
referring African American
patients to hospice.

Allina Health Creates Implicit Bias Training
Program to Address Hospice Disparity
As a result of these discussion
groups, the implicit bias training
program was created to target
providers, starting with hospitalists,
who frequently provide care for
hospice-eligible patients.
Creating awareness of implicit
biases would empower Allina
Health’s hospitalists to deliver
better care and improve hospice
access for African Americans
seeking better end-of-life care.

With the support of the leadership team and
hospitalist leadership, the team created and
implemented trainings to help hospitalists
become more aware of their biases.
The leadership team agreed to include the
implicit bias training as one of the options in
the required annual continuing education
package for hospitalists.

Many of the hospitalists were curious about the
topic, while others admitted they were only there
to receive credit.
By the end of every implicit bias training session,
every hospitalist left with an identified personal
implicit bias and the tools to address it.
After the training, many providers made
comments such as, “I didn’t know I needed this
training; this will make a difference in my care.”

Four Keys to Successful Implicit Bias
Training in Healthcare
Using data to identify disparities is only the first
step to address implicit biases.
The next step is to create a training program that
will have the highest likelihood of success,
incorporating four best practices:
Understand the
role each team
member plays
Gain leadership
support
Provide clear
takeaways from
the training
Share “aha”
moments with
other team
members

Understand the role each team member plays
Hospital systems are traditionally committed to
patients first, making it easy to overlook team
members (e.g., clinicians).
Additionally, the work done in a health system
can be fragmented, meaning it only reaches
staff or patients, but typically not both.
However, this is a problem, as the only way to
reach patients and improve the patient
experience is through investing in, and
empowering, team members through
professional improvement opportunities like
implicit bias trainings, support groups, etc.

Gain leadership support
The leadership team and hospitalist team were
hesitant at first because they had tried trainings
in the past that proved to be less effective.
However, they were willing to try the implicit
bias training.
Leveraging data to identify critical disparities and
the support of the leadership team, the hospitalist
leaders got on board and implemented the
implicit bias training as part of the continuing
education for hospitalists.

Provide clear takeaways from the training
With limited time to deliver the implicit
bias training, it was critical that every
hospitalist left with a clear takeaway that
was uniquely tailored to his/her implicit
biases in regard to providing care.
With a clear call to action, hospitalists
were ready to see patients differently
and address the disparities in access
to care, specifically hospice care.

Share “aha” moments with other team members
By the end of the training, the hospitalists
were fascinated and excited about what
they had learned regarding their own
implicit biases and how those biases
impacted the care they delivered.
As part of the training, instructors invited
hospitalists to share what they learned with
other providers and team members to
spread the excitement about the implicit
bias training.

What’s Next for Allina Health?
Allina Health offered three implicit bias
training sessions in 2019 and plans to
offer additional trainings in 2020.
The leadership team also decided to
implement the trainings in other areas
of the organization based on data-
backed disparities.

What’s Next for Allina Health?
Allina Health has also committed to
developing trainings for providers geared
toward all minorities, not just African
Americans.
While Allina Health waits to see the
results of their new efforts to increase
health equity, efforts to leverage data to
identify disparities in care will continue.

Health Catalyst Sees Opportunity to
Address Biases and Improve Diversity
Hospitals are not the only organizations benefitting from implicit bias training
and diversity improvement efforts.
Although Health Catalyst is a
healthcare data analytics company
whose team members don’t work
directly with patients, the leadership
team recognized that implicit biases
are ubiquitous—no matter the
industry—and that the technology
sector struggles with a clear lack of
gender diversity.
Like Allina Health, the Health Catalyst leadership team implemented implicit
bias trainings to tackle implicit biases and improve gender parity.

Implicit Bias Training Goal is Two-Fold
The goal of the implicit bias training was two-fold: increase awareness
of team member biases and then give team members the tools to
overcome their biases.
Step 1
The first round of implicit bias training at Health Catalyst focused on the basics of
implicit biases—what they are and how we develop them. Once people understand
the fundamentals behind implicit biases—and that everyone has them—team
members were prepared for a deeper dive into their biases.
Create Awareness
Step 2
Health Catalyst’s initial training program provided a framework for decreasing bias in
decision-making and speaking up when inequities are identified. Similar to the
approach at Allina Health, the training included a challenge to each team member to
select one specific behavior to improve or change.
Equip Team Members with the Right Tools

After nearly four years of regular discussions and trainings about overcoming
biases and improving diversity, Health Catalyst has seen major improvements:
PAY PARITY
Men and women at Health
Catalyst earn salaries
within one percent of each
other for similar work
GENDER RECRUITMENT
In 2019, 35 percent of Health
Catalyst’s team members
recruited were female, as
compared to 29 percent in 2018.
EXECUTIVE TEAM
The Health Catalyst
Executive Team is 30
percent female, compared
to 10 percent in 2015.
WORKFORCE BALANCE
Currently, 36 percent of the
workforce is female, compared
to 26 percent in 2015.
PROMOTION OPPORTUNITIES
During 2019, males and females were equally
likely to be promoted across the organization.

Although the above metrics focus on
gender, which has been a primary focus
for Health Catalyst during the last four
years, the next trainings will expand to
focus on improving equity for other
underrepresented groups.

Long-Term Value in Implicit Bias Training
in Healthcare
Whether within a health system, clinic, or
a data and analytics company, addressing
implicit biases with team members can
improve performance and equity.
It allows team members to better
understand personal roadblocks to
development—inherent prejudices.
When team members understand these
limitations, steps can be taken to
overcome them as care is provided to
patients and work occurs in team settings.

For more information:
“This book is a fantastic piece of work”
– Robert Lindeman MD, FAAP, Chief Physician Quality Officer

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People Operations Business Partner at Health Catalyst. She graduated with a
Bachelors in Management with an emphasis in Organizational Behavior and
Human Resources from Brigham Young University in April 2017.
Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
Crystal Anderson
Health Equity Manager at Allina Health. She is a trained community health educator
with several years of experience in health care operations and program development.
She has worked with programs that have served patients across the care continuum
from diabetes prevention to end of life care. In 2016, she led the integration of
LifeCourse, a late life supportive care approach, into a Federally Qualified Health
Center in Minneapolis. Driven by a passion for building relationships and collaborating
with others to improve community health, Vivian works to eliminate health disparities in underserved
populations around the world.
Vivian Anugwom

Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
Health Catalyst is a mission-driven data warehousing, analytics and outcomes-improvement
company that helps healthcare organizations of all sizes improve clinical, financial, and operational
outcomes needed to improve population health and accountable care. Our proven enterprise data
warehouse (EDW) and analytics platform helps improve quality, add efficiency and lower costs in
support of more than 65 million patients for organizations ranging from the largest US health system
to forward-thinking physician practices.
Health Catalyst was recently named as the leader in the enterprise healthcare BI market in
improvement by KLAS, and has received numerous best-place-to work awards including Modern
Healthcare in 2013, 2014, and 2015, as well as other recognitions such as “Best Place to work for
Millenials, and a “Best Perks for Women.”

Implicit Bias Training Helps Eliminate Healthcare Disparities

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