Shifting Frames Consulting

Check out our recent publication in Clinical Simulation in Nursing (Dahlen, McGraw, & Vora, 2024) Brittany Dahlen, Rachael McGraw, and Samreen Vora demonstrating an increase in implicit bias interruption skills and improved patient family experience! We are thrilled to share the outcomes of a simulation-based quality improvement study. Nearly 200 healthcare professionals engaged in simulation-based deliberate practice with a professional actor/simulated participant to integrate implicit bias interruption skills into bedside practice. In this work, we aimed to move quality improvement work from awareness to action. It was crucial to identify outcome measures and a thoughtful design to look at the impact of the intervention. “Learners from multiple disciplines found value in the simulation-based education (SBE) and reported a practice change in applying IBMS at multiple points post-intervention. Additionally, family experience outcomes improved through the study period, indicating a positive impact on patient family outcomes.” We hope this work will lead to future quality improvement and research. It will take all of us, working as a community on a daily basis to dismantle health inequities and injustices. Thank you to the amazing community who made this work possible- professional actors (Maxine Ford, Charla Marie Bailey, Dominique Jones, Michael Terrell Brown, Alsa Bruno, Elise Walker, Javari Horne, Karyn Wilson), facilitators, and quality improvement/research design folks. Your partnership is what sustains us. #HealthEquity #ImplicitBiasInterruption #RealisticPractice #DailyWork #Simulation https://lnkd.in/gHYGefGd Graphic created by Megan Murrell Illustration  © Shifting Frames Consulting, LLC

Does your positive intent align with your impact on patients and families? Sometimes, our explicit values, what we share with others and ourselves, do not match the subconscious or implicit attitudes we hold. This contrast between explicit and implicit attitudes is especially challenging when we consider the impact on care of patients and workplace culture in healthcare. Our intent may be aligned with our explicit professional and personal values but data shows that our impact is often not equitable and not landing how we intended. At Shifting Frames Consulting, we partner with healthcare professionals and organizations to unpack this mismatch and use realistic practice with professional actors to learn  bias interruption skills. Healthcare professionals deserve opportunities to improve their bias interruption skills and to partner in outcomes-driven solutions. Health equity and bias interruption is daily work, requiring unlearning and relearning. A recent article by Dr. Daniel Derbyshire and Tamsin Keay shared the contrast in explicit and implicit attitudes in nurses, all other healthcare professionals, and non-healthcare professionals toward people with disabilities. They found that a majority of respondents explicitly indicate they have no bias, yet there are strong levels of implicit bias toward people with disabilities. Additionally, the biased attitudes have not improved over the 15-year sample period in the study and remained relatively high. The authors offered several interventions to counter, including implicit bias interruption skills such as mindfulness, emotional regulation and perspective taking. The authors recommend simulation, “immersive and realistic scenarios where they can practice interactions with PWD patients in a controlled setting” and working closely with disability justice organizations for partnership in improving care. These are exactly the types of opportunities Shifting Frames Consulting helps create for healthcare professionals. We appreciate the authorship team for naming the need for implicit bias interruption skills, realistic practice and actionable health equity outcomes. #HealthEquity #IntentVersusImpact #ImplicitBiasInterruption #RealisticPractice #DailyWork #UnlearningRelearning https://lnkd.in/gtb3VZYB

The number of people experiencing opioid use disorder (OUD) has increased substantially since 2015. People with OUD deserve non-judgmental and supportive healthcare experiences, and unfortunately, often experience stigma and bias in the healthcare system. Healthcare professionals deserve the opportunity to practice bias interruption skills and the tools to cultivate an inclusive workplace. A recent publication compared the effectiveness of a virtual learning experience (eLearning) to a simulation-based intervention on emergency nurses' stigma and bias toward patients with opioid use disorder. The team found improvement across both groups, with significantly more improvement in the simulation-based education group. Healthcare organizations and healthcare professionals want to improve health equity outcomes across the spectrum of intersectional identities. Many systems rely on eLearning modules to support ongoing professional development for healthcare professionals. Although eLearning can be tailored and interactive, it can also run the risk of a “box-check” measure. Simulation-based education provides the opportunity for finding the words and actions in a realistic setting, which can help uncover biases, integrate bias interruption skills, and improve patient experience. It is much easier to say “I would say X if I were in this situation” versus engaging with another individual in a realistic conversation and unpacking this experience in a facilitated debrief. Although simulation-based education requires vulnerability, it provides opportunities for transformative learning and an impact on outcomes. At Shifting Frames Consulting, we support teams in the achievement of health equity quality improvement. We support organizations in the creation of an outcome framework and implementation of tailored simulation-based learning for implicit bias interruption skills. Healthcare organizations can achieve meaningful health equity outcomes, moving from awareness to action. Thank you Kylie Yearwood, PhD, RN, CNE, CEN, CHSE, Elyssa Wood, Lindsay Schoem BSN,RN,TCRN, Diane Swengros, Danielle DeSilvis Sapsford, Kenya Jenkins, April Brown, Stanger Debra, Lauren Schwindt, Amanda Golino, Shannon Lyons, and Audra Baroni Gollenberg for conducting this important research. #HealthEquity #ImplicitBiasInterruption #Simulation #AwarenessToAction  https://lnkd.in/gStrgTmm

How do health inequities show up in our daily lives? As healthcare professionals, it is important to be aware of how inequity shows up. This awareness allows us to name the inequities and take action. So often, due to the nature of systemic racism and bias, these huge inequities can remain unnamed by healthcare professionals interacting with patients. It is a communal responsibility to not allow the inequities to remain unnamed or unaddressed. An article published in Pediatrics demonstrates naming the degree of the disparities in pediatric safety events in US hospitals stratified by race and ethnicity and payor status. What does this mean for a healthcare professional working directly with patients?  It is important to be aware of the health disparities impacting the patients and families we care for and partner as teams to interrupt the biases in patient care that are contributing to these outcomes. For example, this study revealed Black and Hispanic patients experienced disparities in neonatal blood stream infections. We can practice naming the disparity and explicitly discussing how the team will take action for each patient during patient rounds and for the department during quality improvement efforts. Shifting Frames Consulting supports healthcare teams to identify metrics to measure bias and health inequities and supports teams to interrupt these biases, leading to meaningful change for patients, families, and staff. Thank you, Kavita Parikh, Matt Hall, Joel Tieder, MD, MPH, Gabrina Dixon, Maranda C. Ward, Ed.D, MPH, Pam Hinds, Monika Goyal, Shawn Rangel, Glenn Flores, and Sunitha Kaiser, for this impactful study revealing disparities in pediatric safety events. This work is an important step in moving from Awareness to Action. #HealthEquity #ImplicitBiasInterruption #AwarenessToAction https://lnkd.in/gKZs8-nS

At Shifting Frames Consulting, we use evidence-based strategies to provide organizations and healthcare professionals with the tools to interrupt bias in their daily work. Implicit and explicit bias impacts healthcare interactions everyday. Despite many explicitly held professional codes of ethics and personal values, patient and provider interactions often reveal disparities across many identities. Unfortunately, these disparities break down patient trust, negatively impact patient outcomes, and can also contribute to provider burnout due to decreased connection and distress regarding outcomes. We know healthcare environments are complex and healthcare professionals deserve the time and resources to continuously improve their practice within a system committed to health equity and provider wellbeing. We want to highlight an impactful article which used simulation to understand healthcare professionals’ perspectives on communication feedback on patient encounters. So often, we do not know how something landed for a patient or colleague, we may not ever get feedback that is actionable. Emily Bascom, Reggie Casanova-Perez, Kelly Tobar, Manas Bedmutha, Harshini Ramaswamy, Wanda Pratt, Janice Sabin (she/her), Brian Wood, Nadir Weibel and Andrea Hartzler published excellent work which outlines communication feedback tools that are most appealing to providers regarding implicit bias in patient encounters. Providers in the study shared they preferred a dashboard available to providers on overall communication skills and individual patient encounters. On the dashboard, providers can see the number of interruptions in a visit, amount of eye contact, their dominance in the conversation, and signs of rapport and warmth. 🌱 The dashboard method promotes a growth mindset and counters a shaming mindset. One participant stated they liked the ability to see their overall performance and performance by different patient demographics, stating “It has less to do with the certain group of patients but the way I relate to them”. Providers shared they can use this information to interrupt their biases before a visit, and promote their growth in changing patient experience over time. Overall, this paper provides great insights and there are copious opportunities to apply what was uncovered to further transform the workplace culture. 🎁 It is a gift to receive feedback from others, and this practice can be integrated into our daily work, even when a dashboard may not be available. Thank you to the authorship team for sharing their work! #HealthEquity #ImplicitBiasInterruption #RealisticPractice #SeenHeardAndValued #DailyWork Graphic created by Megan Murrell Illustration  © Shifting Frames Consulting, LLC

Health equity conversations can often get stuck at awareness, with a focus on diagnosing the problem. Although this is an essential step to identify the gaps and build shared language within health equity, ultimately, we must move to action. At Shifting Frames Consulting, we focus on outcomes-driven solutions where patients, families, staff, and organizations can observe measurable changes in their experience and outcomes. Whether the focused effort is on staff retention, patient experience, or specific patient outcome measures, it is essential to have a clear plan.  Health equity improvement efforts will be ongoing, similar to how ongoing improvement efforts around infection prevention and emergency management are a daily practice in healthcare. As healthcare professionals, we are accountable for our own practice, supporting the practice of those around us, and for the system-level improvements overall. When organizations lead health equity improvement efforts through clear strategic plans and measurable outcomes-driven solutions, healthcare professionals can reinforce this plan at the local level. Ultimately, we all want to create meaningful and positive health experiences for patients, families, and communities, it is why we entered our respective roles. Through clear action planning, an organization can support the healthcare professional and the patient family unit in feeling seen, heard, and valued. #HealthEquity #ImplicitBiasInterruption #AwarenessToAction #SeenHeardAndValued Graphic created by Megan Murrell Illustration  © Shifting Frames Consulting, LLC

Roles in healthcare are challenging. We navigate complex systems, high stress situations, and intersect with people during their most vulnerable moments.  The retention of healthcare professionals is a big concern with an impact on patient outcomes and the organization’s finances (e.g., the cost of turnover for one nurse is between $45,000 to $67,000). The impact of discrimination and bias is largely unacknowledged in plans to address workforce turnover. An excellent systematic review by Kyla Woodward and Mayumi Willgerodt PhD, MPH, RN, FAAN, FNASN found very few studies address equity in turnover and retention. And a scoping review by Olihe Okoro, Omolayo Umaru, and Meghana Ray outlined the distinct barriers faced by Women of Color (WoC) in health professions and provided strategies to improve. The review highlights how “it is not merely enough to recruit, but rather efforts should be directed at retaining and developing WoC to achieve higher-level positions.” Researchers, Charlotte Thomas-Hawkins, PhD, RN, FAAN, Linda Flynn, Peijia Zha, and Sakura R Ando MSN, RN found racial disparities in turnover and intent to leave, “Non-white nurses reported negative racial climates, multiple racial microaggression experiences, and high job dissatisfaction and emotional distress.” All of these findings call attention to the need for open conversation and interventions to interrupt workplace racism and bias in order to improve workplace culture and retention. As healthcare professionals and leaders, it is important we discuss the impact of health inequity and workplace discrimination on healthcare professionals and implement interventions to interrupt them. These daily occurrences impact healthcare professionals’ well-being and can lead to high turnover. Thank you to the authors for sharing the important articles. Health equity work is all connected. The experience of the patient/family/community is intertwined with the experience of the healthcare professional. We can improve the environment for everyone.  ❓ What have you noticed in your own workplace?  ❔ How is turnover and retention discussed?  💡 What interventions are currently being used to interrupt workplace bias? #ItsAllConnected #HealthEquity #ImplicitBiasInterruption Citations:  Thomas-Hawkins, C., Flynn, L., Zha, P., & Ando, S. (2022, July/August). The effects of race and workplace racism on nurses’ intent to leave the job: The mediating roles of job dissatisfaction and emotional distress. Nurs Outlook, 70(4), 590600. https://lnkd.in/e6YMyJqT. Woodward, K.F., Willgerodt, M., (2022, July/August). A systematic review of registered nurse turnover and retention in the United States. Nurs Outlook, 70(4), 664678. https://lnkd.in/esTkqbti. Okoro O, Umaru O, Ray M. Women of Color in the Health Professions: A Scoping Review of the Literature. Pharmacy. 2024; 12(1):29. https://lnkd.in/eyCmyHST

Healthcare professionals often look for opportunities for hands-on learning to support our practice. Hands-on practice is even more impactful when it occurs in a realistic setting, integrates feedback and learning from others, and includes the opportunity to put that feedback into practice. At Shifting Frames Consulting, we know healthcare professionals are looking for ways to improve care and we often don’t have the time or resources to practice important skills, including bias interruption. Through experiential learning, healthcare professionals can embed implicit bias interruption skills into their practice.    The development of implicit bias interruption skills is a daily, moment-to-moment practice. It is a lifelong process, not a specific skill we can achieve once and be done. Although we know the common saying of “practice makes perfect”, we believe it’s “good practice that makes better”. The skill of bias interruption is a muscle that will need continuous building and strengthening over time. Bias interruptions skills are just as critical as other essential skills in healthcare and we should not only provide support for folks to develop these skills, we should have measurable outcomes to track the impact.  How do you promote the lifelong practice of bias interruption in your team? #HealthEquity #ImplicitBiasInterruption #AwarenessToAction #DailyWork Graphic created by Megan Murrell Illustration  © Shifting Frames Consulting, LLC

Happy Disability Pride Month! This month, and all year round, is a time to celebrate the work of activists across history and today, to increase disability literacy and to put disability justice principles into action (Berne, Morales, Langstaff, Invalid, 2018). As healthcare professionals, we hold a lot of power and can often be a barrier to a positive healthcare experience for people living with disabilities. In addition, healthcare professionals with disabilities face barriers to their career advancement and discrimination in the workplace.  At Shifting Frames Consulting, we wanted to highlight several resources to increase disability literacy in the health equity space including an article from the President and CEO of the American Association of People with Disabilities, Maria Town, and videos from Disability Rights Education and Defense Fund (DREDF) Healthcare Stories series, which shares experiences and solutions for dismantling structural ableism in healthcare. These are daily examples of structural ableism and interpersonal ableism occurring in our health system. This Disability Pride Month, let’s move from Awareness to Action, and dismantle the ableist language, practices, and structures that remain. We invite you all to join us in at least one Implicit Bias Interruption practice to address the barriers faced in the stories shared.  One example we share is Catch and Replace, seeing bias interruption as a habit we can build. We commit to interrupting biased language (e.g. “crazy”) and interrupting the biomedical model of disability, which sees disability as something to be fixed, versus the social model which shares disability is created by society through ableism. Following the social model, we can partner with patients, families, and healthcare professionals, to improve the accessibility and inclusiveness of our culture and environment. What Implicit Bias Interruption practice are you going to apply? Join us in the journey from awareness to action! #DisabilityPrideMonth #HealthEquity #AwarenessToAction #UnlearningAndRelearning #ImplicitBiasInterruption Article from Maria Town: https://lnkd.in/gT_4kV2G Disability Justice Principles citation: Berne, P., Morales, A.L., Langstaff, D., & Invalid, S. (2018). Ten Principles of Disability Justice. WSQ: Women's Studies Quarterly 46(1), 227-230. https://lnkd.in/gi5drTGc.

Giving and receiving feedback is an essential skill for healthcare professionals. Teams that foster a workplace culture of feedback and growth will be more successful at interrupting bias in their environment. Bias interruption is daily work both as an individual and as a team. Healthcare professionals deserve the opportunity to not only practice how to use bias interruption skills but also to give and receive feedback from others. These skills can help break the silence around health inequities and shift our culture to one of continual growth and actionable impact. At Shifting Frames Consulting, we integrate giving and receiving feedback into all our immersive experiences. The innovative realistic experiences allow teams to practice collaboratively addressing bias in practice and receive feedback from actors embedded in the case. The actor-based feedback, small group feedback, and facilitated reflections allow folks to move from awareness to action and apply the feedback right away in their practice. With implicit bias interruption and feedback skills for both leaders and healthcare professionals, teams can make a measurable impact on health equity outcomes. #ImplicitBiasInterruption #HealthEquity #AwarenessToAction #RealisticPractice #DailyWork Graphic created by Megan Murrell Illustration  © Shifting Frames Consulting, LLC