Shifting Frames Consulting

🦻 Have you heard of ‘thick skin bias’? 🌟 Dr. Eldar Shafir and Dr. Nathan Cheek share in this insightful article a series of 18 studies exploring 'thick skin bias' ‘Thick skin’ bias is when those “from lower socioeconomic status (SES) are systematically perceived as being less harmed by negative experiences than higher-SES people, even when this is patently false.” Sadly, studies have shown that those of low-SES are often perceived as less competent and even 'less human' which then makes inequity more tolerable for those not impacted. 😲 💡 Their work highlights the urgent need to recognize how socioeconomic status shapes our perceptions and treatment of others. They call out that this bias has “profound implications for the institutional and interpersonal neglect of those most in need of greater care and resources”. As we reflect on these findings, let's commit to understanding our own biases. By reflecting on our personal experiences and beliefs and practicing bias interruption skills, we can create a more empathetic and equitable world. ✨ #ThickSkinBias #EmpathyMatters #SocialJustice #HealthEquity #ImplicitBiasInterruption #DailyWork #HumanWork #ItsAllConnected #SeenHeardAndValued https://lnkd.in/gVekxUyQ

We have the power to change workplace culture in healthcare. Mental health crises, burnout, shortages of healthcare workers. All of these concepts are linked to systemic issues within the healthcare education and healthcare systems.  We highly recommend this podcast series from Docs With Disabilities Initiative on Suicidality in Medical Training. This episode in particular, provides daily life examples of how we can change workplace culture in healthcare. At Shifting Frames Consulting, we integrate the power of realistic practice in to promote workplace culture change. 💡 What if we could practice together as healthcare professionals, the actions, words, and reflections needed to shift the culture? 💡 What if Nurse Educators, Fellowship Program Directors, Nurse Managers, etc. could practice role modeling these daily actions? As Suicide Prevention Month comes to a close, we celebrate the powerful and vulnerable stories shared in the Docs With Disabilities Initiative podcast and commit to continuing the daily work to shift the culture of healthcare. 💛988 Suicide and Crisis Lifeline #HealthEquity #ItsAllConnected #RealisticPractice #MentalHealth #DailyWork “The stakes are far too high to maintain a status quo that perpetuates harm.” - Dr. Joseph Murray

As the Hispanic and Latinx/Latine population grows in the US, health disparities continue to widen. At Shifting Frames Consulting, we emphasize the interconnectedness of healthcare barriers. Acknowledging the interconnectedness of barriers experienced in healthcare, allows for more effective quality improvement work focused on addressing multiple barriers. Healthcare is a complex environment and it is important to eliminate a “shame and blame” mindset either by blaming the patient or the healthcare professional for the disparities. Healthcare professional biases and interpersonal factors are one aspect of the barriers faced, and should be addressed without a shame and blame lens.  Many of the barriers to healthcare stem from “institutional racism, disparities in socioeconomic status, and xenophobia”. The authors of a recent article, Samantha Brener, Stephanie Jiang, Emma Hazenberg, and Daniel Herrera shared a cyclical model which demonstrates the barriers present before, during and after healthcare interactions. The Hispanic Cyclical Healthcare Barrier model can help organize solutions to the barriers- promoting dismantling of inequities.  Thank you to the authorship team for sharing this much needed model and the comprehensive insight into healthcare barriers for the Hispanic and Latinx/Latine population. It is daily work, and this information can help us unlearn and relearn to promote health equity. As we celebrate National Hispanic Heritage Month, we can also work to dismantle the barriers facing the diverse Hispanic and Latinx/Latine populations. #HealthEquity #ItsAllConnected #UnlearningAndRelearning #DailyWork https://lnkd.in/gu8wf5Zj

We cannot be silent. 💠Suicide is the leading cause of death for people 10-24 years old in the US 💠Racism and colonization are social determinants of suicide Today is World Suicide Prevention Day and September is National Suicide Prevention Month. So often, suicide prevention techniques are focused on the individual and connecting folks to resources. Although this is important, it is essential to address the role of structural racism and discrimination in suicide risk and take action to disrupt oppression. We would like to highlight an excellent article by Lisa Wexler, Lauren White, Victoria O'Keefe, Stacy Rasmus, Emily E. Haroz, Mary Cwik, Ph.D., Allison Barlow, Novalene Goklish, Emma Elliott, PhD, Cynthia Pearson, and Jim Allen sharing several strengths-based collectivist strategies to use in suicide prevention. The three relationally-oriented strategies for suicide prevention provide examples of Partner, an implicit bias interruption skill necessary for an equity and justice-based practice. Partner identifies a shared goal with the individual and/or community. At Shifting Frames Consulting, we celebrate the leadership of communities such as the American Indian and Alaska Native (AI/AN) communities highlighted in the article and are grateful for the gift these strategies can provide to improve care everywhere. The focus on relationally-oriented strategies not only integrates key cultural values for AI/AN, it role models key practices to interrupt systemic oppression across healthcare. #HealthEquity #ImplicitBiasInterruption #WeNeedYouHere #EndMentalHealthStigma National Alliance on Mental Illness (NAMI) HelpLine is available M-F, 10 a.m. – 10 p.m. ET. Call 800-950-6264, text “helpline” to 62640, or chat online.  In a crisis, call or text 988 (24/7). https://lnkd.in/ghuR6ZWF

Nothing without us. This phrase is an important reminder from Disability Justice activists to partner with folks of many intersectional identities in all aspects of society and life. Partnership is essential to improve health equity outcomes. The folks directly impacted by disparate health outcomes have the most insight into what they need. At Shifting Frames Consulting, we partner with professional actors from the community to co-create meaningful curricula to impact health equity outcomes. We support organizations in cultivating partnerships with community members to ensure the root cause and most important needs are addressed- versus focusing on our own assumptions of what a community might need. One research team shared a great example of a co-design approach to a novel participatory project to impact mental health stigma in rural communities.  ❗People in rural areas have higher rates of depression and suicide when compared with people in urban areas.  ❗People in rural areas are less likely to receive mental health services, often due to inaccessibility. The researchers Rochelle Hine, Brenda Gladstone, Andrea Reupert, Charlotte (Lotti) O'Dea, Rose Cuff, Scott Yates, Anneli Silven Hagström, Dr Violette McGaw, Kim Foster share their strategies and insights, a great opportunity for all of us to integrate these practices into health equity and quality improvement efforts. There is a risk of well-intentioned folks missing the important step of partnership. We want to thank this research team for sharing one way to partner in a co-design approach with rural youth to unpack mental health stigma. #HealthEquity #NothingWithoutUs #ImplicitBiasInterruption https://lnkd.in/gf-yaADa

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