a blurred hospital waiting room

A new online training tool has been shown to be effective in reducing racial bias among staff workers in primary care medical offices, in a study led by Gabriel Tajeu, assistant professor of Health Services Administration and Policy.

“Our research group previously had discovered that front desk staff in the healthcare setting—who weren't physicians or registered nurses—were a fairly significant source of perceived discrimination,” Tajeu says. “That can be a barrier to healthcare. Patients who experience discrimination are less likely to follow treatment plans and less likely to come back for follow up visits. It's associated with worse outcomes.”

Tajeu’s new paper, “Development of a Multicomponent Intervention to Decrease Racial Bias Among Healthcare Staff,” was published in the March issue of the Journal of General Internal Medicine and follows up on those earlier findings, testing a training program the research team developed aimed at reversing bias patterns.

Much of the racial bias that patients may encounter isn’t intentional, Tajeu says.

“It’s subconscious patterns of thinking, or snap judgments,” he explains. “Office staff may not even be aware that they're engaging in disrespectful or discriminatory behavior. We’re not trying to make people feel bad for having these implicit biases. We're trying to make them aware that they have them.”

Tajeu and his colleagues began the research during his postdoctoral studies at the University of Alabama at Birmingham. The researchers recruited staff workers at multiple primary care medical offices and tested them for subconscious attitudes toward people of different races using the Implicit Association Test. They then were given the training program and retested. The overall baseline implicit bias score for the group indicated slight pro-white bias. After the intervention, the implicit bias score decreased to a neutral score, indicating no pro-white or Black bias. 

The intervention consists of five 30-minute modules, including PowerPoint slides and videos, which participants complete online.  

“We wanted to provide some background on the experiences of racial minorities in the healthcare setting, educate individuals on implicit bias and how it may influence interactions with patients—and also generate some emotional connection to the issue,” Tajeu explains. “We wanted to encourage building partnerships with the patients, to treat each individual encounter as a unique experience. Part of bias is that you're not treating each interaction as unique, you’re just using stereotypes to categorize everything.”

Another factor is that biases can emerge when individuals are emotionally taxed or tired, so one module centers on handling stress at work.

Tajeu notes that implicit bias isn’t only happening at the front desk or other parts of patient intake—studies have suggested that higher levels of implicit bias among clinicians results in differences in treatments. But success in countering bias among staff workers, who often aren’t considered key members of the healthcare interaction team and may have lower levels of education than doctors and nurses, is important, he says.

Next, he says, he would like to validate the results in different healthcare settings, improve the production quality of the training materials, and “ultimately tie improvements in perceived discrimination or lowering implicit bias to clinical outcomes,” he says.

“If we are able to reproduce it and improve it, this could be easily disseminated across the country online, particularly if we find it is tied to improvements in clinical measurements,” he says.