Special Projects Fund

Grantee Name

Be More America, Inc.

Funding Area

Special Projects Fund

Publication Date

June 2021

Grant Amount

$150,000

Grant Date:

April 2017- March 2018

Unconscious biases are ingrained habits of thought that lead to errors in how people perceive, reason, and make decisions when interacting with others from different social, racial, and ethnic backgrounds.

In the health care setting, unconscious bias can affect a provider’s line of questioning and lead to misdiagnosis; it can also affect body language and other subtle cues that cause patients to lose trust, withhold information, or fail to follow medical advice. Unlike overt prejudice, unconscious bias is very nuanced and often occurs without the perpetrator realizing it, but its impact is undeniable and substantial. To address the impact of unconscious bias on health care, Be More America created a series of in-person training workshops designed to reduce physician bias in medical decision-making. Based on the success of the in-person workshops, Be More America developed a prototype online training program. NYSHealth awarded a grant to Be More America to scale up this work by deploying the online training program at New York City-based hospitals.

Outcomes and Lessons Learned

  • Produced the Breaking Bias in Health Care (BBHC) online training program: two 25-minute modules designed to familiarize health care providers with the science of implicit bias in a nonacademic, easy-to-understand framework. BBHC focused on (1) the anatomy of bias in the brain and the nervous system; (2) the role of environmental stimuli, such as media, in reinforcing stereotyping and bias; (3) the impact of bias in the clinical encounter as shown through research; and (4) the role of bias in creating and sustaining health disparities.
  • Conducted an internal focus group with 15 advisors from the health care industry to provide candid feedback on the content and user experience.
  • Launched the BBHC program at Northwell Health, training 128 staff members.
  • Assessed participant knowledge, beliefs, perceptions, and shifts in behavior as part of each learning module.
  • Reached more than 7,000 participants through in-person and online trainings, including through 27 keynotes across the nation and 20 racial bias in-person trainings at hospital systems such as Mount Sinai, the University of North Texas, Institute for Healthcare Improvement, and University of Virginia.

Although some of the grant’s objectives were achieved, Be More America underestimated the difficulty in achieving its ambitious goal. Under this grant, Be More America originally intended to launch the training program in six New York City-based hospitals, reaching 2,000 residents and physicians. However, of the six target hospital systems, Mount Sinai was the only one that ultimately participated in BBHC training. Throughout the grant, Be More America engaged in ongoing and extensive communication with each of the six health systems, but the other five hospitals did not fully commit to the training program. Northwell Health did participate in BBHC training, although it was not part of the original cohort for this project.

One possible reason for the lack of participation in the program is that Be More America did not achieve buy-in from the most senior leadership at the hospitals before embarking on this project. Any form of organizational change, particularly as it pertains to behavior and work culture or sensitive issues such as unconscious racial bias, must begin with commitment from the top. Another possibility for the lack of program uptake is that Be More America was not seen by the hospitals as an organization with a robust medical or health care background. Research shows that practitioners in specialized fields, such as health care, are often more receptive to feedback on behavior, actions, and thinking if it comes from a peer. Any effort to address unconscious bias requires a substantial amount of trust, skill, and credibility among all participants. An emphasis on peer relationships, peer-to-peer mentoring, and strong commitments from leadership is key to a successful anti-bias training program.

This grant was an important learning opportunity for NYSHealth. In hindsight, Be More America was not the right entity to carry out this project. Despite two no-cost extensions, Be More America was unable partner with five of the targeted six hospitals to conduct any trainings. Be More America did provide letters of commitment from each of the hospitals upfront, yet it turned out those signatories did not have sufficient decision-making authority in their systems. Additionally, NYSHealth should have worked with the grantee sooner to alter the scope of the grant project and funding amount in response to the grantee’s challenges in securing participation. For future grants of this nature, assessing an organization’s qualifications and track record of success, as well as obtaining buy-in from key hospital leadership, will be prioritized.

Co-Funding and Additional Funds Leveraged: N/A