Quick facts

• Year: 2021 

• Country: United States of America 

• Institution: Children’s Minnesota Hospital 

• Learners: Post-qualifying clinical nurses  

• Aims: The intervention aimed to help healthcare professionals recognise their implicit biases and use practical strategies to reduce biased behaviour in everyday clinical care.

  It focused on building staff confidence when handling difficult conversations and supporting fairer interactions with families, with the broader aim of promoting more equitable and inclusive care within the unit. 

Why was the education intervention developed?

This intervention was created because the team noticed in their hospital, Black and Native American families were being treated differently.

An internal review showed they were more likely to be labelled as “escalating,” have security called on them, or be placed under behavioural contracts. These patterns weren’t random; they reflected the same racial inequities reported across the U.S. health system. 

Local factors also shaped the intervention. Staff had already been trying to reduce the use of security responses and build more trauma-informed approaches.

In addition, both families and staff of colour had raised concerns about ongoing bias in the NICU. Overall, the intervention grew out of a very real and local need to address racial inequities, improve communication with families of colour and give staff practical tools they could use in day-to-day care.

What was involved in the education intervention?

All teaching took place in person at the hospital’s simulation centre, where staff practised using trained Black simulated participants (SPs) playing the role of caregivers.

The programme was built around Transformative Learning Theory, which focuses on using challenging or “disorienting” experiences to spark reflection and behaviour change. The simulations were co-designed with Black SPs, community members and staff.

All SPs completed 16 hours of training, received trauma-informed support and structured debriefing to reflect on their own positionality.  Each session was co-led by one facilitator of colour and one white facilitator to model shared responsibility in anti-racist practice. 

Learners attended only one mandatory session, and before the session, participants completed pre-learning about identity, intersectionality and implicit bias mitigation strategies (IBMS).

During the training, they began with reflection and grounding, followed by two simulation cases using a play/pause method. This allowed facilitators to stop the scenario, discuss emerging biases and let learners practise IBMS strategies like perspective taking, emotional regulation and partnership building.

A 30-minute debrief followed each session, where SPs shared how the interaction felt from their perspective.

How was the education intervention evaluated?

The intervention was evaluated using a range of methods at different points in time: before the training, immediatelyafter and again three and six months later.

Participants completed short, scenario-based questions that asked how they would respond in situations where bias might occur. They were also asked about what motivated them to act fairly and how often they were using the strategies taught during the training in their everyday clinical work. 

In addition to this, the team gathered feedback through written comments, group discussions after the sessions and follow-up conversations with staff who regularly support families in the unit.

This helped provide a fuller picture of changes in awareness, communication styles, and how staff worked together as a team.

What was the impact of the education intervention?

The intervention led to clear improvements in how staff recognised and responded to bias. One of the most meaningful changes showed up in the way families were treated on the unit.

Security calls for “perceived escalation” dropped from eight before the intervention to two during the training period and three afterward.

Even more striking, the number of behavioural contracts and deny-entry actions fell from 29 cases in the two years before the intervention to only three cases in the two years after. This also reduced the racial gap in how often Black and multiracial families were affected by these actions. 

Overall, the intervention strengthened learners’ confidence, improved communication, and supported positive changes in everyday clinical behaviour.

Early outcome data also indicates improvements in how staff responded to families, contributing to fairer and more respectful care.

Key learnings

• Simulation-based training helped staff become more aware of bias and respond more thoughtfully in real clinical situations. 

• The intervention created space for more open and honest conversations about racism within the team, supporting positive cultural change. 

 Challenges

• Data was collected at a group level, meaning individual learning progress over time could not be tracked. This limited the ability to see how each learner’s skills developed in the longer term. 

Recommendations

• Simulation is a strong educational tool, but it is most effective when supported by long-term organisational commitment to anti-racist practice.