Background: Microaggressions and bias events in the clinical environment are widespread and have both individual and structural consequences. Microaggressions are brief and mundane verbal, environmental, or behavioral slights that communicate bias, hostility, or prejudice toward any group. Microaggressions can occur in a variety of interactions between the physician and patients, learners, colleagues, and staff. Studies demonstrate that bias and microaggressions towards marginalized groups throughout medical training and clinical practice contribute to a psychologically unsafe working environment, as well as depression, anxiety, imposter syndrome and burnout in individuals. Psychological safety is key in building a high-reliability organization as well as decreasing burnout and turnover. (1,2)To combat bias, we must first understand their prevalence and the burden they exert. While enterprise-wide anonymous reporting tools existed at our institution, none offered process transparency or feedback to the reporter. To address this, the Hospital Medicine Division (HMD) IDEA (Inclusion, Diversity, Equity, Action) Committee developed a transparent, reporter-friendly process to report and address bias-related events that faculty witness or experience. This self-report tool was modeled after a similar reporting system developed for trainees and students at our institution.
Purpose: The aim of the Bias Event Reporting System we created is to improve the climate and culture of the clinical practice environment by better quantifying and understanding bias events that members of our division experience. The response system is based on the theories of restorative justice and growth mindset with a goal of calling in the source of the event to help foster a psychologically safe workplace.
Description: Reports can be submitted through a self-report system (using a QR code or link to RedCap) or directly to the division chief. The RedCap reports are automatically sent to the division chief as well as the Department of Medicine Director of DEI for review. The system allows the reporter to describe the event, its impact, and any suggestions for how it could be addressed. The self-report form enables the reporter to remain anonymous or share their identity, as well as specify if and how they would like feedback on the event response. Once the division chief receives the incident report, they submit an Incident Report Follow-up via RedCap. This form includes the date the report was received, when discussion with the source of the event was completed, the action plan for responding to the bias event, and timeline for follow-up with the reporter, if desired.
Conclusions: For privacy reasons, report details are limited. Thirteen bias event reports have been made, and the reports primarily involve interactions between faculty. One third of reporters requested follow-up from divisional leadership after discussions with the source of the bias event. One third of cases required discussion with departmental leadership.