A feeling of belonging: An inclusive culture is the foundation for addressing unintentional bias

Unintentional or unconscious bias — stereotypes or beliefs that affect our actions in a discriminatory manner — is a frequent occurrence in the workplace. It often goes unrecognized by those responsible for hiring decisions and creating an inclusive environment for employees.

There are steps organizations can take to raise awareness about this issue and promote a more diverse work environment. Steve Marsh, president, TMF Executive Search, and founder, The Medicus Firm, and Pam Snyder, senior director, physician and advanced practitioner recruitment, Baystate Health, shared best practices for fostering diversity in organizations and in hiring practices during their session at MGMA19 | The Annual Conference in New Orleans.

We all have unintentional biases, which are shaped by the experiences we’ve had throughout our lives and often happen without much thought on our part. Unintentional bias “really underlies our patterns of behavior and can lead a person to actually be at odds with their intentions,” Snyder said of the impressions and conclusions we reach.

Examples of unintentional bias

Some of the more common examples of bias include affinity bias, confirmation bias, halo effect and perception bias.

• Affinity bias: Showing preference for those who are similar to us. For example, three members of Snyder’s staff recently said that she was going to love a job candidate because that individual reminded them of her daughter.
• Confirmation bias: Gathering information that supports our beliefs and biases while ignoring or undervaluing evidence that would disprove those beliefs. For example, Snyder pointed to someone like herself who has an East Tennessee accent being compared to a “Beverly Hillbillies” character. “When you hear someone with an accent like mine … you think they’re not well-educated,” she explained.
• Halo effect: An initial positive impression influences the overall perception of that individual. For example, Snyder harked back to her experience interviewing job candidates in East Tennessee. As an inexperienced recruiter at the time, she would have thought she hit the jackpot on the rare occasion an application from a Harvard graduate came across her desk. “Now that I know what I know … there were things we would ignore about that candidate because of what was on their CV,” Snyder recalled. “If they are a Harvard grad, that means they are well educated; that might not mean that they meet all the competencies we need for our position.”
• Perception bias: Stereotyping individuals whom we might not be as familiar with and allowing those biases to affect our perceptions. Snyder categorized this bias as the most damaging when it comes to recruitment. “Perception bias is worse than confirmation bias … you’re not looking for points to confirm something; you know it,” Snyder stressed. “You met one person that had these attributes … and you formed your opinion and you can’t get away from that.”

What is an inclusive workplace environment?

Unintentional biases can stand in the way of establishing an inclusive workplace environment. Without inclusion, organizations can’t function optimally. According to Marsh, it’s one of the keys to creating a positive workplace culture, along with passion/energy/enthusiasm and core values. However, inclusion is not as easy to characterize as the other two.

One of the most concise definitions comes from Gallup:

Inclusion refers to a cultural and environmental feeling of belonging. Employees in inclusive environments feel appreciated for their unique characteristics and are therefore comfortable sharing their ideas and other aspects of their authentic selves.

Inclusion also is the extent to which employees feel valued, respected, accepted and encouraged to fully participate in the organization.1
 
This feeling of belonging has to be engrained in an organization’s culture. “It is critical to understand that inclusion is a lifestyle and not an event,” Marsh insisted. “It’s the way that you do things. It’s the way you interact. It’s not one major program … it’s how you communicate with your team and your organization.”

It’s challenging for organizations to create this environment because it’s not a day-to-day priority. However, as Marsh pointed out, there’s a substantial return on investment when organizations embrace an inclusive work environment, and the data back it up. Inclusive workplaces are:

• Six times more likely to be innovative.2
• Two times more likely to meet or surpass financial goals.3
• 42% less likely to have employees leave for a new position.4

To truly become inclusive, organizations need to move beyond the human resources (HR) definition. “Where I think some organizations fail is that they believe this is a checkbox,” Marsh said. “They may say, ‘We’ve hired a diverse workforce, we’re in good shape, our numbers look good’; that’s an HR thing. Inclusion/diversity hiring — this is about being part of the fabric of your organization.”

Rather than simply meeting HR standards, organizations should focus on three key elements to promote an inclusive workplace environment:

Acceptance

Acceptance isn’t about quotas; it’s about having an inclusive culture that’s part of the foundation of the organization. Even when an organization excels at competency-based interviewing, unintentional biases can arise after an employee has been hired, Marsh cautioned. To remedy this, Marsh suggests organizations do the following:

• Continually train employees and emphasize communication
• Make sure inclusion is an integral part of branding
• Consider all groups when organizing team-building and social events
• Address issues as they come up.

“If you educate everybody on the fact that they have unintentional bias and you put together a program that shows your workforce that you care, you’re going to achieve the goal,” Marsh said.

Leadership style

Much like acceptance, inclusive leadership starts with training. Marsh affirms that it’s essential to survey employees to find out if they believe their leaders are collaborative, cooperative, collegial, fair and intentional. “Leadership training on inclusion and the communication you have to have with the people who report to you is key,” Marsh stated.

Role-playing is more hands-on than training and can also have a huge impact on leaders. “You give them a situation,” Marsh said. “You have to make an accommodation for someone with a disability,” for example. “How do you handle that conversation to make sure they feel inclusive?” By talking through a set of circumstances, leaders can become more effective at establishing an inclusive environment.

For inclusive leaders, communication style is also vital. “If you have a lot of different people from different races, genders, countries, it’s important to understand there are cultural differences with how you communicate,” Marsh conveyed.

In addition, inclusive leaders should be open to input regarding meeting format. “As leaders, if you’re running your Monday morning meeting or team huddle and you’re never asking for input … you don’t have an inclusive environment,” Marsh said. Input allows your team members to offer diverse ideas and perspectives.

Meaningful process

The larger the organization, the more important it is to have a meaningful process to address issues. In a large organization, “There are more people with unintentional bias,” Marsh said. “So they are going to do things to other people that they don’t even know they are doing.

“When you are addressing issues that pop up with unintentional bias … that can really impact your culture, those are the things you have to think about, ‘what’s the process for this,’” Marsh said. “What teachable moments can I find; what kind of conversation can I have … to educate on unintentional bias.”

Promoting an inclusive environment in interviews

The first step in mitigating unintentional bias is to recognize we all have it. “We’re not above it, and we can’t control the experiences we’ve had,” Snyder maintained. These biases need to be taken into consideration during the interview process.

Even though every individual brings distinct experiences into every situation, a more inclusive environment can be created by focusing on competency-based evaluation during the interview process. “The one thing you have to do with competency-based interviewing is you have to ask BEI [Behavioral Event Interviewing] questions,” Snyder said.

By asking someone about an experience they’ve had in the past (e.g., “tell me about a time when …”), interviewers can get a sense of how the candidate will perform in the position they’re trying to fill. As Snyder relates, a question could be framed as, “Tell me about a time when you had your ideal clinical practice. Tell me about how many patients you saw a day and what support help you had.” This question can help determine whether the candidate has the competency to succeed in your organization.

When interviewing candidates, organizations should follow a set of competency-based evaluation principles: 

• Keep organizational objectives front and center throughout the provider review and interview process.
• Foster competency-based review and reduce unintended bias.
• Hire providers who are aligned with the organization’s culture.

 
Following these guidelines can lead to a significant decline in employee turnover, because successful candidates will have the appropriate competencies to succeed. Such was the case at Baystate Health. According to Snyder, the health system “created five to six areas that everyone in the organization could agree were base competencies.” 

Baystate’s list included:

1. Safety and quality
2. Patient experience
3. Value
4. Citizenship
5. Academic/education/innovation/research
6. Department-specific competencies to do the job

“It’s important to get buy-in from staffers who are working in those departments to tell you what the competencies should be,” Snyder highlighted, “and ask all the candidates the same questions.”

In the Baystate Health example, Snyder focused on citizenship, which Baystate defines as “demonstrating the ability to work respectfully and collaboratively with fellow providers and staff as partners in patient care.” To help determine whether a candidate meets these criteria, interviewers would ask a series of questions related to this definition, including:

• Describe a time when you were part of a team that worked well together.
• What role did you play?
• How do you show respect for others on your team?

 
These questions help Baystate Health evaluate if a candidate is a team player and if that individual’s ego may prevent him or her from being collaborative.

When focusing on competency-based interviewing, Snyder said it’s important to follow these steps:

1. Obtain leader buy-in.
2. Set up diverse interview panels: Not just with respect to sex, ethnicity, etc., but include individuals from different departments and roles to get varied perspectives.
3. Emphasize competencies when evaluating candidates: After interviews have concluded, organize a quick group phone call to converse about candidates’ competencies.
4. Commit to the interview process: Take the time to train interviewers and test them on implicit association to determine their biases.
5. Structure the interview: Ask the same questions to every candidate and avoid spending too much time discussing commonalties with the candidates.
6. Don’t be hesitant about making changes: Getting input from stakeholders even after you roll out an inclusion program can improve your organization’s competency-based evaluation. 

Interviewing for competency is just one part of promoting an inclusive culture. For leaders, the first step is developing an inclusion program. As Marsh concluded, “You can have all of the good intentions in the world, but if you’re scared to address the issues, it all goes for naught.”

What’s your level on unconscious bias?

• To take an online self-assessment to determine your level of unconscious bias, access Harvard University’s implicit association test.
• In addition, the Association of American Medical Colleges has an unconscious bias resources page for health professionals.

Notes:

1. Washington E, Patrick C. “3 requirements for a diverse and inclusive culture.” Sept. 17, 2018. Available from: bit.ly/2N0gasV.
2. Deloitte. “New Deloitte research identifies keys to creating fair and inclusive organizations.” May 10, 2017. Available from: prn.to/2qg2IIE.
3. Ibid.
4. Sherbin L, Rashid R. “Diversity doesn’t stick without inclusion.” Harvard Business Review. Feb. 1, 2017. Available from: bit.ly/33aGfuY.