CHRISTUS trains managers to see, counter unconscious biases

September 1, 2019


Whether it's in management decisions, workplace dynamics or patient care, officials with CHRISTUS Health are aware that underlying biases can be at play.


Such biases, often referred to as implicit or unconscious biases, are part of the innate and experience-based instincts that tell people's brains how to react in given situations. "If we're humans, we have them," said Marcos Pesquera, CHRISTUS' vice president for health equity, diversity and inclusion and community benefit. "It's not good, it's not bad, it just is."

Dr. Sam Bagchi, center, CHRISTUS Health senior vice president and chief medical officer, leads members of the CHRISTUS Health Equity, Diversity & Inclusion Council during a training session as they discuss the impact of bias on decision making and tools to re-direct the human brain toward more inclusive behaviors.
Photo courtesy of CHRISTUS Health

Pesquera doesn't even use the word biases, he refers to these unconscious assumptions as preferences.

As part of CHRISTUS' broader commitment to embracing cultural diversity, creating a welcoming workplace and providing quality care for people without regard to ethnicity or gender, the health system's equity and diversity leaders decided to drill down deeper and help managers explore the roots of any biases they might unconsciously harbor.

Tiffany Capeles, director of health equity for CHRISTUS, says research shows "people like to associate themselves with people who are like them, and that's not wrong, but in the business context when thinking about teams, there's a lot of research that shows that having diverse teams actually benefits (organizations)." Capeles was in CHA's 2019 class of Tomorrow's Leaders.

CHRISTUS, based in Irving, Texas, has facilities in Texas, New Mexico, Arkansas, Louisiana, Mexico, Colombia and Chile.

Cultural agility
The health system turned to Shannon Murphy Robinson, chief executive and co-founder of the leadership training and consulting firm BrainSkills@Work, for training. Murphy Robinson said her firm relies on the latest findings in neuroscience "to help people in organizations be more effective leaders, more inclusive and more culturally agile.

"A lot of our work focuses on helping people understand how good intentions to be inclusive aren't enough and that the brain can trip us up despite those good intentions," she said.

Murphy Robinson

Working with some of the health system's leaders, she crafted a training program for CHRISTUS that focused on its healing ministry. The training started with the system's health, equity and inclusion council, which is headed by CHRISTUS President and Chief Executive Ernie Sadau, and then was provided to its executive council, which is comprised of the system's executive vice presidents and senior vice presidents.

Capeles said the training was an instant hit with this group. "They said this is so amazing and we shouldn't be the only ones to receive it; instead every single leader in the organization who has a direct report should go through this training," she said.


Murphy Robinson conducted training seminars for more than 2,000 managers in group sessions at CHRISTUS ministries in the United States over the course of a year ending this July. The sessions lasted about two hours and attendance was required.

Common ground
Murphy Robinson and the diversity leaders who helped craft the training for CHRISTUS focused it on specific goals including:

  • Creating a common language and shared understanding of unconscious bias and the mechanisms of bias that are inherent in the way the brain is wired.
  • Improving understanding of the impact of bias on decisions and actions, such as hiring, promotion, development opportunities and mentoring.
  • Increasing staff's ability to recognize biases when encountering differences and to mitigate their impact.
  • Providing staff with tools to manage biases more effectively and to continue to cultivate a culture of diversity and inclusion.

The examples used in the training mirrored situations that could come up in CHRISTUS facilities, such as a manager who picks teams for special hospital-related projects but consistently selects the same individuals, denying opportunities to other qualified workers.

Murphy Robinson said CHRISTUS saw the need to move beyond "blaming, shaming and pointing fingers" to helping staff understand that "essentially the brain is a bias-making machine."

Among the tools she shared in her sessions were how to recognize triggers for biases and how to train the brain not to act on those triggers.

"People in health care want to make a positive difference and that's where I found that folks can come into a training like this with some resistance, because no one likes to be told, 'You're biased' — that's not helpful," Murphy Robinson said. "But when you can look at it instead from a neuroscience perspective, you can say, 'Oh, my gosh, there's these dynamics of the brain that I wasn't even aware of. I now understand, and I can do something about it.'"

Increasing awareness
Pesquera was among the early trainees. He said the experience brought to the fore some of his own preferences, such as a special affinity for people who are, like himself, from Puerto Rico.

He said the training helped him appreciate that people have preferences that are subconscious, but nevertheless influence decision-making, particularly in stressful situations and where a quick response is required.

Capeles said that based on feedback she has received, the benefits of the training are being recognized. One worker told Capeles that after the training her manager was clearly more thoughtful during their interactions.

"Our goal and our intention by doing the training was to start the conversation, and we are already seeing that it is raising awareness and that is a win; it is a success for all," she said.

"We started with management and our associates before jumping into the clinical piece of this because if, on our own teams, we're not exploring our own biases, our own reservations, if we're not in touch with who we are, and how others perceive us, or what we say or what we do, then trying to impact patient care is going to be very difficult," Capeles said.


CHRISTUS is working to ensure that the concepts and tools Murphy Robinson shared reverberate across the health system.

Once the training began, Capeles said CHRISTUS leaders realized that the health system's push to identify and counteract implicit biases should be an ongoing project. To that end, the system has hired Warren Chalklen to the new position of manager of cultural competence, diversity and inclusion programs to continue that push across its ministries. As part of his work, he is leading dialogue sessions on diversity issues for employees.

Cultural adaptations
At the same time, Pesquera said CHRISTUS is in the process of taking the training to its ministries in Latin America.

Whereas in its domestic ministries the focus was on biases that can be implicit for workers dealing with patients and colleagues whose cultural differences can be vast, Pesquera said that in Latin America the focus is more on gender diversity.

He is hopeful that the training that has served CHRISTUS well domestically, will translate equally well south of the border.

"We are creating a movement here," Pesquera said.



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