Creating an Inclusive Environment: Instituting a Bias Review System in a Children's Hospital

Children's National Hospital established the Bias Incidents Review Committee (BIRC) in July 2020. This multidisciplinary committee reviews and provides recommendations for all bias reports submitted through the online safety event reporting system.

To describe the development and composition of the BIRC, the types of reports submitted to the committee, common reporting themes, and interventions recommended by the committee.

The BIRC is an interdisciplinary committee developed by the Chief Diversity Officer based on recommendations from hospital leadership that met monthly to review bias reports. The committee included physicians, nurses, social work, human resources, and legal representatives. Annually, the data collected from the bias reports were deidentified and presented to the hospital's Diversity, Equity and Inclusion Steering Committee and employees. The data presented included the category of the bias report, any interventions, and common themes.

The number of reports from fiscal years 2021 to 2022 increased by more than 275% and held steady in 2023. Common themes included perception of disparate treatment of patients and families of color, underuse or inappropriate use of interpreter services, insensitive and/or offensive racial comments by staff, and bias in gender-affirming care. Interventions implemented included increased staffing of in-person and video-based interpreters and staff education about appropriate use of interpreter services for patients.

Data from bias reports have informed interventions to make the hospital environment and care more inclusive. Training was also made available to staff to promote an environment of inclusion and belonging.