"Shifting the Culture and the Way That We Practice": Perinatal Clinicians' Cognitive, Behavioral, and Team-Level...

In recent years, US hospitals have implemented novel interventions to reduce racism, bias, and their effects in perinatal healthcare (e.g., implicit bias training, anti-racism seminars). Healthcare workers may also encounter informal interventions in support of these goals (e.g., peer feedback on microaggressions). There is little scholarship on how equity-focused interventions affect clinicians and clinical teams.

Using qualitative in-depth interview data from 20 California hospital-based perinatal clinicians, we investigated changes in how perinatal clinicians approached their work following equity-focused interventions.

Sixteen respondents discussed changes they observed in themselves or their colleagues. We categorized these as: (1) cognitive changes (e.g., recognizing one's own biased thinking and behavior; better understanding the role of racism in disparities); (2) individual behavior changes (e.g., speaking up about inequities; assessing and mitigating bias in one's own behavior; acting more intentionally when caring for patients at risk for worse outcomes); and (3) team behavior changes (e.g., greater intra-colleague discussion of equity topics; collective accountability; efforts to reduce the harms of bias in clinical care). Many described interventions that overlapped or even synergized with one another, including combinations of formal and informal efforts.

Our findings suggest that equity-focused interventions can produce observable changes in perinatal patient-care processes. However, it may be challenging for evaluators and healthcare leaders alike to understand what interventions, in what combinations and perinatal settings, produce desired results. Researchers will need innovative methods and a deep understanding of the intervention context to rigorously study these novel interventions-overlapping, multi-level, synergistic-and their effects.