Related Experiment Video
Updated: Aug 5, 2026
Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
Published on: February 16, 2011
Advancing Birth Equity Through Quality Improvement Education: The SPEAK UP Champion Course
Renée Byfield1,2, Debra Bingham1,3
1Institute for Perinatal Quality Improvement, Milton, Maryland, USA.
Background:
Black, non-Hispanic, and Indigenous perinatal patients in the United States experience disproportionately high rates of maternal mortality and morbidity compared with other racial and ethnic groups. While multiple social and institutional factors contribute to these inequities, structural racism, including implicit bias, remains key drivers shaping patient-health care professional interactions and the quality and equity of care.
Objective:
To evaluate, using a health equity lens, changes in perinatal health professionals' knowledge, attitudes, awareness, and self-reported preparedness and actions to mitigate racism before and after participation in the Institute for Perinatal Quality Improvement's SPEAK UP Champion course on implicit and explicit racial bias.
Methods:
We analyzed 1,303 pre-course surveys, 772 post-course surveys, and 48 follow-up implementation surveys collected from 28 SPEAK UP Champion courses delivered between 2021 and 2023. Surveys assessed knowledge, attitudes, awareness, and self-reported planned or implemented bias-mitigation strategies. Univariate analyses summarized outcomes, and chi-square tests examined racial differences in self-reported implicit bias.
Results:
Post-course surveys showed improvements in understanding race as a social construct, increased recognition of racism as a driver of perinatal disparities, and heightened awareness of disrespect toward Black and Indigenous patients. Participants reported greater preparedness to identify biased behaviors and develop equity-focused quality improvement (QI) goals, including self-reported planned or early implementation of bias-mitigation strategies. Implementation survey findings reflected respondent-reported practice changes among a small, self-selected subset of participants.
Conclusion:
These findings suggest that (1) the SPEAK UP Champion course was associated with increased racial bias awareness and enhanced participants' reported capacity to develop bias-mitigation QI action plans; and (2) integrating equity-focused education on implicit and explicit racial bias with QI methods may represent a promising, systems-level approach to advancing equity across the perinatal continuum that warrants broader implementation and further evaluation using rigorous outcome measures.
Related Concept Videos
01:26Levels of Health Promotion and Illness Prevention
In primary prevention, actions taken before disease onset prevent the disease from...
01:13Patient-centered Care
01:26Methods Of Healthcare Delivery System
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
01:30Health Information Technology and Healthcare Information System
Health Information Technology, commonly called HIT, integrates advanced information systems and technology in healthcare settings. Its primary functions include:
01:15Nursing Implementation
The five steps to implementing effective nursing care include reassessing the patient, reviewing and revising the existing nursing care plan, organizing the resources and care delivery, anticipating and preventing complications, and implementing nursing interventions.
01:19Quality Assurance