Table 3.

Examples of Individuals Moving through the Cycle.

Cycle Stage	Physician	Nurse	Black Patient
Waking-Up	A physician does not believe themselves to be personally are racist, but the data from their medical director shows disparities in HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) [24] and C-section rates for Black patients.	A nurse views countless news stories on police brutality and the Black Lives Matter Movement, and thus, she begins to reflect upon her role in contributing to racism.	A patient realizes she gets different types of questions from her doctor than the White mothers in her mom group. Questions such as whether she plans to terminate or continue the pregnancy and questions about her relationship with the baby’s father.
Getting Ready	A physician is required to take implicit bias training but is uncertain on how the training will impact their medical practice.	A certified nurse midwife (CNM), continues to raise her consciousness and educate herself on privilege and the construction of racism in the U.S.	A patient begins to educate herself on her birthing options and the hospital policies.
Reaching Out	A physician recognizes the ways in which their biases influence patient care and seeks to identify ways in which their practice might be more holistic by asking patients about their experiences at home, at work, and with family.	A nurse midwife could start with practicing new approaches with her patient interactions, such as looking patients in the eyes when she’s speaking with them, showing patients they have her full attention with the positioning of her body, and making a conscious effort to listen to patients while checking her own biases.	A patient communicates her birthing needs and priorities with her care team.
Implementing with the Provider Community	A physician is, perhaps, now aware of the patient’s support system and considers the patient’s knowledge of their body in medical decision-making.	A nurse midwife becomes her department’s champion for educating the staff on best practices for accountability and decision-making.	A patient asserts her knowledge of her body and experiences to create a birthing plan where she would feel most safe and supported.
Coalescing with the Local Community	A physician ensures patients are discharged with all that they need to care for themselves and their family by connecting with and leveraging community assets.	A nurse midwife leads a power mapping exercise, starting with her network of local CMNs, to identify structure and processes for health equity.	When a patient shares her birth plan, the nurse provides resources to complement the birth plan and to meet the patient’s biopsychosocial needs.
Creating Change	A physician might suggest at quality improvement meetings with all hospital staff to create a system of accountability and leveled hierarchies among all hospital staff.	A nurse midwife builds relationships with local Women, Infants, and Children (WIC) offices and CBOs and creates a transparent process for patients to report harms, mistreatment or complaints.	A patient is educated on ways to report harms and complaints, and they are invited to participate in a department-wide maternal mortality review committee as a patient liaison.
Maintaining	A physician advocates for institutional policy and on-going workshops/medical education to minimize risk of burnout.	A nurse midwife engages with her statewide professional organization to establish policies for investment and promotion of diverse hiring practices.	A patient is introduced to services at health systems and hospitals that have shown a commitment to racial equity, made possible by the strength of community-hospital partnerships