Table 1.

Interventions intended to reduce social bias at multiple levels within healthcare. Synthesised from reviews by authors Hassen and colleagues,⁴ Zestcott and colleagues,⁵ Byrne and Tanesini⁶ and Marcelin and colleagues.⁷ ∗These examples are not exhaustive.

Level of intervention	Strategy	Examples relevant to anaesthesia and intensive care∗
Individual	Ongoing training on cultural safety, minimisation of stereotyping and implicit bias; critical reflection on knowledge, attitudes, beliefs and practice as it pertains to diverse patient care	Sit down with patients to flatten hierarchies before engaging in respectful communication and practised listening
Interpersonal	Take opportunities during clinical encounters with underprivileged or stereotyped groups to practise egalitarian values such that these values become habitual; intentionally diversify experiences with cultural humility and curiosity; develop and implement guidelines on how to address racist or prejudicial comments; seek mentorship and collaboration with underprivileged or stereotyped groups	Checking whether patients have understood care instructions should go beyond simply asking if they understand; it should also consider whether, in their particular circumstances, the patient is happy and able to follow instructions; if difficulties are discovered, care may need to be negotiated
Community	Develop ongoing, meaningful collaborations with underprivileged or stereotyped groups in the community; strengthen links for such groups to primary and further care facilities	Arrange visits to the hospital for local high school students who may not have considered a career in anaesthesia or healthcare, to introduce them to clinical roles and technology and to provide an opportunity to participate in simulation
Organisational	Leadership commitment to culture change within organisation, including appropriate resources; develop guidelines on how to address racist or prejudicial comments, and implement throughout organisation; ensure core leadership demonstrates and supports diversity; meaningful engagement and training for change; incorporate anti-bias efforts into quality improvement initiatives	Whether the institution is performing adequately in terms of serving the community should be judged by representatives of the community, not by hospital committees or management; consider equity during quality and safety reviews – how can the larger negative effects in minority groups be actively countered?
Policy	Recruit and retain diverse staff; involve diverse staff in policy and decision-making; develop a long-term plan for change	Assure racial and sex (and other) diversity on anaesthesia trainee selection committees; reducing bias, this approach will provide role models for new applicants