Unconscious Bias in Leadership

By: Suzie Pierce, RN BSN


“Bias is a disproportionate weight in favor of or against an idea or thing, usually in a way that is closed-minded, prejudicial, or unfair.  Biases can be innate or learned.  People may develop biases for or against an individual, a group, or a belief.”

(Source: Wikipedia)


Today I had plans to write a blog on a recent process improvement project but I could not let go of the devastation gripping our country that is rooted in human bias. As such I wanted to address how bias contributes to gaps in excellence in medical centers.  The bias I will address is observing medical facilities that allow leaders to lead with unconscious bias.

As interim leaders, we sign onto interim engagements to fill in during a leadership vacancy, but our main contribution is assessing the entire operation, presenting our findings with an action plan to create change and help teams through difficult transition periods, resulting in improvements in areas of risk that were identified.  I have found through working as an experienced interim leader, bias is one of the most consistent elements and risk factors in areas of identified risk or weakness that I assess. 

As interim leaders, we have a responsibility to our customer, the health care organization: to lead improvements that will sustain.  Initial assessments should be completed in the first two weeks on assignment.  Keys items of importance are: 

  • What is the mission, vision, and values?  Do you see this in the daily operations and with individuals? As interim leaders we must lead consciously with the mission, vision, and values. We must be adaptable as we enter each new assignment, engaging the team.
  • What has made an organization strong and weak in certain areas?  You must find the past and influences that created the gaps.  Reference this as needed, but do not dwell on it.  You are there to lead forward motion. 
  • Read the organization’s policies and procedures relevant to the topic.  Use the policies and evidenced based research to speak to the need for change and remove any risk of bias. 
  • You will naturally receive unsolicited feedback regarding high performers on your new team and low performers.  Ask how the organization, with its prior and current leaders have addressed performance (not just annually but day to day).  Are some people allowed to get by with lower performance and others held at higher standards? 
  • Do not seek feedback on staff, but do your own assessment.  You will be amazed that your findings fit to the exact problem areas that leadership is having with certain employees. This leads to a much better objective assessment without influence from leadership on insight into employee behavior and performance.


Examples of Unconscious and Unrecognized Bias:


  • Keep your eyes and ears open to watch for any deviations with staff in performance and workflow.  Are staff all treated the same or is there bias? Often the bias I hear, that most would not consider a category of bias:  “she has worked here a long time and yes she makes more errors in patient care then others, but she is dependable and is retiring in a couple years.”  Isn’t this a level of bias?
  • Perform consistent leader rounding (a Studer Company Principle). Which employees stand out with exceptional care, and which receive negative feedback?  Is there follow up with the employees for both praise and the ones that need to improve their patient encounter experiences?  If leaders are uncomfortable addressing concerns with staff underperforming, Isn’t this a level of bias?
  • Nursing is usually the responsible party for the measurable and reportable quality outcomes. Here is an example. A patient has a fall and the bed alarm was not on to warn staff that a patient is unsafely exiting a bed vs. calling for assistance. Perhaps a therapist or transporter was the last person to transfer the patient into their bed and left the bed alarm off.  If a fall then occurs however it is nursing that is responsible.  Most healthcare facilities operate with this same concept.  Leaders need to invest the time with any potential or actual patient safety issue to find out the root cause of the event.   If a situation like this always falls on the nurse on duty, isn’t this bias?  All involved in the patient care and those that contributed to the risk are not accountable.  


Bias whether innate or learned is a key element in leadership.  Leaders must practice with self-awareness. They must look at bias as more than race, religion and other social factors consistently referenced in our society.  Organizations often have gaps in performance because leaders are uncomfortable with confrontation with employees and coaching for excellence.  It is never fun to sit with an employee and progress with corrective action steps.

However, as interim leaders, we must take the steps to address variances to policy with employees and hold all employees to the same performance standards.  That will eventually remove bias. Employees often share with me that no one told them they were underperforming, and yet they excel moving forward.  They become part of the solution to improvements.   They want to do well and be held accountable and see that all staff have the same accountability.  This goes for the top level of leadership: the need to hold middle management accountable and not allow subjective feelings into performance and accountability.  Of course, we must always be compassionate and express and live with compassion, but we cannot vacillate on accountability.   

About the author:


Suzie Pierce, RN BSN

Suzie Pierce, RN BSN is an experienced Administrative Program Director and a well-respected Interim Healthcare Leader focused on Acute Inpatient Rehabilitation, Acute Care Neuro and Trauma.  Suzie is currently working on obtaining her MBA and is a member of the Case Manager Society of America, American Nurses Association and Michigan Nurses Association.  She is recognized by the physicians, executive teams, and staff members she has worked with as a passionate leader who cultivates and builds authentic relationships.

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