A Better
Culture
Org Leadership · Level 1
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1.3 · Outcome
1

ADDRESSING BIAS AND DISCRIMINATION

Organisational Leadership · Level 1 · Domain 1: Practitioner

Learning outcome 1.3

Provide resources for staff and peers to undertake self-assessment of implicit bias. Demonstrate how strengths-based diversity is considered in recruitment and promotion decisions.

Bias does not require conscious intent to cause harm. As an organisational leader, your role is not just to manage your own bias — it is to build systems and habits that make bias visible and correctable for everyone making decisions under your leadership.

Estimated time
45 mins
AMC Domain
Practitioner
Level
1 — Foundation
ⓘ Wellbeing notice: This module explores unconscious bias and structural discrimination in healthcare settings. These themes may be challenging, particularly for people with lived experience of discrimination. Free and confidential support is available 24/7 via Drs4Drs on 1300 374 377.
Key concepts
2

THREE CONCEPTS TO GROUND YOUR PRACTICE

Implicit bias · Self-assessment as leadership · Strengths-based selection

1 2 3
Click the drop-down arrow next to each concept to reveal more detail. All three concepts must be opened to continue.
1
Implicit bias: automatic, subconscious and universal
Implicit biases are automatic mental associations that operate below conscious awareness. They are encoded in subcortical brain structures — particularly the amygdala — that process threat and identity at speeds far faster than deliberate thought. This means a person can hold strong explicit commitments to equality while their automatic responses remain biased. Telling people to "be fair" does not deactivate implicit bias; it requires structured, consistent attention. Crucially, the A Better Culture Curriculum emphasises that recognising and addressing bias is not about blame or guilt — it is about building self-awareness and creating environments where bias can be named and corrected collectively.
2
Self-assessment as a leadership practice
Providing bias self-assessment resources to staff is itself a leadership act. It signals that self-examination is a professional norm — not a remediation activity for those who have "failed". Effective self-assessment tools (such as those drawing on Implicit Association Test methodology) do not produce a final verdict; they surface tendencies and prompt reflection. Their value lies in beginning a conversation, not ending one. As a leader, how you introduce, normalise and follow up on self-assessment resources determines whether staff experience them as punitive or developmental. The A Better Culture Curriculum notes that assessment tools should ideally be co-designed with, and endorsed by, communities most affected by bias — including Aboriginal and Torres Strait Islander people.
3
Strengths-based diversity in recruitment and promotion
A deficit lens asks: "Does this candidate meet the standard?" A strengths-based lens asks: "What does this candidate uniquely contribute that we are missing?" In recruitment and promotion contexts, bias most commonly operates through familiarity heuristics — preferring candidates who resemble current successful incumbents — and through differential interpretation of the same behaviour (for example, labelling assertiveness as "driven" in one candidate and "aggressive" in another). Practical tools recommended by the A Better Culture Curriculum include diversity matrices, equity lenses applied to selection criteria, and structured interview processes. Strengths-based diversity is not about lowering standards — it is about ensuring that all forms of relevant strength are actually visible to decision-makers.
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Activity · Distinction
3

IMPLICIT BIAS VS EXPLICIT PREJUDICE

For each dimension, describe the difference — then reveal the guidance

EX IM

Most bias education collapses implicit bias and explicit prejudice into a single concept — which is why much of it doesn't work. The two are different in how they operate, how they're measured, and how they respond to intervention. Work through each dimension below: describe the difference in your own words, then reveal the guidance to compare.

Describe each dimension, then reveal the guidance. All six dimensions must be revealed to continue.
1
Awareness
How does awareness differ between explicit prejudice and implicit bias?
Write your description to unlock guidance
Guidance — how this dimension differs
Explicit prejudice
Consciously held belief — the person knows they hold this view and can describe it.
Implicit bias
Below conscious awareness — the person is not aware of the association, even when it is shaping their decisions.
2
Controllability
How does controllability differ between explicit prejudice and implicit bias?
Write your description to unlock guidance
Guidance — how this dimension differs
Explicit prejudice
Can be consciously suppressed or expressed by the person who holds it.
Implicit bias
Operates automatically, not easily suppressed; appears most strongly under cognitive load and time pressure.
3
Self-report validity
How does self-report validity differ between explicit prejudice and implicit bias?
Write your description to unlock guidance
Guidance — how this dimension differs
Explicit prejudice
The person can usually describe their belief accurately — direct self-report is a reasonable measure.
Implicit bias
Self-report is often unreliable; measuring implicit bias requires indirect methods (e.g. IAT-style tasks, behavioural audit).
4
Response to good intentions
How does response to good intentions differ between explicit prejudice and implicit bias?
Write your description to unlock guidance
Guidance — how this dimension differs
Explicit prejudice
Conscious good intentions can override the behaviour — "I won't act on this" is broadly effective.
Implicit bias
Conscious good intentions do not reliably override automatic responses; structural and environmental supports are needed.
5
Prevalence
How does prevalence differ between explicit prejudice and implicit bias?
Write your description to unlock guidance
Guidance — how this dimension differs
Explicit prejudice
Varies significantly between individuals — some people hold strong explicit prejudice, others very little.
Implicit bias
Present to some degree in virtually everyone, including those who hold no explicit prejudice.
6
Intervention target
How does intervention target differ between explicit prejudice and implicit bias?
Write your description to unlock guidance
Guidance — how this dimension differs
Explicit prejudice
Direct attitude change through persuasion, exposure or sanction.
Implicit bias
Structural, environmental and habitual correction — change the system, not just the mind.
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Activity · Practical tool
4

THE DIVERSITY MATRIX IN PRACTICE

A panel-side tool — and the debrief patterns it produces

A diversity matrix is a structured tool used before a selection or promotion process begins. Its purpose is to make the full range of relevant strengths visible — so the panel assesses candidates against an explicitly defined capability map, rather than defaulting to an implicit picture of "someone like us." The matrix works in two stages: first, the panel agrees on the dimensions that matter for this specific role and team; second, each candidate is assessed against those dimensions, not against each other.

A note on language: CARM, not CALD

This module uses CARM — Culturally and Racially Marginalised — rather than the older term CALD (Culturally and Linguistically Diverse). CALD has been criticised for focusing on language and culture while obscuring the role of race and racism. CARM makes race visible as a dimension of systemic disadvantage. (See Diversity Council Australia, Words at Work: Should we use CALD or CARM? dca.org.au.)

Important: CARM and Aboriginal and Torres Strait Islander cultural safety are distinct concepts. Cultural safety, as defined by and for Aboriginal and Torres Strait Islander peoples, is not transferable as a term or framework to other racially marginalised groups. In the matrix below, language and CARM community needs are listed separately from First Nations cultural safety.

Example role
Senior Registrar, Emergency Medicine — joining a team of 8 serving a diverse community with a significant CARM patient population and active First Nations outreach program
Capability dimension Current team gap Candidate A Candidate B Candidate C
Clinical procedural skills Low — two recent retirements HIGH MED HIGH
Language skills (other than English) High — 30% CARM patient population NIL HIGH MED
Teaching and supervision experience Moderate — expanding intern intake MED MED HIGH
Rural or remote practice experience High — outreach program gaps HIGH NIL NIL
Research or quality improvement Low — departmental audit backlog NIL MED HIGH
Cultural safety knowledge and practice High — active First Nations outreach program; Aboriginal and Torres Strait Islander staff representation MED HIGH MED
Non-traditional career pathway High — team lacks cognitive diversity HIGH NIL NIL

Note: "Current team gap" is assessed by the panel before reviewing candidate applications. HIGH / MED / NIL ratings are illustrative only; real panels should use behavioural evidence from applications and interviews, not impressions.

Now compare two panel debriefs

Read each debrief, write your analysis, and reveal the guidance. Both panels must be analysed and revealed to continue.
Panel debrief — without the matrix (common pattern)
Chair:Okay, first impressions — I thought Candidate A was the strongest. Very confident in interview, great procedural background.
Member 2:Agreed. Candidate C was technically strong too but I found her harder to follow — not sure how that would land with the team.
Member 3:Candidate B seemed fine but not as sharp as A.
Outcome:Candidate A ranked first, C second, B third.
What's happening in this panel's decision-making? What is being assessed, what is being missed, and how is the conversation flowing?
Write your analysis to unlock guidance
Guidance — what to notice in this debrief

The panel has defaulted to confidence and familiarity. Candidate B's languages and cultural safety strengths — addressing the department's highest-priority gaps — were not named once. Candidate C's communication was evaluated against a cultural norm, not a behavioural criterion. Familiarity has been allowed to stand in for capability, and the decision has been made before the criteria were named.

Panel debrief — with the matrix (strengths-based pattern)
Chair:Let's go through the matrix. We flagged two separate high-priority gaps: language skills to serve our CARM patient community, and First Nations cultural safety practice for our outreach program. These are different dimensions — let's assess them separately. Which candidates address each?
Member 2:On language — Candidate B rated HIGH. She speaks Mandarin and Cantonese, and her referee described how she works effectively with professional interpreters and adjusts her communication style for patients with limited English. On First Nations cultural safety, also Candidate B — her application addressed it specifically, including experience working with community-controlled health services and understanding of cultural determinants of health distinct from general cultural competency.
Member 3:Candidate A covers our procedural and rural gaps well. Candidate C brings strong QI and teaching — those are the next tier of gaps.
Chair:Earlier someone mentioned Candidate C was 'hard to follow'. Let's be specific — was that about the content of her answers or the style? I want to make sure we're assessing communication effectiveness, not accent familiarity.
Outcome:Candidate B ranked first based on highest-priority gap coverage. All three candidates were assessed using the same criteria.
How is this panel's process different? What did the matrix change about how the decision was made, and how did the chair use it in real time?
Write your analysis to unlock guidance
Guidance — what to notice in this debrief

The matrix shifted the conversation from "who felt strongest" to "who addresses what we actually need." The two high-priority gaps were assessed as separate dimensions rather than collapsed into general "cultural fit." The chair also used the matrix as a basis for interrupting bias-coded language in real time — without accusing anyone, just redirecting to the agreed criteria. Note that no one's good intentions were questioned; the structure did the work.

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ⓘ Note on scope. This module focuses on bias in selection and promotion contexts. Outcome 1.1 addresses personal triggers; outcome 1.2 addresses cultural safety specifically for Aboriginal and Torres Strait Islander colleagues. These outcomes are interconnected — bias operates across all three domains simultaneously.
Evidence base · 1 of 5
5

WHAT DOES THE RESEARCH SAY?

Teal et al. (2012) — Medical Education

Why this paper matters for outcome 1.3

This paper provides the foundational educational evidence for what makes bias self-assessment useful in healthcare contexts. It describes specific implicit biases active in clinical settings and tests an intervention designed to help practitioners recognise and manage them — making it directly relevant to your role providing these resources to staff.

Source
Teal CR, Gill AC, Green AR, Crandall S. Helping medical learners recognise and manage unconscious bias toward certain patient groups. Medical Education. 2012;46(1):80–8. doi.org/10.1111/j.1365-2923.2011.04101.x

What they did

Teal and colleagues designed and evaluated a curriculum intervention specifically aimed at helping medical learners become aware of their unconscious biases toward specific patient groups. The intervention combined explicit instruction about what implicit bias is and how it operates, exposure to evidence of bias in clinical outcomes, structured self-reflection activities, and skills training in bias recognition and management strategies.

The paper also draws on the broader literature to map the specific patient groups most commonly affected by implicit bias in medical contexts, and argues for the distinction between implicit and explicit forms of prejudice as a foundational educational concept. The intervention combined awareness with bias-recognition skills and concrete management strategies, in response to evidence that awareness-only training is insufficient.

Heads up. Over the next four pages you'll work through the patient groups the paper identifies, the four kinds of response that show up when bias is named, the patient-safety consequences, and a set of post-reading questions for your own context.
Evidence base · 2 of 5
6

SEVEN AREAS WHERE BIAS MOST OFTEN APPEARS

The patient and workforce groups the paper identifies as most affected

7

Teal et al. identify a set of patient groups where implicit bias has been most consistently documented in clinical settings. The same mechanism appears in workforce decisions — the categories below are where bias is most likely to show up in both the consulting room and the panel room.

Click each trigger to reveal the explanation. All seven must be opened to continue.
1
Race and ethnicity
Among the most extensively documented biases in healthcare. Bias on the basis of race and ethnicity influences pain assessment, treatment recommendations, diagnostic reasoning, and the quality of communication offered to patients. The same mechanism also operates in selection panels — appearing as discomfort with names, accents or unfamiliar training pathways. This is the single most consistent area where good intentions and outcomes diverge.
2
Gender
Differential treatment linked to gendered assumptions about pain tolerance, emotional expression, and patient credibility as historians of their own symptoms. In workforce contexts, the same behaviour described as "decisive" in a man may be coded as "forceful" in a woman, with downstream effects on performance ratings and promotion.
3
Socioeconomic status
Assumptions about treatment adherence, patient engagement and the value of expensive interventions based on perceived social class. These assumptions also surface in selection contexts as judgements about "cultural fit" that map closely to educational background and accent.
4
Body weight
Weight stigma is well-documented in clinical settings and affects both the interactions clinicians have with patients and the quality of investigation and management offered. Weight stigma is one of the few biases where staff are often willing to express it openly, which makes it both visible and uniquely harmful.
5
Sexual orientation and gender identity
LGBTQ+ patients report both explicit and implicit forms of discrimination that affect disclosure, trust and care-seeking behaviour. Inconsistent use of names and pronouns, assumptions of heterosexuality in history-taking, and discomfort with gender-affirming care are common entry points.
6
Age
Older patients are at risk of having symptoms attributed to age rather than investigated; younger patients are at risk of having symptoms attributed to anxiety or non-organic causes. In workforce decisions, age bias is bidirectional — older staff may be assumed less adaptable, younger staff less credible.
7
Disability and mental health diagnoses
Patients with disability or a pre-existing mental health diagnosis experience diagnostic overshadowing: new symptoms are attributed to the existing diagnosis rather than independently assessed. In workforce contexts, disclosed mental health history is one of the most consistent predictors of differential treatment in promotion processes — despite its weak relationship to actual capability.
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Evidence base · 3 of 5
7

FOUR TYPES OF RESPONSE TO BIAS AWARENESS

What happens after a person learns their automatic responses are biased

When bias is named — through self-assessment, peer feedback or audit — four kinds of response are reliably observed. The shape of each matters: an immediate response and a longer-term response can look identical for a moment but diverge sharply in what they produce for patients and staff.

1
Immediate — defensive denial
The sharp, fast reaction: "I'm not biased," "This is offensive," "I treat everyone the same." Felt as protection of identity rather than engagement with evidence. Useful information when it happens — it tells you the message has landed somewhere meaningful — but it tends to shut the conversation down rather than open it.
2
Sustained — guilt and paralysis
A slower, more drawn-out response in people who accept the evidence but cannot find a way to act on it. Shows up as repeated apology, rumination, and reluctance to make any selection or clinical decision for fear of getting it wrong. Sustained guilt rarely produces better decisions; it often produces fewer decisions and quieter ones.
3
Reflective — performative reassurance
Surfaces after time to consider, often once the immediate sting has passed. Sounds like: "I've done the IAT — I'm fine," or "My team is so diverse, this doesn't apply to us." Performative reassurance is a way of discharging the discomfort without changing the practice. Look for action that follows it; without action, the reassurance is the response.
4
Longer-term — integration into practice
The cumulative response of leaders who have done the work over time. Bias awareness becomes a routine feature of decision-making rather than an event: structured panels, debrief language, peer-checking, willingness to be interrupted in real time. This is the response the curriculum is aiming for — quiet, steady, and embedded in systems rather than individual heroics.
Why this matters for you. The four responses look the same in the first conversation; they diverge over weeks and months. As a leader, the response you reinforce in the room — verbally and structurally — shapes which one becomes the team's default.
Evidence base · 4 of 5
8

PATIENT SAFETY IMPACT OF UNCHECKED BIAS

Five areas where the cost shows up clinically

Bias is not a values issue at the edge of clinical care — it is a patient safety issue at the centre of it. The five areas below are the most consistent places where the cost of unchecked bias is paid by patients and by the staff who care for them.

Click each impact area to reveal the detail. All five must be opened to continue.
1
Differential pain assessment and undertreatment
Implicit bias contributes to systematic under-recognition and under-treatment of pain in patients from racially marginalised, lower-socioeconomic and female-identifying groups. The clinical consequence is delayed analgesia and an erosion of trust that the next presentation will be taken seriously.
2
Diagnostic delay and diagnostic overshadowing
Bias narrows the differential. Symptoms in patients with disability, mental health diagnoses or substance use history are attributed to the existing label rather than independently assessed, producing measurable diagnostic delays and avoidable harm.
3
Reduced patient trust and disclosure
Patients who anticipate discrimination disclose less, return less often and disengage from preventive care. The downstream effect is a system that produces a less complete clinical picture for the people who need it most — and then attributes the gap to "poor engagement."
4
Inequitable workforce decisions affecting team capability
Bias in recruitment and promotion shapes who is in the room for the next clinical decision. Teams that systematically under-select for cultural and linguistic capability lose the ability to safely care for the communities they serve — a patient-safety issue, not just an equity issue.
5
Cumulative erosion of cultural safety
Each unaddressed incident — a name mispronounced and not corrected, a pain claim dismissed and not revisited, a candidate rated lower without articulated criteria — adds to a workplace climate in which Aboriginal and Torres Strait Islander staff, CARM staff and patients carry the cost. The harm is rarely traceable to one event; it accumulates.
0 / 5 opened
Leadership implication. Providing a self-assessment resource is not an event — it is part of a system. The resource needs to be introduced deliberately, contextualised within a learning culture (not a compliance culture), and followed up with structured opportunities to act on the findings. Leaders who simply distribute an IAT link without context are likely to produce anxiety and defensiveness rather than reflection and change.
Evidence base · 5 of 5
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POST-READING QUESTIONS CHECK YOUR THINKING

Four questions — respond, then reveal the guidance to continue

Answer all four questions and reveal the guidance to continue. All fields are mandatory.
A
Teal et al. distinguish sharply between implicit bias and explicit prejudice. When a staff member says "I'm not biased — I treat everyone the same," how does this paper help you understand and respond to that statement?
Write your thoughts to unlock guidance
Guidance

This statement reflects a genuine belief — and a genuine misunderstanding of how implicit bias works. The paper explains that implicit biases operate below conscious awareness, meaning a person can sincerely believe they treat everyone equally while their automatic responses systematically differ. The correct response is not to challenge the person's good intentions, but to separate intentions from outcomes. "Treating everyone the same" can itself be a form of inequity when people start from unequal positions. The leadership goal is to shift from "I am not biased" to "I am working to understand where my automatic responses might diverge from my values."

B
The paper identifies that bias activation is strongly influenced by cognitive load and time pressure. Think about your organisation's recruitment or performance review processes. When are participants under the most pressure, and what might that mean for the quality of decisions made at those moments?
Write your thoughts to unlock guidance
Guidance

High-pressure decision moments — last-minute panel member substitutions, long interview days, performance reviews conducted alongside clinical commitments — are precisely the conditions in which Teal et al. document heightened bias activation. Structural solutions are more effective than asking people to "try harder" in these moments. This is an argument for structured interview questions, standardised assessment criteria applied blind to demographic information, mandatory breaks in long selection processes, and explicit rules about how "gut feeling" is and isn't incorporated into deliberations. The question for you as a leader: what specific process changes would reduce cognitive load during your most consequential talent decisions?

C
Teal et al. argue that awareness-only interventions are insufficient and may produce backlash. What does this mean for how you frame and introduce a bias self-assessment resource to your team or direct reports?
Write your thoughts to unlock guidance
Guidance

The framing matters as much as the resource itself. Introduced as a compliance exercise or as evidence of deficit, bias self-assessment can generate defensiveness, tokenism, or the kind of "diversity fatigue" the curriculum identifies as a sustainability barrier. Introduced as a professional development tool within a learning culture, it becomes normalising — a sign that this team takes its obligations seriously. Consider: how would you introduce the Project Implicit IAT to your direct reports in a way that (a) contextualises what the tool does and doesn't measure, (b) makes clear that the results are personal and developmental — not evaluative, and (c) creates a follow-up structure that gives people something to do with what they find?

D
The paper focuses on bias toward patients. The second part of outcome 1.3 asks you to apply a strengths-based diversity lens to recruitment and promotion. What is the connection between these two contexts — clinical bias and selection bias — and why does the curriculum treat them as part of the same outcome?
Write your thoughts to unlock guidance
Guidance

The connection is the same cognitive mechanism operating in different relational contexts. The implicit bias that causes a clinician to underestimate a patient's pain based on race is the same mechanism that causes a panel member to rate a candidate's communication skills differently based on accent. The A Better Culture Curriculum treats these together because the workplace is both a site of patient care and a workplace for staff — and the same people making clinical decisions are making workforce decisions. A leader who takes clinical equity seriously but does not examine recruitment and promotion practices is addressing bias in one part of the system while allowing it to persist in another. Cultural safety for Aboriginal and Torres Strait Islander staff — which the curriculum addresses in outcome 1.2 — is directly undermined by unexamined selection bias.

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Activity
10

MAP YOUR TRIGGERS

Three common bias patterns — map them to your own context

For each of the three common bias patterns below, complete all three cells: the situation in your own context, what you noticed, and one change you would make next time. All nine cells must contain content to continue.

■ Trigger-mapping table
Pattern The situation What you noticed What you would do differently
1. Shortlisting — "culture fit"
A panel member is reviewing two CVs with similar credentials. One feels like a "natural fit" and the other doesn't — they can't articulate why.
Common bias: Familiarity heuristic; in-group preference.
2. Performance review — language
The same behaviour is described with energetic, positive language for one staff member and cautious, qualified language for another. The two people differ on gender or cultural background.
Common bias: Differential interpretation of identical behaviour.
3. Interview debrief — communication
A candidate trained internationally is rated "hard to follow" despite answering the questions accurately. Other panel members nod.
Common bias: Accent and unfamiliarity coded as communication concern.

Your responses are not saved or submitted. This exercise is for your own reflection.

0 / 9 cells complete
Reflection
11

APPLYING THIS TO YOUR PRACTICE

Four questions — expand each and record your thinking

These questions are designed to move from understanding bias in the abstract to acting on it in your specific leadership context. Expand each question and respond before continuing. All fields are mandatory.

1
Think of one bias self-assessment resource available to you right now (for example, Project Implicit IAT). How would you introduce it to your direct reports in a way that is developmental rather than evaluative? What would you say, and what follow-up would you build in?
All fields are mandatory
2
Review the last recruitment or promotion decision process you were involved in. At what points in that process were participants under the greatest cognitive load or time pressure? What structural change could you make to reduce bias risk at those moments?
All fields are mandatory
3
The A Better Culture Curriculum identifies that organisations are not learning if they don't track outcomes. What data does your organisation currently collect that could tell you whether bias is operating in your recruitment and promotion processes — and what data are you missing?
All fields are mandatory
4
Consider a current team member whose strengths you believe are underrecognised by the broader organisation. What specific strengths-based actions could you take as their leader to increase the visibility of those strengths in promotion and development contexts?
All fields are mandatory
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Knowledge check
12

CHECK YOUR UNDERSTANDING

3 questions — no pass or fail, just reflection

Answer all three questions to unlock the next page.
What is the key reason why awareness-only bias training is insufficient, according to Teal et al. and the A Better Culture Curriculum?
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Complete
13

MODULE 1.3 COMPLETE

Addressing Bias and Discrimination — Level 1 Foundation

WELL DONE on completing 1.3

Addressing bias is not a one-time act — it is a leadership practice embedded in the processes, language and systems you build and maintain. This module is the beginning of that practice.

Key concepts
Bias vs prejudice
Diversity matrix
Evidence base
Trigger mapping
Reflection
Knowledge check
Portfolio prompt. Identify one specific recruitment or promotion process you have influence over. Document one structural change you will make before that process next runs, and one bias self-assessment resource you will introduce to participants. Record the outcome after the process has concluded.
Continue Level 1 — next modules
1.4Respectful Workplace Behaviour
1.5Establishing and Sustaining Psychological Safety
1.6Intersectional Approaches to Diversity