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The purpose of this paper is to examine whether the impact of persistent racial bias, discrimination and racial violence is facilitated by otherwise well-intentioned individuals who fail to act or intercede. Utilizing the aversive racism framework, the need to move beyond awareness raising to facilitate behavioral changes is discussed. Examining the unique lens provided by the aversive racism framework and existing research, the bystander effect provides important insights on recent acts of racial violence such as the murder of Mr. George Floyd. Some promise is shown by the work on effective bystander behavior training and highlights the need for shared responsibility in preventing the outcomes of racial violence and discrimination to create meaningful and long-lasting social change.

This paper uses literature based on the aversive racism framework together with the literature on the bystander effect to understand the factors, conditions and consequences for lack of intervention when the victim is African American. This paper also provides evidence and theory-based recommendations for strategies to change passive bystanders into active allies.

The use of the aversive racism framework provides a powerful lens to help explain the inconsistencies in the bystander effect based on the race of the victim. The implications for intervention models point to the need for behavioral and competency-based approaches that have been shown to provide meaningful change.

Several different approaches to address incidents of racial aggression and violence have been developed in the past. However, given the principles of aversive racism, a unique approach that considers the inconsistencies between self-perceptions and actions is needed. This sets a new agenda for future research and meaningful behavioral intervention programs that seek to equip bystanders to intercede in the future.

The need to address and provide effective strategies to reduce the incidence of racial aggression and violence have wide-ranging benefits for individuals, communities and society.

By connecting the aversive racism framework to the bystander effect, the need for different models for developing responsive and active bystanders can be more effectively outlined.

Patient length of stay (LOS) is an important indicator of emergency department (ED) performance. Investigating factors that influence LOS could thus improve healthcare delivery and patient safety. Previous studies have focused on patient-level factors to explain LOS variation, with little research into service-related factors. This study examined the association between LOS and multi-level factors including patient-, service- and organization-level factors.

This study uses a retrospective observational design to identify a cohort of patients from arrival to discharge from ED. A year-long data regarding patients flow trhoguh ED were analyzed using analytics techniques and multi-regression models. The response variable was patient LOS, and the independent variables were patient characteristics, service-related factors and organizational variables.

The findings of this study showed that older patients, middle triage and hospitalization were all associated with longer LOS. Service-related factors such as complexity of care provided, initial ward designation and ward transfer had a significant impact as well. Finally, prolonged LOS was associated with a higher ratio of patients per medical doctor and per nurse. In contrast, a higher number of residents in the ED were associated with longer patient LOS.

Previous studies on patient LOS have focused on patient-level factors, with little research on service-related factors. This study has addressed that gap by examining the association between LOS and multi-level factors including patient-, service- and organization-level factors. Patient-level factors included demographics, acuity, arrival shift, arrival mode and discharge type. Service-level factors consisted of first ward, ward transfer and complexity of care provided. Organizational factors consisted of three ratios: patients per MD, patients per nurse and patients per resident. The results add to the current understanding of factors that increase patient LOS in EDs and contribute to the body of knowledge on ED performance, operation management and quality of care. The study also provides practical and managerial insights that could be used to improve patient flow in EDs and reduce LOS.