ABSTRACTStandardized protocols can reduce the impact of implicit bias but are underused. Since the Institute ofMedicines report Unequal Treatment multiple studies have confirmed that standardization of decision-making processes reduces bias but bias in the allocation of advanced therapies has not been addressed.Using an evidence-based framework for behavior change [Capability Opportunity and Motivation for BehaviorChange/Behavior Change Wheel (COM-B/BCW)] we developed a standardized protocol strategy SeekingObjectivity in Allocation of Advanced Heart Failure (SOCIAL HF) that addresses significant barriers to equity inadvanced therapies: 1) bias 2) subjectivity in evaluation of social support and adherence and 3) poor groupdynamics. Thus SOCIAL HF includes: 1) evidence-based bias training tailored for HF 2) restriction toobjective evaluations of social support and adherence and 3) environmental restructuring and modeling ofmeeting settings to include anonymous electronic voting and equitable seating arrangement. In complexdecision-making that includes individuals and groups our standardized protocol strategy SOCIAL HF has thegreatest likelihood of achieving health equity in advanced HF. Our goal is to assess real-world effectiveness(Aim 1) and implementation (Aim 2) of SOCIAL HF for allocation of advanced HF therapies heart transplantand ventricular assist device implantation. We will use a cluster randomized design to test the effectiveness ofSOCIAL HF strategy. We will evaluate implementation of SOCIAL HF across study sites using mixed-methodsin order to learn optimal implementation strategies to achieve equity. We will use normalization process theoryto evaluate how SOCIAL HF affects processes and outcomes important to advanced HF centers (e.g.fidelity/variation). We will use RE-AIM framework (reach effectiveness adoption implementation andmaintenance) to evaluate factors that promote reach and adoption and resources needed for implementation.We have the relationships infrastructure and expertise to execute this project; our multidisciplinary teamincludes experts in HF evidence-based bias reduction training clinical trials mixed-methods andimplementation science.