Recent events and mounting industry data illuminate an uncomfortable truth: Implicit bias is prevalent in healthcare, and many are unaware. More importantly, it’s hurting patients.
In this post, we’ll touch on ramifications and recommendations for tackling implicit bias as healthcare leaders so that every patient — regardless of background, ethnicity, race, education, sexual orientation, or other factors — gets the absolute best care from you, your team, your organization.
First, it’s helpful to clarify what we mean by implicit bias. The Ohio State University defines it as “attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner.” OSU researchers also list the following characteristics of implicit bias:
There’s no shortage of data pointing to implicit racial and ethnic bias among medical professionals. Leaders hold these biases as well. In one 2015 study, results showed implicit racial bias scores among healthcare workers are like those in the general population, summed up as “positive attitudes toward whites and negative attitudes toward people of color.”
Though unintentional, unconscious bias affects patient-provider interactions, treatment decisions, treatment adherence, and patient health outcomes. Put another way, “racial and ethnic minorities and women are subject to less accurate diagnoses, curtailed treatment options, less pain management, and worse clinical outcomes,” reports Project Hope, a global health and humanitarian relief organization.
The authors, both people of color, describe what that looks like up close and personal:
“We have witnessed black children not being treated as children at all, or not being given the same compassion or level of care — even the use of topical anesthetics — provided for white children. We have witnessed care teams express frustration with the patient’s cultural views, such as forgoing blood transfusions or other clinical interventions, that did not align with ‘common’ or ‘traditional’ views. One of us was reflectively smacked by a frustrated anesthesiologist while she was in active labor for not bending down far enough for an epidural.
For many white patients, these kinds of experiences would be inconceivable. But for black or Hispanic patients, maltreatment can be routine, almost ubiquitous, and those patients are often unable in the moment to seek redress.”
We have much work to do to ensure every patient who comes our way receives the care we’d wish on our loved ones. Healthcare leaders play an essential role in expanding awareness of implicit bias and addressing it.
“Me, biased? I don’t discriminate,” you might think. It’s a common reaction. It’s tough to contemplate the possibility that we harbor implicit (unconscious) bias.
The reality is that our brains function on certain “algorithms” or shortcuts that manifest automatically, “at a level below conscious awareness and without intentional control,” explains the Institute for Healthcare Improvement. Your job as a caring leader is to acknowledge, explore and address this reality.
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One physician uncovers his unconscious bias
Earlier this year, The Philadelphia Inquirer reported the disadvantages that children of color have experienced in dealing with white medical teams. Dan Taylor, a physician who shared his perspective with the Inquirer, recounted his own shock at learning his unconscious bias.
Taylor, who leads the pediatrics clinic at St. Christopher’s Hospital for Children, is widely published and respected in his profession. “Yet when he took an online bias test offered by Harvard, he was stunned to discover that he viewed white and black patients differently,” the article reads. The test measured how test-takers associate groups of people with various traits such as intelligence, athleticism, and goodness.
The realization changed how Taylor approaches his patients and the medical students he supervises, though he acknowledges it’s not a simple switch. “It’s a different way of retraining your brain to listen a different way, to pay attention to very subtle expressions or words or emotions that families express,” he told the newspaper.
We’re not where we need to be and have much to learn about addressing bias in ourselves and our teams. It’s a difficult but urgent charge in our calling as healthcare leaders.
Below we’ve compiled potential next steps, based on recommendations from three sources: Project Hope, Institute for Healthcare Improvement, and “Seeing Patients: Unconscious Bias in Healthcare” by Dr. Augustus White. Healthcare leaders can take these next steps and advocate for them among their followers. Some are amenable to organizational policy reforms, others to innovative programs, and still others to personal advocacy.
Lastly, we’ll leave you with a short video by the Institute for Healthcare Improvement. We hope it will bolster your understanding of implicit bias and help you address it in your life and work.
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