by Nathan Painter, PharmD, CDCES, FADCES
In the U.S., many people (including Black, Indigenous, people of color and many others) face disparities in access to health care, the quality of care received and health outcomes. The attitudes and behaviors of healthcare providers have been identified as one of many factors that contribute to health disparities. Implicit or unconscious bias are thoughts and feelings that often exist outside of conscious awareness, and thus can be difficult to acknowledge and control. These attitudes are often automatically activated and can influence human behavior without conscious volition.
The increasing diversity in the U.S. population is reflected in the individuals who healthcare professionals treat. Unfortunately, this diversity is not always represented by the demographic characteristics of healthcare professionals themselves. Those from underrepresented groups in the U.S. can experience the effects of unconscious biases that derive from cultural stereotypes in ways that perpetuate health inequities. Unconscious bias can also affect healthcare professionals in many ways, including patient-clinician interactions, hiring and promotion, and their own interprofessional interactions.
To improve care in your practice, here are 3 actions you can take to address bias.
- Incorporate bias training. Academic institutions and healthcare organizations must strive to be better to promote diversity in training. Bias training should be included in health professional schools and places healthcare is delivered. All clinicians and staff interacting with patients should receive this training, so they are better attuned to their biases and equipped with skills and tactics to address them.
- Promote diversity in the profession from the beginning. Our approach to diversifying the pipeline of healthcare professionals needs to be dramatically changed. Entrance to professional schools by underrepresented minorities has stagnated or in some cases dropped at a time when more diversity is needed. If programs are interested in increasing the numbers of underrepresented minorities in schools, they need to create relationships with community colleges and high schools to identify students who may benefit from mentorship to pursue healthcare careers.
- Encourage hiring that matches your client diversity. The cost of healthcare education is prohibitive for many students, but it is especially daunting for many students who have no family or community history on which to base an assumption that they will earn enough to meet the responsibilities of repaying such significant loans after school completion. Diversifying the talent pool will require additional financial investments to defray costs and time investments in mentorship and volunteer programs to create opportunities for prospective students. Racial concordance between patients and healthcare professionals is not a panacea, but those who share similar experiences with those they serve can improve the individual’s overall access and experience with care, feelings of being understood, and consequently, optimized management to improve health outcomes.
Healthcare professionals need to address their role in implicit biases in healthcare disparities and overcoming bias isn’t easy. It’s a lifelong process that requires time and attention.
Healthcare professionals need to address their role in implicit biases in healthcare disparities and overcoming bias isn’t easy. It’s a lifelong process that requires time and attention. The best way to start, as an individual or organization, is with a proven framework—such as a cultural competency training and education program. We didn’t develop our unconscious bias alone, and we can’t vanquish it alone. Rather, our ideals must be reflected in our broader culture, until the person-centered approach to communication is the new normal. Nowhere is this effort more important than in healthcare, where inequality and discrimination are a matter of life and death.
For further reading:
FitzGerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics. 2017;18(1):19. Published 2017 Mar 1. doi:10.1186/s12910-017-0179-8
Dovidio, J., et al. Racial Biases in Medicine and Healthcare Disparities. TPM, 2016, Vol. 23, No. 4, pp. 489-510.
Zestcott CA, Blair IV, Stone J. Examining the Presence, Consequences, and Reduction of Implicit Bias in Health Care: A Narrative Review. Group Process Intergroup Relat. 2016;19(4):528-542.
Chisholm-Straker, M., & Straker, H. O. (2017). Implicit bias in US medicine: complex findings and incomplete conclusions. International Journal of Human Rights in Healthcare, 10 (1).
Sunderrajan, Aashna & Lohmann, Sophie & Chan, Man-Pui Sally & Jiang, Duo. (2018). The Psychology of Attitudes, Motivation, and Persuasion. In Albarracin & Johnson (Eds.), Handbook of Attitudes.