How to Overcome Unconscious Bias in Healthcare
Health disparities in the United States have contributed to increased death rates from COVID-19 among minority populations. Black Americans with the disease died at a rate 3.6 times higher than white Americans. The new administration, recognizing the severity of the issue, has appointed a task force to address and combat pandemic-related health disparities.
A recent study found several external factors that contribute to the vastly different health outcomes between minority and majority populations. But internal factors within the healthcare system contribute to disparities, too, namely unconscious bias. Several studies have shown that healthcare providers are less likely to recommend Black and Latinx patients for aggressive treatments than white patients presenting the same symptoms and conditions.
Unconscious bias has a measurable effect on patient outcomes. Here’s how to combat its effects at your healthcare organization.
Unconscious bias permeates every aspect of the business, so a commitment to combating its effects requires a systemic redesign, says Dr. Ronald Wyatt, healthcare equity expert and Vice President and Patient Safety Officer at MCIC Vermont LLC. Leadership buy-in is essential for proactive change, including reallocating resources to ongoing training and better care.
Evaluate the communities you serve, and investigate your organization’s history of interactions with those communities. “What has been your engagement in that community?” Wyatt asks. “How have the communities’ voices been brought into the system?” Identify the communities that, historically, have been most impacted by gaps in care. Are the locations in your system serving those communities staffed and funded appropriately to create a better impact?
Wyatt points to the eight ZIP codes bearing the brunt of the COVID-19 pandemic in New York City. Many, he says, were underresourced and therefore unable to respond effectively to patient needs. Prioritize staffing models, supply chains, opportunities for professional development and facility maintenance at locations where resources are needed, Wyatt says, not just where they’re wanted. Although we all have biases, at the highest levels we must be intentional about providing equitable resources.
We replicate biases when we recruit candidates with the same backgrounds and experiences as ourselves. Cast a diverse net when recruiting, especially from the communities you serve. “Try to recruit within the communities that actually have a stake in that organization,” says Dr. Byron Jasper, Founder, National President and Executive Director at Comprehensive Medical Mentoring Program. Employees from those communities are better equipped to offer insights into and counter stereotypes of the groups you’re serving.
Promote leaders with diverse educational backgrounds and leadership philosophies. Homogeneous viewpoints from the top create a “business as usual” mentality, Jasper says, and can prevent leadership from seeing the bigger problem.
For example, Jasper completed his first residency in Louisiana, where his preceptors taught him everything they knew, but their perspectives were limited. “They couldn’t teach me what they didn’t know,” he says. A fellowship in Washington, D.C., offered a more multicultural perspective, leading to better patient outcomes. “When I moved back to Baton Rouge and started teaching people what I learned,” Jasper says, “you could see the stark difference between my training in the residency program compared to my training in the fellowship.” Find these diverse viewpoints within your organization, and empower those people to share what they know.
Health systems that are genuinely committed to overcoming unconscious bias must set a baseline to measure growth from. The implicit associations test offers some insights, as does patient demographic data and history of complaints, Wyatt says. Develop training to meet your organization’s specific needs.
Unconscious bias education won’t be effective if it’s limited to a one-off day of training. Creating a real impact requires an ongoing conversation and a shift in attitudes. Instead of approaching patients as if you’re the expert or authority, cultivate an attitude of structural humility and willingness to learn from the community, Wyatt says, by treating patients and community members as experts.
Establish routine interactions with your outgroups. If most of your healthcare providers are white but serve a community of color, set up opportunities for those providers to go into the community to better understand them as people and their unique challenges.
Health disparities will only grow if we don’t commit to intentionally overcoming the effects of unconscious bias. From the highest levels of leadership to day-to-day interactions with community members, combating the effects of bias requires intentional decision-making, a willingness to learn and a commitment to changing our behaviors.