In 1966, Dr. Martin Luther King, Jr. shared at the Medical Committee on Human Rights, “Of all forms of inequality, injustice in health care is the most shocking and inhuman.”In the time since then, one would think that every patient who seeks treatment from a healthcare provider receives the same level of care and consideration. Characteristics such as race, gender, sexual orientation, and others, should have no bearing on the quality of patient care. Still, in reality, that is not the case.
Unfortunately, implicit bias affects the healthcare industry as much as it does in other industries and our society in general. So what is implicit bias and how can we prevent it?
Implicit Bias in Healthcare
When it comes to the subject in healthcare, The Joint Commission states: “Implicit (subconscious) bias refers to the attitudes or stereotypes that affect our understanding, actions and decisions in an unconscious manner. These biases, which encompass both favorable and unfavorable assessments, are activated involuntarily and without an individual’s awareness or intentional control.”
The key to understanding this is realizing that most implicit bias is involuntary, and the means to address it requires a conscious effort to recognize that it exists in the first place. Before we jump right into how we can work to remove bias in healthcare, let’s first talk about the ways that it exists.
Areas of Bias in Patient Care
There is an abundance of research that demonstrates the existence of implicit bias in patient care today. Here are a few examples:
- Race: Racial bias in healthcare was outlined in a 2019 Agency for Healthcare Research and Quality Report (AHRQ), which found that white patients were more likely to receive better quality care than those who were Black, Indigenous, and People of Color. This bias leads to those racial groups having more challenges in accessing healthcare and lesser quality outcomes.
- Gender: According to a review from the National Institutes of Health (NIH), some healthcare providers were more likely to have disparate views when chronic pain is reported by women versus men. The NIH review noted that women who reported chronic pain were more likely viewed as emotional or sensitive, while men were considered strong or stoic when dealing with pain.
- Sexual Identity: A Health Services Research (HSR) report highlighted the existence of bias and discrimination against lesbian, gay, bisexual, transgender, and queer (LGBTQ) adults in the United States. The data showed that the bias contributes to poorer health outcomes and contributes to this population’s reluctance to seek care due to concerns about potentially being treated inappropriately.
- Obesity: Wiley Obesity Reviews conducted an extensive study and found significant bias surrounding patients with obesity. The study found that the biases include viewing people with obesity as lazy, weak, unwilling to listen to recommendations, and unlikely to follow treatment plans. The study further suggested that healthcare professionals naturally attributed more of the patient’s symptoms to their obesity rather than considering more alternatives.
Implicit bias is also found to exist in other areas of patient care such as a patient’s age, socioeconomics, religion, level of education, and even insurance status. Geographic location can also be a factor, as both rural and dense urban populations are subject to more bias in general.
Institutional Bias in the Healthcare Industry
Patient care is clearly not the only place where implicit bias exists in the healthcare industry. If healthcare administrators are not aware of implicit bias, it will permeate throughout the organization. Bias can exist in hiring policies and organizational procedures leading to a lack of diversity. Lack of education and training programs that raise awareness and promote diversity can also lead to unconscious bias in the workplace.
Bias can even be found in medical academia, where 95% of the illustrations found in medical textbooks depict white patients. You can observe this for yourself by looking at the medical illustrations that adorn the walls throughout your facility.
How to Address Bias in Healthcare
It goes without saying that everyone deserves to have access to the same levels of care. It is necessary for both healthcare providers and organizations to recognize the existence of implicit bias and enact strategies to remove them.
- Awareness and Education: Recognizing that biases exist is a solid first step. Understanding where and why bias exists is an essential component of taking the next step toward addressing it. Harvard University developed an Implicit Association Test (IAT) to measure individual attitudes and beliefs, which can help you understand if you have an implicit bias. Frequent training that addresses health equity should be the standard for healthcare organizations of all sizes.
- Promote Diversity: As demonstrated, disparity exists across various patient populations. Actively pursuing diversity throughout healthcare organizations will lead to better representation and inclusion that reflects everyone. This can be accomplished through more inclusive hiring practices, promoting more cultural awareness, and actively removing barriers to care.
- Dialog: Having mechanisms that allow employees to share their perceptions about the policies and practices related to diversity and inclusion. Communication is a powerful tool in fostering diversity and eliminating real and perceived discrimination in the organization.
- Establish Systems: Ensure that there are systems in place to monitor and report on processes and outcomes of patient care by race, gender, and areas where bias can exist. Data is a vital tool for self-assessment and to help you evaluate organizational effectiveness in combatting inequities in care. Set goals for improvement and share the results at all levels of the organization.
- Take Action: Thoroughly investigate reports of discrimination, no matter how subtle they may appear on the surface. Taking actions that identify and then help transform unfair treatment demonstrates a commitment to eliminate bias throughout the organization.
Within this industry, each of us has a role to play in addressing and combating bias in healthcare. Learning more about the reality of the problem is vital to the effort. There are many actions you can take to fight bias as a healthcare professional.
- Understand that unconscious bias exists and recognize situations where stereotyping and other biases impact patient care.
- Strive to understand the various cultures that make up your patient population.
- Make a conscious effort to see your patient as an individual, not as a stereotype.
- When offered, commit to making the most of diversity, cultural, and equity training. Suggest other training, if those provided are currently inadequate.
- Form or participate in a diversity and inclusion committee to raise awareness and acceptance of these practices throughout the workplace.
Culture of Caring
The only way we can combat the negative impact that implicit, or overt, bias has in healthcare is by committing to creating the change necessary. At Supplemental Health Care, caring is at our core and our diversity and inclusion committee is working hard to identify and address issues that affect our organization, communities, and industry.
It starts at an individual level in all of us, but to last, it needs to be a healthcare industry-wide effort. Those we serve and care for deserve an equitable healthcare system for all, not just some. By joining together, we can make it happen.
the shc blog