By Dustyn Addington
Part III Mitigating Implicit Bias in Health Care
What can actually be done about implicit bias in health care? It might seem as easy as individuals being aware of the problem, reminding themselves to not be biased, and generally trying harder. But, unfortunately, this just isn’t enough:
Despite its intuitive appeal, a direct approach of confronting an individual with evidence of bias may actually have little effect on that bias. Although people can be rationally convinced that they ought to feel or think differently and they are motivated to do so, the operation of implicit bias is not open to easy identification and effortful control. Indeed, research shows that intentionally trying to suppress bias may actually make it “rebound” at a later time. Instead, a less direct approach can be more effective.
Indirect approaches have been shown to be successful. Research is still ongoing about how to best combat implicit bias, but there are strategies that work.
“The cognitive component of empathy, perspective-taking can reduce bias and inhibit unconscious stereotypes and prejudices. Physician empathy positively affects patient satisfaction, self-efficacy perceptions of control, emotional distress, adherence, and health outcomes.”
“Clinicians who have good emotional regulation skills and who experience positive emotion during clinical encounters may be less likely to view patients in terms of their individual attributes and to use more inclusive social categories. It’s easier to empathize with others when people view themselves as being part of a larger group.
“Consider ‘gut’ reactions to specific individuals or groups as potential indicators of implicit bias, and consider how these reactions might affect your work.”
“Acknowledge and reappraise rather than suppress uncomfortable feelings and thoughts.”
“Exposing people to counter-stereotypic examples of group members. In one experiment, for example, people showed measurably less implicit bias toward Asian Americans after they watched The Joy Luck Club, a movie about Asian immigrants to the United States.”
“Consciously contrasting negative stereotypes with specific counter-examples. For example, suppose you hear or think of a negative stereotype about African Americans. You can compare that stereotype to what you know about a friend or famous person such as Oprah Winfrey or President Obama.”
In a System
“A commitment from institutional leadership is essential to identifying and mitigating unconscious bias. Leaders can engage students, faculty, and staff at all levels to create a reflective climate that acknowledges bias and the effect it can play in the institutional climate, policies, and decision-making.”
Further, “…this commitment should be integrated holistically into all essential aspects of the institution, much like technology gets integrated into most institutional functions.”
“[Teams] and committees involved in high-stakes decision making, such as admissions and appointment, promotion, and tenure (APT), should be diverse in composition and identify clear requirements and interview questions before beginning the selection process.”
“Whenever possible in admissions and recruitment procedures, nonessential identifying characteristics of applicants should be redacted from applications, Forum attendees said. For example, committees can conceal names (which can signal race and gender) on CVs and MCAT and board scores to avoid unwarranted doubts about candidates already deemed qualified earlier in the admissions process.”
“Consciously affirm egalitarian goals and consider specific ways to implement them.”
“Bias can be mitigated through education and training of individuals and teams. Examining implicit biases through the Implicit Association Test, role-playing, and blinded studies can help individuals recognize their own biases.”
Going back to the light switch analogy, when we flip the light switch when the power is out, there is no substantial consequence, no real harm produced. When an individual receives worse treatment or has an ailment left undiagnosed because of implicit bias, there is real harm. There is an unjust disparity.
Structural injustices are difficult, but necessary, to rectify. To mitigate the effects of implicit bias in health systems, solutions must occur at the both the individual and systems level. Governments, businesses, organizations, and individuals must use the research available to rectify the structural injustices produce by implicit bias.
Since implicit bias is embedded in the everyday decisions we make and practices we adopt, our standard behaviors must also be suffused with strategies to resist implicit bias. Mitigating implicit bias requires norms change—in our work, our personal lives, and our minds. The way we think has a real impact on the world. However, it takes more than good intentions to prevent ourselves from doing harm.
Dustyn Addington is the Assistant Director of Learning and Strategy at the Foundation for Healthy Generations. He is also a graduate student in the Department of Philosophy at the University of Washington, researching bias, knowledge, and judgments.