The world has made great strides socially, economically, technologically and in many other fields during the last century. One of those fields that has seen astounding growth through ingenuity, creativity, and in effectiveness is the modern healthcare system.
Heart transplants are now a household idea; cancer survival rates are much higher. These many advances contribute to an increase in average lifespans in the U.S. which, in 1900 was only 47 years old, and in 2019 was 79 years of age. Clearly the healthcare systems and technologies available today are tending to a variety of procedures and techniques that help to make the lives of millions of people per year much better.
Sadly, despite those advances, there are still challenges to healthcare. One problem is a rising awareness in scholarly research that has uncovered an uncomfortable fact: implicit bias.
What is Implicit Bias
Implicit bias refers to an attitude and personality expression of stereotypes that affect one’s understanding, decision, and actions in an unconscious manner. Such biases, whether favorable or unfavorable, are present and active often without voluntary awareness or control. These unconscious biases (also known as hidden biases or implicit biases), demonstrate that a lot of social behavior is controlled by the conditioned stereotypes that people operate out of automatically.
While the root of this unconscious bias is proposed to have been a product of evolutionary biology— as a means of promoting survival by quickly determining and sorting persons into various categories based on social and other characteristics— humankind has not lost these traits. The ability of human beings to do this is helpful in many instances, but as is being uncovered through such studies, can have an ugly side. These implicit biases, which give order to our lives by enabling us to put people into categories for cooperation or protection, are also the foundations of stereotypes, prejudice, and discrimination.
Once learned, such prejudices and stereotypes are strong and very often resistant to change even in the face of evidence that exposes its reality. A collective study done by researchers at Harvard University, University of Virginia, and the University of Washington called the Implicit Association Test (IAT) gathered more than 4.5 million tests and their results from 1998 until 2006.
The quick summary of their findings was that a) implicit bias is a pervasive societal element, b) people are often unaware of these implicit biases, c) implicit biases are predictors of behavior, and d) people will differ in the strengths and expressions of those biases.
The results of these unconscious biases are multitudinous, and while no aspect of our lives is free from these judgements, for the purposes of this discussion, we are only focusing on how these affect the healthcare system. Here are some researched findings about how implicit bias demonstrates itself in the healthcare system.
Examples of Implicit Bias in Healthcare
As healthcare systems began to administer these IAT tests there were a variety of effects which were uncovered.
- Non-white patients are less likely to receive certain interventions for cardiovascular problems.
- Patients of color are likely to be personally blamed for their poor health as a result of their own irresponsibility or passivity.
- Ethnic minorities, people with lower levels of education, and those who are unemployed, spend longer time waiting for care— black and Latino populations 19-25 minutes more on average.
- Physician held false beliefs about patients due to skin color.
Regardless of the variety of consequential outcomes, the main point is that differences in treatment rendered based upon decisions unconsciously informed by implicit biases leads to failures in patient-centered care, levels of interpersonal communication, trust, and diagnoses.
The research supports the idea that a relationship between medical professional biases and patient care can contribute to disparities in how healthcare is administered. These cognitive biases when interacting with race, gender, age etc., affect clinician behavior, decisions.
Thus, things like patients’ avoidance of healthcare systems, lower participation in screenings, delays to care, and overall lower reviews of health care professionals arise. So, the question becomes, what can be done? The following are some strategies for promoting equity and inclusion in healthcare despite cognitive biases.
Strategies for Promoting Equity and Inclusion in Healthcare
Implicit bias, as has been shown, is a present force in our society today not just in a broad sense, but in specific demonstrations such as in the medical field. With this comes the necessity for solutions which will help to reduce this. Here are some strategies for promoting diversity, equity, and inclusion in healthcare:
- Education: informing medical professionals of the reality and possibility of unconscious biases which might include
- Stereotype replacement— helping others to recognize unconscious responses based upon the various major demographic markers of age, race, sex, religion, etc.
- Renewed language— language, which is tethered to stereotypes, limits the ability for understanding, thereby encouraging thought behavior toward various demographics. Providing new, specific words and phrases as alternatives to stereotypical slang helps to promote a shift in mindset.
- Perspective— providing cultural context, even generally, can help to create understanding for the variety of struggles which are common to certain people groups. This understanding breeds compassion and patience which translates to patient care.
- Offering opportunities for cross cultural engagement interdepartmentally would encourage more empathy for various people groups.
- Staffing departments for greater diversification encourages everyday observation promoting greater cultural sensitivity.
Any practice of such strategies will begin to gradually diminish the presence of bias in healthcare, and as such should be thoughtfully implemented in healthcare offices.
Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
J. Michael Jones started writing in the early 1980s, publishing over thirty articles in national medical journals, and The Stones of Yemen is his eighth book, five of them fiction. He had a thirty-eight-year career as a physician associate and worked in refugee camps in Pakistan, Afghanistan, Cyprus, Oman, UAE, Egypt, and Nepal. In addition, he hosted twenty Yemeni students over two years in the U.S. Besides his medical studies, he has a degree in Arabic from the American University in Cairo, which was invaluable during the research for this book. Michael resides with his wife Denise in Washington’s San Juan Islands, where he writes full time. They are the parents of five grown children and one hairy Saint Bernard.
Bio: Rachelle Wilber is a freelance writer living in the San Diego, California area. She graduated from San Diego State University with her Bachelor’s Degree in Journalism and Media Studies. She tries to find an interest in all topics and themes, which prompts her writing. When she isn’t on her porch writing in the sun, you can find her shopping, at the beach, or at the gym. Follow her on Twitter and Facebook: @RachelleWilber; 
