Disclosure. Self Assessment Questions National Pharmacy Preceptors Conference Making Unconscious Bias Conscious

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1 E. Zachary Ramsey, Pharm.D., BCPPS Clinical Pharmacy Specialist in Pediatric Cardiology Residency Programs Director Children s Hospital of Philadelphia Sarah C. Erush, Pharm.D., BCPS Associate Director of Pharmacy Professional Practice Hospital of the University of Pennsylvania Disclosure In accordance with the ACPE s and ACCME s Standards for Commercial Support, anyone in a position to control the content of an educational activity is required to disclose their relevant financial relationships. In accordance with these Standards, ASHP is required to resolve potential conflicts of interest and disclose relevant financial relationships of presenters. In this session: All planners, presenters, reviewers, and ASHP staff report no financial relationships relevant to this activity. Self Assessment Questions I am consciously aware that I have unconscious bias. True False Page 1 of 19

2 Self Assessment Questions Unconscious bias has a significant impact on which of the following? Patient care Resident recruitment Learner assessment Orientation Self Assessment Questions Which of the following is an appropriate way to combat unconscious bias in recruitment? Request photos in application process Structure all interviews as one on one Slow down in decision making process Make requirements for position clear and consistent (preferred language, geographical area, work experience, etc.) Objectives Describe HOW the brain functions to process information and how that can lead to bias Explain what unconscious bias is and the principles associated with it Discuss the impact of unconscious bias and how it affects relationships, recruitment, onboarding of new learners, assessment of learners, and healthcare as a whole Develop strategies to minimize the effects of unconscious bias Identify resources available for additional learning on unconscious and other types of bias Page 2 of 19

3 But First A Few Caveats / Requests Squirm factor Safe environment to share, free from judgment Only successful if willing to share and squirm together Do You Have Any Unconscious Bias? Unconscious Bias Hidden beliefs, attitudes and/or implicit (people) preferences formed by past experiences Implicit associations held do not necessarily align with one s declared beliefs or even reflect stances explicitly endorsed Page 3 of 19

4 Unconscious Bias We ALL Have Unconscious Bias May be hard to accept or make us uncomfortable Brain is hard wired to develop unconscious bias Bias blind spots Not only do we not want to believe we have bias, but we are really good at identifying it in others, but not ourselves Bad combination leading to it being perpetuated and not managed Resistance to susceptibility to bias WITH Unconscious nature of the bias It s All In Your Head Pathophysiology of Unconscious Bias Ventral striatum of brain Activates when doing a task correctly your reward center NOT objective and activates when we believe or feel we are right Dorsal anterior cingulate and anterior insula Activate when making a mistake your pain matrix, provides emotions of anger, frustration Develops starting as young as 5 years of age Page 4 of 19

5 Types of (Unconscious) Bias Over 150 types of cognitive bias SEEDS model categorized into subtypes ( bias bins ) based on source, biology, and/or driving force Similarity Expedience Experience Distance Safety Bias Bin: Similarity Motivation to feel good about self and others Self interest and self sustenance But may conflict with objective perception of self, others, environment Used to promote and protect group (family, team, program, institution) If unchecked may breed or perpetuate stereotypes and/or prejudice Ingroup bias more positive perception of people similar to existing group Outgroup bias more negative perception of people different to existing group Page 5 of 19

6 Bias Bins: Similarity Example Bias Bin: Expedience Mental shortcuts to make quick / efficient / intuitive decisions Decisions may be made on incorrect judgments Brain s 2 systems System 1 Fast and easy, Makes decisions based on associations or intuitions System 2 slower, requires more effort Makes decisions based on objective information that may not be readily available Bias Bin: Expedience Page 6 of 19

7 Bias Bin: Expedience Availability bias (classic) Tendency to make decision on information most readily accessible INSTEAD of on objective information Prevents consideration of all relevant information Belief bias Confirmation bias Halo effect Planning bias Bias Bins: Expedience Example Bias Bins: Expedience Example Page 7 of 19

8 Bias Bin: Experience Naïve Realism Implicit belief that experience corresponds to reality Brain is built to understand the environment or situation as a direct and objective representation BUT, overlooks the varying processes or confounders that solidify that experience (and thus reality) in the brain Past history Personality Emotional state Especially pernicious Bias Bins: Experience Example Bias Bin: Experience False Consensus Effect Overestimation of the extent to which you think others agree with you / think the same way Blind Spot Hindsight Bias Illusion of Control / Transparency Page 8 of 19

9 Bias Bin: Distance Brains assign greater value to things we perceive to be closer to us, simply because they are close Spatially Temporally Short term thinking versus long term investment Bias Bin: Distance Endowment effect Tendency to value things more if we own them or possess them Temporal Discounting Tendency to value things differently on whether they get them now or later Affective Forecasting Bias Bin: Safety Generalizable that decisions are driven by negatives rather than positives Sensitive to information about whether we expect to gain or loss something Evolutionarily adaptive Example: you will stay alive longer by remembering FASTER that a hungry crocodile will kill you rather than a zebra has vertical stripes Page 9 of 19

10 Bias Bin: Safety Loss Aversion Avoid a risky decision if outcome is positive More likely to engage in risky behavior to avoid a negative outcome Minimize the risk of NOT winning but increase the chances of avoiding loss Framing Effect If information framed as a gain people will chose to avoid a risky decision If information framed as a loss people will choose to take the risk to avoid loss Implications of Unconscious Bias Unconscious Bias MAY be Beneficial Adaptive Helps us use previous knowledge to inform and make new decisions Do not have the cognitive resources to make every decision we encounter Page 10 of 19

11 But Unconscious Bias MAY be Harmful Blinds to new information or inhibits from considering a broad range of options and information when making a decision May lead to discrimination Unconscious Bias Stereotype Pre Judging Behavior Discrimination But Unconscious Bias MAY be Harmful Workplace impact Unearned advantages or unearned disadvantages Lack of a diverse team (ethnicity, sex, orientation AND ideology) Employee performance and/or engagement Excluded people have lower morale, performance and engagement Turnover and loss of talent People that are included are more innovative, higherperforming, and willing to help other team members a higher degree of team citizenship So What is YOUR Bias? Page 11 of 19

12 Group Activity: Self Reflection and Share Identify a known bias in yourself; take time to reflect how that bias has or hasn t affected you in a positive or negative way Why has that bias affected you? Have you done anything to mitigate it? Share this information with your fellow preceptors at your table Ways to Combat Unconscious Bias Step 1: Assess and accept your own personal (possible) unconscious bias Important step in understanding the roots of stereotypes and prejudice Consider completing a hidden bias test to identify and measure your unconscious bias Ways to Combat Unconscious Bias Project Implicit Virtual laboratory to educate public on hidden bias and collect data based on responses for ongoing analysis Developed 20 years ago by scientists from U Washington, UVA, and Harvard Implicit Associations Tests (IATs) Page 12 of 19

13 Ways to Combat Unconscious Bias Implicit Associations Tests (IAT) Measures the strength of association between concepts or stereotypes (e.g. fat, gay, latino, clumsy, etc.) and evaluations (i.e. good or bad) 14 tests 8 to 20 minutes to complete Concept that making a response is easier when the items one closely relate to one another share the same response key BEWARE IATs may reveal troubling aspects of human nature or the nature of the participant may cause some discomfort Ways to Combat Bias: Bin Specific Similarity Bias Engage in self (or team ) affirmation Find ways to think of those that are different from us as more similar (i.e. find a common denominator) Remove, when possible, biasing information or features (names, gender, ethnicity, etc.) from application materials Page 13 of 19

14 Ways to Combat Bias: Bin Specific Expedience Bias Provide an incentive for individuals to identify their own mistake(s) Break problem down into multiple component parts Encourage outside opinions Implement a mandatory cooling off period to allow for brain s system 2 to engage Ways to Combat Bias: Bin Specific Experience Bias Obtain objective outside opinions Revisit decisions or ideas after a break to provide ability for a fresh perspective / more objective Take a step back and try to view one s decisions from another s perspective Ways to Combat Bias: Bin Specific Distance Bias Remove distance from consideration Evaluate the outcomes or potential results as if they were equally close in terms of time, distance, and/or ownership Page 14 of 19

15 Ways to Combat Bias: Bin Specific Safety Bias Pretend you are making the decision for somebody else or another group Provide greater distance Ways to Combat Bias: Other Attempt to be more conscious of similarities and differences amongst people Be an ally for the disadvantaged Cultivate meaningful relationships with people different than you Avoid triggers don t make a decision when you are busy, rushed, hungry, tired, anxious, etc. Ways to Combat Bias: Other Slow down when making a decision and revisit the data Ask yourself to support the decision made Avoid reinforcing stereotypes and limit exposure to terminology or jokes that reinforce negative ideas Review paperwork or applications or assessment forms for any hidden biases Page 15 of 19

16 Unconscious Bias in Healthcare Diversity is critical Diverse student populations improve satisfaction in educational experiences Diverse teams solve complex problems better than homogenous ones Multidisciplinary team contribute a range of perspectives to improve patients outcomes Unconscious Bias: Preceptor Implications Relationships Learner expectations onboarding Learner expectations assessment Recruitment Group Activity: Small Group Discussion Work together with your preceptor peers at your table to identify ways that unconscious bias has or could impact the professional experiences of a preceptor As assigned by table from component of resident program on previous slide What ways could these biases or sources of bias be mitigated Share with larger audience to stimulate discussion / gain insight for future growth Page 16 of 19

17 Unconscious Bias in Recruitment Resources Video Links Brain Tricks This is How Your Brain Works: Unconscious Bias Test Teaser: MCT Confirmation Bias: PBS Implicit Bias, review of IAT: Understanding Unconscious Bias: An Introduction to Unconscious Bias: How we make decisions and how Unconscious Bias affects judgement: How Unconscious Bias affects decision making and how we can make better decisions: Unconscious Bias in Recruiting: Dp372Jsj4 Unconscious bias basics: What does my headscarf mean to you? Yassmin Abdel Magied: Resources Lieberman MD, et al. Breaking Bias Updated: The SEEDS Model. NeuroLeadership Journal. 2015;6:1 18. Project Implicit Staats C, et al. Implicit Bias Review. Kirwin Institute ed. Lewis D, et al. Proceedings of the Diversity and Inclusion Innovation Forum: Unconscious Bias in Academic Medicine. Kirwin Institute Page 17 of 19

18 Resources Looking at "fairness" as not an attitude but as a leadership skill that can be developed (Article) Thais Compoint, "What Does Darth Vader Have to do With Inclusive Leadership?" April 19, Companies must tackle hidden bias to reap the benefits of diversity (Report) EY, Outsmarting Our Brains (2013). Collection of resources, videos, facilitation guide and more about unconscious bias at work (Website) Google re:work, "Unbiasing Guide: Raise Awareness About Unconscious Bias." Overview of common biases and importance of organizational practices (Article) Heidi Grant Halvorson and David Rock, "Beyond Bias," Strategy Business, July 13, Understanding the latest science on implicit bias (Publication) Kirwan Institute for the Study of Race and Ethnicity, Implicit Bias Review, Ohio State University (2017). Creating positive habits for culture change (Article) Alison Randel, "Changing Culture: Shift Small Habits for Big Wins," Medium, May 23, Making decisions more consciously through priming, reorganizing structures, and accountability (Article) Howard J. Ross, "3 Ways to Make Less Biased Decisions," Harvard Business Review (April 16, 2015). People more likely to detect bias in others than themselves (Article) Irene Scopelliti, Carey K. Morewedge, Erin McCormick, et. al, "Bias Blind Spot: Structure, Measurement, and Consequences," Management Science, vol. 61, no. 10 (October 2015). Self Assessment Questions I am consciously aware that I have unconscious bias. True False Self Assessment Questions Unconscious bias has a significant impact on which of the following? Patient care Resident recruitment Learner assessment Orientation Page 18 of 19

19 Self Assessment Questions Which of the following is an appropriate way to combat unconscious bias in recruitment? Request photos in application process Structure all interviews as one on one Slow down in decision making process Make requirements for position clear and consistent (preferred language, geographical area, work experience, etc.) Key Takeaways Key Takeaway #1 We ALL have unconscious bias it may be beneficial and it may be harmful but accepting this and working to identify and minimize this unconscious bias is paramount. Key Takeaway #2 When making a decision that may be impacted by unconscious bias it is important to slow down in that process to ensure that your decision is rooted in sound judgement ask for other s input or opinion; step away from the decision, revisit; apply perspective of looking at the decision from another s view, etc. Key Takeaway #3 Numerous resources exist to provide additional education or self assessment on unconscious bias. Final Thoughts and Application Page 19 of 19