The Impact of Unconscious Bias on our Work

Transcription

1 The Impact of Unconscious Bias on our Work René Salazar, MD Assistant Dean for Diversity Professor of Medical Education The Texas Association of Community Health Centers 34 th Annual Conference October 30, 2017

2 Acknowledgements J. Renee Chapman Navarro, PharmD, MD Vice Chancellor, Diversity and Outreach, Professor Anesthesia and Perioperative Care UCSF Elizabeth Ozer, PhD Professor of Pediatrics Department of Pediatrics Division of Adolescent & Young Adult Medicine UCSF

3 Review the state of the science on unconscious bias Summarize the impact of unconscious bias on our work including health disparities Describe several strategies to assess and address unconscious bias individual level organization level Overview

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6 Bias Two Types Conscious (explicit) Effortful Deliberate Slow Controlled Unconscious (implicit) Effortless Automatic Fast Involuntary

7 Bias Problem: Too much information to process

8 Bias Solution: Mental-short cuts The brain seeks to conserve energy. Decision-making and problem solving take heavy cognitive reserve. We ve evolved to have mental short cuts that save time and usually yield reliable results.

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10 Unconscious Bias Often incompatible with our conscious values Certain scenarios can activate Multitasking High stakes/stress Limited time Not limited to ethnicity and race Age, gender, gender identity, physical abilities, religion, sexual orientation, weight, others

11 Bias-Etiology

12 Bias-Etiology

13 Bias

14 Bias

15 Bias and Our Work

16 Bias Compelling body of scientific evidence shows unconscious bias pervasively influences (Wright, AAMC 2010) Daily interactions (microagressions) Workplace: Hiring Evaluation Patient care

17 Bias Compelling body of scientific evidence shows unconscious bias pervasively influences (Wright, AAMC 2010) Daily interactions (microagressions) Workplace: Hiring Evaluation Patient care

18 Bias Orchestrating Impartiality: The Impact of Blind Auditions on Female Musicians Blind auditions-physical screen to conceal candidate s identity-implemented in the 1970 s Blind auditions increased probability women advanced from preliminary rounds by 50% Blind auditions increased hiring of women by 25% Goldin & Rouse, 2000

19 Bias Are Emily and Greg More Employable than Lakisha and Jamal Fictitious resumes sent to help-wanted ads Resumes randomly assigned African-American or Whitesounding names White names received 50% more callbacks for interviews Bertrand & Mullainathan, 2004

20 Mothers Lower perceived competence & starting salaries (Correll et al., 2007; Heilman & Okimoto, 2008) Less interest in hiring & promoting mothers compared to fathers & childless employees (Cuddy et al., 2004) Fathers Bias Not penalized & sometimes benefit from fatherhood (Correll et al., 2007)

21 Unconscious Bias and Health Care

22 Bias Compelling body of scientific evidence shows unconscious bias pervasively influences (Wright, AAMC 2010) Daily interactions (microagressions) Workplace: Hiring Evaluation Patient care

23 Bias Compelling body of scientific evidence shows unconscious bias pervasively influences (Wright, AAMC 2010) Daily interactions (microagressions) Workplace: Hiring Evaluation Patient care

24 Unconscious Bias: Health Disparities Quality of Health Care Non Minority Minority Difference Clinical Appropriateness and Need Patient Preferences The Operation of Health Care Systems Discrimination: Biases, Stereotyping, and Uncertainty Disparity Populations with Equal Access to Health Care Gomes and McGuire, 2001.

25 Unconscious Bias: Health Disparities Quality of Health Care Non Minority Minority Difference Clinical Appropriateness and Need Patient Preferences The Operation of Health Care Systems Discrimination: Biases, Stereotyping, and Uncertainty Disparity Populations with Equal Access to Health Care Gomes and McGuire, 2001.

26 Unconscious Bias-Health Disparities Zescott et al, 2016.

27 Weight Bias 15.5 million (6.6%) adult Americans: BMI > 40 (Slum, 2013) 75% of Texas adults might be overweight or obese by 2040 (TDSHS, 2004) Physicians may spend less time with obese patients and fail to refer them for diagnostic tests. (Phelan, 2015) Medical students more negative stereotyping, less anticipated patient adherence (Persky, 2011)

28 Disability Bias 62 million (30%) adult Americans experience either some difficulty with basic movement, or cognitive, sensory, or emotional problems (Yee, 2011) Primary care facilities: 3.6% had a wheelchairaccessible weight scale and 8.4% had a height adjustable exam table (Mudrick, 2010) Patients with disabilities fewer preventative tests, missed diagnoses, and delayed care (Healthy People 2020)

29 Race Bias Race bias affects clinical decision making (Van Ryn, 2015) Predicts nonverbal behavior such as eye contact and posture Influences the quality of physicians interpersonal communication with African American patients Influences patients trust and perceptions of their physicians Black children with appendicitis less likely to receive opioid medication than White children (12 vs. 34%) (Goyal, 2015)

30 Assessing Unconscious Bias

31 Assessing Unconscious Bias Implicit Association Test (IAT) (implicit.harvard.edu) Introduced in 1998: unconscious (implicit) bias Measures time to match representatives of social groups (age, gender, race, others) to particular attributes (good, bad) Relatively resistant to social desirability concerns Reliability and validity has been rigorously tested

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33 Implicit Association Test

34 Implicit Association Test

35 Breakout Session: IAT Exercise

36 Breakout Session: IAT Exercise 1. What was your reaction when you learned your results? Were you surprised by your results? If so, why? 2. Did you have any resistance to the results? 3. What experiences in your life may have contributed to your results? 4. Reflect on a decision you ve made in the last few days and ask yourself, How might my perceptions or biases have influenced that decision? 5. What are some strategies you can utilize to address unconscious bias in your work?

37 Addressing Unconscious Bias

38 Addressing Unconscious Bias: Individual Increase exposure to counter-stereotypes Enhance internal motivation to reduce bias o Recognize unconscious bias (IAT) o Self-discovery within a non-threatening, private context Increase the understanding about the psychological basis of bias o Normal aspect of human cognition Burgess, et al., 2007

39 Addressing Unconscious Bias: Individual Enhanced empathy o Perspective taking Enhance emotional regulation skills o Stress-reducing techniques Improve ability to build partnerships with individuals o Finding a common ground Burgess, et al., 2007

40 Addressing Unconscious Bias: Institution Concrete, objective indicators & outcomes reduce standard stereotypes (Fiske & Taylor, 1991; Heilman, 2001; Bernat & Manis, 1994) Decreasing ambiguity about individual contributions in performance evaluations (Heilman & Haynes, 2005) Accountability for decision makers (Foschi, 1996;2000; Foschi et al., 1994)

41 Addressing Unconscious Bias: Institution Intervention to reduce implicit gender leadership bias within academic health setting (Girod et al., 2016) 20-minute educational intervention among faculty reduced perception of bias Meta-analysis of diversity training across 65 studies found beneficial effects (Kalinoski et al., 2012) Univ. of Wisconsin intervention to reduce gender-bias changed department climate to support career advancement of women in academic medicine, science & engineering (Carnes et al. Acad Med. 2015)

42 Unconscious bias Summary o Impacts evaluation/hiring and workplace relationships o Contributes to healthcare disparities Strategies to address unconscious bias include o Normalization

43 Strategies (cont) o Self reflection (IAT) Summary o Engagement with others o Pre-established criteria in the hiring process o Accountability

44 Additional Reading

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46 Questions?