The Elephants We Can & Can t See: Bias & Stereotyping in the Care of the Seriously Ill

Transcription

1 The Elephants We Can & Can t See: Bias & Stereotyping in the Care of the Seriously Ill TAMMIE E. QUEST, MD FAAHPM PROFESSOR EMORY UNIVERSITY SCHOOL OF MEDICINE PRESIDENT, AMERICAN ACADEMY OF HOSPICE AND PALLIATIVE MEDICINE

2 Disclosures No industry relationships to disclose

3 Learning Goal Today Explore how we as individuals and as health care providers consciously and unconsciously characterize our world and how this impacts the care of patients and families and how that effects how we work, lead and function.

4 Agreeing to go on the journey

5 The Know-Don t Know Circle

6 How Much Do I Know About the World? Know Good Question

7 What I Am Sure I Know What car I drove in to the conference this morning

8 How Much Do You Know About the World? Know Know You Don't Know Still A Good Question

9 What I am Sure I Don t Know How to unlock the iphone

10 How Much Do You Know About the World? Know Know You Know You Don't Know Think You Know Now I'm Really Curious

11 The Think I Know

12 Things You Think You Know Cinco de Mayo is Mexican Independence Day Mexican Independence Day is September 16 th. Cinco De Mayo marks Mexico's defeat of the French army back on May 5, 1862 There are hundreds of celebrations in the US of Mexican Independence Day.

13 Things You Think You Know Mt. Everest is the tallest mountain in the world. If you measure from the mountain's oceanic base to its peak, Mauna Kea in in Hawaii is the tallest mountain in the world at 33,500 feet high.

14 Things You Think You Know Viking helmets had horns on them. By historical accounts, Vikings helmets did not have horns and its postulated this came from theater depictions in the 1870 s.

15 One Additional Critical Element to the Know-Don t Know Circle

16 How Much Do You Know About the World? AKA = Why We Have a Guest Speaker Today Know Know You Don't Know Think You Know Don't Know What You Don't Know

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18 What does all this mean?

19 Functional Coping Functional Position (Under Stress) How to Grow& Develop Know Don t Know Think I Know Don t Know I Don t Know Learned and verified information Confident Education Learned experiences Willing to learn and have experiences teach me ; acknowledgement Continual life learning; new adventures Tentative Functioning Stereotypes Conscious Bias Willing to be corrected when presented with evidence Complete Blind Spot Unconscious Bias Recognition Unconscious Bias Exists and is Real

20 Stereotype vs. Bias Stereotype is a belief that characterizes people based merely on their group membership Bias is a personal preference, like or dislike that is automatic and immediate and influences behaviors

21 Our Biases Influence Our Behaviors

22 Stereotypes do not necessarily influence our behaviors

23 Automatic Conscious Bias Bias that reflects the attitudes or beliefs that one endorses at a conscious level Healthy Unhealthy

24 Automatic - Unconscious Bias Your Gut reaction The bias in judgment and/or behavior that results from subtle cognitive processes that often operate at a level below conscious awareness attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner WHO IS SMARTER?

25 Unconscious Bias serves a very important purpose We have to make assumptions about the world to live fight or flight

26 Exploring Your Own Unconscious Bias

27 Implicit Association Test Greenwald, McGhee and Schwartz Journal of Personality and Social Psychology Asks you to quickly sort images and phrases IAT predicts actual feelings decisions and behaviors toward groups

28 Tests to discover bias related to: Race Weight Age Sexuality Presidential Skin Tone Countries

29 What does this have to do with Hospice and Palliative Care?

30 The Know-Don t Know Circle On a daily basis we mostly functioning in the don t know what you don t know state. How does this effect: Patients Families Staff Organizations Know Know You Don't Know Think You Know Don't Know What You Don't Know

31 My Own Know-Don t Know Experience My Biases and Stereotypes: Whites don t use drugs as much as blacks (harmful vs. non-harmful lifestyles) Whites would be more forthcoming than blacks on a healthcare crisis (intelligence/communication) Whites don t defraud Medicaid like blacks might (good vs. evil)

32 Work in Our Teams The Caregiver Care Team As we encounter others team members, patients and families: What are our biases? What are our conscious biases? What are our unconscious biases?

33 Reflection: Be willing to admit you have bias and you do stereotype and that it effects patient care Working at the Bedside

34 Getting to solutions.i want to fix it! Self awareness INDIVIDUAL STRATEGIES Understand the nature of bias Discuss with others (particularly with dissimilar groups) Facilitated discussions to promote bias literacy UCSF Office of Diversity and Outreach ORGANIZATIONAL STRATEGIES Develop concrete, objective indicators & outcomes for hiring, evaluation, and promotion to reduce standard stereotypes (Fiske & Taylor, 1991; Heilman, 2001; Bernat & Manis, 1994) Develop standardized criteria to assess the impact of individual contributions in performance evaluations (Heilman & Haynes, 2005) Develop and utilize structured interviews and develop objective evaluation criteria for hiring (Martell & Guzzo, 1991; Heilman, 2001) Provide unconscious bias training workshops for all constituents

35 Unconscious Bias Training Challenges one to examine our own potential bias that are at work in ourselves all the time, that we can t see Utilize emerging best practices to overcome or minimize the effects of unconscious bias both personally and organizationally

36 Developing Cultural Intelligence (CQ) Ang, Van Dyne, & Livermore

37 4 Components of CQ

38 CQ-Drive CQ-Drive is a person's interest and confidence in functioning effectively in culturally diverse settings: Intrinsic interest deriving enjoyment from culturally diverse experiences Extrinsic interest gaining benefits from culturally diverse experiences Self-efficacy having the confidence to be effective in culturally diverse situations

39 CQ-Knowledge CQ-Knowledge is a person's knowledge about how cultures are similar and how cultures are different. Business knowledge about economic and legal systems Interpersonal knowledge about values, social interaction norms, and religious beliefs Socio-linguistics knowledge about rules of languages and rules for expressing non-verbal behaviors

40 CQ-Strategy CQ-Strategy is how a person makes sense of culturally diverse experiences. It occurs when people make judgments about their own thought processes and those of others. Awareness knowing about one's existing cultural knowledge; Planning strategizing before a culturally diverse encounter; Checking checking assumptions and adjusting mental maps when actual experiences differ from expectations.

41 CQ-Action CQ-Action is a person's capability to adapt verbal and nonverbal behavior to make it appropriate to diverse cultures. It involves having a flexible repertoire of behavioral responses that suit a variety of situations. Non-verbal modifying non-verbal behaviors (e.g., gestures, facial expressions) Verbal modifying verbal behaviors (e.g., accent, tone)

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43 Remember the Know-Don t Know Circle Know Know You Don't Know Think You Know Don't Know What You Don't Know

44 Thank You! St. Louis Zoo Yoga Elephant