How Does Unconscious Bias Work in Everyday Life? Ronald M. Wyatt, MD, MHA Hamad Medical Corporation
Hi, my name is Monica Soni. 2
Hi, my name is Dr. Jean O Brien. 3
Hi, my name is Laith Ashley. 4
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Differences In Care Recommendations Equally likely to diagnosis CAD and angina across gender and race variables, but more likely to refer men and white patients to cardiac catheterization than women or black patients. Black race and Hispanic ethnicity were independent risk factors for amputation, even more so than a history of rest pain or gangrene. Across many cancer types, survival differences between blacks and whites dissipated when patients were comparably treated for similar stage cancers. Shulman et al. The effect of race and sex on physicians' recommendations for cardiac catheterization. 1999 Collins et al. Lower extremity nontraumatic amputation among veterans with peripheral arterial disease: is race an independent factor?. 2002 Bach et al. Survival of blacks and whites after a cancer diagnosis. 2002 Santry, HP and SM Wren, The Role of Unconscious Bias in Surgical Safety and Outcomes. 2012
Population Specific Inequities: LGBTQ+ 7 National LGBT Health Education Center https://vimeo.com/143918389?from=outro-embed
Population Specific Inequities: LGBTQ+ Disrespectful treatment, providers lack of awareness, care denial, blaming of sexual orientation/gender identity for illness, violence in health care settings >50% medical school curricula include no information on LGBTQ+ care Extreme poverty http://files.kff.org/attachment/issue-brief-health-and-access-to-care-and-coverage-for-lgbt-individuals-in-the-u-s-2 National LGBT Health Education Center
Population Specific Inequities: LGBTQ+ Disrespectful treatment, providers lack of awareness, care denial, blaming of sexual orientation/gender identity for illness, violence in health care settings >50% medical school curricula include no information on LGBTQ+ care Extreme poverty To Dos: Understanding population, clinical setting, resources and support, medical education Questions about sexual health, sexual orientation, gender identity Make no assumptions Collect SOGI data http://files.kff.org/attachment/issue-brief-health-and-access-to-care-and-coverage-for-lgbt-individuals-in-the-u-s-2 National LGBT Health Education Center
Population Specific Inequities: LGBTQ+ 10 National LGBT Health Education Center
Staff Experience, Safety & Quality Good staff management, climate of trust and respect = higher quality care The greater the proportion of staff from a black or minority ethnic (BME) background who report experiencing discrimination at work in the previous 12 months, the lower the levels of patient satisfaction. The number of both BME and white staff who are praised by management after raising a concern is 3% BME 7.2% for white staff. 24% of BME staff compared to 13% of white staff did not raise a concern for fear of victimization. 11 West M and J Dawson. NHS Staff management and health service quality. Coghill, Y. Race Equality in the NHS. Jan 2016 presentation.
NHS England Staff Satisfaction Survey Q23b 12
What Are Microaggressions? A question, a comment, even an intended compliment, sometimes, that nevertheless suggests something demeaning: White people often ask Asian Americans where they are from, conveying the message that they are perpetual foreigners in their own land. Example telling a person of color that he/she is so articulate, which implies that all other people of color are not. Example You re not like those other [women, gays/lesbians, Blacks, Latinos], etc. o This implies that the person is an exception. 13 Boss Says You re Smart for a Woman, http://www.npr.org/2014/04/10/301417507/boss-says-youre-smart-for-a-woman
What Are Microassaults? Conscious and intentional actions or slurs, such as: Using racial epithets or making derogatory comments Displaying swastikas, confederate flags, etc. Deliberately serving a white person before a person of color in a restaurant 14
What Are Microinsults? Verbal and nonverbal communications that subtly convey rudeness and insensitivity and demean a person's racial heritage or identity. An employee who asks a colleague of color how she got her job or was admitted in college/university, graduate/professional school, etc., implying she may have landed it through an affirmative action or quota system and therefore unqualified for the position. Assuming a professional person of color is the hired help, such as custodian, secretary, bell hop, valet, etc. I never would have guessed you were gay. 15
What Are Microinvalidations? Communications that subtly exclude, negate or nullify the thoughts, feelings or experiential reality of a person of color. You re playing the race card. You re being too sensitive. #Black Lives Matter what about OTHER lives? All lives matter 16
Black Lives Matter vs. All Lives Matter 17
Debiasing Techniques 18 State of the Science: Implicit Bias Review 2015
Debiasing Techniques Training Intergroup contact Taking the perspective of others (empathy) Emotional expression (non-verbal body language) Counter-stereotypical exemplars 19 State of the Science: Implicit Bias Review 2015
Practical Tips to Combat Unconscious Bias in Health Care 1. Have a basic understanding of the cultures your patients come from. 2. Do not stereotype patients, individuate the patients. 3. Understand and respect the power of unconscious bias. 4. Recognize situations that magnify stereotyping and bias. 20 Augustus White, MD, Seeing Patients: Unconscious Bias in Health Care, 2011
Practical Tips to Combat Unconscious Bias in Health Care 5. Know the Culturally and Linguistically Appropriate Services (CLAS) Standards. 6. Do a Teach Back or National Patient Safety Foundation What is my main problem? What do I need to do? Why is it important for me to do this? 7. Assiduously Practice Evidence-Based Medicine 21 Augustus White, MD, Seeing Patients: Unconscious Bias in Health Care, 2011
For Further Reading 22
Questions for Discussion 1. How does health equity apply in your setting? Who in your system receives poorer quality of care and experiences poorer outcomes? 2. What is the state of addressing health equity at your organization? 3. What challenges do you see to advancing health equity in your setting? 23
Agenda 1. What is health equity? 2. How does health equity relate to patient safety and health care quality? 3. What can you do to advance health equity? 24
Health Equity as a System Property 25 IHI Innovation Project Final Report: Health Equity as a System Property for Health Care. Wave 37: October - December, 2015 IHI available on request
What Will You Do? 1. Further explore my own biases https://implicit.harvard.edu/implicit/takeatest.html 2. Advance conversations in your organization 3. Educate team members 4. Review your policies/practices/data collection with an equity lens 5. Review stratified data 6. Plan tests of change based on inequities in our system 26
Integrating Equity into Your Strategic Plan 27