Taking a Hard Look at Implicit Bias to Ensure an Optimal Patient Experience for All

Melissa R. Thornburg, MA
Director, Client Success
pCare

As we continue to battle the global pandemic, patient experience remains a priority for all healthcare workers. Striving to assess our patients’ needs and deliver services to meet and exceed expectations, we are more creative than ever. Thinking outside the box for strategies and solutions, we are driven to soothe our patients while delivering positive outcomes. Our intention is to provide high-quality, comprehensive care to every patient. However, the reality is that while our intentions are pure, we may sometimes fail because of implicit, or unconscious bias. Black History Month is a perfect time to raise awareness of this unconscious bias:

• What it is
• How It Impacts Racial Disparity in Treatment
• Tips on How to Educate and Mitigate Against It.

What is Implicit Bias

According to Patient Engagement HIT, “implicit bias refers to the attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner. These biases, which encompass both favorable and unfavorable assessments, are activated involuntarily and without an individual’s awareness or intentional control. Residing deep in the subconscious, these biases are different from known biases that individuals may choose to conceal for the purposes of social and/or political correctness.” These biases are not purposeful yet can be harmful. They are the product of our upbringing, the people and cultures we have experienced in our lives, and often influenced by mainstream or social media. These biases can contribute to racial disparity in the delivery of healthcare services, resulting in lack of timely care or intervention, and sometimes even death.

For example, “African Americans are generally at higher risk for heart disease, stroke, cancer, asthma, influenza and pneumonia, diabetes, and HIV/AIDS”, according to the Office of Minority Health, part of the Department for Health and Human Services. Many social and environmental factors such as unemployment, lack of access to healthcare, poverty, obesity, and smoking may lead to poor health outcomes in the treatment of these diseases, and a closer look reveals that implicit bias does as well.

Studies indicate many healthcare providers unconsciously exercise bias while treating African American patients, making assumptions regarding:

• Ability to pay
• Intention to adhere to treatment plan/take medications as directed
• Willingness to follow a Diet
• Likelihood to schedule a follow-up appointment

The Impacts 

In many cases, it means that the more aggressive and thorough treatment and services rendered to white counterparts are not as consistently prescribed, therefore resulting in less favorable health outcomes. Two devastating results of this implicit bias reported here in US News and World Reports include that “black children have a 500% higher death rate from asthma compared to white children, and African American adults with cancer are much less likely to survive prostate, breast and lung cancer than white adults.”

The COVID pandemic has brought to the forefront the stark and deadly realities of the health inequities in our society as reported by the CDC  with African Americans experiencing 2.6 times higher case rates, 4.7 times higher hospitalization rates, and 2.1 times more death from COVID-19 compared to white  people. While some of the social and environmental factors listed above contribute to these disparities, implicit bias may also play a role. So what can we do to access our implicit or unconscious biases to avoid affecting patient care and experience?

Mitigation Strategies

Barbara Warren, Director, LGBT Programs and Policies with Mount Sinai Health System, partnered with the Beryl Institute to develop a short PX Learning Bite video titled “Mitigating Unconscious Bias to Provide Patient Experience”. Ms. Warren provides four tips for healthcare providers to help them avoid the unconscious or implicit biases that contribute to racial healthcare disparities:

1. Take actions to bring your biases into conscious awareness.
2. Slow down in your responses.
3. Understand the other possible reactions, interpretation and judgments that may be possible in the interaction.
4. Search for and use colleagues to get input on the most empowering, productive way to deal with the situation.

She encourages viewers to take an “Implicit Associations Test” to help reveal any biases that may affect their patients or customers.

Have you taken time to consider what your biases may be? In honor of Black History Month, and for the benefit of and all your patients and colleagues, take a few moments to think about what biases you may be holding on to based on your upbringing, social or environmental factors, influences by mainstream or social media. Implicit bias not only affects our professional lives, but our personal lives too. We are all seeking connection, purpose, and the satisfaction of helping others. What better way than to make changes in ourselves to help eliminate racial disparities in the delivery of healthcare and improve the patient experience for ALL patients in our care.