Identifying Implicit Bias in Healthcare: 5 Best Practices

Implicit, or unconscious bias refers to the stereotypes, attitudes, and beliefs that impact an individual’s actions and decisions. These biases are formed during a person’s upbringing and are affected by life experiences. Unfortunately, implicit bias in healthcare can affect how clinicians treat patients of particular cultures or groups. This can be detrimental to patient safety and may limit the quality of care a clinician is able to provide.

How can your facility reduce the impact of clinician bias to optimize patient outcomes? In this article, we’ll provide an introduction to implicit bias, review statistics that highlight the significance of healthcare bias on patients and communities, and list five best practices to ensure your patients get the high-quality care they deserve.

What Is Implicit Bias in Healthcare?

Healthcare professionals make an oath to provide patients with respect, dignity, and confidentiality. Unfortunately, implicit bias can affect the type of treatment a patient receives, even if a provider believes they’re delivering fair and ethical care. There are certain factors that may trigger implicit bias in healthcare. Examples include the following patient characteristics:

What Does Research Suggest About Implicit Bias in Healthcare? Statistics

Implicit biases can inadvertently decrease the quality of healthcare that patients of certain groups receive. These involuntary opinions and beliefs are present at interpersonal and institutional levels of the healthcare industry, and can impact a provider’s decision of how to treat a patient’s illness or injury. The following statistics reveal startling examples of unconscious bias in healthcare:

• Physicians are more likely to recommend cardiac bypass surgery for White patients than Black patients. According to one report, physicians incorrectly assumed that their Black patients would not be compliant in attending the follow-up appointments or rehabilitation required after surgery.
• Clinicians are more likely to view women with chronic pain as emotional, hysterical, or sensitive and are less likely to provide pain medication to treat their underlying condition.
• Healthcare professionals tend to view people with obesity as lazy, weak-willed, lacking self-control, and unwilling to follow treatment recommendations.
• Individuals of a lower socioeconomic status or level of education tend to be perceived as less intelligent, responsible, and rational, and unlikely to follow medical advice.
• Black women are 3 times more likely to experience pregnancy-related mortality rates than White women.

How Does Implicit Bias Differ From Explicit Bias?

As explained above, implicit or unconscious bias is unintentional, meaning that an individual holds prejudice but is unaware of the negative attitudes they feel toward certain individuals or groups. On the other hand, explicit bias in healthcare occurs when a clinician is aware of their prejudices and knowingly provides unjust care.

While both types of bias can significantly impact care quality, clinicians who choose to act on explicit bias might not be able to provide the compassionate, equitable care your patients deserve. To avoid patient harm, any instances of racism, sexism, or other forms of overt discrimination should be taken seriously and addressed in a timely manner.

How to Reduce Implicit Bias in Healthcare: 5 Key Tips

All patients deserve just care. The difficult truth is that despite a facility’s best efforts to “level the healthcare quality playing field,” unconscious bias can still negatively impact patient health outcomes. While it may feel uncomfortable to acknowledge, recognizing and addressing the existence of implicit bias in healthcare is essential to providing high-quality care.

Fortunately, there are actions facility leaders can take to mitigate the risks of unconscious bias within their organization. Here are five ideas to get your team on the path to providing more equitable care for your patients.

1. Provide Training on the Harmful Effects of Unconscious Bias

The first step to overcoming the negative effects of healthcare stereotypes is to educate your team on the different types of bias in healthcare and how they can impact the quality of care your organization is able to provide. Many facility leaders raise awareness of the issue by assigning healthcare professionals an “unconscious bias in healthcare” training module to complete during onboarding and in annual competency sessions.

It’s important to remind staff that implicit biases aren’t feelings or reactions they can easily choose to control. They’re present in everyone, even those highly motivated to address and correct health disparities. Instead of feeling guilt, blame, or denial, focusing on improving reactions to these impulses is how we can truly make a difference.

One way to address this head-on is to provide training for clinicians through third-party sources. For example, the Transcultural Nursing Society provides a wealth of resources about implicit bias (including a certification program) and Harvard University offers its Outsmarting Implicit Bias online course to both individuals and teams.

2. Address Microaggressions and Unfair Assumptions

It’s important to take all reports of injustice seriously. Whether the report was made by a member of staff or a patient receiving care, it’s important to show all stakeholders that you’re committed to removing unconscious bias in your organization.

Make it easier for individuals to file a complaint by addressing instances of implicit bias in your facility’s safety event reporting system. Allowing individuals to file a report anonymously can help reduce fear of retaliation, exclusion, or blame.

While overt acts of bigotry or discrimination should never be tolerated, it’s important to remember that unconscious bias typically isn’t intended to hurt or offend. Instead of punishing individuals who acted on or displayed inappropriate bias, counsel staff members on how to correct their actions and prevent similar assumptions from impacting future care.

Since implicit bias in healthcare facilities often goes unnoticed by staff, it may be helpful to send surveys to patients with questions specifically aimed at assessing these issues. Examples of questions include:

• “Do you believe you received fair and inclusive care?”
• “Were you treated with dignity and respect throughout your visit?”
• “Do you believe that your concerns were taken seriously?”
• “Were your cultural, religious, and personal preferences respected during your care?”
• “Do you feel that the care you received was free from bias, whether explicit or implicit?”

3. Establish a Diversity, Equity, and Inclusion (DEI) Committee

A healthcare DEI committee guides care improvement initiatives, policy creation, and recruitment efforts that focus on addressing unconscious biases and health disparities. Successful DEI programs have been known to increase employee engagement, improve productivity, and boost patient satisfaction scores.

Remember that high-quality care isn’t limited to the confines of a hospital room — patients monitor your ability to provide respect in the parking garage, cafeteria, and lobby as well. When developing your facility’s DEI committee, include members from clinical, administrative, and support positions to get a well-rounded perspective that drives change in all levels of your organization.

4. Promote Racial and Cultural Diversity on Leadership Teams

Building a diverse leadership team is essential to developing an inclusive culture in your organization. Patients won’t believe that your organization is dedicated to reducing implicit bias in healthcare if your leadership team is homogenous and unrepresentative of the populations you serve and employ. Show patients — and staff — that you desire input from individuals of all cultures and backgrounds during the decision-making process.

Additionally, building diverse teams can bring in fresh ideas for solving your facility’s problems. Allowing different voices to be heard ensures that business strategies meet the expectations and desires of all patient groups, promoting the success of growth initiatives and marketing strategies.

5. Reduce Caregiver Stress and Burnout

Studies show that caregiver stress and burnout often decreases care quality and increases a provider’s risk of acting on implicit biases. The fast-paced nature of the healthcare industry forces providers to perform quick decision-making and situational judgment, exacerbating unconscious bias.

Allowing providers the time and energy to connect with their patients can alleviate the risks of unconscious bias and can help foster trust and engagement within an organization. Create relaxation rooms for employees to rest while on a meal break and provide a generous wellness benefits package to empower them to perform at their best.

Discover More Ways to Provide Compassionate Care

Understanding the effects of implicit bias in healthcare can help you facilitate healthcare justice, improve patient satisfaction, and boost engagement. Check out our expert insights for additional healthcare resources and guides for promoting equity within your organization.