Implicit Bias in Health Car ____________________________________________________________________
A group of physicians congregate to examine a child’s x-rays but has not been able to reach a diag- nostic consensus. Another physician with no knowl- edge of the case is passing by, sees the x-rays, and says “Cystic fibrosis.” The group of physicians was aware that the child is African American and had dismissed cystic fibrosis because it is less common among Black children than White children. The purpose of this course is to provide health professionals an overview of implicit bias. This includes an exploration of definitions of implicit and explicit bias. The nature and dynamics of implicit biases and how they can affect health outcomes will be discussed. Finally, because implicit biases are unconscious, strategies will be reviewed to assist in raising professionals’ awareness of and interventions to reduce them.
HOW TO RECEIVE CREDIT • Read the entire course online or in print. • Depending on your state requirements you will be asked to complete: ‒ A mandatory test (a passing score of 75 percent is required). Test questions link content to learning objectives as a method to enhance individualized learning and material retention. • Provide required personal information and payment information. • Complete the mandatory Course Evaluation. INTRODUCTION In the 1990s, social psychologists Dr. Mahzarin Banaji and Dr. Tony Greenwald introduced the concept of implicit bias and developed the Implicit Association Test (IAT) as a measure. In 2003, the Institute of Medicine published the report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care highlighting the role of health professionals’ implicit biases in the development of health disparities [1]. Today, some states have passed legislation requiring certain health professionals to take implicit bias training. This ultimately sends a message that biases, racial inequities, and disparities continue to exist in the healthcare system and should be addressed [39]. The phenomenon of implicit bias is premised on the assumption that while well-meaning individuals may deny prejudicial beliefs, these implicit biases negatively affect their clinical communications, interactions, and diagnostic and treatment decision-making [2; 3]. One explanation is that implicit biases are a heuristic, or a cognitive or mental shortcut. Heuristics offer individuals general rules to apply to situations in which there is limited, conflicting, or unclear information. Use of a heuristic results in a quick judgment based on fragments of memory and knowledge, and therefore, the decisions made may be errone- ous. If the thinking patterns are flawed, negative attitudes can reinforce stereotypes [4]. In health contexts, this is problematic because clinical judgments can be biased and adversely affect health outcomes. The Joint Commission provides the follow- ing example [3]:
DEFINITIONS OF IMPLICIT BIAS AND OTHER TERMINOLOGIES
IMPLICIT VS. EXPLICIT BIAS In a sociocultural context, biases are generally defined as nega- tive evaluations of a particular social group relative to another group. Explicit biases are conscious, whereby an individual is fully aware of his/her attitudes and there may be intentional behaviors related to these attitudes [5; 101]. These individuals are generally uninterested in changing their biases [102]. For example, an individual may openly endorse a belief that women are weak and men are strong. This bias is fully conscious and is made explicitly known. The individual’s ideas may then be reflected in his/her work as a manager. FitzGerald and Hurst assert that there are cases in which implicit cognitive processes are involved in biases and con- scious availability, controllability, and mental resources are not [6]. The term “implicit bias” refers to the unconscious attitudes and evaluations held by individuals. These individu- als do not necessarily endorse the bias, but the embedded beliefs/attitudes can negatively affect their behaviors [2; 7; 8; 9; 102]. They are automatically activated, and an individual may not even be aware that these biases affect their behaviors and communication patterns [101]. Some have asserted that the cognitive processes that dictate implicit and explicit biases are separate and independent [9]. Implicit biases can start as early as 3 years of age. As children age, they may begin to become more egalitarian in what they explicitly endorse, but their implicit biases may not necessar- ily change in accordance to these outward expressions [10]. Because implicit biases occur on the subconscious or uncon- scious level, particular social attributes (e.g., skin color) can quietly and insidiously affect perceptions and behaviors [11]. According to Georgetown University’s National Center on Cultural Competency, social characteristics that can trigger implicit biases include [12]:
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