Self-Awareness With knowledge of the development and process of implicit bias as a foundation, a pause-and- reflect approach can increase the occasions when providers deliberately take a few moments to reflect on their thoughts and behaviors when interacting with a patient and/or making an important decision. Pausing allows for a few seconds to reflect on the kinds of associations that they may be making as the patient walks through the door based on the way they’re dressed, their gender, their race, or any other characteristic. Discovering personal tendencies or becoming aware of an area of personal bias can help in modifying communication, where necessary. Such self-awareness can prompt providers to focus on seeing a given patient as an individual (individuation) and trying to see things from the patient’s perspective (perspective taking). Organization Systems and Processes Implicit bias can play a key role in fostering and reinforcing systems of inequities in hiring and promotion. Race, gender, accent, weight, etc. are factors that not only impact implicit bias in patient care but can also influence hiring and promotion decisions. Mitigating unconscious bias in rewards and recognition, as well as in selection decisions, is of critical importance in the work to increase the diversity of medical students, clinical providers, researchers, managers, and senior healthcare providers. Cues and Reminders Information about implicit bias as well as motivation to reflect on personal biases can begin to fade months and even weeks after the initial intervention. Strategies to stimulate recall or remind providers about the work to mitigate implicit bias can be useful. Key words or phrases on the treatment room computer screen or even a specially designed screen saver can be used as a reminder. A mobile phone background can contain a photo or a word that serves as a reminder every time the provider uses the phone. Changing the photo or word periodically can help to avoid habituation. The inside cover of a folder containing CVs can list key phrases to remind search committee members to avoid bias in the screening process. Disparities in access to and delivery of health care services As it is quite apparent that disparities in healthcare exist, The Department of Health and Human Services intends to directly address this inequality in the next four years. It has posted a draft of its strategic goals for the fiscal years 2022- 2026, and impartial access to healthcare is of particular interest. The first of the five stated goals are to “Protect and Strengthen Equitable Access to High Quality and Affordable Healthcare”. 45 As part of this goal, one strategic objective specifies an intent to “expand equitable access to comprehensive, community-based, innovative, and culturally- competent healthcare services while addressing social determinants of health”.
They describe improved access to health-related services for an underserved population through the removal of barriers to access, a reduction in disparities in healthcare, and support of community- based services. An increase in healthcare facilities, a more diverse healthcare workforce and collaboration with cultural and community services can all contribute to improvements in access disparities. 46 Chin et al provided specific suggestions for community involvement through school-based care, household outreach, and religious based care delivery. Members of the community may be involved as peer coaches, peer educators and patient care navigators to enhance use of healthcare services. Educational material intended to address specific cultural perspectives can target unique characteristics of the community and, “open door” clinic policies and streamlined referral processes may contribute to an increase in patient participation. Chin et al also suggest that reduced out of pocket costs, or free giveaways can serve as financial incentives to improve participation in healthcare services. Lastly, psychological services and support through family therapy, motivational interviewing and counseling can help to encourage access to additional services and care. 47
Conclusion
The history of race and racism in America is central to the development of racial implicit bias across various sectors of our society and is a major contributor to racial healthcare inequities. However, we must not lose sight of the intersection of implicit bias and gender, sexual orientation, weight, race, and other individual and group characteristics. Our patients bring their unique physical condition, their intersectional identity, and, in many cases, significant time, living within the ingrained structures, attitudes, and beliefs of this nation. It’s our responsibility to not only engage what we are consciously aware of but also work to uncover personal and organizational biases that impede our movement towards a healthcare environment and society of true equity and the highest quality care.
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