STRATEGIES TO DISRUPT IMPLICIT BIAS
Individuation The health care provider mindfully seeks to see patients as individuals instead of as members of a stigmatized group. This is related to therapeutic relationships, patient-centered care, and culturally competent care. Mindfulness The health care professional purposely takes the time to calm thoughts and feelings by being mindful of the present moment, which can help the health care provider act compassionately toward the patient. This is related to emotional regulation and perspective taking. Partnership Building The clinician intentionally frames the clinical encounter as one in which the health care provider and patient are equals, working collaboratively toward the same goal. Perspective Taking The health care provider purposely and empathetically thinks about what the patient is thinking and feeling, stimulating feelings of care and compassion. This is related to mindfulness and therapeutic relationships. Stereotype Replacement The health care professional reflects on negative reactions to members of vulnerable populations, acknowledges biased responses, considers the reason for the feeling, and commits to responding with compassion in the future. This is related to self-reflection.
Counter Stereotypic Imaging The health care professional, recognizing bias, purposely identifies members of a group who counter the stereotypical image of the group, and replaces the automatic biased image with the positive image. This is related to mindfulness. Emotional Regulation The health care professional reflects on “gut feelings” and negative reactions (dislike, fear, frustration) to patients from vulnerable groups. The health care professional then intentionally strives to be empathetic, patient, and compassionate. This is related to mindfulness and The health care professional frames recognized biases as bad habits to be broken. They develop and use a personal toolkit of self-interventions to replace the bad habit of biased thinking with the good habit of accepting and caring about each patient as an individual. This is related to emotional regulation, individuation, mindfulness, and strategies health care professionals use to help patients change harmful lifestyle behaviors. Increasing Opportunities for Contact The health care professional seeks to develop relationships with members of a group to which the health care professional does not belong, with the goal of dissolving stereotypes. perspective taking. Habit Replacement
DISPARITIES IN ACCESS TO AND DELIVERY OF HEALTHCARE 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 fiscal years 2022–2026, and impartial access to healthcare is of particular interest. The first of the five stated goals is to “Protect and Strengthen Equitable Access to High Quality and Affordable Healthcare.” 44 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. 45 Chin and colleagues 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 the 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 and colleagues 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. 46
DISCOVERY IS THE FIRST STEP: INDIVIDUAL WORK AND REFLECTION
Confronting a microaggression sets a norm that the behavior isn’t acceptable, so people are less likely to do or Harvard’s Implicit Association Test (IAT) These are personal and private evaluations where no personal information is shared. There are a wide variety of evaluations that include topics such as sexuality, race, religion, transgender individuals, disability, and skin tone. There is no cost to complete one or more of the tests. Users will be able to see how their evaluation compares Responding to Microaggressions Ask for clarification: “Could you say more about what you mean by that?” “How have you come to think that?” Separate intent from impact: “I know you didn’t realize this, but when you __________ (comment/behavior), it was hurtful/offensive because___________ .” “Instead, you
say something similar.
with others who are similar to themselves. This is a free and open access tool that allows each of us to discover hidden cognitive biases. www.glaxdiversitycouncil.com/resources/harvard-implicit- association-test-iat/2
could___________ (different language or behavior).” Share Your own process: “I noticed that you ___________ (comment/behavior). I used to do/say that too, but then I learned____________.”
Book Code: PCIL1525
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