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CULTURAL BIAS IN HEALTHCARE
Beth Washington
Director, Diversity & Inclusion
Bronson Healthcare
Jennifer Carpenter
Staff Development Instructor
Bronson Healthcare
We have no disclosures.
Disclosures
• Become aware of your own thoughts about the variety of differences of the people with whom we interact.
• Define culture and bias.
• Discuss the impact of cultural bias on health outcomes.
Objectives
Agree or Disagree?
• I know my own mind.
• I am able to assess others in a fair and accurate way.
Culture
Cultural Layers, Cognitive Associations and Conflict
Family
Age
Personal Experiences
Recreational Habits
Religion
Organizations
Profession
Language
Income
Geography
Neighborhood
Gender/Sexual Identity
Appearance
Sexual Orientation
Race
Ethnicity
Bias
• A process where you prefer one thing over another thing.
– Find order, group things, create structure
– Efficiently move from analysis to action
Hidden - Unconscious - Implicit Bias
• A process where you unknowingly prefer one thing over another thing
• Implicit Associations
“Mindbugs” How are prejudices, biases, and stereotypes like bugs?
Exclusion
Segregation Integration
Inclusion
Equal Justice (Fair, Equitable)
Language and Actions Reveal Mindbugs-Prejudice, Bias and Stereotypes
• “Immigrants don’t want to learn English.”
• “I don’t think of you as black anymore.”
• “Typical white male”
• “Statistics show that most criminals are black men, so be ready for Code Yellow.”
• “You are too young to understand.”
• “Smells like poverty.”
• “Let Jen work the holiday. She’s single; she doesn’t have family.”
Is this your ideal?
Is this your ideal?
Is this your ideal?
Is this your ideal?
Is this your ideal?
THE IMPACT OF IMPLICIT BIAS ON
PATIENT HEALTH OUTCOMES
What Triggers Our Bias? • Non-compliance
• Names
• Language/accent
• Literacy
• Financial status
• Age
• Weight
• Drug or alcohol use
• Smoking
• Pain
• Physical Disability
• Piercings
• Race
• Religion
• Sexual Orientation
• Tattoos
• Hygiene habits
• Personality type
• Food choices
• Assertiveness/Passiveness
• Mental Health Concerns
Your Bias is Showing…
• Behavior • Communication
• Clinical Decisions
• Greater physical distance between self and others
• Less eye contact
• Increased rate of blinking
• Decreased number of smiles
• Shorter length of encounter
Implicit Behaviors
• Dominant tone of voice • Less positive affect • Uninformed/stereotypical conversation choices • Increased speed of speech • Talking with a fake accent/or using incorrect
grammar
Implicit Communication
• Lower referrals to specialists
• Less likely to recommend preferred treatment
• Poor pain management
• Delayed treatment
• Delayed response of staff
Implicit Clinical Decisions
• Distrust in healthcare • Decrease adherence to prescribed treatment • Lower reported understanding of instructions • Decreased confidence in care provided
• Further exacerbation of health care disparities • Perception of discrimination/racism
• Lower patient satisfaction
Impact of Cultural Bias
True Story…
“I am black, my Mother In Law (MIL) is white. My son was in the hospital for 6 days. My MIL never left our side. All but 1 person talked to her… updated her… comforted her during this stay… I was devastated. They barely even acknowledged me, his mother!”
Photo Courtesy of Direct Relief on Flickr
True Story…
“My family is Jewish. Every time we go to the doctors during the holidays everyone asks about Christmas or Santa. I quickly inform them that we are Jewish. It gets awkward after that.” Photo courtesy of Steve Hardy on Flickr
“I walked in and introduced myself. ‘Hi, I’m…”
(Interrupted by family member of patient.)
“They already cleaned our room.”
“That’s nice, I’m Dr. Gomez.”
True Story…
True Story
“My 14 year old daughter was giving birth to my 1st grandchild. I was not happy about it but I was determined to get her through it. Everything went well. My grandbaby was born the nurse kept trying to teach me how to take care of the baby. I told her to teach my daughter not me. The nurse told me ‘Well we know who will be taking care of the child’ in a very snotty voice.” Photo courtesy of MabyCakes on Flikr
“The staff member walked up to the desk and individually asked everyone at the desk except for me ‘Are you caring for the patient in room ABC.’ I sat there and didn’t make a sound. They never asked me. Then they picked up the phone list to call the nurse… It was me. I answered the phone in my most professional voice.”
True Story…
“More Bias…More Problems”
Patient Outcomes
• Identify the behavior
• Seek facts
• Explore their perspective
• Address fears and answer questions
• Use your resources
Our Response to the Patient who Displays Bias
• Acknowledge the existence of bias in healthcare • Explore your personal bias • Be aware of your patients’ biases, concerns and
experiences • Seek commonalities between you and your
patients • Respect differences • Adhere to best practice
• Make a conscious decision to improve
Tips for Reducing Your Bias
Questions?
• Alegria, M., Vallas, M., Pumariega. (2010). Racial and Ethnic disparities in pediatric mental health. Child Adolesc Psychiatr Clin N Am October: 19(4): 759-774.
• Cassata, L., Dallas, C. (2005). Nurses’ attitudes and childbearing adolescents bridging the cultural chasm. The ABNF Journal. July/August.
• Flores, G. (2010). Technical report-racial and ethnic disparitie in the health and health care of children. Pediatrics :125(4).
• Hall, W., Chapman, M., Lee, K., et al. (2015). Implicit racial/ethnic bias amoung health care professionals and its influence on health care outcomes: a systematic review. American Journal of Public Health. December, Vol 105, No. 12.
• Levine C., Ambady, N. (2013). The role of non-verbal behavior in racial disparities in health care: implications and solutions. John Wiley and Sons Ltd. Medical Education, 47:867-876.
References
• Nagarajan, N., Boss, E. (2016) Are there racial disparities in family reported experiences of care in inpatient pediatrics. Clinical Pediatrics. Accessed 9/15/2016.
• Sabin, J., Greenwald, A. (2012) The influence of implicit bias on treatment recommendations for 4 common pediatric conditions: Pain, Urinary Tract Infection, Attention Deficit Hyperactivity Disorder, and Asthma. The American Journal of Public Health. May, Vol 102, No. 5.
• Stone, J., Moskowitz, G.(2011). Non-concious bias in medical decision making: what can be done to reduce it? Blackwell Publishing Ltd. Medical Education. 45: 768-776.
• The Joint Commission, Division of Health Care Improvement. Implicit bias in health care. (2016). Quick Safety, Issue 23. Accessed September, 2016 from https://www.jointcommission.org/issues/detail.aspx?Issue=7fvyBAznC%2bsEDo1YijE9nqske%2fa3R5sZnSmQ%2bDdUHG 0%3d
Link for IAT
References
Thank you! bronsonhealth.com
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