Question

what does the organization base the criteria on in discriminating….that is where job analysis, job description, and KSAOCs come in. For the discrimination to be legal the criteria must be based on KSAOCS that are in the description, which are derived from the job analysis. Then of course you document, document, document your process. The challenge may not be discrimination per se, but unconscious bias which could lead to disparate impact. I do believe everybody has them…the challenge is to recognize them and moderate them. What do you think about unconscious bias? Have you read anything in the healthcare literature that mentions it? How might that affect quality of healthcare?

Answer 1

1)WHAT IS UNCONSCIOUS BIAS?

*Every moment, your brain processes incredible amounts of information. This processing allows you function: to make decisions and take actions.

*The majority of this goes on behind the scenes, a necessary efficiency that means you don’t have to “think” about most of your activity. For example, the minute calculations your brain makes to accomplish simple things, like walking across the room to open a door. Or more complicated things, like assessing a fellow human being.

*Your brain is able to process situations quickly because it relies on what it already knows—or thinks it knows. Your memories help your brain categorize and sort information so it can be quickly analyzed without your awareness. All of your experiences and impressions inform your current actions, and help your brain make automatic conclusions.

* Unconscious (or implicit) bias occurs when this automatic processing is influenced by stereotypes, and therefore those stereotypes impact your actions and judgments.

*What are stereotypes?

• A stereotype is a belief that associates a group of people with certain traits or characteristics.
• A stereotype is a prejudgement of a person, based on a group s/he may be associated with.
• Stereotypes tend to be fixed and oversimplified images or ideas.

UNCONSCIOUS BIAS IN HEALTHCARE SETTINGS

*In medical school, doctors are taught that their personal backgrounds, and the characteristics of their patients, should be excluded from clinical decisions. But in reality, healthcare providers are just as susceptible to unconscious bias as the rest of us. Many non-medical factors influence medical decisions, including a patient’s style of dress, their race, ethnicity, and gender, their insurance status, and the clinical setting (i.e. “bad neighborhood” versus “good neighborhood”). .

*Unconscious bias can lead to false assumptions and negative outcomes. This is especially dangerous in healthcare, where decisions can mean life or death.

*unconscious bias leads to negative outcomes for minority groups in healthcare settings. This in turn contributes to health disparities, in which certain groups experience inequalities in the provision of and access to healthcare.

Examples of unconscious bias leading to health disparities include:

• White male physicians are less likely to prescribe pain medication to black patients than to white patients.
• Doctors assume their black or low-income patients are less intelligent, more likely to engage in risky behaviors, and less likely to adhere to medical advice.
• Pregnant women face discrimination from healthcare providers on the basis of their ethnicity and socioeconomic background.
• Women presenting with cardiac heart disease (CHD) symptoms are significantly less likely than men to receive diagnosis, referral and treatment, due to misdiagnosis of stress/anxiety.

Health disparities are often considered to be a racial or ethnic issue, but people are subject to unconscious bias based on many factors, including:

• Sex
• Sexual identity
• Socioeconomic status
• Education level
• Age
• Disability
• Geographic location

2)How does bias affect healthcare?

* “stereotyping, biases and uncertainty on the part of healthcare providers can all contribute to unequal treatment.” Moreover, even white clinicians who don't believe they are prejudiced “typically demonstrate unconscious implicit negative racial attitudes and stereotypes.”

*Health disparities impact everyone, not just the groups that are discriminated against. Disparities limit the quality of health for the broader population as well, by curbing innovation and reducing overall quality of care.

*There are vast social, moral, and fiscal implications that will only become more pertinent as our population diversifies. It’s imperative that we address the root causes of health disparities, which include social determinants like education and poverty, and are compounded by unconscious bias on the part of healthcare providers.

*Unconscious bias describes associations or attitudes that unknowingly alter one’s perceptions and therefore often go unrecognized by the individual, whereas conscious bias is an explicit form of bias that is based on one’s discriminatory beliefs and values and can be targeted in nature .

*While neither form of bias belongs in the healthcare profession, conscious bias actively goes against the very ethos of medical professionals to serve all human beings regardless of identity.

*Conscious bias has manifested itself in severe forms of abuse within the medical profession. One notable historical example being the Tuskegee syphilis study, in which black men were targeted to determine the effects of untreated, latent syphilis. The Tuskegee study demonstrated how conscious bias, in this case manifested in the form of racism, led to the unethical treatment of black men that continues to have long-lasting effects on health equity and justice in today’s society .

*There is still debate, however, about the degree to which unconscious bias affects clinician decision-making. In one systematic review on the impact of unconscious bias on healthcare delivery, there was strong evidence demonstrating the prevalence of unconscious bias (encompassing race/ethnicity, gender, socioeconomic status, age, weight, persons living with HIV, disability, and persons who inject drugs) affecting clinical judgment and the behavior of physicians and nurses toward patients .

*However, another systematic review found only moderate-quality evidence that unconscious racial bias affects clinical decision-making . A detailed discussion of the impact of unconscious bias on healthcare delivery is out of the scope of this article, which is focused on the impact of unconscious bias as it relates to healthcare professionals themselves. Nevertheless, strategies to mitigate the effects of unconscious bias can be applied to healthcare delivery and patient interaction.

OVERCOMING UNCONSCIOUS BIAS IN HEALTHCARE

*Acknowledging that unconscious bias exists is an important first step to overcoming it. Nobody wants to believe they’re part of the problem. When you think about stereotyping, your first reaction is probably “not me!” But when you start to identify stereotypes that are prevalent in our culture, you’ll realize how many you’ve been exposed to and how insidious they can be.

Strategies to overcome unconscious bias:

1. Recognize stereotypical thinking
2. Replace biases and assumptions
3. Understand the individual
4. Explore a new perspective
5. Increase opportunity for positive contact

*Overcoming unconscious bias isn’t easy. It’s a lifelong process that requires time and attention. The best way to start, as an individual or organization, is with a proven framework—such as a cultural competency training and education program.

*We didn’t develop our unconscious bias alone, and we can’t vanquish it alone. Rather, our ideals must be reflected in our broader culture, until the person-centered approach to communication is the new normal. Nowhere is this effort more important than in healthcare, where inequality and discrimination are a matter of life and death.