Building a Culture of Diversity, Equity, and Inclusion in Health Care
Implicit bias can be a factor in almost any setting in our everyday lives. The ingrained responses we exercise based on how our brains subconsciously process information may lead us to act on unfair stereotypes, rather than forming an opinion based on facts. In a healthcare setting, this cognitive shortcut can have consequences well beyond misunderstanding and offended feelings. Increasingly, research is showing that implicit bias in medicine can negatively impact clinical outcomes and patient-provider relationships.
A recent study by researchers at the University of Chicago sought to quantify potential indicators of implicit bias in the healthcare environment. [i] They used machine learning to analyze 40,113 history and physical notes in the electronic health records (EHRs) of 18,459 patients seen at a large urban academic medical center in Chicago, Illinois, looking for certain negative descriptors applied to the patient or to the patient’s behavior. When controlled for sociodemographic and health characteristics, their findings showed that Black patients had 2.54 times the odds of having at least one negative description in their health records compared to White patients.
What the Researchers Looked For
The study authors selected fifteen “negative descriptors” to include in their analysis. These were: (non-)adherent, aggressive, agitated, angry, challenging, combative, (non-)compliant, confront, (non-)cooperative, defensive, exaggerate, hysterical, (un-)pleasant, refuse, and resist. Next, they looked at the way the term was used, whether positive, negative, or out of context. For example, positive use of one of the listed terms could be “[the patient] is calm and cooperative with the interview,” while a negative one would be “[the patient] is non-adherent with her medication.” An out-of-context reference applied one of the terms to something other than the patient or their behavior.
In the study, they noted that they chose the history and physical note for the analysis because “it is intended to document a comprehensive narrative about a patient and because other providers extract relevant information from it for inclusion in their own chart notes, such as progress notes or discharge summaries.” Thus, it can be reasonably expected that language included in this part of a patient’s chart wouldn’t only reflect the attitude of the provider who made the note but could also influence treatment the patient received from subsequent providers who read it.
While the researchers noted limitations in their study, including the fact that it derived its data from patients at only one facility, the disproportionate number of negative comments in the records of Black patients was clear. The authors noted the critical importance of implicit bias training for healthcare providers “to identify, prevent the introduction of, and discontinue use of negative descriptors in the EHR” to avoid amplifying and transmitting bias throughout a patient’s healthcare journey.
In California, legislators have already recognized the insidious danger that implicit bias in medicine can pose. To combat this, AB 241 now requires that licensed medical professionals receive instruction in the understanding of implicit bias in medical treatment as part of their continuing education requirement. The goal is to reduce the impact that unconscious bias based on race, ethnicity, gender identity, sexual orientation, disability, and other inherent characteristics has both on the willingness of patients to seek care and on the treatment and outcomes they experience when they do.
Unlike overt prejudice, implicit bias influences behavior without the person acting being consciously aware of it. Awareness is the tool we need to understand how implicit bias can come into play and to act in ways that promote better treatment and outcomes. But it can be hard for individuals to recognize it in themselves, especially when they do not consciously hold prejudiced views.
Bridge Training Consultants offers AB 241 training that goes beyond merely meeting the statutory requirements of the bill. We get attendees engaged and participating through humor, offering a non-judgmental environment to explore the concept of implicit bias and guide self-discovery. We offer both remote and in-person training options for your organization to complete its required training in the mode best suited to your needs. To find out how we can help you meet your AB 241 requirements with effective training, contact Bridge Training Consultants today.