Navigating Bias in Healthcare

Self-awareness: To solve a problem, one must first be aware of it.

Background

Team members smiling with hands together in a huddle, with the camera angled below their hands.
Image Source: UMN Storyblocks

Bias is a universal phenomenon by which individuals make a positive or negative assessment of something, whether they are consciously aware of it or not. Just as alluded to by Tom Brokaw, “Bias, like beauty, is often in the eye of the beholder…”1 Our situational assessments are influenced by myriad factors including those hard-wired from our evolutionary as well as historical past, those influenced by our social and cultural environments, and those embedded into the ‘hidden curriculum.’

Dual Process Theory of Decision Making suggests that there are two types of decision-making processes.2
Type 1: The dominant process that involves fast, intuitive decisions often relying on ‘mental shortcuts’ and is, therefore, more prone to bias.
Type 2: This process requires more cognitive energy through slow, methodical thought.

Implications for Interprofessional Teams in Healthcare

Healthcare is not immune to bias, especially because we often find ourselves in fast-paced, high stress environments where we may be stretched thin and feeling cognitive overload. These environments can exaggerate the reliance on Type 1 decision-making, whereby we surrender to our implicit biases, and devastating outcomes can occur. Not only does this lead to disparities in patient health outcomes directly, this also impacts interprofessional collaboration and team communication, thereby worsening patient outcomes further.3

Possible Solutions

Undoubtedly, methods of addressing this behemoth that often bedevils healthcare systems should be identified and deployed at every opportunity. While none of the following suggestions are a panacea for this problem, their use in combination could help tackle the issue. Notably, many of these methods are applicable to healthcare workers as well as patients. Bias is not solely within the purview of any one group of healthcare professionals or patients; all are human and fallible.

Self-awareness: To solve a problem, one must first be aware of it.

One way of improving self-awareness is to commit quality time to learning and talking about bias. Indeed, some may consider this a primary activity that must be done. This could entail: participating in seminars, workshops, community gatherings, workplace ice-breaking events, and so on.

Everyone should deliberately promote equity and egalitarianism. It is important that we all reconsider the appropriateness of “gut-feelings” and instincts. Rather than being completely instinctive, we should consciously review our actions, while seeking others’ perspectives. Thus, we are more likely to make decisions that minimize bias.

Some have also recommended writing daily reflections, which requires a mental review of the day, identifying when bias played a negative role, determining what to do differently to improve outcomes, and consciously incorporating this in the future.

Policymaking: Policies are the pedestals.

Policies promote behaviors congruent to the beliefs, values and goals of an organization or society. Without appropriate policies, visions often die with their champions. Importantly, workplaces should have regulations that lessen negative bias and its effects. Such policies include having mandatory continuous education sessions that address bias, establishing communication strategies that encourage people to discuss bias, and having anonymous reporting channels for victims of bias, among other strategies.

Ice-breaking: Without the ice thawing, fluidity remains a mirage.

Ice-breakers are generally fun team-building activities that foster unity and a sense of togetherness among diverse groups of people. They help people share experiences, learn about one another and boost trust. Thus, participants will discover that they have more in common than initially thought. Having events with people from different healthcare professions is a great option, enabling workers to spend time together without the workplace pressure, find common ground, and gain mutual respect and understanding.

Conclusion

The cost of unbridled bias can be monumental. Bias obviates patient-centeredness in a dramatic fashion. How can we deliver reliable healthcare as a fragmented team, or meritoriously manage a patient against whom we are biased? Aside from monetary or fiscal costs, it may cause irreparable damage, loss of trust, and ultimately, loss of lives. Without making deliberate efforts to stem the tide of uncontrolled bias, the future is grim. Notably, the steps needed to control bias are attainable and will certainly cost less than the alternative. The fight against unrestrained bias in healthcare or any other sphere, is one that requires urgency, and the time is now.

References

  1. Top 40 Tom Brokaw Quotes (2024 update).  https://quotefancy.com/quote/1107430/Tom-Brokaw-Bias-like-beauty-is-often-in-the-eye-of-the-beholder-Facts-are-your-firewall. Accessed 03/08/2024. 
  2. Croskerry, P., Singhal, G., & Mamede, S. (2013). Cognitive debiasing 1: Origins of bias and theory of debiasing. BMJ Quality & Safety, 22(Suppl 2), ii58–ii64. https://doi.org/10.1136/bmjqs-2012-001712
  3. Gopal, D. P., Chetty, U., O’Donnell, P., Gajria, C., & Blackadder-Weinstein, J. (2021). Implicit bias in healthcare: Clinical practice, research and decision making. Future Healthcare Journal, 8(1), 40–48. https://doi.org/10.7861/fhj.2020-0233