Understanding Implicit and Explicit Bias in Healthcare

Cultural Competence (definition)

Interacting with diverse people in a way that takes into account the differences in attitudes, beliefs, and assumptions.

What are characteristics of implicit bias?

Expressed indirectly, individual is unaware, unintended, difficult to identify, spontaneous.

What are characteristics of explicit bias?

Expressed directly, individual is aware, deliberate, easy to identify, planned to harm or discriminate.

Implicit Bias (definition)

Unknowingly showing a preference for one thing, person, or group unconsciously and without intent.

Explicit Bias (definition)

Purposely consciously and deliberately showing a preference for one thing, person, or group.

Affinity Bias (definition)

Similarity bias (another name for implicit bias)

Ex. Trevor has red hair and consistently shows favoritism towards other people with red hair

What are the characteristics of physical bias?

Discrimination against how a person looks: weight, height, skin color, birthmarks, teeth, hair, tattoos, piercings, etc.

Ex. More black women die during childbirth than any other race and ethnic groups

What defines culture?

-Language, stories, customs, assumptions, beliefs, values

-Culture is implicitly understood and affects how a person acts without fully understanding its influence

Describe cultural diversity

That different groups of people have different cultural traditions

What are the most important aspects of cultural competence?

Show

Humility

Accept

Listen

Learn

Types of Implicit Bias

Sexual orientation, gender, religious, age

Types of Explicit Bias

Physical, disease-based.

Marginalized (definition)

Disempowered

Ex. Black people in American are consistently marginalized by the judicial and criminal justice system

Acculturation (definition)

Assimilating

Ex. Since Joan came to DR from Italy, she started using local slang to fit in better among her peers

Immigrants and people in the LGBTQ community makes my job as a nurse more challenging. I always have to speak slower because of a language barrier or watch my words so the patients aren't offended.

Prejudice (judgement, opinion formed before any facts have been issued)

Altruism (definition)

Selflessness

Ex: Although Jordan only had $10 in his bank account, he gave a homeless person $5 for lunch

Cultural Diversity (definition)

A group that includes wide differences in stories, language, customs, beliefs, values, and assumptions.

Cultural Homogeneity (definition)

A group that includes few differences in stories, language, customs, beliefs, values, and assumptions.

Identify the characteristics of cultural competence

Show genuine interest in people

Humility- an individual should never assume they know all about a person or their culture

Accept differences in others

Listen to people’s stories and experiences

Learn about other cultures, places, and people

What is the importance of cultural competence?

-It is the ethical responsibility of the HHS professional to be culturally competent

-A culturally competent HHS professional will have important context to aid in making the best healthcare decisions

-Culturally competent HHS professionals have higher levels of satisfaction

-Culturally competent HHS professionals generally have more positive patient outcomes

Identify the importance of cultural competence

-Ethical responsibility

-Difference experiences

-Context is key

-Greater patient satisfaction

-Improves patient outcomes

Ethical Responsibility

Healthcare ethics is the collections of principles, or a sense of right and wrong, that guide HHS professionals in providing health services.

What are the overall effects of bias for patients or clients?

-HHS professionals' patient interactions and treatment decision, the patient's adherence to advice and instructions, and general outcomes.

-Some healthcare professional hold negative attitudes toward obese patients

Describe how bias can affect client outcomes?

-Poor treatment can lead to high levels of stress to avoiding treatment altogether, which leads to reduced health outcomes for patients

-Implicit racial bias can affect the amount of pain medication that clients receive

Ambivalent (definition)

Patients who have trouble making medical decisions.

What are the effects of physical bias on the access have to healthcare?

Certain groups of people may receive lower quality healthcare, which can lead to incorrect diagnoses, delayed treatment, or avoidance of treatment altogether.

Identify how bias affects clients access to care

-A transgender person may not feel welcome in a family practice and avoid going to the doctor's

-An African American does not receive necessary pain medication from a physician, that physician denies them medical care

-People who do not English may not receive proper care

-Some older clients avoid visiting healthcare providers because they do not know how to schedule online

Implicit or Explicit?

On average, an HHS professional provides less detail in explanations to older patients than to younger or middle-aged patients. The HHS worker seems surprised when asked about this trend and initially denies the claim.

Implicit bias

Implicit or Explicit?

An HHS professional tells an overweight patient to lose weight, even though the patient's weight is unrelated to the current health issue.

Explicit bais

Analyze why cultural competence is important?

-Ethical responsibility

-Difference experiences

-Context is key
Greater patient satisfaction

-Improves patient outcomes

Identify how bias affects client/patient outcomes and access to care?

Bias can negatively affect client outcomes and clients care access, which leads to patients avoiding care and potentially worsening their condition or conditions.

Microaggressions

A subtle, everyday action or comment that communicates bias or prejudice toward a marginalized group (backhanded compliment)

Ex. You’re smart for a women

Prejudice

An unreasonable or unfair opinion or feeling about a person or group, often based on characteristics like race, sex, or religion

Ex. Joe said that women should kept at home

Cultural Sensitivity

Being aware of and respecting differences between cultures, recognizing that one culture is not inherently better than another, and adapting your behavior to accommodate those differences

Ex. Offering translations or materials in multiple languages; Making information accessible to people who may not speak the dominant language.

Cultural assimilation (definition)

Integrating into another culture

Ex. Christina traveled to Nepal and left with strong ties to the culture that she has adopted Samara

If a client says, "Wow, I've done so much travelling this month! I was in Baltimore, Maryland and visited a town called Little Italy. Then, I drove down to the District of Columbia and there was section called Chinatown. It was so wonderful to see how a whole group can be recognized in one space". These would be an example of:

Cultural homogeneity (same/similar culture)

Hector is from Honduras and is sharing his upbringing with the nurse. The information that Hector shared better prepared the healthcare team to provide him optimal care as they were able to understand his cultural beliefs, which changed the course of direction for his care. This is an example of:

Listening to patient stories

An organization that celebrates many diverse holidays to include Black History month, Hispanic Heritage month, Easter, Hanukkah, Yom Kippur and winter Solstice practices:

Inclusicity

If a resident says, "I just diagnosed the patient in room 3 with stomach cancer. It's awfully sad. He has a family and is already in stage 3. If only they would stop eating so much rice". This is an example of:

Disease-based bias

Ms. Popov is attending a health career fair seeking to employ minorities. What is this considered?

Diversity recruitment

What is implicit bias?

Showing a preference for a person or group unconsciously and without intent

Which example demonstrates explicit bias?

An HHS professional says that members of a certain race cannot understand healthcare instructions

This is an example of explicit bias, as the HHS professional verbally acknowledges the bias. Explicit bias must include which of the following?

BE an intentional action

Enzo recently moved to the United States from Italy. He visits a healthcare provider and tries to explain why he is there to the health and human services (HHS) professional at the desk. While Enzo speaks English, he does not speak fluently, and it takes him a long time to express what he wants. When he returns to his seat in the waiting area, he hears the HHS professional at the desk say to their colleague, "If people immigrate here, they need to speak English, or they should go back where they came from."

Which type of bias did Enzo experience?

Explicit bias

A new employee, who does not celebrate Christmas, complains to their supervisor that they felt uncomfortable after being forced to sing Christmas carols with their coworkers. The supervisor apologizes and assigns the employee to complete custodial work during future Christmas activities so they will not have to participate.

What is happening in this scenario?

The new worker is being marginalized.

A transgender patient visits a healthcare provider and explains that their desired pronouns are they/them. The technician rolls their eyes and states to their colleague that they are tired of people talking about their preferred pronouns. The patient overhears the technician while seated in the waiting room.

Which type of bias did the patient experience?

Explicit bias

What is the similarity in the constructs of Bias and Culture?

These are implicitly understood

A clinic manager creates a space in the office to allow patients to come and go as needed to discuss various issues, concerns, or comments regarding the care they receive at the clinic.

Which characteristic of cultural competence did the clinic manager demonstrate?

Listening to patient's stories

An African-American child presented with difficulty breathing and shortness of breath. The team of physicians were reviewing the patient's X-rays and struggled to determine a diagnosis. Another physician looked at the X-rays and identified the ailment as cystic fibrosis. The team was shocked as the diagnosis is more prominent in Caucasians versus African-Americans.

Which term supports this case?

Implicit bias

The tendency to favor or dislike something without good reason. Unfriendly feelings directed against an individual, a group, or a race. Based on someone's race, gender, nationality, social status, sexual orientation, or religious affiliation.

Which term reflects this description?

Prejudice

Members of a minority group are absorbed by the dominant culture, taking on the characteristics of the dominant culture.

Which of these supports this statement?

Cultural assimilation

A 36-year-old Hispanic male client presents to the local emergency room. The client is wearing a hoodie while walking through the hospital. A healthcare staff member asks him to remove the hoodie because it makes other patients uncomfortable. He continues walking around and ignores the directive.

What concept is reflective of the staff member's actions?

Implicit bias

Which situation is present when unconscious biases are activated due to exhaustion, big decisions, or sensitive situations?

High pressure

What is the level of bias in Health and Human Services (HHS) professionals compared to the general public?

HHS professional have similar levels of bias

The Child Life Specialist (CLS) schedules time with a client to discuss specifics within a report. The CLS shows genuine interest and is actively engaged.

Which cultural characteristic is the CLS demonstrating to the client?

Demonstrating interest in people