Addressing implicit bias in health care can improve care delivery

You might have heard that implicit bias plays a role in how health care is delivered in doctor’s offices, hospitals and other health care settings. But what exactly is meant by implicit bias?

Implicit bias refers to the attitudes, stereotypes and generalizations that affect our understanding, actions and decisions in an unconscious manner. It often results in  prejudices in favor of — or against — a thing, person or group.

“All human beings are wired to have bias, and biases are often based on assumptions and stereotypes that are learned over time,” explained Bridget Hurd, vice president of Inclusion and Diversity for Blue Cross Blue Shield of Michigan. “These unrealized or unconscious beliefs can affect our decision-making.”

In a health care setting, implicit bias can have dangerous consequences.

“Every medical professional is mission-driven to heal their patient, but research indicates that bias shows in various ways in the delivery of health care — more often implicitly rather than explicitly,” said President and CEO Daniel J. Loepp in a recent blog “It benefits all medical professionals to spend time working to recognize where implicit bias may be present in the delivery of care and developing approaches to address it to the benefit of patients everywhere.”

Consider these examples:

• Non-white patients presenting to the emergency room with the same symptoms as white Americans are less likely to receive pain medication, according to an article in Physician’s Weekly.

• An article published in the National Academy of Sciences reported that a survey of white medical students in 2016 showed that many had false beliefs about the biological differences between Blacks and whites, leading to different treatment recommendations.

• Early in the COVID-19 pandemic, reports indicated that African-Americans with concerning symptoms weren’t tested as often as their white counterparts, according to a review of billing information conducted by a biotech data firm.

Creating widespread understanding of these disparities in how health care delivery differs based on implicit bias is the first step in successfully addressing this issue.

That’s why Blue Cross is rolling out implicit bias education to health care providers over the next two years. It covers such topics as the science of bias, how it influences behaviors and patient outcomes, and how to make efforts to overcome implicit bias.

In September, leaders and staff at 40 physician organizations that participate in the Physician Group Incentive Program were introduced to implicit bias education. Next, it’s being rolled out to patient-centered medical home physicians and office staff.

“Creating awareness among physicians and office staff is an important step in building cultural competency and addressing gaps in care that may occur due to biases related to race, ethnicity, gender, sexual orientation, obesity or socioeconomic status,” said Hurd, who is leading the new Office of Health and Health Care Disparities.

Practices with PCMH designation will be required to take part in implicit bias educational opportunities this year to continue to receive value-based reimbursement tied to the PCMH designation.

Additionally, Gov. Gretchen Whitmer announced a directive last year that requires medical professionals to go through implicit bias training when obtaining or renewing their licenses.