Is your organization offering implicit bias training? It’s important, and risky, work. In this episode, you’ll learn
- how implicit bias matters to disparities
- why facing bias is “risky business”
- three things to consider as your organization goes forward
Hi. This is 10 minutes to better patient communication. I’m Dr. Anne Marie Liebel. Recently, I was giving a talk about addressing unconscious or implicit bias in our language, at Columbia University’s Mailman School of Public Health. At the end, one of the questions I received from a participant was: “It sometimes take a lifetime to create those biases, that sometimes become innate. How do [we] unlearn those biases?”
I am continually inspired by the work of health providers and public health professionals in helping shape public discourse around some of the most pernicious and difficult issues facing society.
The high-profile nature of the Starbucks incidents give us a chance to locate current conversations of the role of implicit bias in health disparities within the context of public debates–about implicit bias, and about the ways organizations seek to address implicit bias.
In the spirit of continuing a cross-sector dialogue, and sharing in the goal of creating the conditions where everyone has the opportunity to reach their full health potential, I offer here some of what I’ve learned as an educator. I’m not trying to provide a fixed or proper way to address implicit bias. Rather, I’m sharing some topics you might want to think about if your organization is considering the issue of implicit bias.
As you know, historically, Americans have experienced variable access to care based on race, ethnicity, socioeconomic status, age, sex, disability status, sexual orientation, gender identity, and residential location (AHRQ 2016 National Healthcare Quality and Disparities Report).
Health disparities are due to many factors that are man-made. One of them is implicit bias. Recent research on implicit bias has shown how medical care, public health, and human service providers can unintentionally contribute to racial/ethnic health disparities. There are documented links between health care professionals’ implicit bias, and disparities in receipt of health care and in multiple clinical outcomes. These links extend to differences in health services offered and provided to minority populations. In terms of health research, implicit bias has been identified as a cause for underrepresentation of particular groups in public health and epidemiological studies, as well as in clinical trials.
As I’ve written before, some specializations and medical schools have made a goal of diversity and equity. Models, guidance, and theoretical orientations have been developed to address bias and stereotyping.
Yet reaching these goals, or actually following these various models, can be distressing and uncomfortable for those involved. The process of facing biases or stereotypes is, as education leader Marilyn Cochran-Smith pointed out years ago, “risky business.” It can be threatening to acknowledge that we live and participate in networks and systems geared to work better for some than for others; and that we have a place in maintaining these.
Yet some educators have been addressing racism and discrimination on individual and systemic levels for multiple decades. This work itself is built on years of sustained efforts of marginalized people from different race and class groups, who have focused national and international attention on issues of discrimination.
I don’t think there’s a researcher out there who would say, “Yes! a one-shot workshop would undo bias.” It’s probably safer to say there are researchers who would agree training can be helpful as part of larger efforts. If you find yourself in an organization which is or may be addressing implicit bias, I offer three considerations.
- Small changes can be the enemy of large changes
We have all be involved in events or initiatives that have given more the illusion of progress than made substantive progress. Maybe that address the symptoms rather than the cause. The problem comes when doing little things can push ‘bigger things’ further from view, and ultimately make them difficult to engage with.
Take food banks, for example. Food banks are glad when people donate food. They acknowledge they are a front-line, short term resource. But they also know they are not a solution to food insecurity. As people feel they are doing their part by donating to food banks, they can lose sight of the root cause of food insecurity. One organization points out “In fact, food banks are counterproductive because their existence creates the illusion that food insecurity is being taken care of in the community.”
No one is telling you not to donate to a food bank. But donating to food banks, can distract needed attention from why they are there in the first place. Large issues like poverty and income inequality.
So be cautious when small changes in your organization may threaten–even unintentionally–larger changes that need to be made.
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- Limitations of individual-level efforts
Yes, bias is enacted by individuals. And it is hard work delving into how care providers understand and construct issues of bias, and how they link these to their roles as providers.
But as I’ve written before, individual level efforts must be matched and supported by systems-level thinking. Sure, Starbucks closed 8000 stores for half a day. This seems to indicate it’s the front line people, the employees at each site, who were ‘trained.’
But what are they doing systemically? Bias can hide in plain sight– in normal routines. Take a look at some of the structures and processes at your organization. These can hold sedimented biases, often invisible through years of use. Another ways of saying this is, Are your structures working against your goals?
For example, in a medical school, one potent structure is the curriculum. The assumptions you might make about teaching, learning and your audience of learners in your educational programs, endeavors, and materials, all of these may challenge biases—or unwittingly normalize them. I have heard multiple providers in academic medicine talk about the ‘hidden curriculum’ in medical education. I certainly have first-hand experience with unearthing hidden aspects of curriculum in education.
How is your organization handling conversations about who and what is represented, and who is left out? What is being done, if anything, to examine program structures, and to identify the assumptions about the ‘kind of person’ whether it’s a student, patient, community member – who is privileged or ‘does well’ in these structures?
- Bias training as separate from work
Part of what makes for less-than-effective professional development sessions is when they are separated from work. Sure, there is often the need to get people together at the same time, maybe in the same space. And that does mean stepping away from the normal tasks and routines of one’s job.
This makes a complicated situation a little more complicated, when the connection between what is done and said in the ‘training’ and what is done and said in ‘real work’ is left for facilitators and participants to make for themselves. It is to hope for some kind of transfer of these ‘add on’ actions to everyday work, once everybody goes away. Or the responsibility is on participants to find a way to make it work. The subtext is – if they don’t, well that’s on them.
I join my voice with those who suggest that addressing implicit bias is not something we do once (or once a year), but as an ongoing project of our professional lives. As central to and inseparable from the work we do each day.
In this short space I hoped to draw your attention to things you might not have noticed. I hope to offer you a way to think about some of what is involved in addressing implicit bias. It is challenging work. That is why communities of practice are essential. We are socialized into language, and into ways of thinking. And communities of practice can, over time, be powerful forces for socializing us into ways of thinking, talking and acting.
If you would like my help and support in your organization as you address implicit bias, or any of the topics I cover in this podcast series, contact me. Go to health communication partners dot com and click on ‘email us’
I’m Dr. Anne Marie Liebel. This has been 10 minutes to better patient communication.