Just as every individual has their own social determinants of health, every person is capable of stereotyping and exhibiting those unconscious or conscious biases. It’s okay to admit that everyone has biases; the key is to recognize and resolve these biases before any damage occurs, like disparities in the quality of patient care that is provided.
You work in post-acute care, and you’ve cared for a variety of patients and families, often in difficult times as aging in place grows to be the mindset of our modern times. Have you ever received a referral from “that one facility that always seems understaffed and is challenging to work with?” or “the facility that always has complicated patients,” so you cringed a little when they called? Or the house that you drove up to that had a cluttered front yard, and you just knew the inside would be messy and the patient would be challenging?
What about the patient who lived in that nice facility in the expensive part of town, and you breathed a sigh of relief thinking that they would probably have no problems affording extra personal care services? If you are in management, did you think hard about why you hired that nurse with the Masters degree whom you automatically assumed was smarter and more capable than the other applicants with “lesser” degrees?
These may or may not be extreme circumstances, but they serve to make the point clear: bias exists everywhere, even in healthcare. We are all guilty of daily unconscious and conscious biases, even as we work to care for our patients and their families.
How is that possible? More importantly, how do you learn to recognize and resolve bias before it changes your outlook and performance negatively?
In the last few months, I’ve been helping to create several learning tools revolving around social determinants of health and the recognition of the biases that all healthcare providers possess, whether they realize it or not. It’s gotten me thinking about what my own beliefs may be and how I can work harder to avoid letting biases affect my role as a healthcare professional. It’s a fact. We all need to explore what being biased really means.
Short on time? Jump straight to the action steps.
What Does It Mean to Be Biased?
Let’s start by defining bias: According to the Georgetown University National Center for Cultural Competence [NCCC], conscious or explicit bias is defined as feelings, attitudes, or related behaviors that are intentionally expressed. Conversely, unconscious bias or implicit bias is defined as behaviors or affects that occur outside of a person’s awareness, unintentionally.
If you have conscious bias, you are openly expressing it, and allowing it to influence how you act towards an individual or group. When you exhibit unconscious bias, you are unaware that you may be discriminating against an individual or group and often act in direct contradiction to your usual behaviors.
A stereotype is a widely held or popularized belief about a grouping of people with a characteristic, such as being of the same ethnicity or religious affiliation, that may not be accurate but leads to judgement of all individuals with that same characteristic. In health care, recognizing the presence of your own conscious and unconscious biases and how you may inadvertently stereotype patients, families, and even peers or your employees is vital.
Also remember that everyone, your patients, their loved ones, your peers, and yourself have a specific social determinant of health. The Office of Disease Prevention and Health Promotion [ODPHP] defines a social determinant of health as “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” SDOH are non-medical factors that characterize a person.
Bias and Quality of Care: Taking a Step Back
Just as every individual has their own social determinants of health, every person is capable of stereotyping and exhibiting those unconscious or conscious biases. It’s okay to admit that everyone has biases; the key is to recognize and resolve these biases before any damage occurs, like disparities in the quality of patient care that is provided. Create a neutral, unbiased environment as much as possible.
When that challenging facility calls with another referral, don’t roll your eyes, but instead stop and think of how your team may be able to help solve some of those challenges as you provide care.
Don’t make assumptions about that cluttered front yard before you understand the circumstances of the patient and why their home may be the way it is. Maybe they have no help and can’t work in the yard anymore because they are physically unable. Maybe they are grieving after the death of their spouse and can’t bring themselves to clean up the yard.
Just because that other patient lives in an upper-class area in a nice facility does not mean they have not put every dollar into affording the apartment there.
The nurse practitioner who put himself through an online university completed clinical practicums locally and has 15 years of experience as a healthcare professional to bring with him, so take his guidance and learn from it without preconceived notions.
When you interview job candidates, remember that while advanced degrees do show an advanced knowledge base, so do practical backgrounds of seasoned professionals. Look at the entire person and their skills, not just the initials attached to their signature to understand how well they may be able to care for patients.
5 Steps to Deal with Conscious and Unconscious Bias in Post-Acute Care
Based on my research, I am following five steps to help deal with my own biases. Consider sharing them with your peers, your staff, and your patients and their loved ones (as applicable):
Talk About It: Education is key. Spend a team meeting devoted to talking openly and honestly about everyone’s unconscious and conscious biases. Better yet, take 10 minutes out of those planned interdisciplinary team meetings and talk about what biases may exist in relation to your current patient census and the community in which you all work. Airing out these biases allows for self-awareness and reflection and may trigger necessary care plan updates.
Don’t Forget your Empathy: Most healthcare professionals began their careers because they had an innate sense of empathy, to care for others and make their lives better. Don’t forget that level of empathy or be afraid to use it; look at the entire situation before jumping to conclusions.
Understand Sociocultural Norms: Everyone is different; it’s part of what makes post-acute care so interesting! However, it also means everyone’s definition of “normal” is different and based on a variety of factors, from their race, ethnicity, or gender orientation to their religion, lifestyle, or their socioeconomic class. Their “normal” may not look the same as yours, but it is just as valid.
Be Openly Respectful: If someone is different because of their social determinants of health or other factors, don’t shy away. Watch your body language and verbal responses to ensure you are being respectful, nonjudgmental, and welcoming. When in doubt, ask people to explain their background, their beliefs, or their living situation. Respect their challenges and find ways not only to listen to them, but also to help resolve what you can.
Trust is the Top Priority: No one wants to be accused of being biased. It can sting. Whether in dealing one-on-one with a patient or peer, or on a larger scale with a partnering agency in the post-acute setting, trust should be everyone’s top priority. Trust that you can work together effectively toward a common goal and positive outcomes for every patient. Throwing the biases out the window and leaning on each other, leads to better outcomes and success for all in the end.
What to Do Next
TL;DR: It takes a village to overcome some biases. But everyone can work a little harder, have a greater level of self-reflection, and pause before letting those unconscious or conscious biases come out.
that change starts with one person. Here’s what to do to ensure you are that person: