Like tackling any big problem, getting involved in reducing health disparities starts with small steps. As we like to say at IHI, “What can you do by next Tuesday?”
One small step could be to examine your own reactions to people who are different from you — in race, ethnicity, gender, country of origin, age, or many other dimensions of diversity.
If you are like most of us, you have some degree of implicit bias, the attitudes and stereotypes that unconsciously affect how we perceive, respond to, and interact with others. Implicit bias is unconsciously learned through the social environment, and it’s nothing to be ashamed of. (Test your implicit bias using the link at the bottom of this blog post.) The key is acknowledging that you have the bias and not allowing it to contribute to disparities. The 2003 Institute of Medicine publication, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, describes how stereotyping and prejudice, often unconscious, can influence clinical encounters and contribute to low-quality care for minority patients.
Implicit bias isn’t a choice, but dealing with it is.
According to a 2007 article in The Journal of General Internal Medicine, when health care providers focus on the unique characteristics of a person instead of the group or groups to which the person belongs — a process called individuation — providers can prevent stereotypes from negatively affecting their interactions with specific patients. It’s also important to learn about other cultures and consider the group to which a patient may belong, but individuation can help you do this without making assumptions based on stereotypes.
The article outlines key steps to achieving individuation, drawn from social cognitive psychology research:
- Recognize that you have implicit bias and commit to overcoming it. This could involve taking a test like the one below.
- Understand what drives bias and acknowledge that stereotyping happens. Not admitting the potential for stereotyping is more harmful than meeting it head on.
- Build your confidence in interacting with individuals different from you. This may entail engaging in discussions in safe environments or intentionally placing yourself in situations where you interact with someone who is different. The more you practice, the more confident you will become.
- Be aware of your stress level and negative emotions. These mental states can exacerbate stereotyping and profiling.
- Aim to empathize with the other person. When working with others (such as a patient or a partner on a project), try putting yourself in their shoes, regardless of their background and yours. Search for common ground and think of the individuality of the person rather than noticing only the individual’s group identity.
- Approach the individual as a partner. This can be particularly helpful when working with patients, as you can partner with them to improve care rather than providing care “to” the individual.
Take an implicit bias test, which was created by the Harvard School of Public Health. What’s your reaction to your results? If you’re comfortable doing so, please share in the comment box below.
Editor’s note: This blog post comes from the Open School course, TA 102: Improving Health Equity. Click here to see the full catalog of Open School courses. This course will be available at no cost for the rest of 2016.
