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Mitigating Unconscious Bias
to Enhance the Patient
Experience
Monday, April 16, 2018
Presented by:
Pamela Y. Abner, MPA
Barbara Warren, PsyD
This material is the property of the MSHS Office for Diversity and Inclusion
(ODI) and may not be reproduced, edited, distributed or otherwise used
outside of the original intent and method for educating MSHS staff, without
the express permission of the ODI.
Overview of the Mount Sinai Health System (MSHS)
7 1
hospitals
medical
school
38
,000+
employees
6,000 primary and
specialty care
physicians
45 ambulatory practices in
NYC, Westchester, and LI
31 affiliated
community
centers
12 minority-owned, free-
standing ambulatory
surgery centers
3
The Human Rights Campaign currently recognizes all of seven MSHS
hospitals - Mount Sinai Beth Israel, The Mount Sinai Hospital, Mount
Sinai Queens, Mount Sinai St. Luke’s, Mount Sinai West and New York
Eye and Ear Infirmary of Mount Sinai - as leaders in LGBT healthcare
equality.
INSIGHT Into Diversity selected the Icahn School of Medicine at Mount
Sinai as a recipient of the 2017 Higher Education Excellence in Diversity
(HEED) Award – a national recognition which honors “colleges and
universities that exhibit outstanding efforts and success in the area of
diversity and inclusion throughout their campuses.”
Recent Recognitions
DiversityInc listed the Mount Sinai Health System as #1 in 2017 for the top
hospitals and healthcare systems in the country for diversity management.
The award is the result of an extensive survey process detailing information
on senior leadership commitment and accountability, talent development
and advancement and supplier diversity.
Learning Objectives
▶ Gain an understanding of key cultural concepts related to patient care.
▶ Identify how bias and the processes of the unconscious mind can impact
how we interact with patients and compromise inclusion and equity.
▶ Understand how unconscious bias impacts the work environment and the
patient experience.
▶ Learn strategies to mitigate unconscious bias and practice more conscious
awareness in a health care setting.
4
5
Best Practices
Physician Partnership
/Buy-In
Talent Management and
Employee Engagement
Behaviors
Data Strategy
Safety and Quality
The
Patient
Framework for Experience of Care
Communication Strategy
UB education
provides an
understanding
of one’s
behaviors and
beliefs that may
impact patient
experience
Imagine meeting these people as patients for the first time. As you look at each slide,
note your feelings, judgments, and reactions that emerge.
Gender
Skin tone
Setting
Body type Body posture
Clothing
Facial expression
Ethnicity
Age
What patterns do you notice?
What is bias?
A tendency or inclination that results in judgment without question.
A shortcut to interact
with our world An automatic response
Mental associations
without:
• Awareness
• Intention
• Control
These often conflict with our conscious
attitudes, behaviors, and intentions.
What is Unconscious Bias?
Research shows that our brains jump to
assumptions and conclusions without us
even knowing it
This is the science of “unconscious bias”.
Unconscious bias applies to how we
perceive other people. We are all biased
and becoming aware of our biases will help
us mitigate them in the workplace and
socially . Interestingly, the research shows
that both men and women share and apply
the same assumptions about gender.
Borkhoff , C. M., G. A. Hawker, et al. (2011).
50% more men than women were
recommended for knee replacement surgery with the same presenting
medical evidence.
Gender
Weight
Research testing 2284 medical doctors found that overall
doctors show a strong implicit bias against overweight
people.
Men’s bias was stronger than women’s, and bias was
strongest among those tested who were the thinnest.
Janice A. Sabin, Maddalena
Marini, and Brian A. Nosek, 2012
Prosthetics Sexual
Orientation
Appearance
Developmental
Disability
Communication Style
Skin Tone
Weight
Race
Gender
Name
Religion
Learning
Disability
What are
your
biases?
Height
Age
Cochlear
implants
Physical
Disability
Cane
Accent
Wheelchair
Service Animal
Walker
Hearing
Aid Cognitive
Disability
Language
Intellectual Disability
21
Veteran
Status
• Level of communication skills and understanding
• Potential diagnoses
• Health behaviors and habits
• Adherence to treatment
• Desire/ability to effectively participate in their care plan
• Likely treatment outcomes
What assumptions do we make about patients
based on biases ?
Unconscious Bias
Leads to utilization and overutilization of stereotypes and
false beliefs
Influences reasoning and
decision-making Impacts behavior
Results in disparities care and
health outcomes
23
Cycle of Unconscious Bias
Adapted from Ann-Gel S. Palermo, DrPH MPH
“Cycle of Unconscious bias in Clinical Medicine”
Center for Multicultural and Community Affairs, ISMMS, 2015
Impacting
the patient
experience
IDENTITY LENSES
Our unique backgrounds/perspectives influence the way
we make decisions and how we interact with others.
Biases are associated with our:
Cultural identity
Group identity
Individual identity
Institutional identity
25
Source: http://vkc.mc.vanderbilt.edu/etoolkit/general-issues/communicating-effectively/
Accessed 02/12/2018
Catalyzing person or
circumstance
Background
Fast (Emotional)
Brain
Slow (Thinking) Brain
The Unconscious mind
Bias Trap: Priming Effect and “too difficult,”
or “too busy”
▶ Personal bias around the perception that certain people are “too
difficult” or different.
▶ Assumption that interactions with people who are different take too
long and therefore, we are “too busy” to help.
MITIGATION STRATEGY:
Recognize and accept that you have bias; understand other
possible reactions, interpretations and judgements that may be
possible.
Bias Trap: Unfamiliarity and/or Pity
Personal bias that shows up when you see or interact with individuals.
This may be due to:
– Feeling awkward when dealing with a person with a disability.
– Lack of understanding of the person’s situation.
– Unsure how to relate or engage with a person.
MITIGATION STRATEGY:
Know your patterns of bias so that you pay attention to what you
selectively pay attention to; take the stereotype out of the
individual.
Bias Trap: Hidden Disabilities
▶ Not all disabilities are apparent.
▶ You may not realize that the person has a disability as they may
appear to be high-functioning.
– For example, people with psychiatric disabilities or mental illness
may have difficulty coping with daily tasks and relating to others.
MITIGATION STRATEGY: PAUSE and check your reactions,
judgments; aim to explore your own thinking.
30
Source: http://vkc.mc.vanderbilt.edu/etoolkit/general-issues/communicating-effectively/
Accessed 02/12/2018
Selected Strategies to Communicating Effectively
▶ Establish Rapport
– Speak directly with the individual
– Avoid talking to an adult as if he/she were a child
▶ Choose appropriate language
– Use concrete language in short, simple sentences
– Use visual aids or demonstrate
– Avoid jargon
– Avoid shouting
▶ Listen
– Express when you do and do not understand
– Be patient
31
Source: http://vkc.mc.vanderbilt.edu/etoolkit/general-issues/communicating-effectively/
Accessed 02/12/2018
Resources
▶ Cook Ross Unconscious Bias Education http://cookross.com/unconscious-
bias-2/
▶ Association of American Medical Colleges
https://www.aamc.org/initiatives/diversity/322996/lablearningonunconscious
bias.html
▶ Implicit Associations Test at Harvard:
https://implicit.harvard.edu/implicit/takeatest.html
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