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

EQUALITY EQUITY

6

McGurk Effect

Selective Attention

Imagine meeting these people as patients for the first time. As you look at each slide,

note your feelings, judgments, and reactions that emerge.

11

14

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

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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

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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

We see the world as we are,

rather than the way that it is.

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

THANK YOU!

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