Patients should be treated with the utmost respect and equality irrespective of their race, gender, class, age, or any other characteristic. However, personal biases, prejudice, and stereotyping remain pervasive in the contemporary everyday interactions between patients and care providers. The modern healthcare system is characterized by diversity with patients and care providers coming from multifarious backgrounds with differing beliefs concerning various life aspects, such as sexuality and religious beliefs among other attributes. Therefore, implicit associations are likely to influence the way caregivers make their judgments leading to bias. The underlying unconscious, uncontrollable, or irrational processes also manifest in non-verbal communication and behaviors towards patients. As such, caregivers need to be aware of these biases by identifying and ultimately mastering them for the improvement of the quality of care delivered to patients. This paper discusses the various ways that could be employed in overcoming personal biases, prejudice, and stereotyping in the field of healthcare.
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Why Overcome Implicit Bias
In this paper, the term “implicit bias” will be used to mean both personal stereotypes and prejudices among healthcare providers. Bias is the negative evaluation of an individual or group of individuals and its constituents relative to other individuals or groups. According to FitzGerald and Hurst (2017), implicit biases explain a potential “dissociation between what a person explicitly believes and wants to do (e.g. treat everyone equally) and the hidden influence of negative implicit associations on her thoughts and action” (p. 2). For instance, a black patient could be perceived as less competent, which then prompts the provider not to prescribe certain medication to that particular person. The problem with implicit biases in healthcare is that they affect individuals who are already disadvantaged and probably marginalized in many ways, such as the blacks, Latinos, members of LGBTQ, women, mentally ill, the disabled, the overweight, and children among other related groups. In most cases, these people experience negative patient outcomes because they are disadvantaged in one way or another, which affects their capacity to access timely and quality care.
Therefore, overcoming personal biases, prejudices, and stereotypes is an important step toward improving care outcomes among the affected individuals. Zestcott et al. (2016) argue that the available literature shows that one of the leading causes of disparities in health outcomes for minority groups in the US is the widespread implicit biases held by healthcare providers. A systematic review by Hall et al. (2015) agrees with the view by Zestcott et al. (2016) by concluding that people of color are normally associated with negative attributes, and this aspect affects the way they interact with care providers and ultimately their health outcomes. As such, there is an urgent need to address this issue by stipulating the various steps that could be taken at both institutional and individual levels for improved care provision for all patients regardless of their age, race, gender, education level, and all other attributes that differentiate one person from another.
Overcoming Implicit Bias
Implicit bias could be dealt with at the institutional and individual levels. The institutional approach toward solving this problem is two-pronged. First, cultural competence training could be integrated into the curricula to allow students to learn the basics of identifying and addressing their implicit biases when interacting with patients. Second, healthcare institutions could create training programs for their workers to ensure that they gain the relevant skills in cultural competence. According to Marcelin et al. (2019), “A strategy to counter unconscious bias requires an intentional multidimensional approach and usually operates in tandem with strategies to increase diversity, inclusion, and equity” (p. 65). Therefore, training is one of the multidimensional approaches that could be applied in this case to equip healthcare providers with the requisite cultural competence skills to operate professionally in a highly diversified care environment in the contemporary world.
The contemporary approaches to training, through teaching, cultural competence are inadequate to reduce personal biases, stereotypes, and prejudices among care providers. A study by Zestcott et al. (2016) showed by the time students start their training in cultural competence, they have deep-running stereotypes and biases. Interestingly, these biases remain constant or increase over the course of the training. Results from the CHANGES Study whereby 3959 medical students from 49 schools in the US were studied for implicit bias showed that this problem increases significantly by the time students graduate (Phelan et al., 2014). This understanding underscores the need to revise the current training strategies for students to become culturally aware of the nature of patients they are likely to encounter in the workplace.
Therefore, the first step in effective training would involve creating awareness of implicit biases through self-reflection activities. These activities allow students to identify their biases and come up with strategies to overcome them. However, caution should be taken when using this strategy because the available literature suggests that being aware of one’s biases is not enough, as it might not change the way a care provider thinks about different patients (Zestcott et al., 2016). A study by Gonzalez et al. (2014) showed that completing self-reflection exercises and Implicit Association Tests (IAT) might not necessarily change the way medical students view other people. For instance, in this study, 22 percent of the participants doubted the validity of the IAT and questioned whether biases exist in the healthcare system in the first place. Therefore, this approach to teaching cultural competence should change to adopt other functional ways as documented in evidence-based practices.
One way to address the inherent flaws in the current curricula is by avoiding negative role modeling in learning institutions. A study by van Ryn et al. (2015) showed that the majority of students were exposed to negative role modeling by hearing negative comments about various people from the faculty. As such, even when these students are made aware of their implicit biases, they are unwilling to change because they have heard their role models promote the same stereotypes in their conversations. As van Ryn et al. (2015) posit, “These findings point to the need for medical schools, in partnership with clinical training sites, to assess, monitor and, if needed, intervene to improve racial attitudes and behaviors among attending and resident physicians” (p. 1754). The same approach should be applied when training workers for cultural competence in healthcare facilities. Leaders should lead by example, be aware of their biases, prejudices, and stereotypes, and guard themselves against practicing or talking the opposite of what they teach their followers. Additionally, accreditation bodies for various specialties in healthcare should also incorporate cultural competence training and skills in their programs to ensure that the candidates being certified are competent enough to operate professionally in a multicultural setting.
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At a personal level, healthcare providers could be trained to apply various strategies when interacting with their patients as a way of overcoming their inherent biases, prejudices, and stereotypes. The first strategy is the common identity formation whereby the care provider is required to ask his or her client questions that could lead to the formation of common identities (Marcelin et al., 2019). The moment care providers find a common identity with patients, it becomes easy to understand them for whom they are without passing preconceived judgments. For instance, a care provider could ask patients to talk about their families, favorite sports, hobbies, and communities among other related aspects. In these conversations, the care provider is likely to find shared interests with the patients, which makes the two parties a team with common attributes. This realization would play a central role in diffusing hitherto held implicit biases concerning the other party, thus creating room for the advancement of quality care provision for all.
Another strategy is perspective-taking, which allows an individual to actively counter stereotypes. Healthcare providers should endeavor to see the world from the other person’s perspective. Perspective-taking creates room for what Marcelin et al. (2019) call “cultural humility”, “cultural sensitivity” and “cultural curiosity”. Cultural humility focuses on “the individual and teaches that developing one’s self-awareness is a critical step in achieving mindfulness for others” (Marcelin et al., 2019, p. 68). As such, individuals are required to acknowledge that their view of life is shaped by their various life experiences, which could be subject to bias. Therefore, the lens through which a person views the world might not be as open, extensive, or dynamic as perceived. This step then allows care providers to place themselves in the shoes of their patients and try to understand them holistically. Ultimately, the care provider would become empathetic, which easily diffuses any implicit biases that could stand in the way of offering quality services to all patients (Hughes et al., 2020). Cultural competence or humility allows healthcare providers to treat patients as opposed to illnesses (Prasad et al., 2016). These strategies would play a central role in the enhancement of inclusivity in healthcare provision whereby everyone gets equal treatment irrespective of gender, race, age, and other related attributes.
Finally, healthcare providers could choose to deliberately counter stereotypical exemplars. For instance, providers could force themselves to spend time with people of a different race, gender, sexual orientation, or religion. The objective of this exercise is to gain an in-depth understanding of various human backgrounds, which is an important step in deconstructing stereotypes and prejudices built over the years through hearsays.
The world has become one large cosmopolitan area with people from diverse backgrounds meeting and co-existing for various reasons. As such, the healthcare system has to deal with patients from these diversified backgrounds, hence the need for cultural competence in care provision. Overcoming personal biases, prejudices, and stereotypes is the first step toward becoming a culturally competent provider. Such a step would significantly improve the quality of care given to patients and the subsequent outcomes. Both learning and workplace institutions should focus on training programs to ensure that students and workers are competent enough to offer professional care services to all patients regardless of their backgrounds. Cultural competence is the foundation of ensuring inclusivity in care provision and as argued in this paper, different strategies could be employed to achieve this goal.
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