Editor’s note: This is Part 1 of “Battling Bias,” an ongoing series on the role of healthcare executives, administrators, providers and staff in confronting issues of race in their professional lives and their communities.
Countless protests across the United States have elevated longstanding conversations about race in the United States, again shining a light on the role of healthcare professionals in addressing racial inequity.
Medical practice executives and administrators have numerous responsibilities relating to race in their roles, including the following:
- Specific human resource functions of practices (e.g., achieving diversity through recruitment and hiring of providers and staff to reflect the communities they serve)
- Ongoing efforts to promote inclusivity through having a diverse workforce and a strong organizational culture backed by supporting vision and values
- Tracking patient satisfaction and quality measures that might be affected by how providers and staff interact with patients of different backgrounds.
To confront these issues, an understanding of how practice leaders make decisions is crucial for awareness of how bias influences everyday practice management and how to reframe your thinking to eliminate biases from the decision-making process.
Understanding intuition, biases and heuristics
As noted by Brad Wakefield, MBA, FACMPE, vice president, operations, Samaritan Health Services:
Bias is a factor in decision-making1 and can lead to less than optimal decisions. Unfortunately, decision-making theory and training are not commonly taught to managers in healthcare; rather, good decision-making is an expected outcome of education and experience.
If the standard for clinicians is evidence-based medicine, Wakefield suggests healthcare managers be held to a similar standard for their decisions — and any bias involved likely undercuts any decision being made, regardless of how much evidence supports it.
Wakefield explains how intuition, biases and heuristics — the latter being mental shortcuts that ignore parts of information under evaluation — can influence a range of practice management decisions, including hiring, performance reviews, strategic planning, forecasting and budgeting, new services.
We all have unintentional biases, which are shaped by the experiences we’ve had throughout our lives and often happen without much thought on our part.
According to Pam Snyder, senior director, physician and advanced practitioner recruitment, Baystate Health, unintentional bias “really underlies our patterns of behavior and can lead a person to actually be at odds with their intentions.”2
One example of this is confirmation bias: Gathering information that supports our beliefs and biases while ignoring or undervaluing evidence that would disprove those beliefs. For example, Snyder pointed to someone like herself who has an East Tennessee accent being compared to a “Beverly Hillbillies” character. “When you hear someone with an accent like mine … you think they’re not well-educated,” she explained.
Another type of unintentional bias is perception bias — stereotyping individuals whom we might not be as familiar with and allowing those biases to affect our perceptions. Snyder categorized this bias as the most damaging when it comes to recruitment. “Perception bias is worse than confirmation bias … you’re not looking for points to confirm something; you know it,” Snyder stressed. “You met one person that had these attributes … and you formed your opinion and you can’t get away from that.”
How do you measure up?
How do you get away from what you can’t get away from? The first step is to acknowledge that you may have unknown biases. Take a look around your practice. Is the demographic make-up of your employees significantly different than the area you serve? That might be a clue that largely unconscious habits of mind influenced hiring and retention decisions. This leads to the second step: discovering your own biases. Here are some great online resources to help:
- To take an online self-assessment to determine your level of unconscious bias, access Harvard University’s implicit association test.
- In addition, the Association of American Medical Colleges has an unconscious bias resources page for health professionals.
- Frank Cohen, MBB, MPA, director of analytics, Doctors Management LLC, delves deeper into the conscious decision-making process in “Paper or plastic: A look into how decisions are truly made,” an excerpt from his book, Don’t Do Something, Just Stand There: A Primer for Evidence-Based Practice.
Editor’s note: Other installments of the “Battling Bias” series include:
- Part 2: Building diversity in recruiting and hiring
- Part 3: Sustaining inclusivity through organizational culture
- Part 4: Racial bias and its effects on patient care
- Johnson DDP, Blumstein DT, Fowler JH and Heselton MG. "The evolution of error: error management, cognitive constraints, and adaptive decision making biases." Trends in Ecology and Evolution, 2013, 474-481.
- Green C. “A feeling of belonging: An inclusive culture is the foundation for addressing unintentional bias.” MGMA Connection. January 2020. Available from: mgma.com/inclusive-culture.