Numerous studies highlight the existence of "differentiated care." Specifically, these are differences in the management of patients who present a differentiating characteristic, without influence, in theory, on the prognosis.
Implicit biases can play a major role in decision-making, leading to differences in management that no medical reason justifies.
The Child Trends research center in the United States revealed, through a study, a striking example of the consequences caused by implicit biases in health: black women face higher maternal mortality rates than white women.
If everything requires caregivers to treat patients equally, it's naïve to think that certain characters won't unconsciously influence caregivers.
To ensure the safety of care, it is therefore essential to understand implicit biases in order to be able to apprehend them.
Implicit biases: definition
The concept of implicit biases is based on the idea that human thought is partly based on associations. These associations are more or less automatic and unconscious. These associations can be detrimental to patients when they relate to a character trait such as skin color, ethnic origin, weight, religion, gender, sexuality, and many others.
While the explanations of these associations (racism, sexism, grossophobia, homophobia, etc.) must be vigorously opposed, the implicit associations are more complex to grasp.
Implicit biases operate at a subconscious level and manifest in the attitudes and behaviors of individuals who unconsciously behave differently when interacting with people based on their (unconscious) prejudices.
These unconscious behaviors may relate to certain identified or identifiable “categories” of people, either because they are targeted by negative social representations or because they represent significant experiences. *
A protocol will readily be explained less precisely to a person with an "intellectual disability" because they do not understand anything anyway.
An “overweight” person will be less able to follow a protocol because they are not already able to manage themselves on a dietary level.
A black person will be less inclined to respect hygiene rules. A homosexual is more likely to transmit a disease to you.
Here are some factual examples of behaviors that could be found.
In healthcare, implicit biases can have detrimental effects on how patients are managed by healthcare professionals, even though the latter generally aim to manage all patients without distinction of means.
These effects can occur at all stages of the care process and in all dimensions of management: examination, diagnosis, choice of treatment, attitude in dialogue, advice and therapeutic education, etc.
Patients are not the only victims of implicit biases. Indeed, healthcare professionals must also face these unconscious prejudices in their daily lives. A foreign doctor is necessarily less well trained than a French doctor... A woman and a man enter a patient's room: she is a nurse and he is a doctor...
Regarding sexist prejudices in the hospital, 85% of female doctors report having felt discriminated against because of their gender during their professional career, and 8 out of 10 female doctors admit to having already been victims of sexist behavior.*
Understanding implicit biases with SafeTeam Academy
Although implicit biases occur unconsciously, strategies exist to address them:
- We all have implicit biases. Being aware and accepting this weakness is the first milestone to put in place to avoid them as much as possible.
To find out your implicit biases, take this great test made in Harvard.
This test is very interesting: it uses the two modes of cognitive functioning, system 1 and system 2, described by Amos Tversky and Daniel Kahneman (Nobel Prize in Economics). We won't say more...
- Individualize patients rather than perceiving them as belonging to a group.
- Accept the control of others by prioritizing cross-checking, done by a third person, as well as secure communication.
- Develop metacognition. This involves developing one's own critical thinking by regularly paying close attention to one's thoughts: Why do I think this? What sources can I rely on? What would another person think? etc.
It is in this spirit that SafeTeam Academy has decided to address this delicate but fundamental topic, which is unfortunately often unknown to healthcare professionals and absent from initial healthcare training curricula.
Debiasing methods exist (secure communication, cross-checking, team decision-making, etc.) and are frequently presented in our training courses.
We were keen to present the issue of implicit biases in Healthcare because sexist prejudices still exist. In order to combat sexism in Healthcare, SafeTeam Academy recently signed the Femmes de Santé charter.
Femmes de Santé is a collective whose objective is to value and develop the human element at the heart of the healthcare system and to promote the expertise and actions initiated by women in the Healthcare sector.
If you found this article interesting, disturbing or would like to know more, please write to us at: contact@safeteam.academy
