The Time is Now: Overcoming Implicit Bias in Health Care

By Alisahah Jackson, MD, System Vice President, Population Health Innovation and Policy

It is time to tear down the barriers to health equity. As health care providers, we have a tremendous opportunity, and responsibility, to be active participants in rebuilding an equitable healthcare delivery system for all. In order to do this, we must consider the ways implicit bias affects how we meet and treat each patient.

Studies show bias is present in the way caregivers record notes in electronic health records (EHRs), how treatment algorithms are developed, and even the words used to describe a patient’s condition. Health care systems, especially national nonprofit systems like CommonSpirit Health that are focused on health equity, have refocused efforts to identify and address implicit bias in healthcare settings. 

A recent study in Health Affairs uncovered implicit bias in EHRs, noting that “Black patients were more than twice as likely to have their patient behavior and history characterized in negative terms compared to white patients.” Additionally, the study found that patients on Medicaid, who were unmarried, or had comorbidities, were more likely to have negative terms written into their health record. 

A similar study in the Journal of the American Medical Association (JAMA) focused specifically on physicians found that a majority of negative language in EHRs fell into one or more of the following categories: (1) questioning patient credibility, (2) expressing disapproval of patient reasoning or self-care, (3) stereotyping by race or social class, (4) portraying the patient as difficult, and (5) emphasizing physician authority over the patient.

My first call to action to my fellow providers is to remove stigmatizing terms like non-compliant, aggressive, agitated, or uncooperative from our vocabulary because language can negatively impact the care a patient receives in the future. 

Additionally, we need to think in terms of how we can reduce a patient’s barriers to care. While there’s a significant opportunity to address bias in EHRs, health care systems can also contribute to efforts that aim to address the social needs of patients and their communities. Often, when patients don’t adhere to a care plan, it’s not because they don’t want to be healthy. It’s because they are focusing their efforts on maintaining housing and accessing food. If we want patients to follow our plan, we need to uncover their social needs and help them access the support services needed. Hence, my second call to action: Screening for social needs and referral to community resources should be a standard of care for all patients we serve.

CommonSpirit Health serves patients in communities coast to coast – including big cities, small towns and rural areas – and in many different types of care settings. In all, our system encompasses 140 hospitals and more than 1,000 care sites in 21 states. CommonSpirit values the opportunity to serve as an implementation hub for new tools, building thoughtful and intentional thinking about health equity into the back end of new technology in health care. As healthcare providers, we are often the customer using these new technologies coming to market and as such, we have a significant opportunity. My third call to action: As caregivers and providers, we need to advocate to keep health equity at the forefront of our work and hold our partners accountable in supporting these efforts.  

One example is CommonSpirit’s partnership with Docent Health to provide a text-based, AI-enabled virtual care navigator program for maternity services. We are able to provide real-time feedback to optimize the tool against bias built into the algorithm and developed a health equity framework to monitor and measure outcomes across vulnerable populations.

Diversity in the health care workforce is another proven way to intentionally reduce or prevent bias in health care settings. Research demonstrates that patients consistently fare better when treated by clinicians of similar backgrounds who share lived experiences. Final call to action: Become intentional about diversity in your provider recruitment and retention strategies. CommonSpirit has recently partnered with the Morehouse School of Medicine in the creation of the More in Common Alliance, which will increase the pipeline of BIPOC clinicians entering the medical profession who can provide culturally competent care.

As health care providers, we need to advocate for the system changes necessary to improve health for all. We’ve made some progress but there is still much work to do. This requires courageous conversations and providers who will continue to question the status quo. We can all work toward solutions like these and keep implicit bias out of health care. The time is now.