Nursing

• In the U.S., more than 2 million workers face violence on the job each year – and those are just the cases that get reported.
• The effects of workplace violence are profound, including physical and emotional suffering, destroyed careers and harm to companies and society.
• Although estimates differ, researchers have put the cost of workplace violence at as much as US$56 billion annually – and that’s likely an undercount.

Service workers are at risk

• Similarly, a survey by the AFL-CIO found that 53% of hotel workers had experienced harassment on the job.
• Meanwhile, 3 in 4 health care workers report exposure to workplace violence.
• At the same time, men of color and women of all races, who are at elevated risk of having already experienced discrimination, are overrepresented among service industry employees.

Companies fail to prioritize safety

• The potential for cost savings was made clear in another Liberty Mutual report published about two decades later.
• It found that on-the-job violence cost the health and social services sector nearly half a billion dollars in 2022 alone.
• Despite this fact, only about 30% of businesses have established safety and health programs, according to the U.S. Department of Labor’s Occupational Safety and Health Administration.

Opportunities and solutions exist

• Research shows that a diversity, equity, inclusion and belonging lens in the workplace helps create a feeling of safety and confidence that fosters security.
• Many employees will have experienced forms of discrimination in varying degrees of severity throughout their time in the workplace.
• By adopting a DEIB-informed approach and expressing cultural sensitivity, workplaces can become safer environments for everyone.
• Their evidence-based approach encompasses a variety of interventions against workplace violence and works toward creating meaningful change in industries across the country.

Miranda Kitterlin-Lynch volunteered as a speaker at PAVE Prevention Inc.'s annual summits in 2022 and 2023. She has no financial stake in the organization.

• Health institutions have also focused on addressing implicit bias among the next generation of providers.
• But is implicit bias training improving care quality for Black patients?
• We are a social and health psychologist and a health economist who are investigating the role that provider implicit bias plays in racial health care disparities.

What is implicit bias?

• One common misunderstanding is that implicit bias is inherently unconscious and people are unaware of their own negative feelings, beliefs and behaviors.
• In fact, research suggests that people are remarkably accurate in perceiving their own levels of implicit bias.
• At the implicit level, the ABCs arise spontaneously and effortlessly, while ABCs operating at the explicit level are intentional and effortful.

Why does implicit bias matter in health care?

• Extensive research over the past two decades indicates racial inequities in patient-provider communication stem largely from implicit prejudice among health care providers.
• This implicit prejudice manifests during medical interactions with Black patients through a wide range of communication behaviors.
• For example, providers with higher levels of implicit prejudice tend to talk more and spend less time evaluating Black patients.
• However, current research does not support the idea that providers with higher levels of implicit prejudice treat Black patients worse than white patients.

What’s wrong with implicit bias training?

• Many researchers and clinicians see implicit bias training as an essential component of medical education.
• To understand what typical implicit bias training is like, our ongoing systematic review looks at 77 studies on implicit bias training programs in U.S. health care institutions.
• However, the design of these training programs does not align with current scientific knowledge about implicit bias.

• First, while awareness of one’s biases is a necessary first step to mitigating implicit bias, it alone is not sufficient.
• Implicit bias is like a habit: it is deeply ingrained and operates without intentional control, making it challenging to recognize and change.
• Third, training effectiveness is more accurately assessed through patient outcomes, such as care satisfaction, rather than self-reflection or implicit bias scores.

How can health care systems better address implicit bias?

• Developing and implementing effective implicit bias training in health care is a scientific endeavor that requires a strong supporting structure.
• Then, after developing and testing implicit bias training programs, they examine its effectiveness across institutions and among diverse health care professionals.
• We believe this investment is a small price to pay for the invaluable progress it promises in reshaping health care for the better for everyone.

Nao Hagiwara receives funding from National Institute of Health. Tiffany Green does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

• He outlines what he calls the deep medicine framework as a comprehensive strategy for the incorporation of AI into different aspects of healthcare.
• The framework of deep medicine is built upon three core pillars: deep phenotyping, deep learning and deep empathy.
• These pillars are all interconnected and adopting this framework could enhance patient care, support healthcare staff and strengthen the entire NHS system.

Deep phenotyping

• Deep phenotyping refers to a comprehensive picture of an individual’s health data, across a full lifetime.
• A deep phenotype goes far beyond the limited data collected during a standard medical appointment or health episode.

Deep learning

• This is where deep learning – an area of AI that seeks to simulate the decision-making power of the human brain – is so valuable.
• Deep learning uses an algorithm called a neural network that uses little, mathematical computers, called “neurons”, that are connected to one another to share and learn information.

• Advances in neural network algorithms, technology, and availability of digital data have enabled neural networks to demonstrate impressive performance.
• For instance, they have enabled the rapid and accurate analysis of medical images, such as X-rays and MRIs.
• In addition, AI technology like that behind ChatGPT can process medical literature and patient records to help make complex diagnoses.

Deep empathy

• This is the pillar of deep medicine known as deep empathy.
• Healthcare has increasingly become a discipline where the human touch, once its cornerstone, is overshadowed by a relentless pursuit of efficiency.
• AI solutions can be designed to reduce the administrative burdens for staff, opening up more opportunities for meaningful patient interaction.

Will Jones does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

• Recommendations from the disability royal commission and the NDIS review were released late last year.
• In this series, experts examine what new proposals could mean for people with disability.
• Recent media coverage about the National Disability Insurance Scheme (NDIS) frames the choices of people with disability as threats to their safety or the safety of others.

Choosing services and who provides them

• Research indicates people with disability are more likely to be safe and free from abuse when they have choice over what services they receive and who provides them.
• Previous research by one of us (Sophie) also found some people feel safe as a result of having more choice.
• They may be dependent upon one provider for essential services.
• Read more:
  Unregistered NDIS providers are in the firing line – but lots of participants have good reasons for using them

There is more than one way to support safety

• It did make other quality and safety recommendations that have not received the same degree of attention as the controversial recommendation on mandatory provider registration.
• There are also recommendations to help all people with disability to navigate NDIS, foundational and other services and increase decision-making support.
• The recommendations to diversify housing and living supports are critical for expanding both choice and safety.

What about worker safety?

• These workers experience different pay and working conditions depending on the provider they work for and industrial award they are employed under.
• NDIS participants can use online platforms to employ sole-trader support workers rather than going through agencies.
• That said, workers employed by disability service organisations also report low levels of confidence in organisational safety and reporting systems.

What could support safety for everyone?

Rather than assuming choice and safety are in opposition to each other and further restricting choice, our research suggests the following priorities:

• Safety is about being connected and embedded within the community, where many people are looking out for you, checking in on you and noticing if you don’t show up to your usual activities.
• Ultimately, a scheme where people with disability are empowered to make meaningful decisions between quality services, and workers are valued and supported in their roles, will promote safety for everyone.
• Read more:
  States agreed to share foundational support costs.

The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.