Kaiser Family Foundation

• 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.

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