Improving Health Equity: The Role of the Oncology Advanced Practitioner in Managing Implicit Bias

2021 ◽  
Vol 12 (8) ◽  
Author(s):  
Kelley D. Mayden, MSN, FNP, AOCNP, IAC
Keyword(s):  
Health Care ◽  
Patient Outcomes ◽  
Professional Practice ◽  
Health Care Disparities ◽  
Organizational Transformation ◽  
Implicit Bias ◽  
Advanced Practice ◽  
Advanced Practitioner ◽  
Potential Impact

Implicit bias (IB) is the involuntary activation of thoughts, feelings, attitudes, or stereotypes that exist outside of conscious awareness. Implicit bias develops early in life and research documents the existence of IB across health-care settings. Negative IB impacts patient-provider interactions, produces inferior patient outcomes, and contributes to health-care disparities. Oncology APs are subject to IB and should be aware of its potential impact on professional practice. This manuscript explores the concept of IB and reviews evidence examining the clinical impact of IB in the oncology setting. Strategies for identifying and mitigating IB are explored. Highlights include the use of the Implicit Association Test and emotional intelligence. Advanced practice implications are discussed and range from self-improvement to organizational transformation.

scholarly journals Lean management in health care: effects on patient outcomes, professional practice, and healthcare systems

2020 ◽  
Author(s):  
Thomas Rotter ◽  
Christopher Plishka ◽  
Adegboyega Lawal ◽  
Michelle Fiander ◽  
Elizabeth L Harrison ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Outcomes ◽  
Professional Practice ◽  
Healthcare Systems ◽  
Lean Management

scholarly journals The Efficacy of an Antioppression Curriculum for Health Professionals

2019 ◽  
Vol 51 (1) ◽  
pp. 22-30 ◽  
Author(s):  
Diana Wu ◽  
Lamercie Saint-Hilaire ◽  
Andrew Pineda ◽  
Danielle Hessler ◽  
George W. Saba ◽  
...  
Keyword(s):  
Health Care ◽  
Teaching Methods ◽  
Health Professionals ◽  
Health Care Professionals ◽  
Health Care Disparities ◽  
Unconscious Bias ◽  
Survey Response Rate ◽  
The Mean ◽  
Skill Building

Background and Objectives: Health professionals increasingly recognize the role that social determinants play in health disparities. However, little focus is placed on how health care professionals themselves contribute to disparities through biased care. We have developed a curriculum based on an antioppression framework which encourages health professionals to evaluate their biases and combat health care disparities through an active process of allyship. Methods: Teaching methods emphasize skill building and include lectures, guided reflections, and facilitated discussions. Pre- and postsurveys were administered to assess participants’ confidence level to recognize unconscious bias and to be an ally to colleagues, patients, and staff. In total, we conducted 20 workshops with a total of 468 participants across multiple disciplines. Results: The survey response rate was 80%. Using a paired t-test, the mean difference in the pre- and postsurveys revealed a statistically significant improvement across all measures. Participants showed the greatest improvements (large effect size d>0.8) in their understanding of the process of allyship, their ability to describe strategies to address, assess, and recognize unconscious bias, and their knowledge of managing situations in which prejudice, power, and privilege are involved. Conclusions: Results show that an antioppression curriculum can enhance health professionals’ confidence in addressing bias in health care through allyship. For those who value social justice and equity, moving from the role of bystander to a place of awareness and solidarity allows for one’s behaviors to mirror these values. Allyship is an accessible tool that all health professionals can use in order to facilitate this process.

scholarly journals Eliminating disparities and implicit bias in health care delivery by utilizing a hub-and-spoke model

2018 ◽  
Vol 4 ◽  
pp. e26370
Author(s):  
Pradeep Joseph
Keyword(s):  
Health Care ◽  
Health Care Disparities ◽  
Clinical Decision Making ◽  
Care Delivery ◽  
Implicit Bias ◽  
Complex Form ◽  
Community Outreach ◽  
The United States ◽  
Great Success ◽  
Nurse Navigator

The state of health disparities in the United States has remained relatively stable over a number of years. Although overall outcomes for all patients have improved, a difference persists in how different racial, ethnic, and gender groups have fared in our health care system. Many programs that have sought to combat this problem have been predicated on the belief that only a small number of providers in the medical community are aware of their own biases. Accordingly, it was believed that bias awareness is the direct conduit for this particular change in the health system. However, the results of such programs have been unsatisfactory. The reason for such ineffectiveness is that many programs have not taken into account the presence of implicit bias within the patient-provider relationship. This complex form of bias operates in specific ways, and must be dealt with appropriately. The use of digital checklists to aid in clinical decision making has proved to be both a way that patients can receive equitable care, and a way to improve overall patient outcomes. Secondly, in order to reach the most at-risk populations, health care must expand beyond the hospital walls, and out into the community. Nurse navigator programs have been shown to accomplish this with great success. Together, checklists and nurse navigators are the necessary next-step in the battle against health care disparities. What’s more, this two-pronged approach is relatively simple to implement. By making use of current electronic medical records, digital checklists can be quickly installed. Likewise, nurse navigator programs, a comparatively inexpensive option, can be rolled out quickly because of their simple design. A focus on the patient-provider relationship and community outreach is critical for progress in eliminating health care disparities.

scholarly journals A systematic review of implicit bias in health care: A call for intersectionality

2019 ◽  
Vol 13 (1) ◽  
pp. 005
Author(s):  
Oluwabunmi Ogungbe ◽  
Amal K Mitra ◽  
Joni K Roberts
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Sexual Orientation ◽  
Social Identity ◽  
Health Care Disparities ◽  
Implicit Bias ◽  
Health Care Research ◽  
Healthcare Setting ◽  
Unconscious Bias ◽  
Ample Evidence

Background and objectives: Health disparities are a growing concern in health care. Research provides ample evidence of bias in patient care and mistrust between patient and providers in ways that could perpetuate health care disparities. This study aimed to review existing literature on implicit bias (or unconscious bias) in healthcare settings and determine studies that have considered adverse effects of bias of more than one domain of social identity (e.g., race and gender bias) in health care. Methods: This is a systematic review of articles using databases such as EBSCO, Embase, CINAHL, COCHRANE, Google Scholar, PsychINFO, Pub Med, and Web of Science. Search terms included implicit bias, unconscious bias, healthcare, and public health. The inclusion criteria included studies that assessed implicit bias in a healthcare setting, written in English, and published from 1997-2018. Results: Thirty-five articles met the selection criteria – 15 of which examined race implicit bias, ten examined weight bias, four assessed race and social class, two examined sexual orientation, two focused on mental illness, one measured race and sexual orientation, and another investigated age bias. Conclusions: Studies that measured more than one domain of social identity of an individual did so separately without investigating how the domains overlapped. Implicit Association Test (IAT) is a widely used psychological test which is used to determine existence of an implicit bias in an individual. However, this study did not find any use of an instrument that could assess implicit bias toward multiple domains of social identities. Because of possible multiplicative effects of several biases affecting a single entity, this study suggests the importance of developing a tool in measuring intersectionality of biases. IMC J Med Sci 2019; 13(1): 005

scholarly journals Lean management in health care: effects on patient outcomes, professional practice, and healthcare systems

2017 ◽  
Author(s):  
Thomas Rotter ◽  
Christopher T Plishka ◽  
Lawal Adegboyega ◽  
Michelle Fiander ◽  
Elizabeth L Harrison ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Outcomes ◽  
Professional Practice ◽  
Healthcare Systems ◽  
Lean Management

The Role of VA Community Care in Addressing Health and Health Care Disparities

Medical Care ◽  
2017 ◽  
Vol 55 ◽  
pp. S4-S5
Author(s):  
Baligh R. Yehia ◽  
Clinton L. Greenstone ◽  
Christina B. Hosenfeld ◽  
Kameron L. Matthews ◽  
Laurie C. Zephyrin
Keyword(s):  
Health Care ◽  
Health Care Disparities ◽  
Community Care

Prioritizing Diversity in Otolaryngology–Head and Neck Surgery: Starting a Conversation

2020 ◽  
pp. 019459982096072
Author(s):  
Carl M. Truesdale ◽  
Reginald F. Baugh ◽  
Michael J. Brenner ◽  
Myriam Loyo ◽  
Uchechukwu C. Megwalu ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Disparities ◽  
Holistic Approach ◽  
Neck Surgery ◽  
People Of Color ◽  
Underrepresented Minorities ◽  
Medical Centers ◽  
Academic Medical ◽  
Resident Selection

Academic centers embody the ideals of otolaryngology and are the specialty’s port of entry. Building a diverse otolaryngology workforce—one that mirrors society—is critical. Otolaryngology continues to have an underrepresentation of racial and ethnic minorities. The specialty must therefore redouble efforts, becoming more purposeful in mentoring, recruiting, and retaining underrepresented minorities. Many programs have never had residents who are Black, Indigenous, or people of color. Improving narrow, leaky, or absent pipelines is a moral imperative, both to mitigate health care disparities and to help build a more just health care system. Diversity supports the tripartite mission of patient care, education, and research. This commentary explores diversity in otolaryngology with attention to the salient role of academic medical centers. Leadership matters deeply in such efforts, from culture to finances. Improving outreach, taking a holistic approach to resident selection, and improving mentorship and sponsorship complement advances in racial disparities to foster diversity.

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