In the April 2016 issue of Quick Safety, The Joint Commission addresses implicit, or unconscious, bias in healthcare, and its impact on patient safety.
Fifteen years after the publication of two seminal reports from the Institute of Medicine (IOM) – Crossing the Quality Chasm: A New Health System for the 21st Century and Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care – The Joint Commission highlights that racial and socioeconomic inequity persists in health care. In Crossing the Quality Chasm, the IOM stressed the importance of equity in care as one of the six pillars of quality health care, along with efficiency, effectiveness, safety, timeliness and patient-centeredness. Indeed, Unequal Treatment found that even with the same insurance and socioeconomic status, and when comorbidities, stage of presentation, and other confounders are controlled for, minorities often receive a lower quality of health care than do their white counterparts.
The Joint Commission identifies there is extensive evidence and research that finds unconscious biases can lead to differential treatment of patients by race, gender, weight, age, language, income and insurance status, and that bias in clinical decision-making does result in overuse or underuse problems that can directly lead to patient harm.
Implicit bias refers to the attitudes or stereotypes that affect our understanding, actions and decisions in an unconscious manner. These biases, which include both favorable and unfavorable assessments, are activated involuntarily and without an individual’s awareness or intentional control.
In this issue of Quick Safety, The Joint Commission discusses the effects of implicit bias on health care, identifies skills to help combat, reduce, and overcome implicit bias, and presents safety actions to consider to better understand, asses, and correct implicit bias and racial discrimination to support best outcomes and zero harm for patients. Resources are also provided.
The Joint Commission’s Medical Director, Ronald Wyatt, MD, MHA, previously addressed racial bias in the healthcare system, calling for immediate action in a Viewpoint article published in the August 11, 2015 Journal of the American Medical Association (JAMA). The Viewpoint, “Racial Bias in Health Care and Health,” indicates that bias by clinicians—even when they don’t recognize it’s there—has been linked with biased treatment recommendations, poorer quality patient-physician communications, and lower ratings from patients on the quality of the medical encounter.
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