Implicit bias

Implicit biases, also called unconscious biases, are attitudes toward or stereotypes about certain groups of people that are made without consciously thinking about them. These biases can influence a person’s behavior and judgment without that person even knowing about it.

Humans often operate on autopilot, using mental shortcuts to make everyday decisions. While this may be efficient, it also can lead to people making decisions that don’t align with their personal values. These cognitive shortcuts can lead to rash decisions and discriminatory behaviors that favor one group over another.

Some biases are hardwired in our brains. For example, in-group bias: favoring one’s own group (based on team, race, religion, or other shared identities) over other groups. Or anchoring bias: being overly influenced by the first piece of information received.

However, people also learn biases from the news media, education systems, family behavior, systemic inequities, community norms, and other sources. These external factors shape and reinforce implicit biases. For example, in YouTube ads, women represent only 36% of speaking time, enforcing the idea that men have more valuable things to say than women. And in news and opinion media, there’s a 32% overrepresentation of Black family poverty, perpetuating inaccurate representations of Black communities.

While implicit bias is not intentional, individuals and institutions must take responsibility and deliberate action to avoid acting on harmful biases.

Implicit biases influence how people interpret information, treat people, make decisions, and allocate resources. And bias operates on different levels: personal, institutional, and structural.

At the personal level, implicit bias can lead individuals to treat others unfairly or poorly. At an institutional or structural level, implicit bias can perpetuate systemic inequities and unjust outcomes. A biased policy—even if it wasn’t designed with bias in mind—does not require individuals to personally act in biased ways for the negative impact to continue.

All of this is true in health care, too, as the graphic below illustrates.

Health care providers and leaders must examine how implicit bias results in worse health outcomes for some groups.

Examples of the effects of bias in health care include:

• Physicians with an implicit pro-white bias are more likely to associate Black patients with being "less cooperative" and were less likely to refer Black patients with acute coronary symptoms for thrombolysis, the appropriate treatment.
• Women in one urban emergency room wait an average of 16 minutes longer than men to get medication when reporting abdominal pain and are less likely to receive it.
• African American patients reporting pain are 22% less likely than white patients to get pain medication from their doctors.

Implicit bias in health care is real and it’s harming patients. Even if a person’s bias is unconscious, it needs to be acknowledged. Health care providers must challenge assumptions and address implicit bias to better serve their patients and communities.

Health care organizations should focus both on changing institutional processes that perpetuate structural biases and on helping clinicians address the biases in their immediate control.

The NeuroLeadership Institute created one framework to mitigate individual bias:

• Accept that the brain is biased to internalize that unconscious assumptions can lead people to overlook or ignore certain information.
• Label biases as they occur to acknowledge that they’re there and decide the most effective strategy to mitigate that particular type of bias.
• Mitigate the bias by employing tools like if-then plans and decision guides to bypass the bias and make a more informed decision.

Ensure implicit bias training goes beyond theory and awareness. Training works best when people choose to participate and it addresses everyday situations.

Have clinicians reflect on where bias might arise in their encounters with patients. Then, help them plan for how to mitigate those biases through tools like shared decision-making and motivational interviewing. These strategies can help clinicians understand each patient as an individual rather than a stereotype and seek out additional data before making decisions.

It’s crucial to help people plan for biased moments, but training will not eliminate biased decisions. Also consider how to embed preventive measures in workflows to remove triggers that activate or magnify bias in decisions. For example, hardwire evidence-based medicine protocols and embed care checklists.

Acknowledging and addressing unconscious bias is an ongoing process. Organizations must build an inclusive culture that emphasizes the importance of different perspectives and backgrounds.

For each of these conversations, investigate what changes you can implement at an institutional level. It’s critical to help individual staff members address their own implicit biases, but changing organization-wide policies and processes can amplify the impact even further.