By Valerie Romero-Leggott, MD
The need for change haunts every diversity professional, especially in health care, where we are learning that health outcomes can depend on physicians’ intentional decision-making as well as on unconscious biases. Yet the pace of attitudinal change seems to be crawling even as technological change barrels forward. Burnout is high among diversity professionals; a sense of isolation and voicelessness can overwhelm us, especially in the face of forces that don’t see the need for change.
But my view of the task ahead shifted after attending the Unconscious Bias Learning Lab for the Health Professions. The Lab was created through a partnership between the Association of American Medical Colleges (AAMC) Diversity Policy and Programs department and consulting firm Cook Ross. Howard Ross, the author of ReInventing Diversity and charismatic presenter of the workshop, provided participants with a new lens through which to refract familiar problems.
The first thing he did was to completely throw out the shame and blame that often shut down any discussion of inclusion and diversity. Research has proven time and again that unconscious bias, which is a set of tendencies and orientations outside of our awareness, is a natural (indeed, essential) part of being human. At the same time, Ross helped us recognize that our biases can frequently get in the way as we too-quickly exclude options or people it might better serve us to consider.
Because we are not aware that we act with bias, we do it all the time. Over time, such biases become habitual and are reflected in the practices of our institutions. For me, that was an insight from the program: Structures and systems are embedded with the thinking of those who create them, so they reproduce their preferences and biases.
Bias is reflected when we invite faculty of color and women to participate on committees to represent diverse views, but we don’t embrace the perspectives that they bring. If we are aware that biases operate at the individual and at the structural level, we can find better ways to ensure what we want to say actually gets heard and has an impact on committee issues and on wider policies and practices. The AAMC video, “What You Don’t Know: The Science of Unconscious Bias and What to Do About It in the Search and Recruitment Process,” is one resource that can begin to help us change attitudes and outcomes.
Of course, mere awareness that bias exists won’t mean that widespread attitudinal change will speed up. However, as we have come to understand the importance of addressing the social determinants of health (such as food insecurity) in achieving health equity, understanding the importance of addressing unconscious biases and their complicated links to social determinants can create better health outcomes for our patients and communities.
The recent focus on unconscious bias has changed the diversity environment and it has changed me. Now I leave meetings feeling empowered, because I have a more precise vocabulary and new insights to describe what is going on both in myself and in the system in which I work. At the Learning Lab, it felt like learning the language of medicine in the first few months of medical school. Similarly, speaking about bias requires us to find a way to speak so that people can reflect on their unconscious motivations. If we are going to have any kind of culture shift, we need to combine these skills: the professional vocabulary of the health professions with a nuanced vocabulary of bias as an unconscious aspect of rapid decision-making.
In medicine, we learn to examine clues that can prove vital to making someone well. The same attention to detail and connections can engender understanding about how biases are embedded in our unconscious and how they can impact our decisions and the effectiveness of our institutions. Diversity professionals are key partners in our efforts to create a truly diverse and inclusive environment where, over time, unconscious bias can be anticipated, examined, and minimized.
—Valerie Romero-Leggott, MD, is the Vice Chancellor for Diversity and a Professor for Family Community Medicine at the University of New Mexico Health Sciences Center. She can be reached at firstname.lastname@example.org
The next Unconscious Bias Learning Lab for the Health Professions takes place from October 9-11, 2013.