Health Disparities Researchers Target Unconscious Bias in Health Care

Unconscious bias, also called implicit bias, affects health care providers every day, especially when they are stressed or tired. Swift and automatic, it can reduce quality of care and even lead to medical errors.

Michelle van Ryn, Ph.D., HSR – Health Care Policy and Research, is Principal Investigator of Mayo’s Research Group on Equity and Inclusion in Health Care. “All of us, despite the best of all possible intentions, are affected by unconscious processes. It affects what we see, how we react, how we feel, how we behave. If we’re not aware of it and taking measures to counter it, it affects quality of care.”

Watch Dr. van Ryn describe her research in this video:

Nationally, significant numbers of patients in underserved populations receive unequal care, causing large-scale differences in health outcomes. Unconscious bias is an important contributor to health disparities based on race, sexual identity, obesity status or other social identities.

Implicit bias stems from subconscious associations gathered over a lifetime that can override conscious beliefs and cause people to unknowingly act in ways that are inconsistent with their true values.

In health care, unconscious bias might affect a provider’s line of questioning and lead to misdiagnosis. Or it may affect body language and other subtle cues that cause patients to lose trust, withhold information or fail to follow medical advice.

Measuring bias, testing interventions

The Research Program on Equity and Inclusion in Health Care team at Mayo Clinic, led by Dr. van Ryn, is studying unconscious bias and testing interventions to prevent its influence on patient care.

In collaboration with Yale University and the University of Minnesota, the Mayo team is conducting a national study on environment and training in 49 medical schools, and how student attitudes change over time.

An early result from the Medical Student Cognitive Habits and Growth Evaluation Study (CHANGES) found that school climate affected whether students’ implicit race, sexual orientation and obesity bias increased or decreased over the course of medical school.

Researchers are exploring interventions to reduce implicit bias, including:

• Medical school and institutional environments that are accepting and inclusive
• Increased diversity in the health care workforce
• Health care settings that minimize provider stress and fatigue
• Provider training on skills that prevent them from being hijacked by implicit biases: emotion regulation, perspective-taking (putting one-self in the patient’s shoes), and partnership-building with patients

“We have the opportunity here to test strategies that are comprehensive,” says Dr. van Ryn. “Mayo Clinic is an integrated health care delivery system with the will to take action even when inconvenient, to study and intervene, to improve the patient experience.”

The CHANGES study also examines the health and well-being of minority, female, low-income, LGBT and obese students in medical schools, consistent with a National Institutes of Health priority to reduce health disparities by increasing diversity in health professions.

The work of the Research Group on Equity and Inclusion in Health Care is housed in the Division of Health Care Policy and Research and supported by the Office of Health Disparities Research (OHDR) and by grants from other Mayo Clinic and federal sources.

To learn more, watch Dr. van Ryn's presentation in Mayo Clinic's Center for Clinical and Translational Science (CCaTS) Grand Rounds.

— Kris Schanilec, Public Affairs