NEW ORLEANS -- Everyone has unintentional biases, but physician practices can mitigate them with a few simple steps, experts said here.
The speakers defined unintended bias as "stereotypes or beliefs that affect our actions in a discriminatory manner." Such bias may affect our actions in a way contrary to our intentions, two speakers said at the Medical Group Management Association annual meeting.
Unintentional biases -- also known as unconscious biases -- can work against a practice's commitment to diversity in hiring and workplace inclusion, said Steve Marsh, founder of The Medicus Firm, a physician recruiting firm in Dallas. "Diversity and inclusion go hand in hand," he said. "you can do a good job of diversity hiring, but if you don't have an inclusive environment that's welcoming to all the people you brought in, it's worthless; in fact, it can backfire on you."
Achieving these goals "isn't real complicated, it's just really hard to do," he added. "You can't do a a crash diet on diversity hiring; you can't do a crash diet on inclusive culture. It's a lifestyle, not an event."
Many Types of Bias
Pam Snyder, head of recruiting at Baystate Health, a healthcare system based in Springfield, Massachusetts, cited the launch of the video viewing site YouTube as an example of the perils of a non-diverse workforce. When YouTube's mobile version launched, "there was a glitch in it -- 25% of people were reporting it wasn't working," she said.
The reason? The mobile version was designed entirely by people who were right-handed and all turned their phones a certain way to see videos; left-handers turn their phones the opposite way, so the videos all appeared upside down. "Because they had that lack of diversity on their team, the product wasn't launched accurately."
A total of 188 types of unconscious bias have been identified, Snyder said. She listed four of the most common types:
- Affinity bias: We tend to be more receptive to people who resemble our lives in some way. For example, Snyder was hiring a new recruiter on her team, but happened not to be there on the day one candidate came in for an interview. But during a follow-up phone call about the candidate, "I had at least three different staff people say, 'You're going to love her; she reminds me of your daughter.' That was their affinity bias."
- Confirmation bias: We look for information that supports our beliefs and ignoring details to the contrary. Snyder, who is from Tennessee, explained that "when you hear someone with an accent like mine ... you think they're not well-educated. Confirmation bias is when you look for things when you're talking to someone that confirms that."
- Halo effect: There's something good about someone and because of the one good thing, we think everything about them is good. "In Tennessee, when we got a CV [curriculum vitae] and it was from a Harvard grad, we're like, 'We've hit the jackpot,'" she said. "This halo effect was real; there were things we'd ignore about that candidate because of what was on their CV."
- Perception bias: This one is "really scary, worse than confirmation bias," said Snyder. "You know it -- you've met one person that had these physical and emotional attributes and you've formed your opinion and you can't get away from that. That's really the scariest when it comes to recruitment."
Steps to Overcome Bias
To overcome unintentional bias, "the first thing we have to do is accept the fact that we have it," said Snyder. "We can't control the experiences we have had." She suggested taking an "implicit association" test such as offered by Harvard. "You need to take an honest look at your unconscious."
To mitigate bias and foster a diverse workplace, organizations are moving toward competency and evidence-based recruitment, she continued. Part of the competency-based evaluation for interviewees involves asking behavioral event interviewing (BEI) questions involving something the person experienced in the past. Such questions often begin with "Tell me about a time when..."
For example, one practice wanted to know whether its candidates for a physician slot would be able to handle the workload, which involved seeing as many as 25 patients per day with only one medical assistant and a shared RN. So they might ask candidates the following about their previous job experience: "Tell me how many patients you saw in a day and what support you had." If the candidate answers, "I saw 10 patients a day, and had two medical assistants and my own RN," that might mean that the candidate isn't a good match for the position, she said.
A question to ask when you want to find out about the candidate's teamwork abilities is, "Describe a time when you were part of a team that worked well together. What role did you play? How did you show respect for others on the team?" said Snyder. Candidates' egos can really be revealed with this answer; if they answer the question by just talking about themselves, "it's a big red flag for us."
When developing questions for a competency-based evaluation, it's important to get buy-in from the staffers working in the department being recruited for, and to ask all the candidates the same questions, she said. Having a diverse panel of interviewers is also critical. "If you're looking at an interview panel of all white males, you failed." Also, panelists should work in a variety of positions at the company -- "If you're hiring a surgeon, you need someone from the surgery department that's a non-provider ... When you have those different inputs, you get a stronger decision."
Benefits of Diversity
In addition to unintentional biases, practice managers need to be on the lookout for intentional ones as well, according to Marsh. "Over the last 2 or 3 years, I've seen one of the biggest intentional biases ever creep in: politics," said Marsh. "Five times in the last 2 years -- not in group settings, but in individual meetings -- I've heard, 'We can't recruit a Republican' or 'We can't recruit a Democrat.' I've heard it on both sides of the aisle. People have some very strong polarizing biases in the environment we're in right now, but it has nothing to do with competency. It has nothing to do whether they're good for this role."
Hiring a diverse workforce results in more creativity, according to Marsh. "You have all these ideas coming in that you never would have had if everybody looked and acted the same," he said. "If we're able to create an environment where everybody has a voice, you're going to have meetings -- and be thankful for them -- where somebody says, 'I don't think that's a good idea.' If you have an inclusive environment and welcome additional ideas, many times you'll avoid pretty bad circumstances."
Once a diverse workforce is on board, the next step is to work on inclusion, defined as "a feeling of belonging, a feeling of being appreciated for unique characteristics, and the extent to which employees feel valued, respected, accepted, and encouraged to fully participate," said Marsh. And you have to have a meaningful process for addressing bias-related concerns. "You can do everything right, with all the good intentions in the world, but if you're scared to address the issues, it all goes for naught because everybody's watching."