Gov. Gretchen Whitmer’s recent mandate for Michigan health care workers is already in practice at many hospitals and health systems to eliminate cultural biases that can affect care.
Health systems such as Spectrum Health and Metro Health-University of Michigan in Grand Rapids and Bronson Healthcare in Kalamazoo already do implicit bias training, designed to make health care workers aware of how unintentional, subconscious biases may affect how they view a patient and their care.
Brittany Bogan, senior vice president for safety and quality at the Michigan Health & Hospital Association, estimates that roughly half of the hospitals in the state already conduct implicit bias training.
“Many of our hospital systems across the state have already been doing this for some time,” Bogan said. “The training itself helps individuals to identify and acknowledge the biases that you have individually, and these often exist outside of our conscious awareness. So, there’s benefit to everyone for some sort of conversation and training about implicit bias.”
Those biases go beyond race and ethnicity and can include age, religion, gender, weight, socio-economic status, residency and sexual orientation, said Bogan, who’s also executive director of the MHA’s Keystone Center patient safety organization.
Having a better understanding of their own implicit biases should lead to better engagement between care providers and patients, Bogan said, noting many examples of “individuals not being listened to when they know something is wrong and missing a diagnosis because there was an assumption made about the individual.”
Two years ago the MHA identified opportunities for birthing units and obstetrics providers to recognize and address implicit bias, Bogan said. She cites data that show Black women are four times more likely to die during childbirth than white women.
Spectrum Health has been doing implicit bias training since 2015 as part of staff cultural competence training, said Spectrum President and CEO Tina Freese Decker. She estimates that half of Spectrum Health’s employees have gone through cultural competence training in the last three years and said the health system intends to scale up the effort this year.
“We’ve already been deep in this work,” Freese Decker said. “It’s a core part of our teams’ development. It’s not just something we do to check a box. It’s really important that we’re helping our team members know how best to interact with our patients.”
She added that health care is highly personal and requires building trust with patients.
“That means we have to get to know people, we have to understand how they look at things from a different perspective and connect with them to impact their health, impact healthy behaviors and inspire them to take new action,” Freese Decker said.
Pandemic highlights inequities
Freese Decker is “very supportive” of Whitmer’s July 9 executive order that directs state regulators to craft rules requiring implicit bias training for Michigan health professionals as they seek licensure, registration and license renewals. The training is a way to ensure equity in health care access, Whitmer said.
The order directs the state Department of Licensing and Regulatory Affairs to undergo a formal rulemaking process, which could take six to 12 months, officials have said.
The order drew support from health care providers and organizations, and comes amid the COVID-19 pandemic that has disproportionately affected minorities and drawn greater attention and scrutiny to inequities in health care.
“The COVID-19 pandemic has been difficult for everyone, but there is no question that this public health crisis has had a disproportionate impact on people of color. COVID-19 is more than four times more prevalent among Black Michiganders than among white Michiganders,” Dr. Bobby Mukkamala, president of the Michigan State Medical Society and a Flint otolaryngologist, said in a statement.
His group is “proactively engaged” in addressing implicit biases in physicians’ “perceptions, words and actions,” Mukkamala added.
“We look forward to this opportunity to discuss with the administration and other stakeholders strategies that will help physicians and other health team members deliver culturally appropriate, patient-centered care in an equitable manner,” he said.
In supporting the governor’s executive order, the MHA ultimately wants to see implicit bias training “as a foundational element of how an organization functions,” Bogan said. “This should always remain a piece that we are all striving together to ensure equitable care.”
Bronson Healthcare as well has an intercultural development program for leaders that includes implicit bias education, said Beth Washington, vice president of community health, equity and inclusion. The health system offers implicit bias training to all employees and every new employee is “encouraged to explore the Harvard Implicit Association test” that measures subconscious attitude and beliefs, Washington said in a statement to MiBiz.
“Bronson Healthcare wants to do whatever we can to eliminate health disparities and we believe implicit bias training is one of the many ways to advance those efforts,” she said. “The importance of this work is especially highlighted by the disparities more clearly revealed nationally during the COVID-19 pandemic. As a health care system, we have been on a journey to address inequities and we look forward to learning more details about the statewide effort.”
Metro Health - U of M has been doing implicit bias training since November, starting with senior leadership and then extending to managers and employees, President and CEO Peter Hahn said. Requiring the training as part of the formal processes for licensing and relicensing care providers is an “important and good step,” Hahn said.
The training “sort of opens your eyes in really addressing those implicit things that we all believe about each other that we don’t even consciously realize,” he said. “For physicians, there’s really no formal way to get that training, so making it part of the licensing process is a good way to do it and it just opens their eyes to address those implicit (biases).”
Dr. David Spahlinger, president of the Ann Arbor-based University of Michigan Health System, said his organization has trained 14,000 of 28,000 faculty and staff in implicit bias, while another 4,000 have gone through intervention training.
Freese Decker at Spectrum Health said having the training requirement as part of the relicensing process will assure that lessons are regularly reinforced as a routine part of professional development.
“This isn’t a one-and-done process. We have to continually do it,” she said. “The training and the discussion have to continue to build upon each other to make sure it can be applied and improved upon each time.”
As the Department of Licensing and Regulatory Affairs works with groups to craft rules for mandatory implicit bias training, the MHA hopes “to see a lot of flexibility in how the training can be provided,” Bogan said. The association wants to “avoid where it has to be very prescriptive,” she said.
“That’s critical for success and implementation because not every health care worker is going to benefit from the exact same training,” Bogan said.
Options include using web-based, on-demand training in implicit bias — a format that’s used for health care workers to meet professional continuing education requirements, Bogan said. She suggested that MHA members can share their training models for the state to use in formulating rules for mandatory training.
“I don’t see this as one standardized training that every single individual receives,” Bogan said. “There are a variety of mechanisms in which the training can be provided.”