March 21st was the international day for the elimination of racial discrimination. In this article Sarah Esegbona-Adeigbe, Senior Midwifery lecturer at London South Bank university, and steering group member for the Maternity and Midwifery Forum, addresses the importance of dealing with unconscious bias in healthcare.
Unconscious bias- should there be a concern about unconscious incompetence?
To be unconsciously incompetent in clinical practice is a real concern as it means a person is unaware of how to do something and does not recognise the deficit. Unconscious bias has similarities to unconscious incompetence whereby a person also does not recognise the deficit and therefore cannot correct the fault. Healthcare professionals who are found to be practising incompetently would be subject to investigation and remedial training resulting in improvements in practice. The same strategies could be applied to healthcare professionals who are unconsciously biased. However, the main issue with unconscious bias is that it is not obviously a trait that others can recognise, it is also inherent in humans and is a learned behaviour. Furthermore, its existence is often met with denial and objection.
The simple fact is that every individual has unconscious biases and any person who does not believe this already faces the challenge of putting to rights the problem. Unconscious bias impacts on every decision that we make in clinical practice. False assumptions of a person attending for healthcare can lead to negative outcomes and decisions may lead to professional incompetence and ineffective care provision. Despite increased awareness of the impact of unconscious bias on safe and effective health care, drives to input training in midwifery education and practice requires further commitment. Recognition of how unconscious bias contributes to incompetency, leading to inequality in healthcare services and poorer health outcomes, is absent from a majority of healthcare policies, regulations and national guidance including the NMC Code. Unconscious bias and competency should have equal weighting regarding a person’s capability to practice.
NHS England advises that staff complete cultural competence and unconscious bias training, (Personalised care and support planning guidance: Guidance for local maternity systems March 2021). However, it is not clear how these recommendations will be supported, monitored, or financed. Indeed, each organisation may approach this type of training differently, and, in some cases, training may not be mandatory or supplied to all employees. There are also some organisations that have voiced concerns about the effectiveness of unconscious bias training, However, there are also arguments that unconscious bias training lays a foundation and highlights to individuals the dangers of unconscious biases. It is suggested that we need to reframe the conversation around unconscious bias to be more robust and comprehensive so that participants become aware of how biases have real impact on other people’s performance.
Tackling unconscious bias should be undertaken at organisational and national levels, but individuals also have an ultimate responsibility to be aware and address their own biases. Every healthcare professional should strive to practice competently and understand how unconscious biases impacts on quality healthcare provision. Also, speaking out against behaviour that is inequitable and non-inclusive is paramount. Unconscious bias is recognised as being an issue in many different settings and organisations and its importance to improving equality, eliminating prejudices and removing discrimination.
March 8th 2022 was International Women’s day and the campaign theme was # BreakTheBias, advocating a world free of bias, stereotypes and discrimination. People are being asked to Strike the IWD 2022 pose and share your #BreakTheBias image, video, resources, presentation or articles on social media using #IWD2022 #BreakTheBias to encourage further people to commit to helping forge an inclusive world.
Sarah Esegbona-Adeigbe
March 2022