Prescription for Change

Want to eliminate gender bias? There’s a standard for that.


Gender bias and other issues of inequality are hot topics as of late, not only in the political arena but also in the field of health care. In 2016, 50% of physicians admitted bias toward specific types or groups of patients. And this number likely underestimates the implicit bias that can unintentionally cloud clinical judgment.

While some institutions are working to address bias thorough centers of disparity solutions or anti-bias trainings, others are taking a different approach: ensuring care is done in a more systematic and standardized way. By taking this line of attack, Johns Hopkins has effectively eliminated one big source of gender bias.

Dr. Elliott Haut and his team at Johns Hopkins came about their solution to gender bias inadvertently. While working to design a blood clot prevention protocol in 2006, they made an interesting discovery—women who were trauma patients were in considerably greater danger of dying from preventable blood clots than men. While 31% of men were failing to get proper clot prevention, the rate was nearly 45% for women. So the team set out to create a new standard of care for blood clots, developing a computerized checklist that requires doctors to review blood clot prevention in a systematic way.

Since implementation of this new standard, not only has the gender disparity disappeared, but the incidence of potentially preventable blood clots in medical patients dropped to zero. The Hopkins team explains two key ways their decision support tool is able to standardize care while eliminating bias:

  • Disentangles what goes into a medical decision. Physicians are prompted to check for specific risk factors for blood clots, or for bleeding from blood thinning medication. The tool disaggregates the full decision into its component variables. This helps more physicians make the right overall decision by providing guidance at each step.

  • Reduces reliance on human judgement. After completing each step in the process, the system offers a recommended approach for treatment, preventing implicit bias from influencing the decision-making process and ultimate course of treatment.

Care isn't just influenced by the gender of the patient; it can also be influenced by the gender of the physician. A JAMA study recently showed that patients treated by female physicians have better outcomes (based on lower 30-day mortality and 30-day readmissions) than their male counterparts. While the reason for this cannot lie in anatomy itself, the authors hypothesize the difference is linked to varying practice patterns. Among the most striking differences? Female physicians are more likely to adhere to both clinical guidelines and evidence-based practice.

In sum, care standardization has the potential to overcome the subconscious biases and inadvertent practices of physicians that yield variable outcomes and ultimately harm patients. Realizing consistent best practice requires robust infrastructure and capabilities to embed care standards and decision supports into the clinician workflow.

 

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