Health Equity

One pivotal way to identify patients harmed by bias: Ask

Jennifer Lubell , Contributing News Writer

A Latina patient’s pain is documented as psychosomatic.

A 30-year-old presents with chest pain to the emergency department, but no troponin is ordered because the patient is “too young” and it's diagnosed as an anxiety attack.

Someone with obesity feels that health complaints trace back to excess weight as the root cause without complete testing or investigation.

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These are just a few scenarios in which bias can compromise high-quality care.

“We have a lot to learn about equity or lack thereof from patient stories, just as much as data,” said Teresa Arrington, system quality and patient safety program manager at Ochsner Health. Ochsner is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.

Arrington and others convened a group to discuss how Ochsner’s safety-reporting platform could be used to capture stories of potentially inequitable care experiences. 

During an AMA Insight Network webinar, Arrington joined other health system leaders from Children’s Hospital of Philadelphia, MD Anderson Cancer Center, and Dana-Farber Cancer Institute to share strategies about advancing equity through quality and safety.

Each of the health care organizations takes part in the AMA Peer Network for Advancing Equity through Quality and Safety, which equips participating health systems with the foundational knowledge and concrete tools to embed equity throughout their institutions’ health care delivery practices and advance racial justice and equity for their patients, staff and communities.

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Ochsner’s bias query

The Peer Network asks participating teams to embed equity into their institution's safety analysis. Ochsner Health accomplished this by integrating a question to help identify inequities in its safety-reporting solution.

The developers sought close feedback while test-driving the question. The latest iteration asks: “Could this patient's outcome possibly have been impacted by a caregiver's bias? We appreciate your response so that we can better understand when biases might have caused patient harm in unintentional ways.”

Recently, the question landed its first reporting win. A patient with a prolonged history of alcohol-use disorder had bloody gauze over a wound that was under restraints. The reporter noted that caregiver bias toward such patients might cause staff to be less empathetic or attentive. After an initial review, the report was escalated to the local Ochsner Health quality leader. 

Ochsner is open to further evolution of its bias query, “and we're very excited to see where the work takes us and how we can improve for our patients and staff,” Arrington said during the AMA Insight Network webinar.

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The AMA Insight Network helps AMA Health System Program members gain early access to innovative ideas, get feedback from their peers, network with other members, and learn about pilot opportunities. Learn more.

Ochsner Health also plans to roll out a robust educational campaign on bias. The campaign will include several clinical examples that should resonate with physicians and other front-line staff, said Arrington.

Looking outside the health system, Ochsner is partnering with Xavier University of Louisiana—a historically Black university—to set up a medical school that will “to provide greater physician diversity that hospital systems around the country are seeking to address,” said Arrington.

Learn more about a free AMA Ed Hub™ CME series in which Peer Network faculty and guest speakers present a wide range of topics with the goal of helping learners integrate equity into their quality and safety infrastructures to address inequities in care and health outcomes for marginalized patients, communities and populations.