Marti Moore
Martie Moore

He says he stumbled. Others think that something happened in his brain to cause the fall.

Whatever the cause, he fell and fell hard, hitting the bedroom dresser straight on. He was unconscious, but that was missed.

He fractured his neck but that was missed several times. The cervical discs shifted from being fractured and not stabilized. They pressed into the nerves. No one looked at his neck. Suddenly he was unable to empty his bladder. This was new for him; he never had issues emptying his bladder before the fall. 

No one looked at his neck. When the urologist was asked if it could be related to the fall, the response was, “You know he is an 89-year-old man.” A prescription was given to help him with his urinary flow. His neck was broken.

The care providers saw an 89-year-old man. They knew the answers before the questions were asked because he was an 89-year-old man.

Implicit bias influenced them in their actions causing quick deductions and assumptions. There were two factors that were “true:” He was a man, and he was 89-years-old. 

In an informal survey on social media, the question was posed, “If you believed something as truth/factual and information came forward that you now know that what you believe was not as truthful/factual as you thought, would you modify your beliefs or is it too painful (or hard) to do so?” 

Almost all of the respondents indicated that, of course, they would modify their beliefs. As human beings, we want to see ourselves as having the ability to discern and adapt. Yet, we do not. We are held back from doing so because of our biases. Specifically, our implicit biases. 

Webster defines implicit as “understood though not put clearly into words, not affected by doubt.” We have a bias when, rather than being neutral, we have a preference of thought or association about a person or group. Thus, the term “implicit bias” is used to describe when we have attitudes towards people or associate stereotypes with them without our conscious knowledge.

Why does it matter? Studies have shown that most of our actions occur without our conscious thoughts. This means that implicit biases often predict behavior/actions more accurately than conscious values.

In plain speak, many of our actions are done without thought given to them. We do not pause, nor question the situation before us. We act and react based upon our understood but not spoken attributes, combining them with stereotypes and attitudes towards grouping of people.

In the case of the elderly, we quickly attribute much to age. We fail to see the truth, because we think we already know what truth is and miss the pieces of information that can assist us in truly knowing and understanding what is happening. 

What can you do? 

  1. Start to think like your former 2-year-old self. When you were 2, you did not have the answers. You asked “why x 5.”  Become curious and ask questions. Use open-ended phrases such as, tell me more… to further gain understanding. See people as individuals, as unique. 
  2. Educate yourself about implicit biases. The best way is to start with self and explore what implicit biases you might have. The Implicit Association Test is excellent for showing bias and how our unconscious drives our day-to-day decision making. It helps all of us, from all backgrounds, recognize unconscious/hidden biases which may unknowingly distort our objective evaluation and treatment of others. It also opens pathways for participants, once their unconscious bias awareness is raised (in spite of most people’s surprise that they still have room for growth), to take specific behavioral steps to help interrupt some of those biases in their professional and personal performance and interactions.
  3. Practice being mindful and intentional. Take time to pause and reflect on interactions, presumptions that you had and how they influenced your communications/action. Check and reflect on the messaging that you give in your communication. Challenge your thinking by asking, am I thinking through the lens of implicit biases? 

As a wise leader once stated, “This is a take-two moment. I missed doing my best, and because I missed doing my best, I missed the opportunity to give you the best of me.” “I am starting over and trying again.”

Resisting implicit bias is lifelong work. You have to consistently be aware of when it creeps in and is the driver of your decisions, actions and communication. When it is the driver, the risk for harm and medical error is great. We cannot afford that cost anymore. 

Martie L. Moore, MAOM, RN, CPHQ, has been an executive healthcare leader for more than 20 years. She has served on advisory boards for the National Pressure Ulcer Advisory Panel and the American Nurses Association, and she currently serves on the Dean’s Advisory Board at the University of Central Florida College of Nursing and Sigma. She recently was honored by Saint’s Martin’s University with an honorary doctorate degree for her service and accomplishments in advancing healthcare.