Stephanie Huckel, MS – Diversity Specialist, Office of Diversity & Inclusion, Blue Cross & Blue Shield of Rhode Island

Emerson Moses, MBA, FASPR – Director of Provider Recruitment, One Medical Group

IntroductionsEmerson Moses, MBA, FASPR, CMSR

Director of Provider Recruitment at One Medical Group

Senior Physician Recruitment Consultant, Tufts Medical Center, Boston, MA

7 years with Baystate Health, Springfield, MA

3 years in academic medicine & healthcare management at Massachusetts General Hospital

IntroductionsStephanie Huckel, MS

Diversity Specialist, Blue Cross & Blue Shield of Rhode Island

Formerly, Diversity Specialist, Baystate Health

Treasurer, Board of Directors, Jim Collins Foundation

Speaker, 2013 DiversityRx National Conference on Quality Health Care for Culturally Diverse Populations

“Transgender Health: Improving Care through Collaboration”

“Typical” Doctor

“Typical” Doctor

Preference hierarchy

US-born & trained MDs

US born & trained DOs

US born, Internationally trained physicians

Foreign born physicians

68%

26%

7%

What do the stats say?

19.9%

8.7%5.8%

4.8%

3.3%

2.5%

2.4%

2.2%2.1%

2.1%

Top 10 countries where IMGs received medical training

India

Philippines

Mexico

Pakistan

Dominican Republic

USSR

Grenada

Egypt

Korea

Italy

What do the stats say?

1. New Jersey 45%

2. New York 42%

3. Florida 37%

4. Michigan 34%

5. Illinois 34%

6. Connecticut 29%

7. Ohio 29%

8. Maryland 27%

9. Pennsylvania 26%

10. Texas 24%

11.California 23%

12. Massachusetts 22%

13. Virginia 22%

14. Missouri 22%

15. Arizona 22%

16. Indiana 21%

17. Georgia 20%

18. Wisconsin 19%

19. Tennessee 17%

20. North Carolina 13%

Top 20 states where IMGs practice, 2007

What do the stats say?IMGs within each specialty

Internal Medicine – 37%

Psychiatry – 31.4%

Anesthesiology – 28%

Pediatrics – 28%

General/Family Practice – 28%

General Surgery – 19.8%

Radiology – 18.8%

Obstetrics/Gynecology – 17.6%

What do the stats say?IMGs & PerformanceDividing the international medical graduates into those who were foreign-born and those who were American citizens who chose to study abroad, the researchers discovered that patients of foreign-born primary care physicians fared significantly better than patients of American primary care doctors who received their medical degrees either here or abroad. (The New York Times, Aug. 12, 2010)

Culture & Cultural Competence Culture is:

Learned, not innate

Broad, not just race and ethnicity

Changes; is not static

Exists within all groups

Defines group norms and boundaries

Culture & Cultural Competence Cultural competence is:

The ability of individuals and organizations to effectively understand and address the unique perspectives and health needs of various communities

The capacity of a system or of an individual to:

Value cultural influences in individual beliefs and practices

Take into account those influences in delivering services to diverse populations

Bias is not a bad word. Bias is a predisposition to see events, people or items in a positive or negative way.

Bias is an attitude or belief.

Bias is valuable.

A 2012 survey found that 79% of HR professionals report unconscious bias as a widespread issue.

Unconscious Bias

Britain’s Got Talent

http://www.youtube.com/watch?v=RxPZh4AnWyk

“That Calls for Carlsberg”

Ladder ofInference

Observedata

Select data

Add meaning

Make assumptions

Draw conclusions

Adopt beliefs

Take action(s)

Ourbeliefs lead to choices about the data we

select

1. Observe data:2. Select data: it’s

tall and loopy.3. Add meaning: tall

and loopy = awesome (scary)

4. Make assumption: this roller coaster is awesome (scary)

5. Conclusion: definitely should (not) go

6. Belief: all roller coasters are awesome (scary)

7. Take action: get on! (Run away!)

Reflective loop: if you have a great (or terrible) experience, it will reinforce the data you select next time.

Examples of Bias“Dead fish handshake”

Examples of Bias India

The majority of Indians are Hindu

Men customarily do not touch women in either formal or informal situations

A Western woman should not initiate a handshake with a man. Most Indian women will shake hands with foreign women but not men.

Only westernized Hindus will shake hands with the opposite sex

Titles are highly valued by Indians

Examples of BiasFashionably late…

Examples of Bias Russia

Always be punctual, but do not be surprised if the Russians are not on time. It is not unusual for Russians to be 15-30 minutes late.

Don’t try to be subtle and make “suggestions,” assuming that Russians will “take the hint.”

Be factual and include all levels of technical detail

It is not customary for Russians to disclose their home phone or other personal telephone numbers.

Examples of Bias China

Punctuality is very important in China; lateness or a cancellation is a serious affront.

Introductions tend to be formal, with courtesy rather than familiarity preferred.

Avoid making exaggerated gestures or using dramatic facial expressions. The Chinese do not use their hands when speaking and become distracted by a speaker who does.

Examples of BiasLack of eye contact, soft spoken

Examples of Bias Philippines

Staring at someone is considered rude.

Speaking in a loud voice is considered rude.

Filipinos revere harmony; speak in quiet, gentle tones.

Examples of BiasTalking/Standing too close!

Examples of Bias Mexico

A warm, somewhat soft handshake is the customary greeting among men and women

Touch-orientated, lingering handshakes, touching of arms – all signs of willingness to be friendly

Men should avoid putting their hands in their pockets; hands on hips suggests hostility or a challenge.

Mexicans highly value the individual dignity of a person, regardless of social standing or material wealth.

SkillsSeven Steps to Identify & Address Unconscious Bias

Recognize that you have biases.

Identify what those biases are.

Dissect your biases.

Decide which of your biases you will address first.

Look for common interest groups.

Get rid of your biases.

Be mindful of bias kick back.Source: Diversity Best Practices

Resources Project Implicit -

https://implicit.harvard.edu/implicit/demo/

“Proven Strategies for Addressing Unconscious Bias in the Workplace,” Diversity Best Practices –http://www.cookross.com/docs/UnconsciousBias.pdf

Blindspot: Hidden Biases of Good People by MahzarinR. Banaji & Anthony G. Greenwald

The Secret Life of Decisions: How Unconscious Bias Subverts Your Judgement by Meena Thuraisingham

Thank You!

Questions?

Stephanie Huckel, Blue Cross & Blue Shield of Rhode Island (stephanie.huckel@bcbsri.org)

Emerson Moses, One Medical Group (emoses@onemedical.com)