Designing Communication Feedback Systems To Reduce Healthcare Providers’ Implicit Biases In Patient Encounters
Abstract
1 Introduction
2 Related Work
2.1 Feedback Tools For Healthcare Providers
2.1.1 Feedback Reports.
2.1.2 Simulated Patient Interactions.
2.1.3 Social Signal Processing.
2.2 Provider Perspectives on Communication Feedback Tools
3 Methods
3.1 Study Design
RQ: What are primary care providers’ preferences on design features for tools that provide feedback on implicit patient-provider communication biases during clinical interactions?
3.2 Wireframes
3.2.1 Data-Driven Feedback.
3.2.2 Real-Time Digital Nudge.
3.2.3 Guided Reflection.
Age | |
Mean (SD), | 45 (11), |
Gender | |
Woman | 12 (50%) |
Man | 12 (50%) |
Race | |
White | 16 (64%) |
Black/African American | 2 (8%) |
Asian Indian | 1 (4%) |
Chinese | 1 (4%) |
Other Asian | 1 (4%) |
Other: “Mixed” | 1 (4%) |
Other: “Latina” | 1 (4%) |
Decline to State | 2 (8%) |
Ethnicity | |
Hispanic / Latino/a/x/e | 2 (8.3%) |
Not Hispanic / Latino/a/x/e | 20 (83.3%) |
Decline to State/No Response | 2 (8.3%) |
Self-Selected Identity | |
BIPOC: Black, Indigenous, and People Of | 5 (20.8%) |
LGBTQ+: Lesbian, Gay, Bisexual, Trans, | 3 (12.5%) |
LATINX | 2 (8.3%) |
None | 13 (54.2%) |
Decline to State | 1 (4.2%) |
Clinician Role | |
Nurse Practitioner (NP) | 2 (8.3%) |
Doctor of Osteopathic Medicine (DO) | 1 (4.2%) |
Medical Doctor (MD) | 21 (87.5%) |
Years in Role | |
Mean (SD), | 15.7 (12.1), |
Approximate Panel Size (Number of Patients) | |
Mean (SD), | 368.5 (457.3), |
Experiences of Discrimination Measure (EOD) * | |
EOD Measure Score - Mean (SD), | 17.5 (15.6), |
Bias Awareness Measure (1 "Strongly Agree" to 6 "Strongly Disagree") | |
Personal Bias | Mean (SD) |
In most situations, I am objective in my decision making | 2.23 (1.08) |
Biases do not usually influence my decision making | 3.17 (1.52) |
Gender identity affects the types of biases that people have against other people | 1.78 (1.14) |
Societal Bias | Mean (SD) |
People in today’s society tend to treat people of different social groups (e.g., race gender, class) equally | 4.68 (1.69) |
Society has reached a point where all people, regardless of background, have equal opportunities for achievement | 5.65 (0.70) |
Biases in Healthcare | Mean (SD) |
In health care, bias against others is no longer a problem in the area of hiring | 5.13 (1.26) |
In health care, bias against others is no longer a problem in the area of promotion | 5.17 (1.34) |
In health care, bias against others is no longer a problem in the area of leadership | 5.43 (0.97) |
3.3 Data Collection
3.4 Analysis
4 Results
4.1 Part 1 Results – Wireframe Evolution Based on Participant Feedback
4.1.1 Data-Driven Feedback.
4.1.2 Real-Time Digital Nudge.
“It feels counter-intuitive and somewhat ironic that you’re telling somebody to look away from the patient at their watch to tell them to look at the patient more.” – P05
4.1.3 Guided Reflection.
“If you find that you have a subset of patients that it’s consistent where you’re scoring lower then maybe you could then kind of look at some of the characteristics that happened during those times and you might be able to do some pre-visit planning that’s a little bit different… But how can– how can I readjust to improve things there? And this might be where coaching or some kind of an educational thing can help out here.” – P22
“I would love something like if we if you were going to assess me and then there’s I get this little thing in my e-mail, then here are some resources. So I would love, like, a button I could click on after I see my data. And then or even a video saying course or I mean an assigned course is OK, you know, through video. But even if there’s like here are some resources click that we could read.” – P13
4.2 Part 2 Results - Implications
4.2.1 Making Feedback Actionable.
“It’d be fine to have [the quick tips] in its own separate page like this but it could also be direct from the dashboard and results… so that while you’re paying attention to [the dashboard] you can follow [the dashboard] up [with the quick tips]” – P08
“Giving us information on how to better enact, react, interact with diverse patient populations is always a good thing. Because some people, it’s not that we don’t want to change. I think some just don’t know how to change and, you know, if there are resources readily available saying, ’hey, this is an area of for improvement for you’ and then ’here’s the resource on how to do that,’ I think that would be helpful.” – P22
“I do not even know the composition of my patients[race-wise]…it would be nice to see percentages. I would like to understand if my comparison is different from white providers…are they going to have shorter visits with their patients of color vs my data then also understand if I am spending more time with these patients it is because they are presenting with more illnesses…comparing providers of color vs non-providers of color” – P06
4.2.2 Detailing Institutional & Personal Barriers.
5 Discussion
6 Limitations & Future Work
7 Conclusion
Acknowledgments
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