research on unconscious bias

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Unconscious Bias Training That Works

• Francesca Gino
• Katherine Coffman

To become more diverse, equitable, and inclusive, many companies have turned to unconscious bias (UB) training. By raising awareness of the mental shortcuts that lead to snap judgments—often based on race and gender—about people’s talents or character, it strives to make hiring and promotion fairer and improve interactions with customers and among colleagues. But most UB training is ineffective, research shows. The problem is, increasing awareness is not enough—and can even backfire—because sending the message that bias is involuntary and widespread may make it seem unavoidable.

UB training that gets results, in contrast, teaches attendees to manage their biases, practice new behaviors, and track their progress. It gives them information that contradicts stereotypes and allows them to connect with colleagues whose experiences are different from theirs. And it’s not a onetime session; it entails a longer journey and structural organizational changes.

In this article the authors describe how rigorous UB programs at Microsoft, Starbucks, and other organizations help employees overcome denial and act on their awareness, develop the empathy that combats bias, diversify their networks, and commit to improvement.

Increasing awareness isn’t enough. Teach people to manage their biases, change their behavior, and track their progress.

Idea in Brief

The problem.

Conventional training to combat unconscious bias and make the workplace more diverse, equitable, and inclusive isn’t working.

This training aims to raise employees’ awareness of biases based on race or gender. But by also sending the message that such biases are involuntary and widespread, it can make people feel that they’re unavoidable.

The Solution

Companies must go beyond raising awareness and teach people to manage biases and change behavior. Firms should also collect data on diversity, employees’ perceptions, and training effectiveness; introduce behavioral “nudges”; and rethink policies.

Across the globe, in response to public outcry over racist incidents in the workplace and mounting evidence of the cost of employees’ feeling excluded, leaders are striving to make their companies more diverse, equitable, and inclusive. Unconscious bias training has played a major role in their efforts. UB training seeks to raise awareness of the mental shortcuts that lead to snap judgments—often based on race and gender—about people’s talents or character. Its goal is to reduce bias in attitudes and behaviors at work, from hiring and promotion decisions to interactions with customers and colleagues.

• Francesca Gino is a behavioral scientist and the Tandon Family Professor of Business Administration at Harvard Business School. She is the author of Rebel Talent and Sidetracked . francescagino
• KC Katherine Coffman is an associate professor of business administration at Harvard Business School. Her research focuses on how stereotypes affect beliefs and behavior.

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What Is Unconscious Bias (And How You Can Defeat It)

Research-based strategies for how to identify and defeat unconscious bias..

Posted July 13, 2020 | Reviewed by Lybi Ma

• What Is the Unconscious
• Find a therapist near me

How do you defeat unconscious bias? First, you need to know what it is.

Unconscious bias (also known as implicit bias) refers to unconscious forms of discrimination and stereotyping based on race, gender , sexuality , ethnicity , ability, age, and so on. It differs from cognitive bias, which is a predictable pattern of mental errors that result in us misperceiving reality and, as a result, deviating away from the most likely way of reaching our goals .

In other words, from the perspective of what is best for us as individuals, falling for a cognitive bias always harms us by lowering our probability of getting what we want. Despite cognitive biases sometimes leading to discriminatory thinking and feeling patterns, these are two separate and distinct concepts.

Cognitive biases are common across humankind and relate to the particular wiring of our brains, while unconscious bias relates to perceptions between different groups and are specific for the society in which we live. For example, I bet you don’t care or even think about whether someone is a noble or a commoner, yet that distinction was fundamentally important a few centuries ago across Europe. To take another example – a geographic instead of one across time – most people in the US don’t have strong feelings about Sunni vs. Shiite Muslims, yet this distinction is incredibly meaningful in many parts of the world.

Black Americans suffer from police harassment and violence at a much higher rate than white people, people do try to defend the police by claiming that black people are more violent and likely to break the law than whites. They thus attribute police harassment to the internal characteristics of black people (implying that it is deserved), not to the external context of police behavior.

In reality, research shows that black people are harassed and harmed by police at a much higher rate for the same kind of activity. A white person walking by a cop, for example, is statistically much less likely to be stopped and frisked than a black one. At the other end of things, a white person resisting arrest is much less likely to be violently beaten than a black one. In other words, statistics show that the higher rate of harassment and violence against black Americans by police is due to the prejudice of the police officers, at least to a large extent.

However, this discrimination is not necessarily intentional. Sometimes, it indeed is deliberate, with white police officers consciously believing that black Americans deserve much more scrutiny than whites. At other times, the discriminatory behavior results from unconscious, implicit thought processes that the police officer would not consciously endorse.

Interestingly, research shows that many black police officers have an unconscious prejudice against other black people, perceiving them in a more negative light than white people when evaluating potential suspects. This unconscious bias carried by many, not all, black police officers helps show that such prejudices come – at least to a significant extent – from internal cultures within police departments, rather than pre-existing racist attitudes before someone joins a police department.

Such cultures are perpetuated by internal norms, policies, and training procedures, and any police department wishing to address unconscious bias needs to address internal culture first and foremost, rather than attributing racism to individual officers. In other words, instead of saying it’s a few bad apples in a barrel of overall good ones, the key is recognizing that implicit bias is a systemic issue, and the structure and joints of the barrel need to be fixed.

The crucial thing to highlight is that there is no shame or blame in implicit bias, as it’s not stemming from any fault in the individual. This no-shame approach decreases the fight, freeze, or flight defensive response among reluctant people, helping them hear and accept the issue.

With these additional statistics and discussion of implicit bias, the issue is generally settled. Still, from their subsequent behavior, it’s clear that some people don’t immediately internalize this evidence. It’s much more comforting for them to feel that police officers are right and anyone targeted by police deserves it; in turn, they are highly reluctant to accept the need to focus more efforts and energy on protecting black Americans from police violence, due to the structural challenges facing these groups.

The issue of unconscious bias doesn’t match their intuitions and thus they reject this concept, despite extensive and strong evidence for its pervasive role in policing. It takes a series of subsequent follow-up conversations and interventions to move the needle.

This example of how to fight unconscious bias illustrates broader patterns you need to follow to address such problems to address unconscious bias to make the best people decisions. After all, our gut reactions lead us to make poor judgment choices, when we simply follow our intuitions.

1) Instead, you need to start by learning about the kind of problems that result from unconscious bias yourself, so that you know what you’re trying to address.

2) Then, you need to convey to people who you want to influence, such as your employees or any other group or even yourself, that there should be no shame or guilt in acknowledging our instincts.

3) Next, you need to convey the dangers associated with following their intuitions, to build up an emotional investment into changing behaviors.

4) Then, you need to convey the right mental habits that will help them make the best choices.

It takes a long-term commitment and constant discipline and efforts to overcome unconscious bias.

Originally Published at Disaster Avoidance Experts on June 23, 2020.

Tsipursky, G. (2019). Never Go With Your Gut: How Pioneering Leaders Make the Best Decisions and Avoid Business Disasters. Newburyport, MA: Career Press.

Gleb Tsipursky, Ph.D. , is on the editorial board of the journal Behavior and Social Issues. He is in private practice.

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• What Is Unconscious Bias? | Definition & Examples

What Is Unconscious Bias? | Definition & Examples

Published on February 27, 2023 by Kassiani Nikolopoulou and Tegan George. Revised on August 9, 2024.

Unconscious bias refers to the automatic associations and reactions that arise when we encounter a person or group. Instead of maintaining neutrality, we tend to associate positive or negative stereotypes with certain groups and let these biases influence our behavior towards them.

Unconscious bias can lead to discriminatory behavior in healthcare, the workplace, educational settings, and beyond.

Table of contents

What is unconscious bias, what causes unconscious bias, unconscious vs. explicit bias, unconscious bias examples, how to reduce unconscious bias, other types of research bias, frequently asked questions about unconscious bias.

Unconscious bias is an implicit preference for (or aversion towards) a particular person or entity. These feelings can be either positive or negative, but they cause us to act unfairly towards others. This can manifest as affinity bias , or the tendency to favor people who are similar to us, but any identity-based aspect (e.g., age, gender identity, socioeconomic background, etc.) can be the target of unconscious bias.

We are, by definition, unaware of biases that affect our decisions and judgments: this is why they are called unconscious. For example, when most people hear the word “nurse,” they are more likely to picture a female, even if they don’t consciously believe that only women can be nurses. Because unconscious bias operates below our awareness, it can be challenging to acknowledge and manage.

There are several factors at play within our unconscious biases:

• Brain categorization . Humans have a natural tendency to assign everything into a relevant category. This happens unconsciously, but this categorizing also leads us to assign a positive or negative association to each category. Categories allow our brains to know what to do or how to behave, but classifications often cause us to overgeneralize.
• We rely on heuristics. We often rely on “automatic” information processing to go through our day, involving little conscious thought. These mental shortcuts allow us to exert little mental effort in our everyday lives, and make swift judgments when needed.
• Social and cultural dynamics. Our upbringing and social environment, as well as any direct and indirect experiences with members of various social groups, imprint on us. These shape our perceptions, both consciously and subconsciously.

Both unconscious and explicit bias involve judging others based on our assumptions rather than objective facts. However, the two are actually quite different.

• Unconscious bias occurs when we have an inclination for or against a person or group that emerges automatically .
• Explicit bias includes positive or negative attitudes that we are fully aware of and openly express. These attitudes form part of our worldview.

Despite their differences, unconscious bias can be just as problematic as explicit bias. Both can lead to discriminatory behavior.

Unconscious bias can lead to discriminatory behavior when it comes to hiring a diverse workforce.

Both positive and negative unconscious beliefs operate outside our awareness and can lead to structural and systemic inequalities. If we want to reduce it, we must first become conscious of it. The following strategies can help:

• Taking the Harvard Implicit Bias Association Test (IAT) can help you realize that everyone, including you, has implicit or unconscious biases. Recognising them for what they are increases the likelihood that next time you won’t let these hidden biases affect your behaviour.
• Seek out positive intergroup contact. Unconscious bias towards a particular group can be reduced through interaction with members of that group. For example, you can make it a point to engage in activities that include individuals from diverse backgrounds.
• Counter-stereotyping. Exposure to information that defies persistent stereotypes about certain groups, such as images of male nurses, can counter gender-based stereotypes.
• Unconscious bias training. Although raising awareness is important, it’s not sufficient to overcome unconscious biases. The most successful training programs are ones that allow individuals to discover their biases in a non-confrontational manner, helping them seek out the tools to help reduce and manage these biases.

Cognitive bias

• Confirmation bias
• Baader–Meinhof phenomenon
• Availability heuristic
• Halo effect
• Framing effect
• Optimism bias
• Negativity bias
• Affect heuristic
• Representativeness heuristic
• Anchoring heuristic
• Primacy bias

Selection bias

• Sampling bias
• Ascertainment bias
• Attrition bias
• Self-selection bias
• Survivorship bias
• Nonresponse bias
• Undercoverage bias
• Hawthorne effect
• Observer bias
• Omitted variable bias
• Publication bias
• Pygmalion effect
• Recall bias
• Social desirability bias
• Placebo effect
• Actor-observer bias
• Ceiling effect
• Ecological fallacy
• Affinity bias

Implicit bias refers to attitudes that affect our understanding, actions, and decisions in an unconscious manner. These attitudes can be either positive or negative. Affinity bias , or the tendency to gravitate towards people who are similar to us, is a type of implicit or unconscious bias.

Similarity bias or affinity bias is a type of unconscious bias. It occurs when we show preference for people who are similar to us (i.e., people with whom we share a common attribute, such as physical appearance, hobbies, or educational background).

The opposite of explicit bias is implicit bias (or unconscious bias). This refers to all the subconscious evaluations we have formed about a certain group. Implicit bias can influence our interactions with members of this group without us realizing.

Demand characteristics are a type of extraneous variable that can affect the outcomes of the study. They can invalidate studies by providing an alternative explanation for the results.

These cues may nudge participants to consciously or unconsciously change their responses, and they pose a threat to both internal and external validity . You can’t be sure that your independent variable manipulation worked, or that your findings can be applied to other people or settings.

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Nikolopoulou, K. & George, T. (2024, August 09). What Is Unconscious Bias? | Definition & Examples. Scribbr. Retrieved September 16, 2024, from https://www.scribbr.com/research-bias/unconscious-bias/

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Understanding Unconscious Bias

The human brain sometimes takes cognitive shortcuts to help make decisions, shortcuts that can lead to implicit or unconscious bias. Damien Meyer/AFP via Getty Images hide caption

The human brain sometimes takes cognitive shortcuts to help make decisions, shortcuts that can lead to implicit or unconscious bias.

The human brain can process 11 million bits of information every second. But our conscious minds can handle only 40 to 50 bits of information a second. So our brains sometimes take cognitive shortcuts that can lead to unconscious or implicit bias, with serious consequences for how we perceive and act toward other people.

Where does unconscious bias come from? How does it work in the brain and ultimately impact society?

Short Wave reporter Emily Kwong speaks with behavioral and data scientist Pragya Agarwal , author of Sway: Unravelling Unconscious Bias .

Email the show at [email protected] .

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Mahzarin Banaji opened the symposium on Tuesday by recounting the “implicit association” experiments she had done at Yale and at Harvard. The final talk is today at 9 a.m.

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Turning a light on our implicit biases

Brett Milano

Harvard Correspondent

Social psychologist details research at University-wide faculty seminar

Few people would readily admit that they’re biased when it comes to race, gender, age, class, or nationality. But virtually all of us have such biases, even if we aren’t consciously aware of them, according to Mahzarin Banaji, Cabot Professor of Social Ethics in the Department of Psychology, who studies implicit biases. The trick is figuring out what they are so that we can interfere with their influence on our behavior.

Banaji was the featured speaker at an online seminar Tuesday, “Blindspot: Hidden Biases of Good People,” which was also the title of Banaji’s 2013 book, written with Anthony Greenwald. The presentation was part of Harvard’s first-ever University-wide faculty seminar.

“Precipitated in part by the national reckoning over race, in the wake of George Floyd, Breonna Taylor and others, the phrase ‘implicit bias’ has almost become a household word,” said moderator Judith Singer, Harvard’s senior vice provost for faculty development and diversity. Owing to the high interest on campus, Banaji was slated to present her talk on three different occasions, with the final one at 9 a.m. Thursday.

Banaji opened on Tuesday by recounting the “implicit association” experiments she had done at Yale and at Harvard. The assumptions underlying the research on implicit bias derive from well-established theories of learning and memory and the empirical results are derived from tasks that have their roots in experimental psychology and neuroscience. Banaji’s first experiments found, not surprisingly, that New Englanders associated good things with the Red Sox and bad things with the Yankees.

She then went further by replacing the sports teams with gay and straight, thin and fat, and Black and white. The responses were sometimes surprising: Shown a group of white and Asian faces, a test group at Yale associated the former more with American symbols though all the images were of U.S. citizens. In a further study, the faces of American-born celebrities of Asian descent were associated as less American than those of white celebrities who were in fact European. “This shows how discrepant our implicit bias is from even factual information,” she said.

How can an institution that is almost 400 years old not reveal a history of biases, Banaji said, citing President Charles Eliot’s words on Dexter Gate: “Depart to serve better thy country and thy kind” and asking the audience to think about what he may have meant by the last two words.

She cited Harvard’s current admission strategy of seeking geographic and economic diversity as examples of clear progress — if, as she said, “we are truly interested in bringing the best to Harvard.” She added, “We take these actions consciously, not because they are easy but  because they are in our interest and in the interest of society.”

Moving beyond racial issues, Banaji suggested that we sometimes see only what we believe we should see. To illustrate she showed a video clip of a basketball game and asked the audience to count the number of passes between players. Then the psychologist pointed out that something else had occurred in the video — a woman with an umbrella had walked through — but most watchers failed to register it. “You watch the video with a set of expectations, one of which is that a woman with an umbrella will not walk through a basketball game. When the data contradicts an expectation, the data doesn’t always win.”

Expectations, based on experience, may create associations such as “Valley Girl Uptalk” is the equivalent of “not too bright.” But when a quirky way of speaking spreads to a large number of young people from certain generations,  it stops being a useful guide. And yet, Banaji said, she has been caught in her dismissal of a great idea presented in uptalk.  Banaji stressed that the appropriate course of action is not to ask the person to change the way she speaks but rather for her and other decision makers to know that using language and accents to judge ideas is something people at their own peril.

Banaji closed the talk with a personal story that showed how subtler biases work: She’d once turned down an interview because she had issues with the magazine for which the journalist worked.

The writer accepted this and mentioned she’d been at Yale when Banaji taught there. The professor then surprised herself by agreeing to the interview based on this fragment of shared history that ought not to have influenced her. She urged her colleagues to think about positive actions, such as helping that perpetuate the status quo.

“You and I don’t discriminate the way our ancestors did,” she said. “We don’t go around hurting people who are not members of our own group. We do it in a very civilized way: We discriminate by who we help. The question we should be asking is, ‘Where is my help landing? Is it landing on the most deserved, or just on the one I shared a ZIP code with for four years?’”

To subscribe to short educational modules that help to combat implicit biases, visit outsmartinghumanminds.org .

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How Effective is Unconscious Bias Training? A comprehensive evaluation of recent assessments

Reviewed by Nick Spragg

A Review of

Unconscious Bias Training: An assessment of the evidence for effectiveness

Doyin Atewologun Tinu Cornish Fatima Tresh

If applicable, enter a short description here..

Introduction

Unconscious bias training: An assessment of the evidence for effectiveness by Doyin Atewologun, et al. is a literature review and meta-analysis of studies that examines the evidence for the effectiveness of unconscious bias  training programs in actually reducing unconscious bias in individuals and organizations. The authors first define unconscious bias as the automatic and unintentional stereotypes, attitudes, and beliefs that people hold about particular groups of people. They argue that these biases can have negative effects on people’s behaviors and decision-making, leading to discrimination and inequality. To address this issue, many organizations have started to implement unconscious bias training (UBT) programs, which aim to increase awareness of these biases and reduce their influence. 

UBT interventions target the automatic behavioral functions in the brain which employ heuristics, or mental short-cuts, to process the large amounts of information individuals receive quickly so that people can carry out tasks efficiently. These mental short cuts can reinforce negative social stereotypes, especially for women, ethnic minorities, differently abled individuals, neurodiverse individuals, and others with protected characteristics. Atewologun et al. reference a previous intervention carried out by Baroness McGregor-Smith, member of the UK House of Lords, entitled, “Race in the Workplace.” In the 2017 study, Mcgregor-Smith examined the deep structural and historical biases that prevented individuals with protected characteristics from progressing in their careers. Mcgregor-Smith recommended that the UK Government implement a free digital unconscious bias training resource, which became a widely utilized resource in both the UK public and private sectors. The authors reevaluate these interventions a year following their initial implementation.

Doyin Atewologun is the Dean of the Rhodes Scholarship at the University of Oxford and is an expert on diversity, leadership, organizational culture, and intersectionality.  Tinu Cornish is an Occupational Psychologist who focuses on psychological approaches to diversity and inclusion leadership. Fatima Tresh is a psychologist and expert in human cognition and behavior addressing diversity, equity, and inclusion barriers. 

Methods and Findings

Atewologun et al.’s assessment aims to achieve three objectives evaluating UBT program implementations across the UK: (1), to demonstrate evidence in favor of UBT’s effectiveness (2) to analyze the contextual conditions under which UBT is most effective; and (3), to highlight evidence gaps for further research. The authors underscore that “effectiveness” in this assessment is contingent on the aims of the training designer. A 3-part rapid evidence assessment methodology was utilized to assess the UBT’s effectiveness:

Identify evidence from online databases

• Published peer reviewed articles (N=57)
• Non-academic searches like reports (N=31)

Evaluate the quality of the evidence

• Utilize the Maryland Scale of Scientific Methods (ranking scale of 1-5: 1 exhibiting the lowest rigor (before-after comparison) 5 exhibiting the highest rigor (randomized control trial))
• Exclude sources with low scientific rigor (Level 1)

Analyze the evidence 

• Identify aims and design of the intervention, draw conclusions about outcomes, and review the gathered evidence (N=18)

Among the key findings in the article, the authors highlight four types of UBT interventions they will measure: (1) awareness raising, (2) implicit bias change, (3) explicit bias change, and (4) behavior change. 

Awareness Raising 

Among the selected studies, eleven studies explicitly aimed to raise awareness of implicit bias, and the authors conclude in their analyses that UBT interventions can substantially increase awareness of bias. Whatley’s 2018 Implicit Association Test highlighted a successful intervention. In the study, Whatley measured UBT’s effectiveness on a multidisciplinary team’s attitudes toward African American students in special education. Whatley’s pre- and post- evaluations of a bias literacy workshop indicated the UBT intervention substantially improved both staff vulnerability to bias and individual student expectations.

Implicit Bias Change

Of the eleven studies aiming to change implicit bias, Atewologun et al. found that there is mixed evidence for UBT’s effectiveness. Two studies suggested that UBT can reduce the strength of bias; yet, there was no evidence that UBT can reduce bias to the extent of “neutral” preference. In Girod et al.’s 2016 evaluation of an educational presentation on reducing gender bias, 281 faculty members across 13 clinical departments at Stanford University indicated in the pre-trial a slight preference for males in leadership positions (this was consistent across all racial groups), and this male preference reduced in the post-trial measure. Yet, the authors concluded that males and older participants held stronger racialized and gendered implicit biases in both the pre- and post- trial measures. 

Explicit Bias Change

Nine studies reviewed in the assessment indicated that UBT is effective in changing explicit bias, but less effective than awareness raising or implicit bias changing . Of the available research, it was unclear to the authors how to best measure explicit bias. In Moss-Racusin et al. ‘s 2016 “scientific diversity” workshop administered to 126 life sciences instructors, the aim of the study was to increase awareness of gender diversity, reduce gender bias, and increase diversity-promoting actions. In this particular study, all three aims were effectively achieved. 

Behavior Change

Of the ten studies aiming to change behavior, only two of these studies actually measured behavior change Because of this limitation, the authors concluded that there is insufficient evidence to indicate UBT’s effectiveness. Research examining behavior change is limited, and  methods evaluating behavior change have low validity because they do not measure actual observed behavior change. In Forscher’s 2017 UBT intervention administered to 292 United States university students, researchers found that the effects of unconscious bias awareness waned two weeks post-intervention. However, a follow-up study conducted two years later between the intervention group and a control group indicated possible long-term behavior change. Participants in the intervention group were more likely to publicly refute an essay endorsing racial stereotyping than the control group.

Conclusions

In the concluding remarks, the authors highlight a variety of high-level observations about the assessed literature. Among these observations, the most notable include:  

• Male participants hold stronger unconscious gender biases than female participants. This gap can be reduced with UBT, and UBT may be more effective for men with respect to gender biases. There is some evidence that online and face-to-face UBT are equally effective for awareness raising.
• Mandatory UBT is generally more effective for behavior change than voluntary UBT. This is not supported by more rigorous studies, however. 
• Bias reduction strategies are more effective for reducing implicit bias and ineffective in reducing explicit bias.
• Some mindfulness interventions can reduce implicit bias and possibly mitigate discriminatory actions. 
• Bias mitigation strategies may have back-firing effects if participants do not want to be influenced or do not agree with the proposed direction of influence. 

In the final remarks, the authors set forth a series of recommendations for practice and future research. The first recommendation is to have a more nuanced approach to UBT content: use an implicit association test to increase awareness of unconscious bias and measure changes in implicit bias, educate participants about unconscious bias theory, and integrate bias reduction strategies in the UBT to increase participant confidence in managing their biases. The second recommendation focuses on the UBT context, such as delivering training to those who work closely together in a team unit or otherwise. Finally, the third recommendation is to evaluate effectiveness: randomly assign matched participants to control and intervention groups and deliver training to control groups when effectiveness has been established.

The authors suggest multiple areas for further research: systematic comparisons of approaches and design characteristics, investigations of UBT’s effectiveness in reducing bias against all protected groups, uniform measurement outcomes of UBT, structural changes due to UBT interventions, additional cognitive or social processes integral to maintaining inequity, and the impact of mandatory versus voluntary attendance on UBT effectiveness.

• Training & Evaluation
• Training Evaluations
• explicit bias
• implicit bias
• organizational behavior
• Unconscious bias
• unconscious bias training

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• Spragg, Nick
• Atewologun, Doyin
• Tinu Cornish
• Fatima Tresh

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Article Contents

Unconscious bias—the role it plays and how to measure it, impact of bias on healthcare delivery, measuring bias—the implicit association test (iat), mitigating unconscious bias, call to action.

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The Impact of Unconscious Bias in Healthcare: How to Recognize and Mitigate It

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Jasmine R Marcelin, Dawd S Siraj, Robert Victor, Shaila Kotadia, Yvonne A Maldonado, The Impact of Unconscious Bias in Healthcare: How to Recognize and Mitigate It, The Journal of Infectious Diseases , Volume 220, Issue Supplement_2, 15 September 2019, Pages S62–S73, https://doi.org/10.1093/infdis/jiz214

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The increasing diversity in the US population is reflected in the patients who healthcare professionals treat. Unfortunately, this diversity is not always represented by the demographic characteristics of healthcare professionals themselves. Patients from underrepresented groups in the United States can experience the effects of unintentional cognitive (unconscious) biases that derive from cultural stereotypes in ways that perpetuate health inequities. Unconscious bias can also affect healthcare professionals in many ways, including patient-clinician interactions, hiring and promotion, and their own interprofessional interactions. The strategies described in this article can help us recognize and mitigate unconscious bias and can help create an equitable environment in healthcare, including the field of infectious diseases.

There is compelling evidence that increasing diversity in the healthcare workforce improves healthcare delivery, especially to underrepresented segments of the population [ 1 , 2 ]. Although we are familiar with the term “underrepresented minority” (URM), the Association of American Medical Colleges, has coined a similar term, which can be interchangeable: “Underrepresented in medicine means those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population” [ 3 ]. However, this definition does not include other nonracial or ethnic groups that may be underrepresented in medicine, such as lesbian, gay, bisexual, transgender, or questioning/queer (LGBTQ) individuals or persons with disabilities. US census data estimate that the prevalence of African American and Hispanic individuals in the US population is 13% and 18%, respectively [ 4 ], while the prevalence of Americans identifying as LGBT was estimated by Gallup in 2017 to be about 4.5% [ 5 ]. Yet African American and Hispanic physicians account for a mere 6% and 5%, respectively, of medical school graduates, and account for 3% and 4%, respectively, of full-time medical school faculty [ 6 ]. As for LGBTQ medical graduates, the Association of American Medical Colleges does not report their prevalence [ 6 ]. Persons with disabilities are estimated to be 8.7% of the general population [ 4 ], while the prevalence of physicians with disabilities has been estimated to be a mere 2.7% [ 7 ]. Furthermore, although women currently outnumber men in first-year medical school classes [ 8 ], gender disparities still exist at higher ranks in women’s medical careers [ 9–11 ].

Unconscious or implicit bias describes associations or attitudes that reflexively alter our perceptions, thereby affecting behavior, interactions, and decision-making [ 12–14 ]. The Institute of Medicine (now the National Academy of Medicine) notes that bias, stereotyping, and prejudice may play an important role in persisting healthcare disparities and that addressing these issues should include recruiting more medical professionals from underrepresented communities [ 1 ]. Bias may unconsciously influence the way information about an individual is processed, leading to unintended disparities that have real consequences in medical school admissions, patient care, faculty hiring, promotion, and opportunities for growth ( Figure 1 ). Compared with heterosexual peers, LGBT populations experience disparities in physical and mental health outcomes [ 15 , 16 ]. Stigma and bias (both conscious and unconscious) projected by medical professionals toward the LGBTQ population play a major role in perpetuating these disparities [ 17 ]. Interventions on how to mitigate this bias that draw roots from race/ethnicity or gender bias literature can also be applied to bias toward gender/sexual minorities and other underrepresented groups in medicine.

Glossary of key terms.

The specialty of infectious diseases is not free from disparities. Of >11 000 members of the Infectious Diseases Society of America (IDSA), 41% identify as women, 4% identify as African American, 8% identify as Hispanic, and <1% identify as Native American or Pacific Islander (personal communication, Chris Busky, IDSA chief executive officer, 2019). However, IDSA data on members who identify as LGBTQ and members with disabilities are not available.

The 2017 IDSA annual compensation survey reports that women earn a lower income than men [ 18 ], and a review of the full report demonstrates similar disparities among URM physicians, compared with their white peers [ 19 ]. While it may not be feasible to assign a direct causal relationship between unconscious bias and disparities within the infectious diseases specialty, it is reasonable and ethical to attempt to address any potential relationship between the two. In this article, we define unconscious bias and describe its effect on healthcare professionals. We also provide strategies to identify and mitigate unconscious bias at an organizational and individual level, which can be applied in both academic and nonacademic settings.

Even in 2019, overt racism, misogyny, and transphobia/homophobia continue to influence current events. However, in the decades since the healthcare community has moved toward becoming more egalitarian, overt discrimination in medicine based on gender, race, ethnicity, or other factors have become less conspicuous. Nevertheless, unconscious bias still influences all human interactions [ 13 ]. The ability to rapidly categorize every person or thing we encounter is thought to be an evolutionary development to ensure survival; early ancestors needed to decide quickly whether a person, animal, or situation they encountered was likely to be friendly or dangerous [ 20 ]. Centuries later, these innate tendencies to categorize everything we encounter is a shortcut that our brains still use.

Stereotypes also inadvertently play a significant role in medical education ( Figure 1 ). Presentation of patients and clinical vignettes often begin with a patient’s age, presumed gender, and presumed racial identity. Automatic associations and mnemonics help medical students remember that, on examination, a black child with bone pain may have sickle-cell disease or a white child with recurrent respiratory infections may have cystic fibrosis. These learning associations may be based on true prevalence rates but may not apply to individual patients. Using stereotypes in this fashion may lead to premature closure and missed diagnoses, when clinicians fail to see their patients as more than their perceived demographic characteristics. In the beginning of the human immunodeficiency virus (HIV) epidemic, the high prevalence of HIV among gay men led to initial beliefs that the disease could not be transmitted beyond the gay community. This association hampered the recognition of the disease in women, children, heterosexual men, and blood donor recipients. Furthermore, the fact that white gay men were overrepresented in early reported prevalence data likely led to lack of recognition of the epidemic in communities of color, a fact that is crucial to the demographic characteristics of today’s epidemic. Today, there is still no clear solution to learning about the epidemiology of diseases without these imprecise associations, which can impact the rapidity of accurate diagnosis and therapy.

Unconscious bias describes associations or attitudes that unknowingly alter one’s perceptions and therefore often go unrecognized by the individual, whereas conscious bias is an explicit form of bias that is based on one’s discriminatory beliefs and values and can be targeted in nature [ 14 ]. While neither form of bias belongs in the healthcare profession, conscious bias actively goes against the very ethos of medical professionals to serve all human beings regardless of identity. Conscious bias has manifested itself in severe forms of abuse within the medical profession. One notable historical example being the Tuskegee syphilis study, in which black men were targeted to determine the effects of untreated, latent syphilis. The Tuskegee study demonstrated how conscious bias, in this case manifested in the form of racism, led to the unethical treatment of black men that continues to have long-lasting effects on health equity and justice in today’s society [ 21 ]. Given the intentional nature of conscious bias, a different set of tools and a greater length of time are likely required to change one’s attitudes and actions. Tackling unconscious bias involves willingness to alter one’s behaviors regardless of intent, when the impact of one’s biases are uncovered and addressed [ 22 ]

There is still debate, however, about the degree to which unconscious bias affects clinician decision-making. In one systematic review on the impact of unconscious bias on healthcare delivery, there was strong evidence demonstrating the prevalence of unconscious bias (encompassing race/ethnicity, gender, socioeconomic status, age, weight, persons living with HIV, disability, and persons who inject drugs) affecting clinical judgment and the behavior of physicians and nurses toward patients [ 12 ]. However, another systematic review found only moderate-quality evidence that unconscious racial bias affects clinical decision-making [ 23 ]. A detailed discussion of the impact of unconscious bias on healthcare delivery is out of the scope of this article, which is focused on the impact of unconscious bias as it relates to healthcare professionals themselves. Nevertheless, strategies to mitigate the effects of unconscious bias (discussed later) can be applied to healthcare delivery and patient interactions.

While we know that unconscious bias is ubiquitous, it can be difficult to know how much it affects a person’s daily interactions. In many cases, an individual’s unconscious beliefs may differ from their explicit actions. For example, healthcare professionals, if asked, might say they try to treat all patients equally and may not believe they hold negative attitudes about patients. However, by definition, they may lack awareness of their own potential unconscious biases, and their actions may unknowingly suggest that these biases are active.

To measure unconscious bias, Drs Mahzarin Banaji and Anthony Greenwald developed the IAT in 1998 [ 24 ]. Many versions of the IAT are accessible online (available at: https://implicit.harvard.edu/implicit/ ), but one of the most studied is the Race IAT. The IAT has been extensively studied as an inexpensive tool that provides feedback on an individual biases for self-reflection. The IAT calculates how quickly people associate different terms with each other. To determine unconscious race bias, the race IAT asks the subject to sort pictures (of white and black people) and words (good or bad) into pairs. For example, in one part of the Race IAT, participants must associate good words with white people and bad words with black people. In another part of the Race IAT, they must associate good words with black people and bad words with white people. Based on the reaction times needed to perform these tasks, the software calculates a bias score [ 20 , 24 ]. Category pairs that are unconsciously preferred are easier to sort (and therefore take less time) than those that are not [ 24 ]. These unconscious associations can be identified even in individuals who outwardly express egalitarian beliefs [ 20 , 24 ]. According to Project Implicit, the Race IAT has been taken >4 million times between 2002 and 2017, and 75% of test takers demonstrate an automatic white preference, meaning that most people (including a small group of black people) automatically associate white people with goodness and black people with badness [ 20 ]. Proponents of the IAT state that automatic preference for one group over another can signal potential discriminatory behavior even when the individuals with the automatic preference outwardly express egalitarian beliefs [ 20 ]. These preferences do not necessarily mean that an individual is prejudiced, which is associated with outward expressions of negative attitudes toward different social groups [ 20 ].

Many of the studies of unconscious bias described in this article use the IAT as the primary tool for measuring the phenomenon. Nevertheless, the degree to which the IAT predicts behavior is as of yet unclear, and it is important to recognize the limitations and criticisms of the IAT, as this is pertinent to its potential application in mitigating unconscious bias. Blanton et al reanalyzed data from 2 studies supporting the validity of the IAT, claiming that there is no evidence predicting individual behavior, with concerns for interjudge reliability and inclusion of outliers affecting results [ 25 ]. Response to this criticism by McConnell et al describes extensive training of test judges and evidence that the reanalysis was not a perfect replication of methods [ 26 ]. Blanton et al argue further in a different article that attempting to explain behavior on the basis of results of the IAT is problematic because the test relies on an arbitrary metric, leading to identified preferences when individuals are “behaviorally neutral” [ 27 ]. Notwithstanding the limitations of the IAT, none of its critics refute the existence of unconscious bias and that it can influence life experiences. The following sections review how unconscious bias affects different groups in the healthcare workforce.

Racial Bias

Medical school admissions committees serve as an important gatekeeper to address the significant disparities between racial and ethnic minorities in healthcare as compared to the general population. Yet one study demonstrated that members of a medical school admissions committee displayed significant unconscious white preference (especially among men and faculty members) despite acknowledging almost zero explicit white preference [ 28 ]. An earlier study of unconscious racial and social bias in medical students found unconscious white and upper-class preference on the IAT but no obvious unconscious preferences in students’ response to vignette-based patient assessments [ 29 ]. Unconscious bias affects the lived experiences of trainees, can potentially influence decisions to pursue certain specialties, and may lead to isolation. A recent study by Osseo-Asare et al described African American residents’ experiences of being only “one of a few” minority physicians; some major themes included discrimination, the presence of daily microaggressions, and the burden of being tasked as race/ethnic “ambassadors,” expected to speak on behalf of their demographic group [ 30 ].

Gender Bias

Gender bias in medical education and leadership development has been well documented [ 11 , 31 ]. Medical student evaluations vary depending on the gender of the student and even the evaluator [ 31 ]. Similar studies have demonstrated gender bias in qualitative evaluations of residents and letters of recommendations, with a more positive tone and use of agentic descriptors in evaluations of male residents as compared to female residents [ 11 ]. Studies evaluating inclusion of women as speakers have also demonstrated gender bias, with fewer women invited to speak at grand rounds [ 9 ] and differences in the formal introductions of female speakers as compared to male speakers [ 32 , 33 ], with men more likely referred to by their official titles than women.

Sexual and Gender Minority Bias

Sexual and gender minority groups are underrepresented in medicine and experience bias and microaggressions similar to those experience by racial and ethnic minorities. Experiences with or perceptions of bias lead to junior physicians not disclosing their sexual identity on the personal statement part of their residency applications for fear of application rejection or not disclosing that they are gay to colleagues and supervisors for fear of rejection or poor evaluations [ 34 ]. In one study, some physician survey respondents indicated some level of discomfort about people who are gay, transgender, or living with HIV being admitted to medical school. These respondents were less likely to refer patients to physician colleagues who were gay, transgender, or living with HIV [ 35 ]. These explicit biases were significantly reduced, compared with those revealed in prior surveys done in 1982 and 1999; opposition to gay medical school applicants went from 30% in 1982 to 0.4% in 2017, and discomfort with referring patients to gay physicians went from 46% in 1982 to 2% in 2017 [ 35 ]. The 2017 survey did not measure levels of unconscious bias, which is likely to still be pervasive despite decreased explicit bias. As with other types of bias, these data reveal that explicit bias against gay physicians has decreased over time; the degree of unconscious bias, however, likely persists. While this is encouraging to some degree, unconscious bias may be much more challenging to confront than explicit bias. Thus, members of underrepresented groups may be left wondering about the intentions of others and being labeled as “too sensitive.”

Studies including the perspectives of LGBTQ healthcare professionals demonstrate that major challenges to their academic careers persist to this day. These include lack of LGBTQ mentorship, poor recognition of scholarship opportunities, and noninclusive or even hostile institutional climates [ 36 ]. Phelan et al studied changes in biased attitudes toward sexual and gender minorities during medical school and found that reduced unconscious and explicit bias was associated with more-frequent and favorable interactions with LGBTQ students, faculty, residents, and patients [ 37 ].

Disability Bias

Physicians with disabilities constitute another minority group that may experience bias in medicine, and the degree to which they experience this may vary, depending on whether disabilities may be visible or invisible. One study estimated the prevalence of self-disclosed disability in US medical students to be 2.7% [ 7 ]. Medical schools are charged with complying with the Americans With Disabilities Act, but only a minority of schools support the full spectrum of accommodations for students with disabilities [ 38 ]. Many schools do not include a specific curriculum for disability awareness [ 39 ]. Physicians with disabilities have felt compelled to work twice as hard as their able-bodied peers for acceptance, struggled with stigma and microaggressions, and encountered institutional climates where they generally felt like they did not belong [ 40 ]. These are themes that are shared by individuals from racial and ethnic minorities.

A strategy to counter unconscious bias requires an intentional multidimensional approach and usually operates in tandem with strategies to increase diversity, inclusion, and equity [ 41 , 42 ]. This is becoming increasingly important in training programs in the various specialties, including infectious diseases. The Accreditation Council for Graduate Medical Education recently updated their common program requirements for fellowship programs and has stipulated that, effective July 2019, “[t]he program’s annual evaluation must include an assessment of the program’s efforts to recruit and retain a diverse workforce” [ 43 ]. The implication of this requirement is that recognition and mitigation of potential biases that may influence retention of a diverse workforce will ultimately be evaluated (directly or indirectly).

Mitigating unconscious bias and improving inclusivity is a long-term goal requiring constant attention and repetition and a combination of general strategies that can have a positive influence across all groups of people affected by bias [ 44 ]. These strategies can be implemented at organizational and individual levels and, in some cases, can overlap between the 2 domains ( Figure 2 ). In this section, we review how infectious diseases clinicians and organizations like IDSA and hospitals can use some of these strategies to address and mitigate implicit bias in our specialty.

Organization-level and personal-level strategies to mitigate unconscious bias. Orange circles indicate organization-specific strategies, green circles indicate individual-level strategies, and blue circles represent strategies that can be emphasized on both organizational and individual levels to mitigate implicit bias.

Organizational Strategies

Commitment to a culture of inclusion: more than just diversity training or cultural competency.

Creating change requires more than just a climate survey, a vision statement, or creation of a diversity committee [ 45 ]. Organizations must commit to a culture shift by building institutional capacity for change [ 41 , 46 ]. This involves reaffirming the need not only for the recruitment of a critical mass of underrepresented individuals, but equally importantly, the recruitment of critical actor leaders who take the role of change agents and have the power to create equitable environments [ 41 , 47–49 ]. These change agents need not themselves be underrepresented; indeed, the success of culture change requires the involvement of allies within the majority group (eg, men, white people, and cis-gender heterosexual individuals). IDSA has demonstrated a commitment to this type of culture change with recent changes in leadership structure and with intentional recruitment of individuals invested in diversity and inclusion; however, there is always room for reevaluation of other areas where diversity is desired.

Committing to a culture of inclusion at the academic-institution level involves creating a deliberate strategy for medical trainee admission and evaluation and faculty hiring, promotion, and retention. Capers et al describe strategies for achieving diversity through medical school admissions, many of which can also be applied to faculty hiring and promotion [ 49 ]. Notable strategies they suggest include having admissions (or hiring) committee members take the IAT and reflect on their own potential biases before they review applications or interview candidates [ 49 ]. They also recommend appointing women, minorities, and junior medical professionals (students or junior faculty) to admissions committees, emphasizing the importance of different perspectives and backgrounds [ 49 ]. Organizations can also survey employee perception of inclusivity. These assessments include questions on the degree to which an individual feels a sense of belonging within an institution, alongside questions pertaining to experiences of bias on the grounds of cultural or demographic factors [ 50 ]. Conducting regular assessments and analysis of survey results, particularly on how individuals of diverse backgrounds feel they can exist within the organization and their culture simultaneously, allows organizations to ensure that their trainings on unconscious bias and promotion of cultural humility lead to long-term positive change. Furthermore, realizing that different demographic groups may feel less respected than others provides information on areas of focus for consequent refresher seminars on combating unconscious bias in conjunction with cultural humility.

Meaningful Diversity Training and the Usefulness of the IAT

Notwithstanding potential criticisms of the IAT with respect to prediction of discriminatory behavior, this can be a useful tool within a comprehensive organizational training seminar directed toward understanding and addressing individual unconscious bias. In the study by Capers et al, over two thirds of admissions committee members who took the IAT and responded to the post-IAT survey felt positive about the potential value of this tool in reducing their unconscious bias [ 28 ]. Additionally, almost half were cognizant of their IAT results when interviewing for the next admissions cycle, and 21% maintained that knowledge of this bias affected their decisions in the next admissions cycle [ 28 ]. Perhaps this knowledge led to conscious changes in committee member behavior because, in the following year, the matriculating class was the most diverse in that institution’s history [ 28 , 49 ]. A similar bias education intervention coupled with the IAT led to a decreased unconscious gender leadership bias in one academic center [ 48 ]. IDSA and infectious diseases practices (or academic divisions) could consider ways to incorporate this into already established training for those in leadership roles or on leadership search committees.

Of course, the potential applicability of the IAT can be overstated—at best, several meta-analyses have demonstrated that there may only be a weak correlation between IAT scores and individual behavior [ 51–53 ], and several criticisms of the IAT have already been discussed here. Additionally, while important to acknowledge that bias is pervasive, care must be taken to avoid normalizing bias and stereotypes because this may have the unintended consequence of reinforcing them [ 54 ]. Important points that should be emphasized when using the IAT as part of diversity training include that (1) people should be aware of their own biases and reflect on their behaviors individually; (2) the IAT can suggest generally how groups of people with certain results may behave, rather than how each individual will behave; and (3) on its own, the IAT is not a sufficient tool to mitigate the effects of bias, because if there is to be any chance of success, an active cultural/behavioral change must be engaged in tandem with bias awareness and diversity training [ 55 ].

Individual Strategies

Deliberative reflection.

Before encounters that are likely to be affected by bias (such as trainee evaluations, letters of recommendation, feedback, interviews, committee decisions, and patient encounters), deliberative reflection can help an individual recognize their own potential for bias and correct for this [ 56 ]. It is also a good time to consider the perspective of the individual whom they will be evaluating or interacting with and the potential impact of their biases on that individual. Participants can be encouraged to evaluate how their own experiences and identities influence their interactions. Including data on lapses in proper care due to provider bias also proves helpful in giving workers real-life examples of the consequences of not being vigilant for bias [ 51 , 57 ]. This motivated self-regulation based on reflections of individual biases has been shown to reduce stereotype activation and application [ 44 , 58 ]. If one unintentionally behaves in a discriminatory manner, self-reflection and open discussion can help to repair relationships ( Figure 3 ).

Strategies to address personal bias before and after it occurs.

Question and Actively Counter Stereotypes

Individuals may question how they can actively counter stereotypes and bias in observed interactions. The active-bystander approach adapted from the Kirwan Institute [ 59 ] can provide insight into appropriate responses in these situations ( Figure 4 ).

Kirwan Institute approach to countering unconscious bias as an active bystander.

Strategies That Apply to Both Organizations and Individuals

Cultural competency and beyond: cultural humility.

Healthcare organizations seeking to develop providers who can work seamlessly with colleagues and more effectively treat patients from all cultural backgrounds have been conducting trainings in cultural competency [ 60 ]. The term “cultural competency” implies that one has achieved a static goal of championing inclusivity. This approach imparts a false sense of confidence in leaders and healthcare professionals and fails to recognize that our understanding of cultural barriers is continually growing and evolving [ 61 ]. Cultural humility has been proposed as an alternate approach, subsuming the teachings of cultural competency while steering participants toward a continuous path of discovery and respect during interactions with colleagues and patients of different cultural backgrounds [ 62 ]. Other synonymous terms include “cultural sensitivity” and “cultural curiosity.” Rather than checking a box for training, cultural humility focuses on the individual and teaches that developing one’s self-awareness is a critical step in achieving mindfulness for others [ 63 ]. Cultural humility emphasizes that individuals must acknowledge the experiential lens through which they view the world and that their view is not nearly as extensive, open, or dynamic as they might perceive [ 61 ]. By training leaders and healthcare professionals that they do not need to be and ultimately cannot be experts in all the intersecting cultures that they encounter, healthcare professionals can focus on a readiness to learn that can translate to greater confidence and willingness in caring for patients of varying backgrounds [ 61 ].

As cultural humility is important to recognizing and mitigating conscious and unconscious biases, patient simulations and diversity-related trainings should be augmented with discussions about cultural humility. By integrating cultural humility into healthcare training procedures, organizations can strive to eliminate the perceived unease healthcare professionals might experience when interacting with individuals from backgrounds or cultures unfamiliar to them. Cultural humility starts from a condition of empathy and proceeds through the asking of open questions in each interaction ( Figure 1 ). Instilling elements of cultural humility training within simulation-based learning provides participants with experience in treating a wide array of patients while providing low-risk, feedback-based learning opportunities [ 22 , 64 ].

Diversify Experiences to Provide Counterstereotypical Interactions

Exposing individuals to counterstereotypical experiences can have a positive impact on unconscious bias [ 10 , 44 , 55 ]. Therefore, intentional efforts to include faculty from underrepresented groups as preceptors, educators, and invited speakers can help reduce the unconscious associations of these responsibilities as unattainable. Capers et al suggest that including students, women, and African Americans and other racial and ethnic minorities on admissions committees may be part of a strategy to reduce unconscious bias in medical school admissions [ 49 ]. If institutions, organizations, and conference program committees are aware of their own metrics in this respect, following this information with deliberate choices to remedy inequities can have a profound impact on increasing diversity [ 65 ]. Furthermore, in medical training, while deliberate curricula involving disparities and care of underrepresented individuals are beneficial, educators must be aware of the impact of the hidden curriculum on their trainees. The term “hidden curriculum” refers to the aspects of medicine that are learned by trainees outside the traditional classroom/didactic instruction environment. It encompasses observed interactions, behaviors, and experiences often driven by unconscious and explicit bias and institutional climate [ 66–68 ]. Students can be taught to actively seek out the hidden curriculum in their training environment, reflect on the lessons, and use this reflection to inform their own behaviors [ 67 ]. Individuals can intentionally diversify their own circles, connecting with people from different backgrounds and experiences. This can include the occasionally awkward and uncomfortable introductions at professional meetings or at community events, making an effort to read books by diverse authors, or trying new foods with a colleague. These are small behavioral changes that, with time, can help to retrain our brain to classify people as “same” instead of “other.”

Mentorship and Sponsorship

Mentors can, at any stage in one’s career, provide advice and career assistance with collaborations, but sponsors are typically more senior individuals who can curate high-profile opportunities to support a junior person, often with potential personal or professional risk if that person does not meet expectations. URMs and women physicians tend not to have as much support with mentoring and sponsorship as the majority group, white men. Qualitative studies of URM physician perspectives typically reveal themes of isolation and lack of mentorship, regardless of the URM group being studied [ 30 , 36 , 69 ]. Possible reasons include lack of mentors from similar backgrounds or ineffective mentoring in discordant mentor-mentee relationships. Mentor-training workshops that intentionally include unconscious bias training can enhance the effectiveness of mentors working with diverse trainees and junior faculty and address this potential barrier to URM success [ 70 ]. Providing mentorship within an individual department, as well as support for participating in external mentorship and career development programs, can help create sponsorship opportunities that eventually influence career advancement [ 41 ]. Many professional societies such as IDSA provide mentorship opportunities, and these can be enhanced by encouraging more sponsorship of junior clinicians for opportunities such as podium lectures, moderating at conferences, writing editorials, or committee positions.

In the years since the IAT was first described, researchers have published countless data on the impact of unconscious bias. Fortunately, explicit and implicit attitudes toward many disenfranchised groups of people have regressed to a more neutral position over time [ 71 ], but this does not mean that unconscious bias has disappeared. Just as healthcare providers are required to stay up to date on medical techniques and procedures to best serve their patients, we propose that trainings involving the social aspects of medicine be treated similarly. Cultural humility is characterized by lifelong learning and is a key aspect of a successful provider-patient relationship. Thus, it is imperative that healthcare organizations and professional medical societies such as IDSA continually provide healthcare professionals with learning opportunities to enhance their interactions with individuals different from themselves. Effectively addressing unconscious bias and subsequent disparities in IDSA will need comprehensive, multifaceted, and evidence-based interventions ( Figure 5 ).

Unconscious bias highlights.

IDSA has demonstrated a commitment to diversifying its society leadership by commissioning the Gender Disparities Task Force and the Inclusion, Diversity, Access & Equity Task Force, reconfiguring existing committees, developing new committees (eg, the Leadership Development Committee), and creating new opportunities, such as the IDSA Leadership Institute. While these are important and impactful actions, we propose the following additional steps to address the role of unconscious bias in various settings. First, develop an IDSA-sponsored climate survey to assess perceptions of inclusion and belonging within the Society, and repeat this climate assessment after implementing bias reduction strategies. Second, provide IDSA-sponsored education/training on unconscious bias reduction strategies and cultural humility to academic infectious disease divisions and fellowship programs to support the recruitment and retention of a diverse infectious diseases physician workforce. Third, develop benchmarks for excellence in infectious diseases divisions and fellowship training programs to evaluate these bias reduction strategies. Fourth, provide education/training on unconscious bias–reduction strategies and cultural humility to leadership and membership within IDSA. Specifically, the board of directors, the Leadership Development Committee, the Awards Committee, and others involved in electing, nominating, or honoring members should consider including incorporating the IAT and bias-reduction education for their committee members. After implementing such strategies, IDSA should reevaluate metrics of awardees, committee chairs, and leadership to determine whether these strategies made an impact. Fifth, cultivate existing mentorship programs within IDSA, with the added focus of intentional mentoring and sponsorship of groups traditionally underrepresented in leadership. Sixth, commit to consistent review and revision of infectious diseases recruitment messaging, ensuring that materials and media counter harmful stereotypes and represent true diversity. Seventh, collect, review, and publish metrics of diversity in all facets of the membership, including IDWeek speaker demographic characteristics, IDSA journal editor/reviewers, guideline authorship, and committee membership, with intentional response strategies to change these demographic characteristics to a more diverse distribution. Eighth, be transparent about reporting of metrics, with clear accountability and flexibility to adjust initiatives based on results.

Although there are numerous data describing the impact of unconscious bias on healthcare delivery, clinician-patient interactions, and patient outcomes, discussion of these aspects is out of the scope of this article, which focuses on the impact of unconscious bias on healthcare professionals. Additionally, the majority of data on unconscious bias presented in this article relates to general academic training and career development, as data in the infectious diseases practice community is limited. This represents an area of need for evaluation within the specialty of infectious diseases, since a vast majority of members are in clinical practice and may experience bias in varying degrees. While it is important to support trainees who may experience unconscious bias, it is also critical to provide support for infectious diseases clinicians further along in their careers, as a means to maintain retention in the specialty. Finally, some individuals may prefer person-first language, while others may prefer identity-first language when referring to disabilities. We consistently used person-first language throughout this manuscript based on the recommendation by the Centers for Disease Control & Prevention ( https://www.cdc.gov/ncbddd/disabilityandhealth/pdf/disabilityposter_photos.pdf ).

Supplement sponsorship . This supplement is sponsored by the Infectious Diseases Society of America.

Acknowledgments . We thank Drs Molly Carnes, Ranna Parekh, and Arghavan Salles, as well as Lena Tenney, for critical review of this manuscript before publication; Mr Chris Busky, for providing written communications about the demographic characteristics of IDSA membership and leadership; and Catherine Hiller, for her assistance with manuscript preparation.

J. R. M. wrote first draft and subsequent revisions; D. S. and R. V. contributed to the first draft and subsequent revisions; S. K. contributed to the first draft and subsequent revisions; Y. A. M. contributed to subsequent revisions; and all authors reviewed a final version of the work before submission.

Potential conflicts of interest . J. R. M. and D. S. are members of the IDSA Inclusion, Diversity, Access & Equity Task Force. All other authors report no potential conflicts.

All authors have submitted the ICMJE form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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• Published: 08 March 2021

Understanding unconscious bias

• Barry Oulton 1  

BDJ In Practice volume  34 ,  pages 26–27 ( 2021 ) Cite this article

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What if you could improve the way you communicate with your patients, peers and team by recognising your unconscious biases and challenging them? Dr Barry Oulton explores.

Most of us don't like to think of ourselves as discriminating against others or having biases towards or against certain groups, but unconscious bias or 'implicit bias', as it is also called, is innate to human nature.

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Oulton, B. Understanding unconscious bias. BDJ In Pract 34 , 26–27 (2021). https://doi.org/10.1038/s41404-021-0685-8

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Understanding unconscious bias

This animation and briefing on unconscious bias adapted by Professor Uta Frith DBE FBA FMedSci FRS introduce the key concepts and current academic research around unconscious bias with the aim of alerting Royal Society selection and appointment panel members to potential biases that can arise when making judgments or decisions.  They form part of the Society’s efforts to ensure that all those who serve on selection panels are aware of differences in how candidates may present themselves, how to recognise bias in oneself and others, how to recognise inappropriate advocacy or unreasoned judgement. All panellists receive an electronic copy of the briefing in advance of any meeting, it is also read at the beginning of each meeting as a reminder.

The Society is concerned with excellent science wherever and by whomever it is done and is committed to increasing diversity in STEM by seeking out participation from underrepresented groups, in order to build and develop a world in which studying and working in science are open to all.  Addressing unconscious bias is one tool that the Royal Society is using to ensure that our funding, awards and appointments are drawn from the widest range of talent.

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Making better decisions in groups

Diversity in science

Implicit and unconscious, the bias in us all

• Unconscious bias briefing

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Unconscious bias among health professionals: a scoping review.

1. Introduction

2. materials and methods, 3.1. search results, 3.2. study characteristics, 3.3. results of the studies.

3.4. Biases

3.5. geographical distribution, 3.6. involved health professions, 4. discussion, 5. conclusions, author contributions, institutional review board statement, informed consent statement, data availability statement, acknowledgments, conflicts of interest.

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Meidert, U.; Dönnges, G.; Bucher, T.; Wieber, F.; Gerber-Grote, A. Unconscious Bias among Health Professionals: A Scoping Review. Int. J. Environ. Res. Public Health 2023 , 20 , 6569. https://doi.org/10.3390/ijerph20166569

Meidert U, Dönnges G, Bucher T, Wieber F, Gerber-Grote A. Unconscious Bias among Health Professionals: A Scoping Review. International Journal of Environmental Research and Public Health . 2023; 20(16):6569. https://doi.org/10.3390/ijerph20166569

Meidert, Ursula, Godela Dönnges, Thomas Bucher, Frank Wieber, and Andreas Gerber-Grote. 2023. "Unconscious Bias among Health Professionals: A Scoping Review" International Journal of Environmental Research and Public Health 20, no. 16: 6569. https://doi.org/10.3390/ijerph20166569

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The Science of Unconscious Bias: What, Why, & How

by Michael Miller | Sep 4, 2018

A growing body of psychology research points to an uncomfortable truth about decision making: unconscious bias influences all of us and even the simplest decisions we make.  Whether it’s our level of hunger, the time of day, or our mood, there are quite a few internal and external factors that creep into our decision making equation without our permission or awareness – and quite literally change our minds.

The research is equally amazing and alarming. If the people whose job it is to decide on inmates’ parole and students’ college admissions are biased by unrelated factors and they don’t even know it, how can we protect our own decisions from unwanted influence?

The first step is to understand the most common forms of bias that everyone experiences but hardly anyone recognizes. And the next step is to employ specific strategies to protect ourselves against making faulty, biased decisions unwittingly.

Let’s start by looking at the fascinating psychology research into unconscious bias that proves just how prevalent it is. Warning: it’s kind of scary.

Prisoners’ Parole Applications: A Shocking Example of Unconscious Bias

Are Israeli courtrooms biased against Palestinians? That’s one of many possibilities a team of researchers in Israel considered as they looked for patterns in the granting of parole. And they found a pattern all right, but not the one anyone expected.  What made the biggest difference was the part of the session when the committees’ decided on each case. That’s right. The decision of whether someone should stay locked up, or go free, largely came down to a factor that had nothing to do with the case itself.

Let that marinade for a minute.

It’s pretty messed up, huh? I could hardly believe it. But it’s true. The committees were far less likely to grant parole toward the end of a session, most likely the result of what’s known as decision making fatigue. There are many factors that go into the decision of whether or not to grant parole; it’s a complex decision that takes into account the crime, time served, and other circumstances. As the session goes on and they hear multiple cases, the committee members get tired, and as they do, the fatigue makes them increasingly likely to stick with the status quo, which in this case meant denying parole applications. But this all happened without them knowing that anything but the facts at hand had influenced their decisions.

That’s unconscious bias at work.

You can read more about the research here.

A similar study in the United States found that the time of day when admissions officers read a high school applicants’ essay played an outsized role in how they scored it. It’s scary that a decision so important like a prisoner’s parole or a student’s college admission could be influenced by something so random, right? But that is the power of unconscious bias on decision making, and the same phenomenon impacts every one of us as we make all types of decisions. We’re often biased in ways that we’re not even aware of. 

To understand the extent to which we are all biased, consider this study from the University of Virginia on hunger and visual perception. It turns out that what we see isn’t always very accurate.

Research finds evidence of unconscious bias in parole committees’ decision making – the time of day when the committees decided a case heavily influenced the outcome. Scary stuff, huh? And in terms of unconscious bias, this is just one study in a growing body of research…

How Big Is That Hill? Unconscious Bias and Getting Hangry

Imagine that you have a group of people at the bottom of a hill.   If you came up with some way for them to describe the size of the hill, they would probably all say something similar, right? They are, after all, staring at the same exact hill, and it is a specific size. But actually that’s not how it works. Everyone’s perception of the hill is different based on the resources each person has to climb it at that moment.

In a research study at the University of Virginia, researchers divided participants into groups based on the amount of glucose they were given before rating the difficulty of climbing the hill. The presence or absence of glucose, a simple sugar and the body’s preferred fuel for physical exertion, determined how big the hill seemed for each person. The more glucose they had, the smaller the hill seemed. The less glucose, the bigger the hill. Now how could this be?

It really comes down to the fact that the brain is more concerned with survival than objectivity. To our brains, it’s less important how big the hill actually is and more important how big it is relative to our resources. On a very basic, biological level, we all experience the world through biased lenses. Our brains are biased to ensure our survival above all else, even the truth.

How big is that mountain? It depends on how hunger you are, according to research from the University of Virginia. Because the human brain is more concerned with surviving and thriving than it is with objectivity.

Research into hunger more generally has found that it tends to amplify the negativity of a negative experience. This is the experience commonly known as hanger – hunger driven anger. I’d speculate that the same forces are at play here. Since we have less resources to deal with the negative stimulus, it seems more overwhelming, and just plain worse.

And in a very similar way to the judges in Israel and the admissions officers in the US, the group at the bottom of the hill or someone who is hungry isn’t aware that the amount of glucose in their blood is impacting its perceptions of the world, and as a result, its decision making. But it is – in a very real, measurable way. That’s unconscious bias at work.

So fatigue and hunger are two forms of unconscious bias. And the last one I want to look at, and it’s probably the hardest to perceive and guard against because it’s changing all the time, is our mood.

You Don’t See That ? Unconscious Bias and Mood Goggles

Of all the stimulus that comes upon our eyes, ears and noses every day, we consciously take in about 1% of it. We’re always filtering; we have to. But the crazy part is, we tend to notice things that match the way we’re already feeling. Our brains like certainty, to know what’s going on. So when we’re anxious, we’re more likely to see threats. When we feel serene, we’re more likely to see evidence that the world is wonderful. The result is that the way we’re already feeling is reinforced – again and again. As I have struggled with depression over the years, I have felt the extreme of this tendency: When you are depressed, you see obstacles and hopelessness all around.

And what’s more is that these feelings, just like the physical sensation of hunger, impact our decision making in a big way. Fear breeds uncertainty and a limited perspective. Anger instills confidence and a greater tolerance for risk than normal. Sadness tends to make people more analytical. Even happiness has been found to make people more gullible. If we’re not aware of these biases, we can make some really suboptimal decisions. Our mood changes and we think, “Gee, why didn’t I analyze that more carefully? Or why did I over analyze that situation to death?”

Have you ever made a decision that you could clearly see in retrospect had been influenced by your mood? If so, share it in the comments below.

So considering all this, how can we be sure that we’re not making biased decisions?

Fascinating psychology research into unconscious bias, and 5 tips to increase self-awareness and check your own decisions for bias.

5 Ways to Overcome Unconscious Bias

Unconscious bias exists for all of us, so what can we do to overcome this limitation and make optimal decisions?

There is no surefire way, but here are 5 steps to go through and check for your own unconscious biases:

1. Check your basic needs. Am I hungry? Thirsty? Tired? Do I need to go to the bathroom? And you can not only think about if these things are true, but also think about how they would impact the decisions you’re making if they were. If I am hungry or tired, for instance, and a coworker asks me to take on an extra project, how would that influence my thinking as I go to respond? The answer to this one is clear: Hunger and fatigue mean that I don’t have the resources, and I would be more likely to decline or feel overwhelmed. Which is fine unless you think about how easy those are to change, and then I may want to hold off for a couple hours, or days, before responding. So be sure to check your basic needs before making almost any type of decision.

2. Take your emotional temperature. Ask yourself, what am I feeling? And how would that impact the decision I am making? Write down your feeling and compare it to the research on how that may influence your decision making progress. In today’s technological age, when sending what my Dad calls ‘email missiles’ is easier and more common than ever, this is a really vital skill. I am angry, and that could make me overconfident and minimize the risk I am taking by doing this. Or more often for me, I am sad and that could make me overanalyze a decision, even one as simple as how to word a text message. Recognizing these patterns before you make the decision is a game changer.

3. Consider big decisions in several sittings. Since fatigue, mood, hunger, the time of day, and even the lighting in a room have all been found to influence our decisions, it’s probably best to think about big decisions at several different times and in different locations. That way you can be sure that you are looking at it from several different angles, and sort of hedging your bets against making a biased decision.

4. Pretend to be someone else. A growing body of research shows that one way we’re unconsciously biased is in reserving wise reasoning for others’ problems that we do not apply to our own. It’s known as Solomon’s Paradox. For more on this, I highly recommend this article. To combat this trend, look at your own problems from a third-person perspective, like you are looking in on your own life. It may unearth some previously undiscovered biases in how you are thinking about the situation.  For this to be effective, you should take care of you basic needs first, or you may think your friend’s situation is worse than it is!

5. Travel forward in time. Similarly, we often make decisions based on restraints and pressures related to time. So next time you are making a big decision, ask yourself: How would I feel about this in 5, 10 or 15 years? Thinking far into the future can help eliminate some unconscious bias and help us connect the decision to what really matters to us.

What’s new in emotional intelligence?

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A Journey through Empathy & Optimism: Amy Jimison in Voices from the Network

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Trust, Diversity & Emotions: Key Strategies from EQ Diversity Practitioner Michael Eatman – Voices from the Network

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Great article, Michael! This research dovetails beautifully with an area of great interest to me: law of attraction concepts and practices, through the unfolding of leading-edge discussions with Esther Abraham Hicks (via YouTube.) I love how this research underscores the understanding that we live in an attraction-based energetic universe, that like energies attract. It’s the how and the why we will always manifest experiences to reinforce our bias, our beliefs.

Every belief is a vibration. The question is, are we biased positively or negatively? And what is that positive or negative in relation to?

According to law of attraction principles, emotions fall on an energetic scale similar to frequencies on a radio tuner. Depression and despair at the bottom, appreciation and joy at the top. We are both the tuner of incoming radio frequencies–we receive frequencies–and we are transmitters, putting out vibrations. Most of the time unconsciously. And most of the time, we live in an echo chamber, receiving and transmitting back the conditions we perceive around us through our senses. Understood this way, emotions can be seen to serve as an internal guidance system to indicate being in alignment (+) or out of alignment/resistant (-).

The exciting thing: people are discovering we can learn to broadcast only the highest good, regardless of the conditions. And that is a big deal!

Picture a river flowing swiftly. Call it chi, ki, prana, grace, the eagle’s emanations, or all-that-is. When we are at the surface which is flowing 24/7 like a river, it feels good. Easy. Fun. Effortless. When we are out of alignment, we are resisting the current, and that feels bad. Like trying to swim upstream. Resistance is hard work. Resistance also pulls us down below the surface of stream, especially when we look backwards and hold on to grievances and fears. We get dragged right down towards the dark, resistant emotions.

When we are in a state of non-resistance, we float up like a cork, and become receivers of pure positive energy and a million cooperative components of the universe conspiring to help us. IT is because we have the leverage of the flow of source.

When we understand how law of attraction works, negative emotions become helpful indicators of misalignment, or resistance. We come to appreciate them as speed bumps at the edge of the highway. That appreciation itself brings us back up into alignment!

Negative emotions become not something to despair over, but valuable information to help us steer ourselves back up into the stream, in the flow. Becoming aware of and caring about our emotions, practicing shifting our emotional state deliberately to better-feeling, more positive vibrations, we can become conscious attractors, allowers, creators. That’s what law of attraction is all about.

This research also dovetails with all the great spiritual traditions as well. It explains why addicts hit rock bottom and then come back up: it is when we surrender, let go, trust, have faith, and release resistance — that we naturally float back up like corks, into the stream.

Reading this article, I feel quite heartened. Understanding from many different angles is coming to light at just the right time. As with all great advances throughout history, it is yet another turn of the upward spiral in the evolution in consciousness.

It has long been said that “hearts [emotions] that seek God [good] find him.” And that when one individual masters unconditional alignment with Source, they positively affect the vibration of 1,000 others around them. That would be interesting to study and document. I recently have been meeting people who are quite good at being in alignment unconditionally, and have witnessed their affect upon others.

Thanks for this article.

Great article, and resonates with me as a coach and teacher. When training teachers, I often recognise they are displaying unconscious bias that means their expectations of children and young people are limited. Developing their EQ can help them to recognise this and move towards adopting a more compassionate and egalitarian outlook for the children they teach.

That’s very interesting, Ruth. Thanks for sharing. A great coach can really help by making visible these forms of unconscious bias that are hard to see by oneself. What are the limiting beliefs that you often see teachers having about children?

It all starts with self awareness and ends with the choices we make. Great scientific insight very similar to the one practiced in CQ. EQ is so simple to understand, great to teach and hardest to apply. Yet, like life itself, it unravels only when we accept it.

Hi Rishabh,thanks for sharing. I agree that it all starts with self-awareness and acceptance, and really comes down to our choices. What is CQ?

Wonderful article with crucial insights for Self-Awareness and how it relates with our decision making. We really become a victim to our Unconscious Bias, especially in more demanding situations when we are challenged by mounting stress, hunger etc. Thanks Miller for bringing a very important aspect of decision making to our focus.

Thank you, Tauquir! You make a good point that unconscious bias and its effects seem to worsen – or sort of come to light – in demanding situations. As always, thanks for your support and insight!

Thanks for this important article. In these fractured times, disseminating the research is especially important!

No problem, Annette! I agree that it’s especially important these days. Thanks for reading and sharing!

Hi Annette, thank you! I enjoyed writing and sharing it, and you’re right, it’s very needed these days

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Understanding Unconscious Bias: Ask Catalyst Express

Unconscious Bias is an association or attitude about a person or social group that, while not plainly expressed, operates beyond our control and awareness, informs our perceptions, and can influence our decision-making and behavior. It exists in each person’s worldview and affects our actions from the classroom to the workplace. And while we may not be conscious of our own biases, many of those around us do perceive them. As a result, unconscious bias creates barriers to inclusion, performance, engagement, and innovation. Though we cannot completely rid ourselves of unconscious bias, learning how to mitigate its impact is a skill that all of us can learn.

Catalyst Resources on Unconscious Bias

• 11 Harmful Types of Unconscious Bias and How to Interrupt Them
• 5 Ways to Identify Effective Unconscious Bias Training
• Artificial Intelligence: The New Frontier for Confronting Gender Bias
• Sharing Failures Leads to Learning Opportunities for All
• Boston Scientific: Accelerating Progress for Women by Creating Equal Opportunities for Growth Supporter Exclusive To reach an even wider audience, Boston Scientific instituted a required online unconscious bias training—available in 18 languages—to help employees reflect and recognize their own biases and embrace DEI efforts. To date, 98.6% of employees have completed this training. The company also created an online Inclusion Toolkit that offers employees on-demand content, including an inclusive behaviors self-assessment, manager skill-building resources, and educational anti-racism resources.
• Parexel: Leveraging Gender Partnership to Advance Women in Leadership Supporter Exclusive The first step was to educate leadership in such a way that they would feel personally committed to making this change—by sitting across the table and telling them that their unconscious bias was impacting the company’s ability to benefit from the contributions of many highly-qualified candidates. DEI leadership arranged a series of talks from outside speakers and invited senior leaders to attend; this effectively constituted some of the company’s first unconscious bias and inclusion training.
• The Boston Consulting Group (BCG)—Women@BCG Supporter Exclusive BCG also implemented many programs and activities that promote awareness and affiliation, including Unconscious Bias training that was mandatory for all Partners and Principals, as well as leaders who managed key people processes (such as recruitment and learning and development). Over 90% of Partners, Principals, leaders, and teams participated.
• Break the Cycle—Eliminating Gender Bias in Talent Management Systems ( see also: French translation )
• How to Combat Unconscious Bias as an Individual ( see also: French translation , Japanese translation )
• How to Combat Unconscious Bias as a Leader in Your Organization ( see also: French translation , Japanese translation )
• What is Unconscious Bias?

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• CatalystX Discussion Facilitation Guide–Unconscious Bias: From Awareness to Action Supporter Exclusive
• Knowledge Burst: Running More Inclusive Meetings Supporter Exclusive
• Knowledge Burst: Managing Affinity Bias Supporter Exclusive
• Building Inclusion for Indigenous Peoples in Canadian Workplaces
• The Day-to-Day Experiences of Workplace Inclusion and Exclusion
• Day-to-Day Experiences of Emotional Tax Among Women and Men of Color in the Workplace
• Empowering Workplaces Combat Emotional Tax for People of Colour in Canada
• Engaging Men: Barriers and Gender Norms
• Break the Cycle—HR Experts: Eliminate Gender Bias From the Recruitment Process
• Break the Cycle—Managers: Eliminate Gender Bias in Development Opportunities
• Break the Cycle—Senior Leaders: Self-Assessment and Action Plan

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• AI and Gender Bias
• Gendered Ageism
• A Conversation on Unconscious Bias Supporter Exclusive
• Eliminating the Double Bind Supporter Exclusive
• International Women’s Day  – Sharing Perspectives (EMEA Roundtable Recording) Supporter Exclusive

Other Resources on Unconscious Bias

• Unconscious Bias, Implicit Bias, and Microaggressions: What Can We Do About Them? American Bar Association
• The Unconscious Bias in HR Series – #1. Introduction EuroGender
• How to Tackle Unconscious Bias in Your Workplace Forbes
• What Unconscious Bias Training Gets Wrong… And How to Fix It The Guardian
• Are You Aware of Your Biases? Harvard Business Review
• Test Yourself for Hidden Bias Learning for Justice

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Implicit bias.

Harini S. Shah ; Julie Bohlen .

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Last Update: March 4, 2023 .

• Continuing Education Activity

Implicit bias is the attitude or internalized stereotypes that unconsciously affect our perceptions, actions, and decisions. These unconscious biases often affect behavior that leads to unequal treatment of people based on race, ethnicity, gender identity, sexual orientation, age, disability, health status, and other characteristics. In medicine, unconscious bias-based discriminatory practices negatively impact patient care and medical training programs, hinder effective communication, limit workforce diversity, lead to inequitable distribution of research funding, impede career advancement, and result in carriers and disparities in the access to and delivery of healthcare services. This activity will address strategies to reduce the harm of implicit bias, clinician self-awareness and self-assessment of personal biases, and the role of the interprofessional team in increasing awareness and reducing bias-based discriminatory behavior.

• Recognize how implicit bias affects the perceptions and treatment decisions of clinicians leading to disparities in healthcare delivery and health outcomes.
• Identify stigmatized groups and strategies to eliminate discriminatory behavior in healthcare delivery for these groups.
• Describe strategies to increase awareness of personal unconscious biases in daily interactions and change behavior accordingly.
• Discuss how interdisciplinary teams can reduce the harmful effects of implicit bias in medicine.
• Introduction

Implicit biases are subconscious associations between two disparate attributes that can result in inequitable decisions. They operationalize throughout the healthcare ecosystem, impacting patients, clinicians, administrators, faculty, and staff. No individual is immune from the harmful effects of implicit biases. Unconscious bias-based discriminatory practices negatively impact patient care, medical training programs, hiring decisions, and financial award decisions and also limit workforce diversity, lead to inequitable distribution of research funding, and can impede career advancement. [1]

When implicit biases are ignored, they jeopardize delivering high-quality healthcare services. [2] A simple analogy can exemplify implicit bias in healthcare in action. Several physicians are reviewing the chest x-ray of a black man with a productive cough to determine a possible diagnosis. Another physician, not privy to the patient's demographics, joins the discussion later and quickly states that his condition most likely is cystic fibrosis. The clinicians were initially influenced by the patient's demographics and then realized the chest X-ray findings were diagnostic for late-stage cystic fibrosis, a condition more common in White populations than other races. 

Explicit versus Implicit Bias

With explicit bias, individuals are aware of their negative attitudes or prejudices toward groups of people and may allow those attitudes to affect their behavior. The preference for a particular group is conscious. For example, a hospital CEO may seek a male physician to head a department due to his explicit belief that men make better leaders than women. This type of bias is fully conscious.

Implicit bias includes the subconscious feelings, attitudes, prejudices, and stereotypes an individual has developed due to prior influences and imprints throughout their lives. Individuals are unaware that subconscious perceptions, instead of facts and observations, affect their decision-making. Implicit bias and explicit bias are both problematic because they lead to discriminatory behavior and potentially suboptimal healthcare delivery.

We all hold implicit biases. Implicit bias is challenging to recognize in oneself; awareness of bias is one step toward changing one's behavior. [1] Cultural safety refers to the need for healthcare professionals to examine themselves and the potential impact of their culture, power, privilege, and personal biases on clinical interactions and healthcare delivery. This requires health providers to question their own attitudes, assumptions, stereotypes, and prejudices that may contribute to a lower quality of healthcare for some patients. Cultural safety compels healthcare professionals and organizations to engage in ongoing self-reflection and self-awareness and hold themselves accountable to provide culturally safe care, which the patients and their communities define. [3] Healthcare professionals and their healthcare organizations should work together to develop strategies to mitigate the harmful effects of bias and reduce bias-based decisions that contribute to barriers to healthcare access, healthcare disparities in patient care delivery, and lack of workforce diversity.

Stigmatized Groups and the Implicit Association Test (IAT)

Although we may consciously reject negative associations with stigmatized groups, it is virtually impossible to dissociate from a culture impregnated with such stereotypes. Patients from stigmatized groups may have one or more of these characteristics or conditions: advanced age, non-White race, HIV, disabilities, and substance or alcohol use disorders. [4] [5] [6]  Other factors include low socioeconomic status, mental illness, non-English speaking, non-heterosexual, and obesity. [7] [8] [9] [10] Implicit biases, by definition, occur in the absence of salient understanding or conscious awareness. [11] [12]  However, we can apply harm mitigation strategies to avoid the destructive implications of implicit bias. To this end, recognition is the first step.

Implicit biases in healthcare are well-characterized by studies that use Implicit Association Tests (IAT) to evaluate medical decision-making toward stigmatized groups. The IAT measures the strength of associations between concepts and evaluations or stereotypes to reveal an individual's hidden or subconscious biases (Project Implicit - implicit.harvard.edu). The IAT is a highly validated measure for implicit biases; although vulnerable to voluntary control, the tool remains a gold standard in implicit bias research. [13] [14] Studies have shown that strong implicit biases hinder communication. [15] Effective patient-healthcare provider (HCP) communication is associated with reduced patient morbidity and mortality, lower healthcare costs, and decreased rates of HCP burnout. [16] [17] [18] [16]

Implicit biases become destructive when they translate into microaggressions, defined as verbal or nonverbal cues that communicate hostile attitudes towards those from stigmatized groups. [19] [20] Although often unintentional, microaggressions maintain power structures and threaten the psychological safety of patients, resulting in adverse public health implications. [21] Reducing microaggressions has been shown to reduce HCP burnout and depression. [22] [23]

Implicit Bias Awareness and Training

Comprehensive implicit bias training enhances the healthcare workforce's financial value, productivity, and longevity. The recognition of implicit bias is the first step in mitigating its effects. Many states in the US require implicit bias training for employment and licensure in the healthcare profession. The ongoing engagement of implicit biases among HCPs promotes cultural safety in healthcare organizations, representing a critical consciousness that welcomes accountability in the collaborative effort to provide culturally safe healthcare as defined by patients and their communities. HCPs should be aware of their implicit biases but not blame themselves when situations out of their control arise—respect for themselves, peers, and patients is the utmost priority. Progress toward reducing implicit bias is limited without personal discomfort and vulnerability.

Currently, very limited knowledge exists on how to conduct effective implicit bias training. However, studies show that incorporating mindfulness, coalition-building, and personal retrospection alongside broader structural changes is integral in reducing the harmful effects of implicit bias in the clinical environment. [2] [24] [25] This article provides strategies to mitigate the impact of implicit biases among physicians, residents, physician assistants, pharmacists, registered nurses, nurse practitioners, medical assistants, medical scribes, certified registered nurse anesthetists, physical and occupational therapists, chiropractors, dentists, hygienists, licensed nutritionists, dieticians, social workers, counselors, psychologists, other allied health professionals, and healthcare trainees. Implicit bias in continuing education is required in many states.

Implicit Bias Training: State Legislation and Requirements for Healthcare Providers

California - AB241 (legislation)

Illinois - Sec. 2105-15.7 (legislation)

Michigan - R 338.7001 (legislation)

Maryland - HB28. Sec. 1-225 (legislation) (HB28)

Minnesota - Sec. 144.1461 (legislation)

Washington - Sec. 43.70.613 (legislation)

Massachusetts - 243 CMR 2.06(a)3 (legislation)

New York - S3077 (legislation)

Pennsylvania - HB 2110. Title 63. Sec. 2102a (legislation)

Indiana - HB 1178 (legislation)

Oklahoma - HB 2730 (legislation)

South Carolina - H 4712. Session 123 (legislation)

Tennessee - SB0956 and HB0642 (legislation)

• Issues of Concern

Harm-Reduction Strategies for Stigmatized Groups

Studies show that implicit bias training has little to no benefit without disaggregating the experiences of stigmatized groups and providing actionable recommendations. Here, we outline harm-reduction strategies, disaggregated based on the previously stigmatized groups (advanced age, nonwhite race, HIV positive, disabilities, substance use disorder, alcohol use disorder, low socioeconomic status, mental illness, non-English speaking, non-heterosexual, and obesity). Patients often belong to more than one group, given the intersectionality of historically disadvantaged populations in the US (e.g., being black with low socioeconomic status).

Persons of Advanced Age

Older adults are often associated with a cultural fear of death and dying. [26] [27] This fear is so pervasive that older adults may even internalize that they're a burden to others. [28] [21] HCPs may perceive older adults as less independent (regardless of decision-making capacity), attention-seeking, unrewarding to care for, and visually unpleasant. [29] From a mental health standpoint, physicians are less willing to treat older adults with suicidal ideation than young adults with suicidal ideation. Healthcare trainees are more comfortable interacting with older adults (compared to younger adults) with suicidal ideation. [30] Nurses with negative perceptions towards older adults provide less health education and have shorter patient interactions with older adults. [30]

Implicit bias can result in less mental health treatment for individuals of advanced age. Strategies to reduce implicit bias are created to educate clinicians that older adults deserve mental health treatment and should not be overlooked due to unconscious prejudicial negative feelings that clinicians may hold. HCPs should aim to schedule multiple health appointments in the same location and allot extra time for care for older adults. A healthcare team must ask for written permission before speaking with family members and caregivers. Healthcare teams should talk directly to patients even if a caregiver is present. Studies have shown that peer mentor support among older adults and support from those who have experienced illness facilitates patient empowerment. [31] Providing multiple forms of accessible communication ensures a complete understanding of care. [32]

Persons of Nonwhite Race

In 2021, the Center for Disease Control and Prevention (CDC) cited racism as a serious public health threat (CDC, 2021). Indeed, numerous studies have shown specific examples of race-based discrimination in healthcare settings. For example, implicit racial biases impact clinical decision-making for pain management, noninvasive cardiac testing, thrombolysis, cardiac catheterization, and cancer screening. [33] [21] Pediatric nonwhite patients also face implicit racial biases from HCPs. [34] [35] [36]  Black, Latinx, and indigenous patients are frequently met with verbal dominance from HCPs and negative experiences in the medical setting, compromising trust in HCPs and patient care quality. [37] [38] [39] HCPs who score highly on the IAT for black-white implicit bias are often rated poorly by black patients regarding patient-centered care. [37] Implicit biases against those of nonwhite race are particularly salient when the clinician perceives increased time pressure and ambiguity, such as in acute care or emergencies. [40] [41] [42] The COVID-19 pandemic exacerbated discriminatory attitudes towards HCPs of Asian and Pacific Islander descent. [43] [44]

Strategies to reduce harm from implicit racial bias include finding things in common such as a shared group membership, which has been associated with a decrease in implicit racial bias. [25] Counter-stereotypical examples, such as a 36-year-old black male CEO of a Fortune 500 company, may also result in unconscious prejudice or stereotyping. [45] Expanding one's network and forming friendships with people of different healthcare professions further reduces the effect of implicit bias in the healthcare setting. [45] One may learn to recognize personal changes in non-verbal (e.g., gestures, eye contact, body distance) and paraverbal (e.g., tone, pitch, volume) communication behaviors. [46] [45] [21] Racialized experiences are valuable in a patient's health history; rather than ignoring these experiences, one can recognize their impact on health outcomes. HCPs may ask clinical questions to ascertain a patient's experiences with racism. [47] Examples of questions to determine racialized experiences are as follows:

• "Many of our patients face racism in healthcare; is this something you've experienced before?"
• "Are there any important life events that you've experienced or are currently experiencing that affect your health?"

Finally, it is essential to thank patients for sharing their stories, validate them, and acknowledge the trauma that those experiences may have caused. Knowledge of these experiences gives context to patients who lost trust in the healthcare system or may appear "non-compliant." Incorporating this practice into healthcare workflows enhances value-based care. [48]

Persons with Limited English Proficiency

The nature of implicit bias toward those with limited English proficiency stems from an inherent miscommunication in health care. For English speakers, speaking English in the work setting is comfortable; when HCPs are displaced from their comfort zone, study findings reveal that healthcare quality declines. The widespread use of medical interpreters has reduced many patient barriers, but interpreters are usually only available in large healthcare systems and are not often used during outpatient care. As a result, HCPs often translate to the best of their ability when communicating with a patient with limited English proficiency. Although faster, this method leaves wide gaps in the exchange of health information and treatment compliance. [49] [50] [51] As mentioned previously, patient unfamiliarity and HCP time constraints are two competing factors that widen disparities in healthcare delivery. [15]

Strategies to reduce harm due to implicit bias against those with limited English proficiency include consistently using professional medical translators in outpatient and inpatient settings. Before patient care visits, it is more effective if HCPs and staff can ensure the professional translator is available for the entire appointment. [15] Caution must be taken when caregivers or family members offer to translate for older adults, as studies show this approach compromises patient autonomy over their care. 

Persons Living with HIV (PLWH)

The nature of implicit bias against persons living with HIV (PLWH) has deep roots in AIDS exceptionalism, a Western response to a lethal virus that initially disproportionately affected men who had sex with men (MSM). Fear and stigma in the early 1980s drove a public health response that worsened the alienation of PLWH. The long-term impact of this public health response is a deeply held, false narrative that PLWH are dangerous. This narrative continues to dampen opportunities for well-studied public health measures to expand prophylaxis, diagnosis, and treatment of HIV. [52]

Implicit biases and stigma associated with HIV are independent barriers to testing, adherence, and retention. [53] [54] HCPs are responsible for understanding their implicit biases against PLWH and reducing their influence on providing equitable, timely HIV treatment. Unlike other groups, greater exposure to PLWH and training to reduce the stigma associated with HIV is associated with more positive experiences among patients and HCPs. [55] Examples of implicit biases or perceptions held by HCPs are as follows: PLWH are poor, have many sexual partners, could have avoided HIV if they wanted to, and are affected due to risky or irresponsible behavior. [56] [57] Some studies have shown that HCPs would themselves feel ashamed if they were infected with HIV, contributing to a fear of occupational exposure to HIV. [55] [58] [59]

Strategies to reduce harm due to implicit biases against PLWH include actively countering the belief that HIV is avoidable without irresponsible behavior. Decades of studies have shown that PLWH is not the problem; a nationwide response that fails to protect its vulnerable population(s) has a more catastrophic outcome than the role of any individual group. [59] Furthermore, one must actively avoid the assumption that HIV runs in specific circles or neighborhoods; public health efforts to target at-risk groups do not necessarily equate to deeming which are high-risk communities.

Persons of the LGBTQIA+ Community

The stigma surrounding PLWH and its misconstrued association with the lesbian, gay, bisexual, transgender, or queer/questioning (LGBTQ) community is exacerbated by heteronormative microaggressions when receiving healthcare, conveying the message that non-heterosexual identities are abnormal, different, or inferior to the heterosexual majority. [60] Unsurprisingly, HCPs identifying as heterosexual tend to harbor these implicit associations. [61] [62] Among HCPs, mental health providers are least likely, and nurses are most likely to hold implicit preferences for heterosexual patients. [61] When caring for sexual minority patients, HCPs with implicit biases express discomfort while taking patient sexual histories and advising about safe sex behaviors, compromising the quality of care for sexual minority patients. [61]

To reduce harm from implicit biases against those identifying with the LGBTQ community, it is essential to do one's diligence in understanding the terminology and how patients define themselves. [63] For example, a person whose gender differs from that assigned at birth may refer to themselves as transsexual in formal settings but may also use self-descriptors such as trans, gender non-conforming, they/them/theirs, or nonbinary. HCPs should discuss and use patient self-descriptors both in communication and medical documentation. The more HCPs deliberately create safe spaces for patients of the LGBTQ community, the easier it will be to use patient self-descriptors in HCP workflows. [64]

Although not enough to produce culturally competent care, small changes such as supporting the observance of LGBTQ Pride Day or encouraging employees to use their descriptor pronouns can have a positive impact. [65] Lastly, HCPs should be aware of this population's relevant social and health needs and provide appropriate screenings and treatment without isolating patients. [66] Examples of these needs include violence prevention, comprehensive mental health treatment, discussions on substance and alcohol use, HPV screening, food insecurity, transgender transitional care, and hormonal therapy. [67] [68] [69] [70] [71]

Persons with Substance Use Disorder, Alcohol Use Disorder, History of Incarceration, or Exposure to Police Violence

Individuals with substance and alcohol use disorders, a history of incarceration, or exposure to police violence represent a population with significant unmet social and health needs. These unmet needs are exacerbated when HCPs hold negative implicit attitudes that individuals belonging to these groups are poorly motivated, manipulative, noncompliant, and violent. [72] [73] [74] HCPs have been shown to unfairly judge patient "treatability" before admission to rehabilitation programs, provide lower-quality palliative care for late-stage patients with cancer and substance use disorders and display microaggressions towards pregnant patients with substance use disorders during prenatal visits. [75] [76] [75] [77]

Studies findings reveal that medical, nursing, and pharmacy trainees rarely receive training in healthcare delivery for persons with histories of criminal legal system exposure, characterized as those with frequent police stops, arrests, and incarceration, despite this group representing 57% of men and 31% of women in the US population. [78] [79] [80]  As more individuals are released from jails and prisons into the community, HCPs unaware of their prejudicial negative feelings toward persons with criminal legal system involvement may threaten the psychological safety of an already vulnerable, community-dwelling population. [81]

One goal of implicit bias awareness and training is to reduce the harmful effects of implicit biases toward community-dwelling persons with a history of criminal legal system involvement. To do this, we must first dismantle the idea that a person with a history of incarceration must be a bad person; some groups are more likely to be incarcerated due to race alone. [82] [83]  Nearly 1 in 3 black men will be imprisoned in the US. [83] Furthermore, sentence length, police brutality, and delayed parole are features encumbered by implicit bias. [84] [85] [86] [87] Prevalent comorbidities such as severe mental illness make it virtually impossible to re-integrate into one's community without the assistance of a strong family network, healing environments, and financial resources. [88] [89] [90] Trauma-informed healthcare is messy, difficult, and time-consuming, but essential, given the complex health needs of this population. Individuals with a history of incarceration may present anywhere in the healthcare system. HCPs, when able, must carefully document these experiences in a protected health record to inform other HCPs and avoid re-traumatizing patients. 

Persons with Low Socioeconomic Status or a History of Homelessness

It is well-documented that HCPs working in safety-net hospitals and emergency departments express disdain towards individuals with low socioeconomic status and homelessness, colloquially known as the "revolving door" of acute care utilization in this population. [91] [92] HCPs may perceive hospital admissions of patients with a history of homelessness as an unnecessary use of resources that may otherwise be used for those who need them. [93] [94] [95] Discriminatory behavior towards those experiencing homelessness is associated with suboptimal healthcare delivery and increased hospitalizations, exacerbating the "revolving door" problem. [54] [96] [97] [98] [99] [100] An explanation for discriminatory behavior among HCPs is relative exhaustion from large patient loads, administrative pushback, and competing demands in acute care environments, which tend to amplify implicit biases. [42] [41]

Strategies to reduce harm from implicit biases towards individuals from this group are twofold: 1) countering burnout with mindfulness and positive coping mechanisms and 2) eliminating the belief that low socioeconomic status and/or homelessness is earned. [101] [102] [103] [104] On the contrary, decades of research suggest that homelessness is neither incidental nor self-directed. Adverse childhood experiences and "poverty traps"—systems designed to siphon wealth from the poor to the wealthy—make it virtually impossible for those in poverty to gain enough social capital to access outpatient preventive healthcare. [105] [106] [107] Indeed, it may be easy to blame patients experiencing homelessness for their unmet health needs, but the habit of doing so perpetuates negative behaviors, worsens burnout, and decreases job satisfaction among HCPs. [108] [109] [110] [111]

Persons with a Disability

Evidence exists for the presence of implicit bias toward persons with a disability (PWD) from OT/PT specialists, [112] genetic counselors, [113] healthcare researchers, and other HCPs [114] [115] In the US, PWD receive suboptimal preventive care and have overall poorer health statuses compared to those without a disability, partly due to negative implicit attitudes from HCPs. [116] [117] [118] [119] When asked about their willingness to treat PWD, HCPs feel largely unprepared to care for PWD and prefer not to treat them due to limited education on PWD's unique health needs. [120] Interestingly, studies show that current healthcare education paradoxically promotes ableist viewpoints. [121] [120] [122]

To reduce harm from HCP implicit biases toward PWD, HCPs should involve PWD in redesigning clinic spaces to improve accessibility. Many US outpatient clinics have incorporated features such as wheelchair-accessible doors, touchscreens, height-adjustable exam tables, and scales with handrails, but the lack of national standardization remains a limitation. [123] [124] [125] Additionally, not including PWD in clinic redesign has led to mediocre improvements in accessibility. [125] [123] To address this issue, focus groups with PWD as team members could develop patient-centered questions to identify patients needing healthcare accommodations. [126] Long-term changes include increasing the representation of HCPs with disabilities. [127]

Persons with Mental Illness

The prevalence of mental illness is rising due to increased recognition and treatment (National Institute of Mental Health, 2022). Unfortunately, the negative stigma of having a mental illness prohibits many from seeking treatment. [21] [128] The stigma surrounding mental illness has deep roots in US history; in the 19th and early 20th centuries, those with severe mental illness were held in asylums with limited access to the outside world. Deinstitutionalization, or the release of patients with serious mental illness into the community, began in the 1950s and was largely driven by financial burdens for the rising welfare state in maintaining asylums. [129] [130] Unfortunately, closing asylums was not met with increased community-based mental health services, leading to the systematic stigmatization and criminalization of patients with serious mental illness. [129] This history reflects a broader message that forms implicit biases among HCPs today: that having a mental illness is shameful. [128] [131] [132] [21]

Strategies to reduce harm due to implicit biases toward those with mental illness include speaking up when HCP colleagues dismiss a patient's mental illness or use it as a reason for lower-quality medical treatment. [133] [134] [135] HCPs should avoid the assumption that patients with mental illness seek to take advantage of the healthcare system. [135] Indeed, numerous studies suggest that those with mental illness are quickly labeled as "frequent flyers" in acute care settings, more likely to be dismissed when complaining of pain, despite having more complex health needs. [136]

Persons with Obesity

Those with obesity are too often misrepresented as lazy, irresponsible, and lacking self-discipline; however, ample evidence suggests that genetic factors, socioeconomic status, and environment can change a person's obesity risk. [137] The idea that individuals with obesity are inferior is perpetuated in social media, colleges, and health care. [138]  

Strategies to reduce harm to those with obesity starts with using appropriate terminology. For example, HCPs must use the word obesity as a noun describing an illness and not use the word obese as an adjective to describe a patient. The proper terminology is a patient with obesity and not an obese patient. This concept also applies to electronic health documentation; for example, the HCP should record a patient's information as a "31-year-old patient with obesity" and not a "31-year-old obese patient."  [139] While HCPs must provide optimal health recommendations for patients, they must recognize the genetic, environmental, and ethnic factors influencing body fat distribution. The best outcomes for weight management occur in collaboration with an interdisciplinary team of dieticians, primary care providers, and bariatric services. [140]

• Clinical Significance

The US healthcare system poses many challenges to HCPs: administrative burden, high patient load, and inefficiencies. Acknowledging and reducing implicit biases may seem like insurmountable tasks given these challenges. After all, how can you be emotionally available to recognize your own biases when you are barely managing to keep the ship afloat? A part of this reality is true; it is impossible to eliminate one’s own implicit biases and treat everyone equally all the time. However, studies have shown that practicing mindfulness, attentional control, and emotional regulation, in addition to showing compassion when able, positively impacts the culture of healthcare. [54]

At the health systems level, providing implicit bias training courses for employees is not enough. Healthcare systems must 1) create stress-free spaces for HCPs to debrief and reflect on their experiences with implicit bias, 2) stop pressuring HCPs to constantly make major decisions during intense cognitive stress, and 3) provide opportunities for role-playing encounters with patients when implicit bias is perceived or acknowledged, as studies show the more HCPs practice these discussions, the more likely implicit biases are acknowledged and reflected upon in patient rooms. [9]

• Enhancing Healthcare Team Outcomes

Although the relationship between implicit bias and interdisciplinary teams is relatively unexplored, it is evident that no single member is responsible for molding a healthcare team's culture. A culture that values open discussion of biases and protects psychological safety promotes team productivity, whereas rudeness and negative behaviors in healthcare teams may adversely affect team performance. [141]  [Level 1] The "butterfly effect" is the idea that small team changes can significantly impact other parts of the process or system; it occurs in a system where implicit biases are openly recognized without repercussions. [142]  [Level 3]

Tools for self-reflection of implicit biases among healthcare teams have been shown to improve patient trust in the quality of care. [Level 1] Clear communication of expectations and responsibilities minimizes the impact of bias on choosing team roles. [143]  [Level 1] Implicit bias training can provide new team knowledge when additional learning is needed. Graduate medical education that includes implicit bias training has been shown to improve leadership qualities in trainees, which may foster an equitable team culture. [144]  [Level 1] However, isolated training does not result in equitable care without team members applying knowledge acquired in daily interactions. [1]  [Level 3] Therefore, regular check-ins and debriefs are essential to ensuring that team members feel prepared to engage in self-improvement. [143]  [Level 1]

Interprofessional Education Collaborative and Core Competencies

Interprofessional teams share their values, perspectives, and strategies for planning interventions, and each member of the team plays a role in delivering patient care. Team members share their expertise and skills to provide effective patient care and achieve optimal outcomes. Teams function optimally when the members effectively communicate and have mutual respect for each other and their individual roles. Four core competencies have been established for interprofessional collaborative practice (see IPEC Core Competencies for Interprofessional Education Collaborative):

• Work with individuals of other professions to maintain a climate of mutual respect and shared values. (Values/Ethics). When team members place a high value on treating patients and team members equally and respectfully and operate ethically, interventions to reduce the harmful effects of implicit bias that result in health disparities can be created in a culturally safe and accepting environment.
• Use the knowledge of one's own role and those of other professions to appropriately assess and address the health care needs of patients to promote and advance the health of populations. (Roles/Responsibilities)  Each interprofessional team member is responsible for identifying how implicit bias affects perceptions and clinicians' treatment decisions, leading to disparities in healthcare delivery and health outcomes.
• Communicate with patients, families, communities, and professionals in health and other fields in a responsive and responsible manner that supports a team approach to promoting and maintaining health and preventing and treating disease. (Interprofessional Communication) Discussions regarding cultural safety and the continued need for clinicians to engage in ongoing self-reflection and self-awareness and hold themselves accountable to provide culturally safe care should be a priority. Open discussions focused on accepting that everyone has implicit biases and that everyone has the ability to recognize them and change their behavior through interventions, such as counter-stereotyping, are helpful. Strategies to improve patient-clinician communication are beneficial, especially with patients in stigmatized groups.
• Apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan, deliver, and evaluate patient/population-centered care and population health programs and policies that are safe, timely, efficient, effective, and equitable (Teams and Teamwork)  Teams should work together to develop strategies to eliminate discriminatory practices that result in disparities in healthcare delivery, limited access, and suboptimal patient outcomes. Time should be given to interventions that embrace and increase diversity in the workforce.
• Nursing, Allied Health, and Interprofessional Team Interventions

If members of an interprofessional health team don’t acknowledge their individual implicit biases, we will still leave a large hole in the potential to address bias in healthcare. The entire interprofessional team, including clinicians, nurses, pharmacists, therapists, and other ancillary and administrative personnel, is responsible for openly discussing implicit biases influencing the care provided and keeping one another accountable.

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Disclosure: Harini Shah declares no relevant financial relationships with ineligible companies.

Disclosure: Julie Bohlen declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Shah HS, Bohlen J. Implicit Bias. [Updated 2023 Mar 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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• 19 unconscious biases to overcome and h ...

19 unconscious biases to overcome and help promote inclusivity

Unconscious biases are learned assumptions, beliefs, or attitudes that we aren’t necessarily aware of. While bias is a normal part of human brain function, it can often reinforce stereotypes. To combat unconscious bias, learn about different types of biases, how they might surface at work, and how to avoid them so you can build a more inclusive and diverse workplace.

That being said, these biases can lead to skewed judgments and reinforce stereotypes, doing more harm than good for companies when it comes to recruitment and decision-making. 

It’s especially important to be aware of these biases during the hiring process since they can impact the success of your future team.  

To help you recognize and combat unconscious bias in the workplace, we cover 19 unconscious bias examples and prevention strategies. Taking the steps to reduce biases will help you improve inclusivity, trust, and productivity within your company. 

What is unconscious bias?

Unconscious bias, also known as implicit bias, is a learned assumption, belief, or attitude that exists in the subconscious. Everyone has these biases and uses them as mental shortcuts for faster information-processing.

Implicit biases are developed over time as we accumulate life experiences and get exposed to different stereotypes. 

According to the Kirwan Institute for the Study of Race and Ethnicity , “These biases, which encompass both favorable and unfavorable assessments, are activated involuntarily and without an individual’s awareness or intentional control.”

As a result, unconscious biases can have a big influence on our limiting beliefs and behaviors. When this translates to our professional lives, it can affect the way we hire, interact with colleagues, and make business decisions. 

If not properly addressed, these biases can negatively impact a company’s workplace culture and team dynamics. 

Although these biases are pervasive, you can reduce their impact with deliberate attention and effort. Being aware of and understanding the different types of biases that exist can help you find ways to combat them. 

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Types of unconscious bias

Unconscious biases manifest in different ways and have varying consequences. Some biases arise from judging people’s appearances, some are derived from preconceived notions, and others are borne of logical fallacies. We explore these common biases in detail below. 

1. Gender bias

Gender bias, the favoring of one gender over another, is also often referred to as sexism. This bias occurs when someone unconsciously associates certain stereotypes with different genders.  

This type of bias may affect recruitment practices and relationship dynamics within the company. An example of this bias during hiring is if the hiring panel favors male candidates over female candidates even though they have similar skills and job experience. 

Another well-known example is the gender pay gap. As of 2021, the average median salary for men is about 18% higher than women’s.  

The gender bias may reduce job and career advancement opportunities for certain populations.  

How to avoid gender bias

Here are some ways to create a more gender-diverse workplace: 

Set gender-neutral recruitment standards: Define the ideal candidate profile ahead of time and evaluate all candidates against those standards. 

Create diversity goals: Set qualitative gender diversity goals to create a more gender-balanced team. Support and provide resources for women to take on leadership roles. 

Ageism refers to stereotyping or discriminating against others based on their age, often happening to older team members. 

Although workers ages 40 and older are protected from workplace discrimination under the Age Discrimination in Employment Act, filing for a lawsuit against an employer can be a lengthy and costly process. 

Because not everyone files a complaint, ageism is still a prevalent issue. An AARP survey found that about 60% of workers age 45 and older have seen or experienced age discrimination in the workplace.

An example of ageism is if an older team member was passed over for a promotion, which ended up going to a younger team member with less seniority and experience. 

Companies that discriminate based on age may lose out on the valuable knowledge and experience that older workers bring. There may also be serious legal consequences if a team member decides to file a job discrimination lawsuit. 

How to avoid ageism bias

Preventing ageism involves combatting age-related stereotypes as well as engaging older team members in the workplace. Here are some ways to do that:

Don’t make assumptions based on age: For example, don’t automatically presume that older workers don’t know how to use technology or aren’t open to learning new skills. Provide equal learning opportunities for everyone. 

Foster cross-generational collaboration: Create two-way mentorship programs where a senior team member is paired with a new hire. This kind of collaboration facilitates communication between team members of different stages, which can help break down misconceptions about age.  

3. Name bias

Name bias is the tendency to prefer certain names over others, usually Anglo-sounding names.

Name bias is most prevalent in recruitment. If a recruiter tends to offer interviews to candidates with Anglo-sounding names over equally qualified candidates with non-Anglo names, this bias is present.  

Name bias can have a negative impact on diversity hiring and result in companies missing out on talented candidates. 

How to avoid name bias

A simple solution to avoid name bias is to omit names of candidates when screening. To do this, you can:

Use software: Use blind hiring software to block out candidates’ personal details on resumes.

Do it manually: Designate a team member to remove personal information on resumes for the hiring team. 

4. Beauty bias

Beauty bias refers to the favorable treatment and positive stereotyping of individuals who are considered more attractive. This has also given rise to the term “ lookism ,” which is discrimination based on physical appearance. 

An example of beauty bias is a hiring manager who is more inclined to hire candidates they think are good-looking. 

Hiring decisions should be based on skills, experience, and culture fit rather than physical appearance.

How to avoid beauty bias

Here are some ways to avoid beauty bias when screening job applicants:

Omit pictures from resumes: Focus on an applicant’s qualifications and experience when screening resumes.

Conduct telephone screening: Before scheduling an interview, consider doing a short telephone interview to get to know the applicant better without being influenced by their appearance. 

5. Halo effect

The halo effect, a term coined by psychologist Edward Thorndike in the 1920s, occurs when we develop an overall positive impression of someone because of one of their qualities or traits. 

This effect may lead us to inadvertently put people on a pedestal since we’re constructing an image of a person based on limited information. 

An example of this effect in recruitment is when a hiring manager sees that a candidate graduated from a prestigious school and assumes that they excel at their job. 

This halo is based on the hiring manager’s academic preferences. However, the school that someone went to doesn’t necessarily determine their level of job competency.  

By focusing too much on one positive trait, we may overlook negative behavior that could end up harming the company—for example, if a candidate was fired for misconduct in a previous job. 

How to avoid the halo effect

To reduce the impact of the halo effect, you could try out different interviewing strategies:

Conduct multiple interviews: Set up several rounds of interviews for candidates with different levels of management. That way, a candidate can be evaluated from various perspectives. 

Diversify your interview team: Getting someone from another team to interview the candidate may help since they’ll have less reason to “halo” them as they won’t be working with them directly. 

6. Horns effect

The horns effect is the opposite of the halo effect. This bias causes us to have a negative impression of someone based on one trait or experience. 

Putting too much weight on a single trait or interaction with someone can lead to inaccurate and unfair judgments of their character. 

For example, a new team member thinks the constructive criticism they received from their manager is harsh and assumes that their manager is a critical and stern person. 

If left unchecked, the horns effect can damage the cohesiveness and trust between team members. 

How to avoid the horns effect

In order to reduce the horns effect when interacting with others, try to: 

Challenge your first impressions: Take the time to get to know someone so you can develop a more concrete impression of that person as a whole.

Make judgments based on evidence: Ask yourself how you developed your first impression of someone and find evidence to support or refute that impression based on additional interactions. 

7. Confirmation bias

Confirmation bias is the tendency to seek out and use information that confirms one’s views and expectations. In other words, cherry-picking information to validate certain points. 

This affects our ability to think critically and objectively, which can lead to skewed interpretations of information and overlooking information with opposing views. 

For example, a product developer comes up with a product idea for the athletic market. Although market research shows little interest in the product, they try to validate the idea by reaching out to athlete friends who they know will support the idea. 

Although there’s gratification in validating a current idea, it’s important to consider the potential consequences of following through with the idea. 

How to avoid confirmation bias

Here are some ways to reduce confirmation bias:

Gather multiple sources: Whenever you’re testing a hypothesis or conducting research, gather information from a wide variety of sources to get a balanced perspective. 

Standardize interview questions : When recruiting new talent, come up with a list of standard interview questions to prevent asking off-topic or pointed questions that may or may not confirm your beliefs about a candidate. 

8. Conformity bias

Conformity bias is similar to groupthink, which occurs when we change our opinions or behaviors to match that of the bigger group, even if it doesn’t reflect our own opinions. 

This bias may occur when we encounter peer pressure or are trying to fit into a certain social group or professional environment. 

For example, a team is deciding between two proposals. One person thinks proposal A is better, but the rest of the team is leaning towards proposal B. That person is swayed by their opinions and ends up voting for proposal B because everyone else did. 

Although conformity can help prevent conflicts, it may also limit creativity, open discussions, and having other perspectives available. 

How to avoid conformity bias

Here are some ways to help encourage honest opinions in the workplace:

Use anonymous votes or surveys: The option to give feedback anonymously allows the freedom to express opinions without worrying about others’ preferences. 

Ask for opinions in advance: Before going into a meeting, have a private conversation with each team member to get their opinions. This gives everyone plenty of time to think about a topic and express their thoughts without the pressure of presenting in front of colleagues. 

9. Affinity bias

Affinity bias is also known as the similarity bias and refers to the tendency to favor people who share similar interests, backgrounds, and experiences. We tend to feel more comfortable around people who are like us. 

This bias may affect hiring decisions. For example, a hiring manager gravitates towards a job applicant because they share the same alma mater.

Over time, the affinity bias in hiring can hamper a company’s diversity and inclusion efforts. 

How to avoid affinity bias

While eliminating affinity bias entirely may not be possible, there are ways to reduce its effects:

Create a diverse hiring panel: Different people with varying perspectives and interests that conduct interviews can help reduce the affinity bias of one individual.

Go beyond hiring for “culture fit": The more hiring managers have in common with candidates, the more likely they are to evaluate them as a good “culture fit.” But the term "culture fit" is vague, and it can mean different things to different people. To assess candidates fairly, use specific language and examples when sharing feedback about them. Describe how well they embody company values or align with company missions. 

10. Contrast effect

We often make judgments by making comparisons. As a result, our judgments may be altered depending on what standard we’re comparing something to. This is known as the contrast effect.  

For instance, a team member is happy to receive a “meets expectations” on their performance review. However, they start to feel inadequate after finding out most of their colleagues got “exceeds expectations” on their reviews. 

Even though they got a decent review, the team member judges themselves more critically since their comparison standard is their colleagues’ results. 

There can also be positive contrast effects, which occur when something is perceived to be better than usual because it’s being compared to something worse. 

How to avoid the contrast effect

Here are some strategies to try when using comparisons to make decisions:

Make multiple comparisons: Instead of coming to a conclusion after making one comparison, compare something against different standards to broaden your perspective. 

Talk it out: Explain how you came to a given conclusion to your colleagues so they can understand your point of view. 

11. Status quo bias

This bias describes our preference for the way things are or for things to remain as they are, which can result in resistance to change. 

Following the status quo is a safe option and takes less effort, but it also results in becoming stagnant. As the business landscape continues to shift, change is necessary for business longevity and innovation. 

An example of the status quo bias in a company is continuing to hire team members from the same demographic group, making no effort to move forward with diversity goals. 

By repeatedly engaging in the same hiring practices, you may miss out on great candidates who can bring fresh ideas and perspectives to your company. 

How to avoid the status quo bias

Here are some ways you can challenge the status quo:

Use the framing effect: We often follow the status quo to avoid a loss, which we place greater weight on compared to gains. The framing effect involves looking at the default option as a loss to encourage exploring alternative options as gains. 

Encourage outside-the-box thinking: Create an environment that celebrates creativity and innovation. Adapt an open mindset to change so that your team can continue to push the status quo. 

12. Anchor bias

Anchor bias occurs when we overly rely on the first piece of information we receive as an anchor to base our decision-making upon. This causes us to see things from a narrow perspective. 

For example, the first thing a recruiter finds out about a candidate they’re interviewing is that they were unemployed for the past year. The recruiter focuses on this fact rather than the candidate’s solid qualifications and skills.

Instead of relying on one piece of information to make a decision, it’s important to look at the whole picture. 

How to avoid anchor bias

It takes time to make a thoughtful decision. Here are some tips to keep in mind:

Conduct thorough research: The first option may not always be the best one. Explore various possible options and their pros and cons before deciding.

Brainstorm with your team: Discussing a given decision with your teammates can help reveal the strengths and weaknesses of a plan. 

13. Authority bias

Authority bias refers to the tendency to believe in authority figures and follow their instructions. 

Generally, following a trusted authority figure with relevant expertise is a good idea. However, blindly following a leader’s direction without your own critical thinking may cause future issues.

For example, if a team member unquestionably follows their manager’s instructions to write a report in a way that matches the manager’s opinions, this could jeopardize the integrity of the report.

When receiving instructions on an area outside of your manager’s expertise, it can be worthwhile to seek additional information or expertise to minimize potential issues that may arise.

How to avoid authority bias

As with many unconscious biases, developing awareness of the bias is a good first step to countering it. 

Here is how to avoid being influenced by authority bias:

Ask questions: Don’t be afraid to ask your manager or company leader questions. The level of detail they provide may be an indicator of whether an idea was well thought-out or if it’s their authority coming into play. 

Do your research: Conduct your own research on a given topic to identify other credible sources or experts and see whether their suggestions align with your manager’s suggestions. 

14. Overconfidence bias

Overconfidence bias is the tendency for people to think they are better at certain abilities and skills than they actually are. 

This false assessment of our skill levels, stemming from an illusion of knowledge or control, can lead us to make rash decisions. 

For instance, an overconfident CEO decides to acquire a startup that they see high potential in and believe will bring high returns even though their performance indicates otherwise. 

Previous success or accomplishments may lead to an inflated ego. While leading with confidence is a good thing, it’s important to not let it get in the way of logical thinking and decision-making. 

How to avoid overconfidence bias

Here are tips to follow when you’re making decisions:

Consider the consequences: The decisions you make can have an impact on your company. Before committing to a decision, determine all the possible outcomes to ensure you’re prepared for them.

Ask for feedback: Getting feedback from your team can help you identify areas of improvement, whether it’s related to your performance or your ideas. Constructive criticism can keep egos in check.  

15. Perception bias

Perception bias occurs when we judge or treat others based on often inaccurate, overly simplistic stereotypes and assumptions about the group they belong in. It may involve other biases such as gender, age, and appearance. 

This type of bias may result in social exclusion, discrimination, and an overall reduction of a company’s diversity goals.

Say, for example, a team member doesn’t invite a teammate to an after-work social event because they assumed that they wouldn’t share similar interests with the group. 

Perception bias can make it difficult to have an objective understanding about members from diverse groups.

How to avoid perception bias

Reducing the impact of perception bias requires recognizing your biases:

Challenge your assumptions: Ask yourself, “How well do I really know that person or the group they belong to?” Don’t let preconceived notions prevent you from meeting or including new people. 

Think about the accuracy of statements: When you find yourself using strong words like “all,” “always,” and “never” to describe a certain group, pause and take a moment to ask yourself how accurate the description is. 

16. Illusory correlation

Illusory correlation is when we associate two variables, events, or actions together even though they’re unrelated to each other. 

For example, a hiring manager asks a candidate interview questions in an effort to gain insight into their personality but are unrelated to the job itself. Since the candidate struggles to come up with answers, the hiring manager decides they would not be a good fit.

These illusions can leads us to making decisions based on inaccurate correlations. 

How to avoid illusory correlation bias

We may be more prone to see false correlations in circumstances that we’re unfamiliar with or have little knowledge of. 

Here are tips to avoid making illusory correlations:

Get informed: Learning more about the areas you’re not familiar with can help you find evidence to support or refute the correlation. 

Consider all possibilities: When you associate two things, consider the likelihood of the cause and effect. You can also use a contingency table to visualize the relationships between the cause and effect. 

17. Affect heuristic

Heuristics are mental shortcuts that help us make decisions more efficiently. The affect heuristic occurs when we rely on our emotions to make decisions. This may help us reach a conclusion more quickly, though it may not always be accurate or fair. 

For example, an interview candidate makes an off-hand comment that offends a recruiter, though that wasn’t their intention. The recruiter decides to reject the candidate because they were vexed by the comment even though they were the most qualified candidate. 

Since emotions may cloud your judgment, it’s important not to make decisions in the heat of a moment. 

How to avoid the affect heuristic bias

Here are ways to lower the influence of emotions in different circumstances: 

Be aware of your emotions: Simply being aware of our level of emotions in a situation can help us step back from the situation and evaluate it more logically. 

Take time to reflect: Reflect on an event some time after it occurs. Your emotions likely won’t be as strong as they were during the event, so you’ll be able to come to a more objective conclusion. 

18. Recency bias

Recency bias occurs when we attribute greater importance to recent events over past events because they’re easier to remember. 

This bias is more likely to occur when we have to process a large amount of information. For example, since hiring managers often review a high volume of job applications in a day, it may be harder to recall candidates screened earlier during the day. 

Recency bias can also manifest during the interview process when a hiring manager becomes more inclined to make hiring decisions based on the most recent candidate they interviewed. 

To overcome this bias, using techniques to strengthen your memory can be helpful. 

How to avoid recency bias

Here are some tips to prevent recency bias when interviewing candidates: 

Take notes: Take detailed notes during each interview and review them afterward. This can help you keep track of notable candidates regardless of when you interviewed them. 

Give yourself mental breaks: Doing back-to-back interviews can be mentally draining. When your working memory takes a toll, you’re more likely to be affected by recency bias. Stay mentally alert by taking breaks in between interviews so your brain has time to absorb and remember the information.   

19. Idiosyncratic rater bias

Idiosyncratic rater bias affects the way we evaluate the performance of others. We often rate others based on our subjective interpretations of the assessment criteria and our own definition of what “success” looks like. 

In other words, we’re generally unreliable when it comes to rating other people. Research has found that about 60% of a manager’s rating is a reflection of the manager rather than the team member they’re rating. 

For example, a manager who excels at project management has higher standards for this skill and gives harsher ratings to team members for this skill. On the other hand, the manager is more lenient when rating team members’ marketing skills because they are less familiar with that area. 

Sources of rater bias may come from other biases, such as the halo effect, affinity bias, and confirmation bias. 

How to avoid idiosyncratic rater bias

Here are some strategies to avoid this bias when doing performance reviews: 

Set specific and clear assessment criteria: Create a rubric or a specific set of standards for evaluating performance. This prompts managers to provide supporting evidence based on a team member’s performance or achievements to determine how well they did.  

Conduct multi-rater reviews: This process involves a team member getting feedback from their colleagues and managers in addition to doing a self-evaluation. Having multiple reviews to draw from can help managers gain a more holistic view of a team member’s performance and identify potential areas for growth. 

Why it’s important to tackle unconscious biases

As these examples show, unconscious biases can hinder decision-making, impact team dynamics and leadership styles , and limit company diversity. This, in turn, can reduce equal opportunities for team members and job applicants. 

Tackling unconscious biases can help address these issues, as well as improve company diversity. 

Increased company diversity can bring additional benefits such as:

Increasing company profitability: Teams that have solid problem-solving and decision-making skills can bring a competitive advantage to a company. For example, a McKinsey study found that gender-diverse companies were 21% more likely to gain above-average profitability.

Attracting diverse talent through inclusive hiring practices: By implementing inclusive recruitment strategies, companies are able to reach out to a wider talent pool. Job seekers would also be more likely to apply to companies that prioritize diversity. 

Increasing innovation: Diverse teams can bring a variety of fresh ideas to the table, allowing teams to come up with creative solutions that can drive sales. For example, a study by the Boston Consulting Group found that companies with diverse management teams bring 19% higher innovation revenue. 

Boosting company productivity: University research found that tech firms with diverse management teams have 1.32 times higher levels of productivity . Increased productivity can lead to more efficient project management and implementation. 

Encouraging higher employee engagement: Deloitte research showed that company diversity is directly related to employee engagement . Higher employee engagement can lead to higher job satisfaction, which in turn, can lower the turnover rate. 

Making fair and more efficient business decisions: Inclusive teams can make better business decisions up to 87% of the time. These business decisions can help improve a company’s performance and revenue. 

Be conscious of your unconscious biases

The good news: Once you’re aware of your unconscious biases, you can take steps to mitigate their effects. By taking micro-steps such as revamping your interview questions template and encouraging cross-team collaboration , you’re working towards a more diverse and inclusive workplace environment for you and your team.

Related resources

How to give and take constructive criticism

Data-driven decision making: A step-by-step guide

Listening to understand: How to practice active listening (with examples)

How executives and individual contributors differ when it comes to AI

11 Examples of Unconscious Bias in the Workplace

• September 11, 2024

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• Unconscious bias may lead to unfair treatment. This may particularly apply in the workplace because of predetermined beliefs about a person’s identity.
• Several unconscious biases can affect employees and leadership in workplace organizations. This includes name bias, racial bias, gender bias and anchoring bias.
• Unconscious bias in the workplace can be solved through different tactics. These may include diverse hiring panels and education and training programs.

Table of Contents

Unconscious bias plays a big role in workplaces around the globe, where individuals of different backgrounds come together. Many people have good intentions. However, some may unknowingly let preconceived notions or experiences influence their judgment of others. This can impact decisions made by recruiters or interactions between colleagues. Unconscious bias can lead to unfair treatment or missed opportunities for those who are judged.

Ahead, we discuss what unconscious bias is and why it is important to address it. We will also cover examples of unconscious bias in the workplace and the effects of unconscious bias on organizations. 

What Is Unconscious Bias?

Unconscious bias is the quick and unintentional judgments people form about others based on their background, appearance or other characteristics. Unconscious bias is also referred to as implicit bias . 

These biases can be formed through exposure to false information and stereotypes. They may also be influenced by other factors, including the media, family systems or a lack of exposure to diversity. Unconscious biases occur in everyday life, including in workplace culture.

Why Is It Important to Address Unconscious Bias at Work?

It is critical to address unconscious bias because it is essential for creating a fair, inclusive and productive workplace. It also reduces discrimination and fosters a culture of inclusivity. Addressing unconscious bias can lead to better mental health for employees, higher job satisfaction and lower employee turnover. It may also lead to improved market success, increased employee engagement and more innovative and diverse perspectives. Biases can be reduced through dedicated conversations, training and equitable hiring practices. 

11 Examples of How Unconscious Bias Affects the Workplace

Unconscious bias can manifest in different ways. Take a look below at 11 types of unconscious bias that can affect the workplace. 

1. Confirmation Bias

Confirmation bias (or cognitive bias) leads people to search for data and information that aligns with their beliefs. These individuals may become siloed in their belief systems. They may not extend their knowledge beyond what they know or seek other information that may dispute it. Understanding this bias and tackling it can lead to a more well-rounded viewpoint and mindset. 

In the workplace, this bias may result in individuals not accepting others’ points of view or not expanding their own. This can lead to less collaboration and reasonable decision-making among team members. It can also impact candidates in the hiring process.

2. Racial Bias

Racial bias is a type of unconscious bias. That is because people may subconsciously base their thoughts and actions on assumptions about someone’s race. 

A Pew Research Center survey from 2022 reported that racial and ethnic bias is an issue in workplace practices. According to the survey, 64% of Black American adults said it is a major problem in hiring, compared to 30% of their white counterparts. In addition, 56% of Black Americans said racial and ethnic bias was an issue in performance reviews, compared to 23% of their white counterparts. 

Racial bias in the workplace can affect an individual’s sense of belonging and create teams that lack diversity and inclusiveness. Ultimately, it can impact how employees feel about their career path and future with an organization.

Some organizations have started using artificial intelligence (AI) during hiring and performance evaluations to reduce this bias. Based on the survey mentioned above, many think that AI could help create more fair and equitable outcomes by minimizing the influence of racial bias. 

3. Gender Bias

Gender bias is a type of unconscious bias where a person favors one gender identity over another. Or they attach particular stereotypes to different gender expressions. In the workplace, this bias can lead to inequalities in performance rewards, support or mentorship opportunities. It can also appear in compensation and exacerbate the gender pay gap.

According to the 2022 Deloitte Women @ Work report, 59% of women stated they had experienced microaggressions and other mistreatment in the workplace. This percentage increased from the year prior, a reported 52%. According to the data, more than 90% of women feel that disclosing this type of mistreatment will result in harmful consequences to their careers.

4. Attribution Bias

Attribution bias occurs when a person judges another person’s actions based on previous interactions or information. This can lead to assumptions and inaccurate conclusions about them. This commonly happens without considering the full context of their background or personality. In the workplace, it is important to get a comprehensive understanding of an individual’s situation before forming an opinion.

5. Affinity Bias

People hold affinity bias (or similarity bias) when they favor individuals who share similar interests, backgrounds and experiences. In an organization, affinity bias may occur when searching for candidates from particular companies or educational institutions. This form of bias can lead to unequal opportunities and hinder diversity and inclusion.

6. Conformity Bias

Conformity bias, also known as groupthink, occurs when individuals adopt the views or opinions of the majority instead of thinking independently. This type of unconscious bias can impact creativity, as people may prioritize consensus over innovative solutions. In the workplace, conformity bias can appear during meetings or during board votes, where the pressure to align with the group can impact decisions.

7. Affect Heuristic

Affect heuristic means we depend on our emotions rather than facts to make decisions. This form of bias can lead to irrational or unfair choices. For example, someone may favor a project because it “gives them a good feeling” rather than using solid evidence. In a workplace, affect heuristic can negatively impact decision-making and lead to less effective results. 

8. Contrast Effect

Contrast effect is the comparison of multiple subjects or individuals. In the workplace, this could refer to comparing candidates or employees who are up for a job or promotion. Equally comparing candidates in the interview process and employees for role advancement may combat the contrast effect and mitigate bias in organizations. This type of unconscious bias can create a negative workplace culture and culminate in lower diversity rates and employees leaving a company.

9. Beauty Bias

Beauty bias, or attractiveness bias, is when people are presumed to be more qualified and accomplished based on their physical appearance. In the workplace, this can lead to favored or unfair treatment of employees based on their appearance. Holding this type of bias can eventually result in higher turnover in the organization.

One way to prevent beauty bias is to perform phone screenings before a video or in-person interview to get to know potential hires. Another way is to exclude photos from candidates’ resumes.

10. Name Bias

Name bias is a type of unconscious bias where someone makes assumptions about an individual based on their first and last name. A Harris Poll survey reported the beliefs of over 2,000 U.S. employees regarding names. About 36% of persons of color surveyed said their name typically gets mispronounced, compared to 18% of their white counterparts. Approximately 33% of the people of color surveyed said they came in contact with discrimination at the workplace because of their names. This was in comparison to 16% of their white counterparts. 

In the workplace, this type of bias and the mispronunciation of names can cause individuals to avoid communication or collaboration with other team members and can lower employee morale.

11. Anchoring Bias

Anchoring bias can cause individuals to make decisions solely based on initial information received. A person may make all future decisions based on that initial information. In the workplace, anchoring bias can present as individuals not embracing new ideas from their teammates or not asking for a second opinion on a client matter. Seeking other resources in the workplace may help mitigate inaccurate decision-making. It can also help eliminate anchoring bias.

The Effects of Unconscious Bias in the Workplace

From initial resume screenings to performance assessments, unconscious bias can negatively affect the workplace. It can also hinder efforts to diversify an organization. 

How to Overcome Unconscious Bias

Fortunately, unconscious bias can be resolved through many factors, including enforced company policies and using inclusive language in company communications. In addition, building a diverse workforce, using multifaceted hiring panels and holding routine education sessions can help eradicate unconscious bias.

Stay up to date with the latest from Robert F. Smith about the importance of addressing unconscious bias in the workplace by following him on LinkedIn . 

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Priority Initiatives

Privacy Policy

Across our Communities

Mbe entrepreneurship & supplier diversity.

1. Provide technical expertise: offer subject matter and technical expertise to catalyze and support community initiatives 

E.g., tax/accounting experts to help MBEs file taxes

E.g., business experts to help MBEs better access capital and craft business plans to scale their teams and operations

Access to Capital (CDFI/MDI)

2. Fund modernization & capacity-building and provide in-kind subject matter experts – $30M: help 4-5 CDFIs/MDIs over 5 years modernize their core systems, hire and train staff, expand marketing and standup SWAT team of experts to conduct needs diagnostic, implement tech solution & provide technical assistance

Systems and technology modernization – $10M-15M: Add/upgrade core banking systems, hardware and productivity tools, train frontline workforce on new systems & technology and hire engineering specialists to support customization and news systems rollout – over 5 years

Talent and workforce – $10M: hire and train additional frontline lending staff and invest in recruiting, training, compensation & benefits and retention to increase in-house expertise and loan capacity – over 5 years

Other capacity-building and outreach – $8M: hire additional staff to increase custom borrower and technical assistance (e.g., credit building, MBE financing options, etc.) and increase community outreach to drive regional awareness and new pipeline projects – over 5 years

Education/HBCU & Workforce Development

3. Offer more paid internships: signup onto InternX and offer 25+ additional paid internships per year to HBCU/Black students 

Digital Access

4. Issue digital access equality bonds: issue equality progress bonds and invest proceeds into SCI’s digital access initiatives

5. Fund HBCU campus-wide internet – up to $50M in donations or in-kind: Partner with the Student Freedom Initiative to deliver campus-wide high-speed internet at ~10 HBCUs across SCI regions

6. Be an advocate for SCI priorities: engage federal and state agencies to drive policy and funding improvements to better support SCI’s near-term priorities

E.g., Engage the Small Business Administration and Minority Business Development Agency to increase technical assistance programs and annual spend to better support Minority Business Enterprises (MBEs) with capital and scaling needs

E.g., Ask the Federal Communications Commission (FCC) to include multi-dwelling unit connectivity in its new broadband connectivity maps and ask the National Telecommunications and Information Administration (NTIA) to allow non-FCC data in state broadband plans to unlock ~$285M in potential government broadband funding for 5 SCI regions

Directly Fund SCI

7. Invest directly into SCI (coming soon): provide funding for SCI to pool and invest in community initiatives that are most well-positioned for funding and can drive direct community impact.

Memphis, Tennessee

Lead community organization: The Collective Blueprint

Our ambition:

Increase the volume and value of Black-owned businesses – through corporate MBE spend and MBE startups & scaling

1. Scale technical assistance – $15M: fund* to expand technical assistance through business coaches and wrap-around services for 500+ MBEs over 5 years to help them scale from <$1M to $5M+ in annual revenue

2. Standup MBE fund – $15M: standup/scale MBE fund* to offer more flexible access to capital arrangements 400-500 MBEs over 5 years

 * Lead organization: The Collective Blueprint ; Contributing local organizations for community strategy include (but not limited to): Community Unlimited , Women’s Business Center South , Epicenter , others

Estimated impact (of all initiatives): 2.3x increase in MBE value & 20K+ new jobs, boosting Black community’s net worth by ~$3B+

Modernize CDFI/MDI systems and tech as well as recruit and upskill talent to increase CDFI/MDI capacity and ability to inject more capital into Black communities

3. Provide loan guarantees – $15M: create a fund* to provide 80% loan guarantees over 5 years to encourage lender participation and inject more capital into the community

4. Conduct advocacy: ask US Treasury & Tennessee State to allow Tennessee CDFIs/MDIs to retain SSBCI capital & offer loan guarantees to boost loan issuance

5. Fund modernization & capacity-building and provide in-kind subject matter experts – $30M: help 4-5 CDFIs/MDIs** over 5 years modernize their core systems, hire and train staff, expand marketing and standup a SWAT team of experts to conduct needs diagnostic, implement tech solution & provide technical assistance

* Leading organizations for community strategy include (but not limited to): Community LIFT , Memphis CDFI Network , etc.

* In partnership with National Bankers Association and Appalachian Community Capital ; CDFIs/MDIs being considered include: Community Unlimited, Hope Credit Union, River City Capital, United Housing Inc, etc.

Estimated impact (of all initiatives): ~$330M+ in additional loans per year to support ~30K+ MBEs

Lower financial burden for Black students, increase number of Black college graduates, increase Black workforce and executive representation and their access to high-paying jobs

6. Standup training hub – $30M: fund* the establishment a world-class training hub that offers certificate-granting STEM and innovation programs in advanced manufacturing, health care, etc. to 10K+ youths

7. Fund SFI program – $7M: fund the Student Freedom Initiative’s  Income Contingent Alternative to Parent Plus to support ~15 Black STEM students per year forever at 4 HBCUs**

* Lead organization: The Collective Blueprint ; Contributing local organizations for community strategy include (but not limited to): Greater Memphis Chamber and Workforce Midsouth

** Minority Serving Institutions / HBCUs with STEM programs being considered: Le Moyne-Owen, Baptist Memorial, University of Memphis, Rust College

Estimated impact (of all initiatives): 8K+ additional college graduates and 10K workers with high-paying wages to drive ~$1B+ in economic growth

Increase accessibility, affordability and adoption of high-speed Internet

8. Accelerate digital access initiatives – $75M:  partner with local orgs* to invest in setting up internet connections / installing hotspots, offering laptops and supporting adoption (through government subsidy technical assistance and digital literacy) to connect ~135K homes to high-speed internet in the Memphis region

9. Raise community awareness & adoption of Emergency Broadband Benefit: increase door-to-door and community outreach in low-income neighborhoods to get households onto EBB to help connect ~135K unconnected households 

 * Lead organization: The Collective Blueprint ; Contributing local organizations for community strategy include (but not limited to): CodeCrew

Estimated impact (of all initiatives): ~135K households connected to high-speed internet to unlock ~$2B+ in economic potential

Houston, Texas

Lead community organization: Greater Houston Partnership

1. Scale team – ~$3M: hire 3-4 FTEs over 5 years for One Houston Together * to help companies increase MBE spend from ~2% to 5-10%+ as well as BIPOC workforce advancement and BIPOC board representation 

2. Increase MBE certification and scale technical assistance – ~$2M: partner with One Houston Together * and the Houston Minority Supplier Development Council (HSMDC) ** to certify additional MBEs, develop Minority Business Finder database tool and provide resources and services to help local MBEs scale and participate in Pathways to Excellence program

3. Commit to increase racial diversity in supply chain and procurement: increase MBE spend in Greater Houston region* to 5-10%+

* One Houston Together serves as lead (please contact if you are interested in funding these initiatives)

** Houston Minority Supplier Development Council (HSMDC) serves as a partner organization (please contact if you are interested in learning more about this initiative)

Estimated impact (of all initiatives): 2.5x increase in MBE value & ~55K new jobs, boosting Black community’s net worth by ~$12B 

4. Fund modernization & capacity-building and provide in-kind subject matter experts – $30M: help 4-5 CDFIs/MDIs* over 5 years modernize their core systems, hire and train staff, expand marketing and standup SWAT team of experts to conduct needs diagnostic, implement tech solution & provide technical assistance

* In partnership with National Bankers Association and Appalachian Community Capital ; CDFIs/MDIs being considered include: Unity National Bank, Unity Bank of Texas, PeopleFund, Houston Business Development Inc, etc.

Estimated impact (of all initiatives): ~$330M in additional loans per year to support ~30K MBEs

5. Fund SFI program – $120M: fund the Student Freedom Initiative’s Income Contingent Alternative to Parent Plus * to support ~1.2K Black STEM students per year forever at 7 HBCUs**

* Student Freedom Initiative serves as lead (main contact if you are interested in learning more and funding this initiative)

** Minority Serving Institutions / HBCUs with STEM programs being considered: Texas Southern University, University of Houston, Prairie View A&M University, Houston Baptist University, University of Houston-Clear Lake, University of Houston-Downtown, University of St Thomas.  

Estimated impact (of all initiatives): 5K+ additional college grads & ~600 workers with senior exec positions / high-paying wages to drive ~$0.2B in economic growth

6. Accelerate SCI’s digital access initiatives – up to $80M in donations or in-kind: invest in setting up internet connections / hotspots, offer laptops/Chromebooks and support adoption (through government subsidy technical assistance and digital literacy) to connect ~145K homes to high-speed internet in the Houston region*

7. Raise community awareness & adoption of Emergency Broadband Benefit: increase door-to-door and community outreach in low-income neighborhoods to get households onto EBB to help connect ~145K unconnected households 

* Community organization(s) being identified 

Estimated impact (of all initiatives): ~145K households connected to high-speed internet to unlock ~$3B in economic potential

Greater New Orleans, Louisiana

Lead community organization: Urban League of Louisiana

1. Scale Black Business Works Fund – $10M: grow the Urban League of Louisiana’s Black Business Works Fund to support ~3K-4K MBEs over 5 years with emergency working capital needs to support/sustain ~$1B+ in annual revenues

2. Scale technical assistance – $20M: fund the Urban League of Louisiana , New Orleans Business Alliance , Thrive New Orleans and Propellor to scale bookkeeping, B2C payment, marketing support & subsidized rent to scale 200+ MBEs from <$1M to $5M+ in annual revenue

Estimated impact (of all initiatives): 2.5x increase in MBE value & 8K+ new jobs, boosting Black community’s net worth by ~$2B+

3. Fund modernization & capacity-building and provide in-kind subject matter experts – $30M: help 4-5 CDFIs/MDIs* over 5 years modernize their core systems, hire and train staff, expand marketing and standup SWAT teams to conduct needs diagnostic, implement tech solution & provide technical assistance

* In partnership with National Bankers Association and Appalachian Community Capital ; CDFIs/MDIs being considered include: New Orleans Business Alliance (community convener), Liberty, TruFund, LiftFund, NewCorp, etc.

4. Subsidize internships & apprenticeships – $40M: fund the New Orleans Youth Alliance , YouthForce NOLA and the Urban League of Louisiana to place and help subsidize apprenticeships, internships and other work-based learning experiences for ~20K young adults in high-pay sectors (e.g., energy)

5. Fund SFI program – $12M: fund the Student Freedom Initiative’s Income Contingent Alternative to Parent Plus to support ~120 Black STEM students per year forever at 3 HBCUs*

* Minority Serving Institutions / HBCUs being considered: Dillard University, Southern University – New Orleans and Xavier University of Louisiana

6. Scale career prep – ~$10M: scale the New Orleans Youth Alliance and YouthForce NOLA with 15-20 coaches over 5 years to equip ~20K young adults with skills for high-paying industries, job search & prep and subsidized transportation

Estimated impact (of all initiatives): ~2K additional college graduates and ~20K workers with high-paying wages to drive ~$1B in economic growth

7. Accelerate SCI’s digital access initiatives – up to $35M in donations or in-kind: partner with New Orleans’s Office of Information Technology & Innovation and Education SuperHighway to invest in setting up internet connections / hotspots, offering laptops/Chromebook and supporting adoption (through government subsidy technical assistance and digital literacy) to connect ~55K homes to high-speed internet in Greater New Orleans region

8. Raise community awareness & adoption of Emergency Broadband Benefit: increase door-to-door and community outreach in low-income neighborhoods to get households onto EBB to help connect ~55K unconnected households

Estimated impact (of all initiatives): 55K households connected to high-speed internet to unlock ~$1B in economic potential

Charlotte, North Carolina

Lead community organization: Charlotte Regional Business Alliance

1. Offer in-kind FTEs: provide 2-5 in-kind FTEs to the Charlotte Regional Business Alliance (CRBA) over 5 years to convene corporate partners, assess their MBE spend, develop pipeline to increase MBE spend to 5-10%+

2. Offer technical assistance expertise: partner with the Charlotte Regional Business Alliance (CRBA) to advise/mentor ~200 MBEs on capital/loan access to help them scale from <$10M to $50M+

3. Commit to supplier diversity: increase MBE spend in Charlotte region to 5-10%+

Estimated impact (of all initiatives): 3x increase in MBE value & ~13K new jobs, boosting Black community’s net worth by ~$2B+

4. Fund modernization & capacity-building and provide in-kind subject matter experts – $30M : help 4-5 CDFIs/MDIs* over 5 years modernize their core systems, hire and train staff, expand marketing and standup SWAT team of experts to conduct needs diagnostic, implement tech solution & provide technical assistance; in-kind experts to also help build out the MBE ecosystem through CDFIs/MDIs, market CDFI/MDI offerings and programs and help draft final loan agreements to qualify borrowers between investment fund(s) and CDFIs/MDIs

* CDFIs/MDIs being considered (examples and not exhaustive): Security Federal Bank, Institute / North Carolina Community Development Initiative, Sequoyah Fund Inc, Self-Help Credit Union, BEFCOR, Aspire Community Capital, etc.

* In partnership with National Bankers Association and Appalachian Community Capital ; CDFIs/MDIs being considered include: Security Federal Bank, Institute / North Carolina Community Development Initiative, Sequoyah Fund Inc, etc.

5. Fund SFI program – up to $10M: fund the Student Freedom Initiative’s HELPS program to support ~1.5K+ students per year at HBCUs* with emergency expenses – e.g., unexpected health costs, late rent payments, etc.

* Minority Serving Institutions / HBCUs in Charlotte that are being considered: Johnson C. Smith University, Johnson & Wales University – Charlotte, Charlotte Christian College

6. Provide in-kind staff: offer 2-5 FTEs to the Charlotte Regional Business Alliance (CRBA) over 5 years to track Black-/Brown-executive representation, convene corporate partners to develop executive pipeline and hiring plans and support corporate partners to increase representation from ~10% to 30%+

Estimated impact (of all initiatives): 2.5K+ additional college graduates and 2.5K workers with high-paying wages to drive ~$0.2B in economic growth

7. Raise community awareness & adoption of Emergency Broadband Benefit: increase door-to-door and community outreach in low-income neighborhoods to get households onto EBB to help connect ~35K unconnected households

Estimated impact (of all initiatives): ~35K households get connected to high-speed internet to unlock ~$700M in economic potential for Charlotte

Birmingham, Alabama

Lead community organization: Prosper Birmingham

1. Fund startups and give access to investor network – $70M: grow the Prosper Health Tech Fund – powered by Gener8tor – and offer venture capital technical assistance to scale 50+ startups from <$1M to $5M+ in annual revenue; near-term priority is to secure $4M in venture investment by end of May 2022

2. Fund technical assistance – $25M: fund Prosper Birmingham , Magic City Match , and Birmingham Business Alliance to establish/expand business advisory programs, renovate and subsidize retail/office space for MBEs and scale coaches & support services (e.g., digital footprint, B2C platforms, accounting & bookkeeping, recruitment, etc.) to help 100+ MBEs scale from <$1M to $5M+ in annual revenue

Estimated impact (of all initiatives): 3x increase in annual MBE revenue & 8K+ new jobs, boosting Black community’s net worth by ~$2B+

3. Fund modernization & capacity-building and provide in-kind subject matter experts – $30M: help 4-5 CDFIs/MDIs* over 5 years modernize their core systems, hire and train staff, expand marketing and standup SWAT team of experts to conduct needs diagnostic, implement tech solution & provide technical assistance

* In partnership with National Bankers Association and Appalachian Community Capital ; CDFIs/MDIs being considered include: First Bancshares, Commonwealth National Bank, TruFund, Sabre Finance, Bronze Valley, etc.

4. Fund scholarships and hire coaches – ~$35M: scale Birmingham Promise fund to financially support 200-250 students per year over 4 years to increase college retention and graduation rates

5. Fund endowment – $2M: support 50 University of Alabama at Birmingham college students per year with housing to reduce their financial burden and increase college retention and graduation rates

Estimated impact (of all initiatives): 6.5K+ additional college graduates & 35K workers with high-paying wages to drive ~$1.2B in economic growth

6. Raise community awareness & adoption of Emergency Broadband Benefit: increase door-to-door and community outreach in low-income neighborhoods to get households onto EBB to help connect ~35K unconnected households

Estimated impact (of all initiatives): 48K households get connected to high-speed internet to unlock ~$700M in economic potential for Jefferson County