It's time for accountability in healthcare

Three essential steps for cultural competence in healthcare

I was skeptical when I first encountered the Health at Every Size (HAES®) community. Having heard many negative opinions from "health experts," I approached HAES® with a guarded mind. Despite my skepticism, I challenged my own biases by learning from and engaging with fat activists, who opened my eyes to how misguided my old beliefs about health were.

However, around the time I first learned about fat liberation, I also learned about calls to hold writer and speaker Dr. Lindo Bacon accountable for the repeated harm they have caused in the HAES® community. As Dr. Bacon was one of my first introductions to HAES®, I grappled with the fear that despite my best intentions, I might inadvertently perpetuate the same harm as Dr. Bacon.

I’m confident I’m not the only person who grapples with those thoughts. 

In my work, I’ve learned that fear is the primary barrier to embracing new ideas, methods, or frameworks. Due to fear and implicit biases, healthcare providers may make false assumptions about the health of certain groups. For instance, providers may assume that White people are more compliant with treatment plans than Black people. Or, they may believe that people in plus-sized bodies are healthier than those in straight-sized. As a result, implicit bias can contribute to false assumptions that prevent certain groups from getting the equitable treatment they deserve.   

This is why cultural competence in healthcare is essential. Providers can better consider the patients' values, attitudes, and beliefs through cultural competence. In addition, cultural competence helps providers better determine which interventions and treatment plans would best fit the patient’s needs. Hence, fostering cultural competence is essential for confronting these biases head-on. Here are three actionable steps you can take as a provider to do just that. 

Step 1. Acknowledge the Existence of Implicit Biases

In the past, I would have hesitated to make this the first step until I discovered how deeply ingrained our implicit biases are. One of the things that has been enlightening for me over the past few months of deep-diving into implicit bias is how resistant people are to the idea. The reason is that explicit biases are much more apparent, as people are consciously aware of them. In comparison, implicit biases are often shaped by societal norms and experiences. As a result, they influence our perceptions and behaviors in ways we may not consciously see.

For healthcare providers, bringing awareness to and confronting their implicit biases can create cognitive dissonance. Even though they say they value health equity, when their actions aren’t reflected, it can create fear due to the “cancel culture” that has arisen. However, if we want to be providers who genuinely want health equity, we must start by acknowledging and accepting the existence of these biases. By doing so, we can begin the journey toward dismantling them and becoming more culturally competent.

Step 2. Embrace the Power of Education

Anyone who knows me knows I deeply value education because it is a powerful tool for transforming the world—especially healthcare. By educating ourselves about our implicit bias, we have a starting point to understand where we are (aware of our implicit bias). However, to get to where we want to go (dismantling our implicit bias), we need to educate ourselves on how exactly to do that. 

This is where engaging in continuous learning and self-reflection become key. Doing so allows healthcare providers to gain insight into their biases and how those biases, if not addressed, can impact patient care. For instance, once a provider becomes aware of their false assumptions of Black women or people with plus-sized bodies, they can take proactive steps to challenge those beliefs. Further, seeking diverse perspectives and experiences helps providers broaden their understanding and cultivate empathy toward those whose backgrounds differ from ours. Thus, embracing education becomes a decisive step toward overcoming implicit biases.

Step 3. Create Accountable Spaces for Dialogue

I have to credit the Association for Size, Diversity, and Health (ASDAH) for teaching me about the importance of “accountable” versus “safe” spaces. As much as we might want to, no provider can guarantee that any space we create will be “safe,” as there are too many variables (i.e., other humans) to control. Instead, we can ensure that those in our spaces are held accountable for the harm they cause. However, don’t take that to mean accountability is just about preventing negative experiences.

When we create accountable spaces, we also allow providers to have open and honest dialogue. This means they can openly discuss their biases and experiences without having to feel like they are being judged. It also means that they can learn through doing, which allows them to meaningfully reflect on what they’re learning. One caveat of this is that it will be essential to build trust and create some community agreements. For instance, what’s said here stays here, but what’s learned here leaves here, is a community agreement that has helped keep people in my spaces accountable for not unintentionally doing harm to eachother. Thus, by creating accountable spaces, we can break down barriers and foster understanding between providers and patients of diverse backgrounds.

Final Thoughts

I know that confronting fear is not easy, but it is necessary for achieving cultural competence in healthcare. By confronting my fear, I started acknowledging and addressing my implicit biases. Through doing so, I’ve been able to help other healthcare providers create more inclusive and equitable practices. Whether you’re a provider or patient, I hope you recognize that embracing education, awareness, and dialogue are powerful tools for transformation.

Ready to take the next step towards cultural competence in healthcare? Subscribe to the Enhance Black Women's Health (EBWH) community newsletter for resources and insights on addressing implicit biases in your practice. If you’re already subscribed, don’t forget to invite a friend to join the conversation and amplify our impact.