Healthcare Social Workers Confronting Bias in a "Doctors Know Best" Environment

Background and Purpose: Implicit bias in healthcare shows up in many forms, including racial, ethnic, gender, weight, disability, sexual orientation, and socioeconomic status and has been known to impact healthcare professionals’ (HCP) decision-making leading to a lower quality of care for patients. While implicit bias training for HCPs is growing, there is limited evidence that training alone significantly impacts subsequent behaviors. Despite all of these data, there is a dearth of research on the role that members of multidisciplinary teams play in identifying and disrupting healthcare bias among one another. The National Association of Social Work’s (NASW) Code of Ethics mandates social workers (SW) promote equity and social justice with and for marginalized and oppressed populations and the NASW Standards for Social Work Practice in Health Care Settings highlights the importance of fostering and strengthening interdisciplinary collaboration. Healthcare SWs in multidisciplinary environments are seen as vital team members. Still, their contributions are often perceived as less important than medical staff and they are viewed as outsiders whose opinions and expertise are less respected than other HCPs. This study explores the perceptions and experiences of SWs regarding healthcare bias, aiming to illuminate the facilitators and barriers to SWs disrupting implicit bias in healthcare settings within multidisciplinary teams.

Methods: Employing phenomenological and narrative qualitative approaches, the study employed purposive, convenience, and snowball sampling strategies to recruit SWs from various healthcare settings. Ten participants engaged in semi-structured interviews, conducted via Zoom, allowing for both audio and video recordings. Data collection involved a researched-designed interview guide that prompted participants to discuss their experiences with multidisciplinary teams in healthcare settings, implicit bias, power dynamics, organizational culture, and personal identities. Thematic analysis was used to analyze the transcripts, ensuring rigorous coding through multiple cycles and ongoing reflexivity checks.

Results: Initial findings revealed that SWs often navigate complex layers of identity, privilege, and team and organizational cultures when addressing bias against marginalized patients, with many reporting specific instances of witnessing and challenging discriminatory behaviors with other HCPs. Preliminary data suggests that the SW’s individual confidence level, hierarchy of multidisciplinary treatment teams, mismatch in ethical standards among multiple disciplines, and misunderstandings and undervaluing of the role of SWs by other HCPs and medical disciplines can make it challenging for SWs to feel comfortable or safe disrupting incidents of healthcare implicit bias when witnessed.

Conclusions and Implications: The study highlights important insights into the role of SWs in combating implicit bias among individuals with marginalized and stigmatized identities within healthcare. It suggests that SWs' confidence levels, team dynamics, and organizational culture significantly shape their interactions with healthcare systems and their ability to advocate for patients that are unfairly treated. These findings call for enhanced training programs that address implicit bias in healthcare settings, targeted healthcare social work curriculum, and organizational policies and practices that empower SWs to act effectively within multidisciplinary teams to promote equity in patient care. Further research is recommended to explore broader implications for healthcare practices, particularly in enhancing advocacy strategies amongst social work professionals.