Q&A: Addressing the root causes of health inequality

Q: During the novel coronavirus (COVID-19) pandemic, it has become abundantly clear that the burden from this disease has not been shared equally. Minorities have been disproportionately affected, and many of the problems are due to structural inequalities that existed long before the pandemic began. How can case managers address some of these underlying problems in hopes of improving health equality?

A: Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP, DBH(s), author of the HCPro book End-of-Life Care for Case Management, which will be published this month, says there are some strategies that you should use.

“Being mindful of unconscious, implicit, even explicit bias is critical,” she says. “It’s tough for case managers to consider their bias, or that they have any. However, everyone has bias; these are the natural values, beliefs, and mores we all grew up with.”

Having bias doesn’t make you a bad person. “The challenge for case managers is when these biases interfere with patients, their families, or interactions with them,” says Fink-Samnick.

Bias can be more difficult to spot and control in times of high stress. “It is especially tough right now for everyone in healthcare. The pandemic has everyone scared and anxious, if not crispy around the edges,” she says. “Case managers are moving quickly, and considering their biases may not be a priority. However, recognizing and managing biases is one way case managers fulfill their ethical obligation to patients and professional case management’s standards of practice and codes of professional conduct.”

In her new book, Fink-Samnick discusses several models that can help case managers recognize and address bias to improve care for their patients:

• Step 1: Recognize we all have bias
• Step 2: View bias as a strength
• Step 3: Own your bias, when possible
• Step 4: Maintain objectivity and consider:
  • a. What facts do I have about this particular situation?
  • b. Does this situation remind me of another situation?
    • -If yes, why?
    • -What did I learn at that time?
    • -What do I still need to find out to be more effective?
• Step 5: Openly explore bias-related discomfort with all people involved
• Step 6: Ask questions to ensure understanding of the situation
• Step 7: Seek feedback about your bias from colleagues, patients, and families