Systemic bias and workforce inequity: Care quality and value effects

ABSTRACT

Session Description Themes of inequity, injustice, and health disparities are woven through the history of medicine. The national and specialty-wide conversation about these critical problems has evolved in the past year in parallel with major social movements around the world. In combination with the COVID-19 pandemic, these conversations have shed light on ways in which privilege, disadvantage, and systemic biases have contributed to diminished quality of medical care and exacerbated disparities in health outcomes. This panel, sponsored by the American Academy of Otolaryngology- Head and Neck Surgery Patient Safety and Quality Improvement Committee and featuring national experts in health care quality, value, and diversity, justice, and inclusion will complement other sessions at this meeting addressing inequities in health care. In this panel, we will focus specifically on how systemic bias and workforce inequity directly contributes to disparate, low-quality, and low-value health care. We will focus on racism, sexism, and anti-LGBTQ+ bias in both the workforce and in treatment of patients, providing a review of current knowledge on the effects of these biases on the quality of surgical care in the United States, including effects on provider-patient interaction, treatment recommendations, and adherence to these recommendations. We will then address ways in which inequities in the otolaryngology workforce further limit opportunities for patient-physician racial concordance and exacerbate disparities in patient outcomes and strategies to begin addressing workforce diversity and inclusion problems. These issues will be examined for both academic and nonacademic practice settings. We will connect quality to costs of care to discuss how systemic bias affects the value of surgical care delivered to patients of different privilege and how this difference in value perpetuates injustice in health care. Outcome Objectives: (1) Define privilege, bias, equality, equity, inclusion, and justice as individual constructs in the context of medical, and specifically otolaryngologic, care. (2) Summarize current knowledge of the effects of systemic racism, sexism, and anti-LGBTQ+ bias on workforce equity and quality of care in otolaryngology. Demonstrate specific examples in otolaryngology. (3) Relate the effects of these biases to the value of otolaryngologic care.