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Hello everyone and welcome to culture of how, in an environment of health disparities Providence is committed to improving diversity, equity and inclusion in our communities, workplaces, schools and more. We focus on what the future of healthcare looks like in today's changing culture. And together, we will discuss how we can turn the conversation of culture and healthcare into lasting, meaningful action. I'm Anna Nolan, a Licensed Marriage Family Therapist and Program Manager for our behavioral health and primary care integration program in Orange County, California, and under for under Providence for St. Joseph St. Jude and Michigan heritage and Medical Group. Joining me today is jan q Candia. She's a licensed clinical social worker that performs as a behavioral therapist for St. Jude heritage Medical Group located in Fullerton, California. Today, we are discussing the topic of increasing our level of cultural competence by navigating our own individual and universal biases. Jackie, I am so excited to have this conversation with you today. Can you tell us a little bit about yourself and your work with providence?

1:20
Hi, Anna. Yeah, of course. So, like you mentioned, I am a therapist for Providence, I work and support our primary care integration program, we're kind of an extension of them. So working with patients who are being directly referred by their primary care doctors and providing them short term based therapy.

1:44
I'm so excited because you know, I also have a background in therapy as well. And this is really a conversation where we get to have therapists or therapists, topics on, of course, as we are all here for bias. Now, let's kind of dive into it. And let's talk about what that really means. And what it is, we have so many different types of biases. But you know, what it really kind of comes down to is, a lot of the times our brain gathers data I know, at a young age, you know, we always say kids absorb information like a sponge. And the reality is, is as we continue to grow, we don't necessarily stop. And what bias really is, it's it's our filter of our experiences, all the things that we have accumulated over time, every time we interact with someone, we gather all of that data, and sometimes our brain, what it does is it does make judgments. Now our job is to really identify how it makes the judgment and what can we do about it. Jackie, how many, in your experience in your work as well, you know, what kind of different biases have you come across?

2:48
I mean, I think in different platforms of the work that I've done, I've definitely come across quite a few types of different biases, you know, implicit bias, conscious bias, unconscious bias, environmental bias. And I think all of these different biases have, you know, a big impact on someone's ability to want to seek out support or, you know, be even open to having a conversation with somebody about maybe even working on their mental health or addressing mental health concerns. I mean, if we go into the different types of biases, you know, unconscious bias, right, that's something that someone may not be necessarily aware of. And it kind of, is something that might be stored, you know, in someone's databank in your brain. And they're not, may not be necessarily aware of the fact that that's what they're being biased about. You know, we as human beings, we carry biases, because we all have had both different and similar experiences to each other and having these biases, whether they're conscious or unconscious, they don't make us bad people, it just means that we want to be aware of, you know, the biases and try not to have them interfere with our judgment or decision making. Another form of bias that I have come across is implicit bias. You know, we can have beliefs that don't match or contradict our belief system, without us realizing it. And you know, an example of that can be we can be honest about liking a particular social group, however, still have an unconscious bias or bias towards that same social group. This may be related to our past, maybe our upbringing. You know, we talked about environmental biases that can also play a role in this. And you know, it these experiences may have kind of given us a little bit of like a guide in how we have these biases, but it's also our responsibility, you know, to educate ourselves and you know, take into consideration how we can better understand them. and not let them affect us, like I previously mentioned, and love it,

5:03
you're breaking it down because this topic, it can be so convoluted. There's so many different types. And there's so many different filters that go along with it. I love that you mentioned a couple of minutes ago, even mentioning it doesn't make us bad people, if you're human, you have bias unless you were a robot or AI. But because we are human, we have these experiences, they started to accrue over time. And we have ones that maybe we're not aware of, like you mentioned, the implicit, and we have ones that we are aware of, which is the explicit bias. And those are the decisions that we are actively making with the intention of knowing what our biases are. And you know, as we're talking about this, I can tell you, I feel like the word bias has such a negative connotation to it, because it comes as such an accusation. You know, when someone accuses you, like you're biased, it really kind of its comes with the accusation of saying, We can't see objectively, we can't see clearly the situation for what it is. And I think over time, there's just been such a negative meaning to it. We want to break away from that, we want to talk about more of how can we normalize the idea that every single person has bias. And if we know what it is, if we can identify it, it's really more information that we have, you know, Jackie, I always think about mental health, and how we think about something like anxiety. If you go through the symptoms of anxiety of a panic attack, and you don't know what it is, it feels really scary, it feels like we're not sure if we're gonna have a heart attack, we're not sure if we're dying. You know, when our heart hurts, our chest hurts, we get these palpitations. But the more we know about what anxiety is, what a panic attack is, the more we'd have control over it, I think about bias is the same thing as especially in this day and age is the more information we have about it, the more we know, the more we're able to make informed, respectful decisions, without having to be unfair to anyone or even a particular type of group. Now, I know when we talk about bias, we often think about the really common themes of race and ethnicity. But Jackie, have you seen other themes that have been coming up such as age or background, gender identity, sexual orientation, being differently abled some of these topics that maybe are not as known?

7:20
Yeah, absolutely. I mean, like you mentioned, I think, you know, the one that people know about the most, or can maybe pinpoint it and see clearly as bias, or race and ethnicity, and, you know, some areas that people might not kind of put into that category of having a bias or, you know, being biased about a certain situation, I think, even in just the work that I do, some of the stuff that I've come across is, you know, bias based on age, you know, bias based on gender bias based on, you know, someone's ability, you know, bias based on their social status. And so, it definitely is something that exists, and it's something that, you know, can impact somebody's well being and their ability to be able to kind of move forward or thrive. But I think these different biases, also are something that, you know, people fail to realize, as biases, I think, you know, when you when someone brings up, you know, like, an older person's ability to do X, Y, and Z. They see it as like, oh, well, they're older. So, you know, that's probably the reason why they can't rather than that, no, that's an assumption, right? That's an assumption that they're making about someone based on their age, without recognizing that person might actually be quite able. Right. And so I think it's not some people don't even recognize that they're being biased in that situation. You know, and I have an example of, you know, coming across something like that. My husband and I were at a grocery store not too long ago, and, you know, we were parking and we had noticed that, you know, there was a woman that had parked her car in a handicap space. And, you know, she had the handicap placard on her car, and you know, she had everything that she needed to be able to be able to park in that spot. But I guess, some woman had come out of her car at the same time we did along with the woman who had parked in the handicapped spot. And the woman that got out of the car in the handicap spot, she was walking, you know, normally into the grocery store and my husband and I heard the other woman say, well, she doesn't look handicap and, you know, that's kind of, you know, where, that's an example of, you know, of someone who might be differently abled. being biased towards that, right we have this bias that someone who is parking in a handicap space should, you know, either have difficulty walking should You know, have maybe in a wheelchair, you know, a cane. There's various different ways that we've kind of thought of someone to be, you know, considered handicap. And, you know, there's so much more to that right, there could be underlying things that we physically may not be able to see that puts them in that category as well. So, you know, that's another example of our bias towards someone who you know, might be, have a disability.

10:27
And isn't it amazing how our brain can make such quick and snap judgments. And I think in some situations, it will serve as well. Like if we're walking down a dark alley, and we are noticing a dark figure behind us, our brain is going to immediately make a snap judgment, you need to run this as a dangerous situation we need to get out of here. But sometimes our friend makes those same snap judgments in situations where maybe we need to take a step back and reevaluate. I love your example of Yankee, because that's a great example of a situation where maybe we need to take a step back and think, Okay, is there more to what I'm seeing on the surface. You know, in behavioral health, we always talk about the iceberg, we only see the tip of the iceberg. But there's so much more going on underneath the surface for someone, what I've come to learn in my work in mental health and behavioral health is that everyone puts a mask on, we show ourselves to people who we trust, but sometimes when we don't, we have the mask on ready to go, some people wear the mask very well. And it's hard to really get an idea of what's going on the inside. Like you mentioned, you know, being differently. abled means so many different things, it doesn't mean a physical thing at all times, it can mean something that's internal, that's going on things that we can't see. And a big part of it is going to be how do we check in with ourselves and have enough self reflection? So the big question I always get, and I would imagine you can't janky that you always do too, is okay. So you know all this about having a bias? What do we do with it? What are some things that we can do to be proactive? And making sure that we're checking in with ourselves?

12:04
Well, I think the first thing is, you know, bias biases come from thinking that we know something, right. So the initial part of that is that we've either maybe, through our upbringing, through our environment, through systems have been taught to perceive something a certain way. So we think we know, you know, why, you know, these things exist, or why certain people, you know, ages things, or, you know, someone's sexual orientation, or race or ethnicity, whatever it is. So we have this, like, kind of perception that we think we know, rather than what it actually is, right? So. So I think biases, one way I can describe it, you know, is like having tunnel vision, right? We can only see what we think we know, rather than the bigger picture. And so, you know, when it comes to things like understanding the grander scheme of things, I think it's educating ourselves, right, taking the time to learn asking questions, being open to receiving new information, you know, having open ended conversations with other people to get a better idea of what it actually is, rather than what we think it is.

13:17
Absolutely. And really even the topic of bias. It's such a gray area, I always think about the opposite. So if we're talking about logic, right, if we're thinking about math, two plus two will always equal four, no matter how many ways we look at it, and no matter what we do, that's always going to be a concrete solid answer. But when we think about something like as we're talking about bias, and even as we're talking about tying into cultural competence, it's such a gray area, and it's really not about finding a solid answer, that's going to be one and all forever. It's something that is really about how about gathering information and gathering data, and continuously updating it as we have more interactions and more connections with others, the more we are able to be vulnerable and connect, the more we're able to update this information databank that you were talking about earlier. It's really fascinating the way the brain works, because our brain is always trying to predict what's going to happen next, because it wants to make sure that we're safe. So whenever our brain comes across any situation where it feels like it's unpredictable, it feels like it's out of our control, and it's tying in with our fears, our brain will always freak out. So what it does in compensation is it will try to make things as predictable, so it gathers as much data as they can. And it says, I think I know what this person's about. I think I know what this group is about. But the tricky part in the slippery slope is we really don't know, as you mentioned to we could have two people with similar experiences, but completely different internal dialogue of what's really going on. Their thoughts are different. Their emotions are different. As we even think about cognitive behavioral therapy, and we use it so widely in therapy. It's really the foundational process of identifying how our thoughts tie in with our emotions, leading to what our behaviors are. Now, when I think about even bias, I think about, okay, how do we identify what our bias thoughts are? How do we check in with ourselves to think about what do we feel when we think about these thoughts? And how does it guide our behaviors. Sometimes, if we have such a disconnect with our thoughts and our emotions, and we go straight to behavior, we start to act on impulse. And that gets really scary when we come across, you know, those that we don't want to hurt, but we do end up hurting. One of my favorite quotes I have to share with you is by Matthew Hague, it's, in order to get a proper weight in order to get over a problem, it helps to look at it, you can't climb a mountain if you pretend it isn't there. And this is really what the conversation is about today. So how do we identify what the mountain is? How do we know how to climb it? And how do we do it in a way that's so respectful and kind and compassionate towards others? Because, you know, I feel like that's what really life is about, it's really about connection and getting to know one another, the more we get to know another person, the more we get to expand our experiences. And we know that not everyone is black and white, and it doesn't fall into all or nothing thinking. But what it does is it really helps our brain wrapped around the idea that each human being is complex. Now, Jackie, what do you think of the idea? Because this question comes up a lot is, can a person not have any bias at all? Is that a goal that we should work towards?

16:32
I mean, I think, you know, saying that someone can't or doesn't have any biases, I think that might be, you know, kind of unlikely, right? We're all human beings, and we've all had different experiences that have kind of formed some of these biases. And I don't think it's necessarily, you know, I was trying to get to a place where we don't have any biases at all, but you know, that we are more self aware, right, I think the self awareness piece, is crucial to to minimizing and reducing some of our biases. Because we want to be able to create a situation where we're not having unfair circumstances, and we're not, you know, isolating certain groups of people, or we're not letting it affect our quality of work. And so I don't think it's possible for it to never exist, but I do think it's possible to put them in check. And I think that requires us to be self aware about that. It's not someone else's responsibility to educate us on that, or, you know, kind of simplify it or dumb it down for us, but it definitely is ours, right, it's our job to be able to put it in check and identify, like, Hey, this is maybe an area that I'm lacking, or an area that I don't really necessarily understand, or comprehend, and do my due diligence to be able to, you know, learn more about it, educate myself on it, you know, take a step back and look, you know, outside in sometimes before, you know, creating an unfair circumstance per se.

18:01
It's really fascinating that you bring that up, because you know, how, how easy could it be if we just approached every single person we met with curiosity with a blank slate? With the idea of asking, you know, how can I how can I better understand you share with me your struggles, share with me what you've been through, it really brings the topic up in mind of the idea of colorblindness or even bias blindness. I always think about it in the sense that it comes with good intentions. It comes with this intention of wanting equality for all. And I really think about the differences. You know, with colorblindness, even with bias blindness, it's almost like saying, I want equality for both of us. Therefore, your struggles, and my struggles are on the same level, which is a slippery slope. Or as I think about bias awareness is really more about saying, I want a quality for all of us, helped me understand what you've been through, helped me understand what your struggles have been. And it's really the acknowledgement of your pain and my pain doesn't mean that one is greater doesn't mean that one is more important. It just means that everyone has gone through such significant different struggles. And it's important to share stories. It's important to talk about this. There's another group called I really love and it is by Robin Bender Salazar and he says humanity has always used conversation to transform the world around them. I feel it's so powerful, because even as we're having a conversation about it, I encourage of course more people to have conversations about it. When we start to find ourselves in our comfort zone and we feel really comfortable with everything that we're doing the people around us, we really should take a step back and ask Is there any room for growth if I'm so comfortable? Should I step outside of my comfort zone a little bit to get to know someone new to get to know someone different? Jackie and your experience? You know, what's it been like to step outside of the comfort zone, and really kind of getting a blank slate open picture of somebody.

20:04
Yeah, I mean, I think initially, it's really difficult, I'm not gonna lie, I think sometimes when you're raised to think a certain way or believe certain things kind of going against that isolates you, right? It might make you the black sheep. And, you know, even a personal example of myself is I come from a very conservative, strong South Asian community and South Asian beliefs in itself can have very conservative views at times. And so for someone like myself to be able to work in the field of mental health, mental health is very stigmatized in my community, right, there's a lot of biases already formed regarding mental mental health, right, and just having a mental illness in general. And so I think in with that example, it can be very difficult sometimes to step out of, you know, that comfort zone, or what what you know, and, you know, kind of go against the water rather than, you know, go with the flow, because it does isolate you, right, it does kind of put you in a bubble where you might be having to tackle that on your own right. And so, I can understand sometimes why people might just go with the flow, and kind of acknowledge some biases, as you know, they are because it prevents them from being put in a position to be isolated, right, maybe by the community you grew up in, or maybe by your family, or maybe by, you know, spiritual religious beliefs, or whatever it might be. So I think, you know, in those situations, it's always not the easiest choice to start off with. But I think once you're in it, and you're, you know, really trying to kind of clear yourself of some of these biases, like you mentioned previously, Anna, of, you know, taking the time to reflect and learn and educate yourself, that you're surely you slowly start realize that a lot of the times you are following blindly, right, that you're, you're not really taking into consideration the bigger picture, but just a small kind of fragment of what it actually is.

22:07
I love that you mentioned the family unit. Because as we're talking about the idea of checking in with our biases, there are so many different environments that bring upon and trigger different emotions in us, right. So if we're thinking about the family unit, or even relationships that we've had for a long time and family, I say loosely, it could be the family that we grew up with, it could be the family that we've chosen. When the the family, it's a little more difficult, I feel because we are so closely embedded within this system, we have these long relationships that we've had for many, many years. And sometimes when we're so deep in it, it's hard for us to take a step back and see. Whereas sometimes in a professional setting, let's use healthcare as an example, it could be sometimes a little easier to be able to check your biases at the door, because we can say, Okay, this is a professional setting. This is what I'm going to do. And it's common to ask questions, it's common to approach it with curiosity, it's common to, you know, wants to get to know a person that we don't know very well like an acquaintance. Or as sometimes when we have our deeply bedded relationships, maybe we're not asking questions to get to know them a little more. Maybe we've gotten so comfortable that we have forgotten to really inquire about, you know, do they have different thoughts on us? Do they have different perspectives and preferences? It's so important regardless of the relationship, as an acquaintance, whether in your professional setting in your personal life, what would it be like to continue to ask questions continue to get to know the person continue to connect? I love research of Brene Brown because she her entire career, she's researching how do we connect with each other? How do we create a sense of belonging. And when we look at something like when we are checking in with our own biases, we are really making sure that we are checking in with our experiences are assumptions, to be able to set that aside so that we can connect so that we can belong. One of the things that I really think about often Jackie's biases, it's not as black and white, right? There's such complexity to it. What do you think of the idea of there's positive in biases?

24:15
I think sometimes, you know, the positive component to sometimes having a bias is it'll, it can serve as a protective factor for some people, right? It and it's it's also very dependent on how that biases is, you know, relate, perceived, believed even because as long as it's not impacting or getting in the way of, or impacting a group of people or getting in the way of, you know, growth or whatever it might be, I think sometimes having those biases can be advantageous, because it might allow them to create a protective factor in a situation that may not be so beneficial to them, right. But I think It's also how it's disseminated and how it's portrayed.

25:04
I love that because it's really about how we use it to write, it's not about looking at like, it's good and bad, because very rarely in this world, and in this life is something just truly 100% Good and bad. But the way we want to look at it is, how do we use it to be more respectful? How do we use it to connect? And one of the things I really think about is, you know, being in healthcare, do you have have you had the experience of seeing it play out whether it is for the better? Or maybe for the worse? Having having bias maybe impacting patients getting health care?

25:39
Yeah, I mean, I think I've seen it more for the worse of patients getting the support that they needed. You know, I think nowadays, it's one of those situations where I hear a lot from, you know, some of the patients that I work with that it might be more so leaning towards a provider might have bias towards, you know, treating a particular diagnosis, because of the risks, right. So in that sense, I don't think it's necessarily always a bad thing. I think it might be just, maybe the provider had a bad experience with someone who had the same health condition in the past. And so they're not necessarily wanting to go a treatment route that might be, you know, what the patient is okay with or what their patients like, oh, well, why don't we go this route, or what? A provider might be a little bit more hesitant, right. But at the end of the day, if we're truly advocating for our patients and wanting them to get the best care possible, I think take, you know, kind of removing those biases, and all it takes is giving the patient all options possible, right risks, benefits, you know, upside downside, and that can help remove some of those biases as well. You know, I think also age, like I mentioned previously, like, there's also a stigma with older adults, right? There, many people might have the bias of like, oh, well, why are we doing such invasive procedures on them, or spending so much time with treatment, when we know that they probably won't be here for much longer, right. And so I think some of those biases do come up in the healthcare setting, when it comes to providing patient care, and sometimes I don't think it's always Ill intended. I do think that sometimes it might be just because, you know, okay, this is this might even cause them to have more concerns, right? If we're doing an invasive procedure on a 93 year old, there might be some long term consequences after that, and could make things more difficult. So I just think that some some of those things definitely do come up in, you know, working with patients, or what I've heard from patients in getting the services that they need.

27:46
That's such an important topic to bring up, because it's so important to emphasize to patients, to everyone, to empower them to advocate for themselves to share their story. It's hard because of course, if we, we don't know, if someone we know on the surface things, like our brain makes those quick snap judgments, it's important to be able to advocate for ourselves to be assertive. And to say, you know, I'd really like for you to take a look at this again, or I'd really like for you to share with me, again, have helped me understand if we can talk about it a second time a third time, helped me understand what your recommendations are, you know, being able to speak to our own experiences. And what we also want out of healthcare as well and, and behavioral health and what we want out of life in general, it's good to have an idea, like you said, of all the pieces of the puzzle, all of our options so that we can make an informed decision. One of the things I always think about with biases, okay, if we flip it to because it's not black and white, right? It's not an all or nothing if we flip it to how we can we use this to our advantage? It could be used as a tool to just gather more information. It's not used as a tool to attain a one and only answer. So for thinking about it in terms of health care as well, in the examples that you janky it could be used as a tool to say, Okay, I think I have an idea of what's going on. But what would it be like if I asked more questions to find out more answers to gather more information, not to mean that the answers are going to be solving the issue here, it just means that okay, the more data we collect, the more information we have about a person, the more we see them as a human being. And the more we can treat the complexity of what's going on, instead of maybe the all or nothing or black or white issue. And I think it's really the idea. We're getting into the gray area of how to think with biases here and we're getting into the gray of how to live with it, what to do with it, how to use it to our advantage, instead of having it be something that's a challenge or a barrier that we feel like we can't get over. I know it can be discouraging sometimes if we have something that is that feels a little shameful, right and to be honest, because bias has such a negative connotation that there's a lot of shame with it, that we may not want to talk about it, we may not want to explore a little more. But the biggest thing we want to take away from what can we do is? How can I self reflect and think about this as a tool, instead of it finding a one all be all answer in itself. And we think about interactions with relationships instead of looking for answers, and using it to solidify what we think about a person entirely, and we generalize it. Because really, that's how stereotypes form. We want to be able to think about, okay, this is one person's experience. Is it possible that another person of similar circumstances will have a different viewpoint? You know, as we're talking about the complexity of it? Is it possible to get to know a person underneath the mask? Is it possible to ask more meaningful questions, I always say, you know, small talk is, is, you know, we talk about the weather, and we talk about something that's very on the surface, it doesn't really do anything for our soul. But when we talk about the things that are deeper, and more vulnerable, we're showing people who we really are. And that's really what combats, having biases is, if you show people who you really are, it's, it's really on them what they decide to do with that information. For us, we've made the leap and sharing a piece of ourselves with another person.

31:21
I think along with it, and, you know, besides, I mean, culturally competent providers, if you want to be a culturally competent provider, and be able to kind of check your biases, aside from you know, a showing them who we are, it's also allowing them and providing them a space to show them who, you know, show us who they are, right? It goes both ways, right? It's, it's one thing to allow someone to know, you and the intricacies and be vulnerable and provide it, you know, compassion and all of that. But it has to go both ways, right? You have to be willing to allow someone to have that space, and to allow yourself to be more culturally competent. Don't assume that someone from a particular race or ethnicity, you know, falls into a certain kind of criteria, maybe when it comes to their health, or that they're already predisposed to something like that. But allowing them the opportunity to share that and providing a safe space for them to do that.

32:17
Absolutely anything on that, you know, I've worked with patients who are a little older, and it's so strong, how biases can impact us, because it's not just the biases we have about other people. But it's the messages we've accrued about ourselves and where we're at, I've had patients who are a little older, who have said, Oh, you probably think I don't know anything, you probably think I can't do anything, because it's this message that gets sent out to society that gets generalized as a universal bias. But then it comes back inward. And that's what they start to think about themselves. And that's the dangerous part is when we have biases that we have similarities with other people who have the same biases, that becomes a universal bias. It always comes back around because that's the message that we then absorb. And we ask, Oh, is that? Is that what I'm like? Is that where I'm at with my life at this moment? You know, when we talk about something like ageism, when we get to a point where we think about oh, this is what society thinks of people who are my age? Is that really reflection of me. And that's really what we're really trying to come back. We want to have the conversation, we want to connect with others, because there's this golden rule that might be a little outdated. And it's Do unto others as we would have others do unto ourselves. And I always say it's a little outdated, because what if we, instead of the golden rule? What if we transitioned to the platinum rule, which is treat others how they would like to be treated?

33:49
I think that's so important, I think, yeah, you know, do unto others as we would have others do unto ourselves, it really, it's assuming that everybody wants to be treated the way that we want to be treated, right? We're, like you said, human beings are not black and white, where there's a lot of gray area. And so the platinum rule is really kind of being able to put all that other stuff aside and ask somebody and treat somebody the way that they would like to be treated. You know, we can't just assume that everyone, there's a universal way everybody wants to get treated, right? Different people's experiences, kind of might change that. And it might, you know, some things might be acceptable for one and may not be acceptable for others, right. And so knowing how to really be able to acknowledge what other's needs are and how they would like to be treated rather than the assumption of like, oh, well, I would like to be I like to be treated nicely and with kindness and with, you know, someone who's soft spoken and edited. And so I'm assuming that that's what they would like as well. But that's not always necessarily the case. It could be something that's completely opposite of that

34:59
and It's so important, as we're talking about this rule to, as we're talking about connecting, and being vulnerable. A big part of it too, is communication. If we were able to communicate how we like to be treated, how we like to be communicated? What's our love language? How do we know how we like to receive affirmations? How do we like to receive feedback, it all goes into the same effort of wanting to communicate better wanting to get a better understanding of another person. And that in itself, we take that and we respect it, then we honor it. And it enhances the relationship so much, I can't even begin to tell you, when someone starts to communicate and understand how the other person likes to communicate, it's almost like you're finally on the same wavelength, instead of having am and FM radio that separate, you can finally be on the same wavelength to get an idea of Oh, when this person is direct, that's really their communication style. It's not personal to me. And I think about bias and cultural competence, and really the same manner of wanting to really get an understanding of each individual, how they communicate with their preferences. And our brain, what it does is it gets used to storing individual databases instead of generalizing if our brain is used to generalizing and taking things and saying, overall, this is what I think of this, this target group. It's going to continue that pattern unless we break it, if we start to take an individual information, and we say this person likes to communicate this way, this person's love language. Is this, what our brain does is it goes okay, we're individualizing. So we're going to have separate buckets for each person instead of grouping it all together, which then creates bias.

36:42
Absolutely, I think, you know, when we can see the person, as you know, a separate entity, and you know, not kind of lumped them together as a whole, right, not assuming that all fifth graders are all going to be the same, but that this specific fifth grader, you know, Johnny is, you know, these are his interests, and they vary from his classmate, Ashley Right, and allowing people to have that ability and be acknowledged individually rather than as a whole.

37:11
I love that I really reminds me of the saying that my perspective is my reality. But what would it be like if we changed it to our perspective, is our reality, it really, it does wonders what empathy can do to be able to step into someone's shoes, to know that they are a different person, even amongst a group to be able to have different characteristics for them, different traits, everyone can be loving, they can be loving in a different way, they can be angry, and they can all show it differently as well. And it really reminds me, the more we step outside of our comfort zone, the more we step outside of our perspective, it doesn't become my perspective. But it becomes our perspective. And that's such a beautiful way to communicate a beautiful way to connect. And it's a way to make us all feel like, you know, we are closer to one another. Because as you know, Jackie, being in behavioral health, it can be very isolating to feel like we're alone, to feel like maybe no one's experiencing what we are. But to be in a group of people who we can be individuals and come together. I really think that's what it's all about. Yeah, absolutely. I think

38:21
as providers, even in just like a grander scheme of like health care, right? Every department has like their own, kind of like pros and cons. And, you know, sometimes, you know, providers may not see addressing mental health concerns as the priority. And, you know, we might realize, like, hey, until we get some of this stuff figured out, the rest is kind of just going to be the way it is right. And so sometimes it is very isolating and lonely, because it may not be seen in the way that it needs to be seen. And I think when you talk about bias, that's exactly what it is. Right? It's saying that, based on what you want to see, not really what's the entire picture. You know, I really like going back to that quote of just treating others how they would like to be treated. I think that also goes with, you know, when you're working in a professional setting, when you're working with your colleagues and you know, not assuming that, you know, they are a certain type of way or, you know, you not having an assumption about a provider like that all providers who work in this specific field, have this kind of, you know, perception about X, Y and Z and I've come across that quite a bit, you know, and working with other professionals and other specialties as people are like, Oh, well, cardiologists are always like this. And you know, doctors who work in pulmonology are always like this, and so not kind of grouping people up

39:43
here, right when we start to say always, or never, that's a red flag for us to check in with ourselves. Now, Jackie, is there anything else that we haven't covered that you want to make sure our listeners know?

39:54
Um, no, not that I can really think of, but I think one thing that you know if we're going To take it upon ourselves to help people check their biases or understand their biases, or even bring their biases to the forefront so that they can start working on that. Don't you know, assume that someone isn't willing to change? I think that's the big thing that I've come across is some people will say, Oh, well, they're just fixed in their ways are, you know, that's just how he is? Or she is? And I think it's one of those that's an in itself is another bias, right? It's an assumption. And so, you know, giving everyone that blank slate like we talked about, and I think more often than not, you'd be surprised that people are actually willing to hear you out and understand if it's, you know, information is disseminated appropriately, compassionately, not in a non defensive kind of stance, and I think if you are able to do that people are willing to hear you out.

40:51
Absolutely. And I will say this kind of work is incredibly difficult. I know we're talking about and as we're giving you examples, you know, I want to just emphasize this is meaningful, reflective, but incredibly difficult work. And if you're willing to do it, it's got amazing results. It's, it's really did the defensive seeing and black and white versus seeing in color. It really changes our outlook and our perspective entirely. But Jackie, thank you so much for your time today, you know, thank you for joining us today on culture of health. We look forward to continuing the important conversation on equity, diversity and inclusion and health care. With more experts from Providence with future episodes. Make sure to listen to all our shows on dash radio under future of health radio, or your favorite podcast platform. And follow us on social media. We can be found on twitter and facebook at Providence, and Instagram under Providence Health Systems. To learn more about our mission programs and services, go to providence.org. And please remember the information provided during this program is for educational purposes only. You should always always always consult with your health care provider. If you have any questions regarding a medical condition or treatment. Thank you everyone for listening. And remember, at Providence, we seize a life in you