This article appears in the October issue of Patient Safety Monitor Journal.
Every facility wants to give the best possible care to every patient who walks through its doors, regardless of sexual orientation or gender identity. But wanting to help people isn’t the same as helping them or knowing what they need.
In 2016, 4.1% of the U.S. population identified as being lesbian, gay, bisexual, or transgender, and competency in the special needs of LGBTQ patients is increasingly expected of providers.
While “there is not a [federal] legislative mandate that addresses this specifically, many providers are being sued because of a lack of cultural competence and appropriateness,” says Venessa Marie Perry, president/CEO of Health Resource Solutions LLC in Washington, D.C.
Some cases, such as Taylor v. Lystila, involving a transgender patient whose provider refused to hive her hormone replacement therapy, have explicitly referenced the Affordable Care Act (ACA).
How HHS weighs in on LGBTQ rights
Section 1557 of the ACA prohibits discrimination in federal healthcare programs against groups covered by various anti-discrimination laws, such as the Civil Rights Act. Subsequent HHS regulations indicate the department considers these laws to apply to LGBTQ federal beneficiaries as well, and the language in a proposed HHS rule issued on September 8, 2015, suggests that a final rule will make this explicit: “We believe that discrimination on the basis of sex further includes discrimination on the basis of gender identity.”
Regulation affecting healthcare providers increasingly refers to LGBTQ needs. For example, the most recent meaningful use final rule includes a requirement that certified electronic health record (EHR) technology be used to “record a patient’s sexual orientation and gender identity (SO/GI) in a structured way with standardized data” as “a crucial step forward to improving care for LGBT communities.”
The language of “cultural competency” is well established in HHS sub-departments, says Perry, as shown by tools like the 2012 MLN Matters, “Cultural Competency: A National Health Concern,” and the Office of Minority Health’s “Think Cultural Health” page.
“The number of increasing health disparities in minority and disadvantaged communities has indicated that there is a need for providers who understand and are able to relate to the sensitive needs of the population,” she explains.
Given this trend, it behooves providers to make sure they’re equipped to provide a welcoming environment to LGBTQ patients.
Four tips to promote cultural competency
To properly promote cultural competency, try the following four tactics.
1. Explain the need
“Professionals in the field are not empty vessels; many have carefully figured out over time how they want to talk to patients,” says Liz Margolies, founder and executive director of the National LGBT Cancer Network in New York City. “The challenge is to convince them that the way they’ve been doing it isn’t working well for a whole population of people and to ask them to change without shaming them; making them defensive will only lead them to shut down.”
“Many providers proudly say, ‘I treat everyone the same’—they think this shows that they don’t discriminate,” Margolies adds. “But not every patient needs the same thing.”
Explain the difference as one between “treating people how I want to be treated” and “treating people the way they want to be treated,” she suggests.
2. Don’t neglect nonclinical staff
A welcoming environment begins at intake. Think about your answers tot he following questions, says Lillian Rivera, director at The Center for LGBTQ Youth Advocacy and Capacity Building of the Hetrick-Martin Institute in New York City.
“When they go the physical space…do they see images that are reflective of their experiences?” Rivera asks. “Are reading materials reflective of their experiences? Are they referred to by the names that they choose and affirm or by names that have been assigned to them? Do you have gendered restrooms?”
Margolies’ training film, Vanessa Goes to the Doctor, suggests intake forms that include variant names or pronouns, for example. She also recommends making sure receptionists understand how to address a transgender woman whose legal name is different from her preferred one,f or example.
3. Address community-specific health issues
Providers are encouraged to proactively address care concerns of importance to LGBTQ patients. For example, says Rivera, “I would include some information about HIV, specifically with your African-American and Latino gay men”—populations for whom HIV rates are high.
4. Work with professionals
“I strongly recommend hiring an individual or organization that has solid history of training healthcare providers” in cultural competency, says Margolies.
She recommends exploring the National LGBT Health Education Center of The Fenway Institute, part of Fenway Health in Boston; the Healthcare Equality Index benchmarking tool of the Human Rights Campaign in Washington, D.C.; and her own Cultural Competency Toolkit.
Editor’s note: Reporting on this story was provided by Roy Edroso.