Strategies for creating LGBTQ-inclusive health care environments

More health systems are making commitments to LGBTQ inclusion, but these commitments aren’t always clear the moment individuals walk into a health care facility. However, because early impressions are particularly important in helping people feel welcomed, it’s an aspect to which more organizations are paying attention. 

As a 2017 poll by the Harvard Chan School, NPR and the Robert Wood Johnson Foundation on Discrimination in America found, 18% of surveyed LGBTQ Americans reported avoiding going to a doctor or seeking health care out of concern that they would be discriminated against or treated poorly because of their LGBTQ identity. That jumps to 22% for transgender individuals. Establishing an inclusive environment from the very first contact is a critical first step in securing the trust of all patients, visitors and guests. 

While any step in this direction should be in line with the broader organizational framework, there should also be input from impacted communities. Facilities professionals can gain insight through organizationwide surveys or by working with an existing LGBTQ task force, advisory group or champion to expand the focus from clinical to environmental policies. These allies also can ensure posted language is appropriate and inclusive. 

That was the route the Philadelphia-based Einstein Healthcare Network, now part of Jefferson Health, took when it began updating its waiting rooms as part of the launch of its Pride Program seven years ago. 

“We had about 10 volunteers from our LGBTQ affinity group, and we asked them to walk through the waiting room and share what made them uncomfortable and what made them feel welcome,” says David Jaspan, DO, chair of obstetrics and gynecology for Einstein Healthcare and a key member of the health system’s Pride Program.

The first factor the team identified as unwelcoming was the language on signage and the types of families represented in the visual cues. 

“It was ‘mom and baby,’ and breastfeeding, not chestfeeding,” Jaspan says. That has changed. “It really is about creating that safe space,” Jaspan says. “The goal here is to not make anyone feel uncomfortable. Some people say ‘chestfeeding,’ whereas our signage says breast/chest feeding so everyone can participate in that knowledge.” 

The labor and delivery department at Einstein also is updating signage to focus on “parents” and help parents to feel comfortable providing their preferred pronouns. 

Some health facilities also include signage such as rainbow flags and equality stickers to demonstrate support for the LGBTQ community. “Putting those stickers at the front desk or in the bathroom immediately created a welcoming sense, that we recognize the differences and are working toward being more accepting,” Jaspan says. 

GLMA: Health Professionals Advancing LGBTQ Equality, a national organization advocating for health equity, has written the “Guidelines for Care of LGBTQ Patients,” which encourages providers to include clues in health care spaces that help patients determine what information they may comfortably share with their health care provider. Inclusive reading material provides a sense of authenticity, and GLMA suggests subscribing to local LGBTQ newspapers or magazines to include in waiting rooms, displaying photographs or posters that depict LGBTQ families, and including display brochures that highlight LGBTQ health concerns. These depictions can help put people at ease before their first interactions with caregivers. 

Single-sex restrooms are another important element of creating an inclusive environment. Public restrooms have been the site of harassment, embarrassment and controversy for LGBTQ people, and gender-neutral restrooms throughout the health care facility should be a priority. 

Single occupancy unisex or all-gender restrooms outfitted with wheelchair accessibility are ideal. For facilities not in a position to retrofit existing bathrooms, planning departments may consider including a preference for all-gender restrooms in future new construction. 

Of course, the single most important step facilities professionals should be taking is training all staff members on LGBTQ competency. 

LGBTQ inclusivity is not simply for care providers. All patient-facing positions, from maintenance supervisors to environmental services staff, should have basic training on LGBTQ identities, terminology, health disparities and competency. It is equally important to establish a clear process for reporting and responding to any instances of discrimination or other concerns that may arise.

“Mistakes are going to happen,” Jaspan says. “But the other aspect of this to remember is that, as long as you are coming from a good place, just make sure that you’re willing to evolve and change and learn.”