Multidisciplinary Team Promotes Health Equality and Access to Health Services for the LGTBQ Community

Various health risks are elevated in the lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) population. According to the World Health Organization’s guidelines on HIV prevention, diagnosis, treatment and care for key populations, transgender persons are disproportionally affected by HIV. The United States Government initiative, Healthy People 2020 topics and objectives for lesbian, gay, bisexual and transgender health, reports LGBTQ youth are more likely to attempt suicide. Gay and bisexual men and transgender women are at higher risk for HIV and STDs, especially among communities of color. Breast, cervical and prostate health is often overlooked. LGBTQ persons are frequently marginalized and stigmatized. This population experiences multiple barriers to health and wellbeing. Many believe they are not able to receive non-biased health care, impacting their motivation to access services. In addition, the Healthy People 2020 goal to improve the health, safety, and well-being of lesbian, gay, bisexual, and transgender (LGBT) individuals calls upon all in the health care field to act.

In an effort to promote health equality and access to health services for LGBTQ persons, a community hospital with ancillary specialty services formed a multidisciplinary LGBTQ Healthcare Equality Committee. The overall goal of the Committee is to guide the organization in becoming a trusted partner for LGBTQ patients, families, employees and the community through education, collaboration, policy and practice. Committee members include nurses from all levels of the organization, ancillary service providers, and staff from Human Resource, Information Technology, management and administrative support. Members include those who support family members and friends who identify as LGBTQ, as well as self-identified LGBTQ persons working in our organization.

A four-fold strategy was identified to reach target goals while creating a welcoming and inclusive environment.

1) Select a framework for defining and achieving goals. The framework selected to meet this goal is the Human Rights Campaign (HRC) Healthcare Equality Index (HEI). HEI is a national benchmark tool that evaluates healthcare facilities policies and practices related to the equity and inclusion of their LGBTQ patients, visitors and employees. Criteria for the HEI are non-discrimination and staff training, patient services and support, employee benefits and policies, as well as patient and community engagement.

2) Collaborate to educate the committee, the organization, and the community. Collaboration with national experts such as The National LGBTQ Health Education Center provides current knowledge from introduction to terminology through clinically relevant and specific medical assessments and procedures. Focusing on transgender persons, we hosted a global leader in gender affirming surgery who spoke on transgender health needs to an intra-professional audience. Two education events specifically related to the LGBTQ senior population were held, one in collaboration with a community outreach day and another in partnership with a local academic hospital. Older LGBTQ adults face additional barriers to health care because of isolation, fewer family supports, and a lack of social and support services (Healthy People 2020, 2018).

3) Integrate with the organization’s current programs and processes. Goals related to ANCC Nursing Magnet designation, The Joint Commission survey process, Nurses Improving Care for Healthsystem Elders (NICHE), community outreach, and employee recruitment and retention were considered in the context of the LGBTQ Healthcare Equality Committee work.

Initiatives were built around patient services and support, employer policy and benefits, non-discrimination and staff training, and community outreach. Examples include Electronic Health Record changes for gender identification, communication, preferred pronoun, and new identification bands in maternal child health to accommodate all parent configurations. Internal and external education included an informational poster at the organization’s Nursing Research Council sponsored Nurses’ Week Education event highlighting the achievements of the LGBTQ committee, community outreach and internal education during Pride Month. Changes were made in policy and benefits for employees, as well as patient rights policies.

4) Seek measurable outcomes data. Utilizing the HEI criteria, over the past two years the organization received Leadership designation with rating scores of 100. In 2018 the preliminary score received was again 100. Initial target goals for EHR communication improvements are met. In concert with the HEI process, the organization was able to track completion of on-line education offerings specific to the LGBTQ population offered to employees. The Transgender Care post-lecture evaluations show attendees self-rated an increase in competence from low to moderate or high, or moderate to high in the areas of knowledge, communication & healthcare needs of the transgender population.

Work of the LGBTQ Healthcare Equality Committee is on-going with a commitment to identify areas of need to improve healthcare access and reduce barriers through education and dedication to evidence based best practice for all our patients. Creating an inclusive environment to promote health care access is one way to reduce health risks, while also opening the door to establish on-going routine health care for the LGBTQ population.