For larger clinics and networks of clinics, executive leaders, including Chief Executive Officers, Chief Operations Officers, Chief Medical Officers, and the governance body, can be instrumental in getting new practices and processes adopted to enhance care for SGM patients. Similarly, middle managers who run a particular department or carry out a strategic function of the clinic and supervisors and team leaders who are directly responsible for managing the work of providers and staff are influencers in their own right. They can encourage others at the clinic to give organizational change a chance by cultivating positive staff attitudes and openness to new policies and practices. For example, they can play critical roles in promoting implementation leadership supportive of the team and its efforts.
Although leaders can inspire and motivate employees to implement innovations and reward them for doing so, they can get overwhelmed by competing demands, fiscal constraints, and staffing and workflow challenges. Responsibilities such as ensuring clinic compliance with new regulations, managing and making the most of complex IT systems, or building and expanding new programs in the community, in addition to general oversight, can prevent administrators and leaders from taking on new initiatives to improve care for SGM people. Still, garnering their support is crucial if the initiative is to succeed at the clinic. It also is critical that they support change champions by providing sufficient time and resources for the champions to facilitate the practice transformations.
We propose four basic strategies that an Implementation Team can use to garner support across multiple levels of leadership in the clinic.
- Schedule meetings with leaders to discuss the recommendations to improve SGM health and health care featured in this toolkit. The team can draw from the toolkit’s content to present:
- National priorities regarding SGM health and health care.
- A snapshot of health and healthcare disparities affecting diverse SGM patients, focusing on those likely to be prevalent in the community served by the clinic.
- The team’s initial Action Plans to address the health and healthcare disparities affecting SGM patients through the resources provided in the toolkit.
- Ideas for building on similar organizational change initiatives to improve patient-centered care more generally that may already be underway at the clinic.
- Invite key leaders to the team’s meetings, especially during the earliest stages of planning. Their presence and participation will demonstrate to others that the clinic is prioritizing the implementation of recommendations. Leader engagement can also contribute to increased support and resources necessary for implementation.
- Keep key leaders informed at regular intervals about the Implementation Team’s activities, including its successes and challenges. The perspective of leaders can be instrumental in helping the team figure out how to build on successes and troubleshoot challenges!
- Clarify to key leaders that high-quality health care for SGM people is a priority in the community. One great way to do this is to reach out to community partners and patients who can convey these priorities to leadership by taking part in meetings or putting pen to paper in correspondence with leaders and expressing their support for making changes in the clinic.