There are several broad areas of recommendations for clinics to increase access and quality of care for SGM people that we review in Chapter 9. These areas include: (1) Adopt SGM affirmative policies and procedures; (2) Create a welcoming physical environment for SGM patients; (3) Document sexual orientation and gender identity information; (4) Provide ongoing training for all employees in SGM cultural competency, including use of supportive language; and (5) Initiate clinical workforce development to encourage delivery of high-quality services for SGM patients.
The Checklist for Recommendations to Improve Primary Care for SGM patients assesses capacity in each area. Many of its items come from the Health Equality Index developed by the Human Rights Campaign.5 The checklist helps determine things already in place at the clinic and things it could do to make it more SGM-friendly. Responses to this checklist can inform what the team might focus on during the planning stage. A sample of items that make up this checklist appears in Template 5.1 (Appendix A).
We encourage the team to use the checklist (or one like it) as part of the organizational assessment. We also advise the team to consult with clinic leadership, personnel, patients, and/or patient representatives when completing the checklist to make sure nothing related to SGM patient care is missed.
Template 5.1 Checklist for Recommendations to Improve Primary Care for SGM Patients | ||||
Persons completing checklist: | ||||
Date(s) of checklist completion: | ||||
Recommendation Area 1: Adopt affirmative policies and procedures | ||||
a. The clinic maintains a Patient Non-Discrimination Policy or Patient Bill of Rights that is explicitly inclusive of sexual orientation and gender identity. | ☐ Y | ☐ N | ☐ N/A | ☐ U |
b. The clinic has a systematic process for sharing the Patient Non-Discrimination Policy or Patient Bill of Rights with all patients. | ☐ Y | ☐ N | ☐ N/A | ☐ U |
c. The clinic has a systematic process for sharing the Patient Non-Discrimination Policy or Patient Bill of Rights with all staff and providers who have direct contact with patients. | ☐ Y | ☐ N | ☐ N/A | ☐ U |
d. The clinic has an Equal Visitation Statement that explicitly bans discrimination of visitors and chaperones based on sexual orientation or gender identity. | ☐ Y | ☐ N | ☐ N/A | ☐ U |
e. The clinic has a systematic process for sharing the Equal Visitation Statement with all patients. | ☐ Y | ☐ N | ☐ N/A | ☐ U |
f. The clinic has a Patient Medical Decision-Making policy that explicitly recognizes the right of patients to decide who will make medical decisions if they are unable to do so. | ☐ Y | ☐ N | ☐ N/A | ☐ U |
g. The clinic has a systematic process for sharing the Patient Medical Decision-Making Policy with all patients. | ☐ Y | ☐ N | ☐ N/A | ☐ U |
h. The clinic has a systematic process for sharing the Patient Medical Decision-Making Policy with all staff and providers who have direct contact with patients. | ☐ Y | ☐ N | ☐ N/A | ☐ U |
i. The clinic has a Patient Confidentiality Policy that acknowledges that patient-provider discussions are confidential and protected information. | ☐ Y | ☐ N | ☐ N/A | ☐ U |
j. The clinic has a systematic process for sharing the Patient Confidentiality Policy with all patients. | ☐ Y | ☐ N | ☐ N/A | ☐ U |
k. The clinic has a systematic process for sharing the Patient Confidentiality Policy with all staff and providers who have direct contact with patients. | ☐ Y | ☐ N | ☐ N/A | ☐ U |
l. Any clinic policy defining family members or guardians of pediatric patients is broad enough to include non-traditional families, including LGBTQ. | ☐ Y | ☐ N | ☐ N/A | ☐ U |
m. The clinic maintains an Employee Non-Discrimination Policy that explicitly includes employees’ sexual orientation, gender identity, or gender expression. | ☐ Y | ☐ N | ☐ N/A | ☐ U |
n. The clinic has a systematic process for sharing the Employee Non-Discrimination Policy with new and existing personnel. | ☐ Y | ☐ N | ☐ N/A | ☐ U |
o. The clinic has established mechanisms for both patients and personnel to report discriminatory behavior that violates any policies described above. | ☐ Y | ☐ N | ☐ N/A | ☐ U |
p. The clinic communicates this reporting mechanism for disclosing discriminatory behavior effectively to staff and patients. | ☐ Y | ☐ N | ☐ N/A | ☐ U |
q. The clinic has a procedure to respond to discrimination reports and take corrective action if necessary. | ☐ Y | ☐ N | ☐ N/A | ☐ U |
r. The person or people responsible for addressing reports of discrimination have the necessary training and skills to respond appropriately to such reports. | ☐ Y | ☐ N | ☐ N/A | ☐ U |
s. The clinic offers the same benefits that spouses receive to unmarried, long-term partners of personnel. | ☐ Y | ☐ N | ☐ N/A | ☐ U |
t. The clinic offers staff at least one health insurance plan that covers gender-affirming care. | ☐ Y | ☐ N | ☐ N/A | ☐ U |
Action Planning Considerations | ||||
1. What in the clinic facilitates the adoption and enforcement of affirmative policies and procedures?
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2. What in the clinic gets in the way of adopting and enforcing affirmative policies and procedures?
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3. What are the next steps for ensuring the adoption and enforcement of affirmation policies and procedures?
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