In this final chapter, we provide specific guidance on implementing basic recommendations for improving healthcare access and quality for SGM patients. Recommendations have been selected that are likely to help you and your colleagues transform your primary care practice into one that is sensitive to the needs of SGM patients. The recommendations presented lay the foundation for removing barriers that prevent SGM patients from getting or benefitting fully from primary care. They also will encourage the cultivation of relevant SGM knowledge, skills, policies, and practices in the clinic. Overall, these recommendations will facilitate the broader goal of providing primary care that is both patient-centered and trauma-informed. In addition, efforts to implement these recommendations will complement other organizational change or quality improvement initiatives underway at the clinic.
Table 9.1 includes an overview of each recommendation, describing the barriers it addresses, the rationale for its inclusion, and other resources that the clinic’s Implementation Team can tap for further information and guidance. As the team moves forward with these efforts, keep in mind that SGM people are represented in all patient populations served by the clinic. As described in Chapter 6, they are also part of every racial and ethnic group and age category, reside in rural, urban, and suburban areas, and have a range of physical abilities, socioeconomic backgrounds, and legal statuses. A detailed description of each recommendation follows in Table 9.1, which includes discussing key steps that the team can incorporate into its Action Plans for advancing health and health care for SGM people.
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Key recommendations, barriers addressed, and rationale with hyperlinks to guidance documents | ||||
Recommendation | Barrier Addressed | Rationale | Resource with hyperlink for online access* | |
1. Adopt affirmative policies and procedures | Compared to heterosexual and cisgender people, SGM people are more likely to face discrimination as patients, staff, and providers in health service systems. | Demonstrate the clinic’s commitment to preventing discrimination of SGM-identified patients and employees while enforcing affirmative policies and procedures to protect these individuals. | ||
2. Create a welcoming physical environment | Compared to heterosexual and cisgender people, SGM people are more likely to experience healthcare settings as non-inclusive, face discrimination and implicit biases among staff, and avoid necessary treatment.
| Establish a physical environment in which visual cues and other front-facing markers of acceptance enable SGM patients to feel safe, understood, and included. | ||
3. Document sexual orientation and gender identity information | Having information about sexual orientation and gender identity is integral to routine patient care. Such information can help clinic personnel understand the extent of and address SGM health and healthcare disparities. | Be able to interact with SGM patients individually and more accurately document, understand, and address SGM health and healthcare disparities as an organization. | ||
4. Provide ongoing training for all employees in SGM cultural competency, including use of supportive language | Healthcare professionals report feeling undertrained to provide culturally- competent services for SGM individuals. The language used by SGM people to discuss their identities is changing rapidly, so there is always something new to learn. | Expect and empower all employees to become familiar with basic approaches to cultural competency when caring for SGM people while increasing awareness of common SGM terminology and their comfort in using neutral and gender-inclusive language when communicating with all patients. | Human Rights Campaign Training through the Center for Affiliated Learning The Fenway Institutes National LGBT Health Education Center: Learning Modules Please see Section 5 below for more resources on clinical care recommendations. | |
5. Initiate workforce development to encourage delivery of high-quality services for SGM patients | Healthcare professionals report feeling undertrained to provide competent care to SGM patients. | Provide clinical care to SGM patients per national recommendations and best practices. | Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People | |