Section 1. Adopt affirmative policies and procedures

Having policies that affirm SGM people and prohibit discrimination against them is a cornerstone to creating a clinical environment that supports all patients and employees.¹ General policies that do not specifically address protected classes are not enough. Examples of policies suggested by the Human Rights Campaign are:

Patient Non-Discrimination or Bill of Rights: Explicitly references “sexual orientation” and “gender identity or expression” as protected categories. 

Equal Visitation Policy: Explicitly bans discrimination in visitation based on sexual orientation and gender identity, emphasizing the right of patients to designate visitors of their choice, including same-gender partners and parents.

Patient Medical Decision-Making: Explicitly recognizes the right of patients to decide who will make medical decisions if they are unable to do so.

Patient Confidentiality Statement: Acknowledges that the content of patient-provider discussions represents confidential and protected information to encourage SGM patients and others to disclose information pertinent to their health and health care.

Employee Non-Discrimination: Explicitly bans discrimination based on sexual orientation and gender identity or expression to ensure equal treatment of SGM employees.

Employee Institutional Benefits: Extends all institutional benefits to spouses and same-gender partners on an equal basis, including sick leave, bereavement leave, parental leave, retirement plans, insurance, and more.

Gender-Affirming Care Coverage: Ensures that health insurance offered to employees includes gender-affirming care. 

Enforcement of affirmative policies and procedures

It is not enough to create policies and formally adopt them; they must be implemented and enforced. Non-discrimination policies related to staff can be posted on job announcements, applications, employment brochures, and the clinic’s website. Policies centered on patient care should be posted in the waiting room area, treatment rooms, and on the clinic’s website. Policies should be shared with patients at intake, patient visits, and written communication, including email.

All staff have a responsibility to uphold policies that support and affirm SGM people. This expectation should be conveyed during orientation and reinforced regularly through basic education. Routine oversight should be conducted to ensure official policies and procedures for reporting violations are being followed.

Policies and procedures should be detailed in employee manuals. Guidelines for staff handling of policy and procedure violations, including consequences for specific offenses, should be clearly outlined. The clinic governance body (e.g., Board of Directors) should appoint one or more persons to handle violations. These staff must be prepared to respond promptly and appropriately in all communications about alleged violations. Patient materials such as documents, website postings, posters, and pamphlets should detail policies and procedures, including reporting violations.

Potential steps to include in action plans for creating affirmative policies and procedures

1. Review current policies and procedures to determine if changes are necessary.
2. If needed changes are identified, adhere to organizational procedures for changing and approving policies at the clinic.
3. Develop a written draft of policy changes and procedures for addressing policy violations, including a plan to communicate changes to all staff and patients.
4. Obtain organizational approval to move forward with the proposed changes.
5. Share the policy changes and rationale for their adoption with all employees. As part of this process, educate staff about the goal of changes and what effective implementation looks like.
6. Train staff responsible for handling policy violations and procedures to address employee and patient concerns about the policies on an ongoing basis.
7. Implement the policy changes when all procedures are in place.
8. Monitor implementation of the policy changes (e.g., track complaints and violations), adjusting strategies to raise awareness, and educate employees and patients as needed.