The physical environment of the clinic should be positive and welcoming for all patients, including those who are SGM. Many SGM people have experienced discrimination when trying to access health care. Fostering a welcoming physical environment might make them less apprehensive about going to a primary care clinic for services. The Patient Non-Discrimination Policy or Bill of Rights, Equal Visitation Statement, Patient Medical Decision-Making Policy, and Patient Confidentiality Policy should be prominently displayed in the clinic’s waiting area to put patients and their families at ease. In addition, there are some low-cost measures suggested by GLMA (formerly the Gay and Lesbian Medical Association) that any clinic can implement to make a strong statement and ensure that SGM patients feel affirmed as soon as they come through the front door, as described below.2
- Hang posters and artwork depicting culturally diverse same-sex couples or transgender and gender-diverse people, or posters from non-profit SGM or HIV/AIDS organizations.
- Exhibit brochures and other educational materials that include information inclusive of SGM people. These materials should be available in languages used by patients in the community.
- Post rainbow pride flags, transgender pride flags, equality flags, pink triangles, and other SGM-friendly symbols in waiting areas. (Safe Zone signs should only be posted if staff have completed appropriate training.)
- Display SGM-specific media, including magazines or newsletters about and for SGM and HIV-positive individuals.
- Make gender-inclusive restrooms (e.g., restrooms that any patient can use regardless of sex designated at birth or gender identity) accessible to all patients.
- Train staff responsible for answering patient questions if signs depicting more than two genders are selected.
| SGM Friendly Symbols | |||
 |  |  |  |
| Rainbow Pride Flag | Bisexual Symbol | Transgender Pride Flag | Progress Pride Flag |
Key implementation considerations
It is important to follow the clinic’s policies for getting permission to hang items on walls or for sharing educational materials, magazines, and newsletters in waiting rooms and other patient areas. Appendix F features guidance on where the clinic can procure such items. It is also critical to educate clinic staff about the meaning of SGM symbols before making them visible in the clinic and provide them with support to address patient concerns.
Having a welcoming physical environment means making gender-inclusive restrooms accessible to all patients
Transgender and gender-diverse people may not feel comfortable using public restrooms, including single-stall facilities if they are differentiated by sex designated at birth or gender. They may anticipate harassment and negative reactions from providers, staff, and other patients. If the clinic has single-stall restrooms available for patients, an easy alternative is to avoid gender markings on the door. Labeling 
them as “restroom” or “bathroom” rather than as “men’s room” or “women’s room” and allowing access to all people regardless of their gender identities. Other language, such as “all-gender restroom” or images depicting more than two types of people, may be challenging to implement depending on the beliefs and comfort of people in the clinic. The Implementation Team should consult with staff and patients to decide which option will best fit the culture of the clinic and community. When single-stall restrooms are not available in areas typically occupied by patients, the clinic can post signs publicizing access to gender-inclusive restrooms elsewhere in the facility. Signs should clarify if patients need to ask the front desk for restroom access. All staff must be prepared to respond appropriately to requests for access. Finally, signs can be hung at the entrance of multi-stall restrooms, supporting the right of individuals to choose the accommodation best suited to their needs.
Potential steps to include in action plans to make gender-inclusive restrooms accessible to all patients
- Conduct an inventory of all restrooms available to patients in the clinic.
- Determine the restroom access and signs that are best for the clinic, carefully considering options for patient waiting areas that lack single-stall restrooms.
- Prepare a proposal to institute gender-inclusive restrooms and obtain organizational approval.
- Once the proposal is approved, order new signs and prepare for their installation.
- Inform staff of pending changes to restroom signs and respond to their questions and concerns.
- Train staff who will be responsible for patient questions if signs depicting more than two genders are selected.
- Evaluate the transition to gender-inclusive restrooms and respond to staff and patient concerns. Adjust changes to restroom use and signage as needed.
- If no single-stall restroom is available, ensure alternative procedures are in place to allow patients to use restrooms safely (e.g., offer patients the use of a staff restroom).