Risk Management Tools & Resources


Providing Culturally Competent Care for LGBT Patients

Laura M. Cascella, MA

Providing Culturally Competent Care for LGBT Patients

Diversity is a cornerstone of American culture that is reflected in our national institutions and endeavors, including healthcare. Doctors, healthcare professionals, and staff interact on a daily basis with people of varying backgrounds. Although patient population might differ based on geographic location or type of facility, the need for culturally competent care never diminishes.

One facet of this diverse society is people in the Lesbian, Gay, Bisexual, and Transgender (LGBT) community — roughly 4 percent of the U.S. population.1 Although each component of this community is unique, the term “LGBT” often is used to describe this dynamic group as a whole and to discuss issues — such as access and barriers to healthcare — that affect various individuals within this community. (Note: To emphasize inclusivity, the initialism “LGBT” might also include other initials, such as “Q” [for queer or questioning] and “I” [for intersex].)

The Joint Commission’s (TJC’s) field guide, Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community, explains that “LGBT individuals experience disparities not only in the prevalence of certain physical and mental health concerns, but also in care due to a variety of factors, including experiences of stigma, lack of awareness, and insensitivity to their unique needs."2

TJC’s publication goes on to list other potential barriers to care that LGBT individuals might face, such as “refusals of care, delayed or substandard care, mistreatment, inequitable policies and practices, little or no inclusion in health outreach or education, and inappropriate restrictions or limits on visitation.”

In an attempt to overcome these numerous issues and align with the ideals of patient-centeredness, a number of healthcare organizations have made strides in recent years to address cultural competency for LGBT patients. ECRI Institute notes that “The end result from LGBT-inclusive approaches is not only the delivery of appropriate care but also improved patient and family satisfaction."3

As with most quality improvement initiatives, more work remains in determining and adopting best practices for providing culturally competent care to the diverse LGBT population. However, as a result of the work that has already been done, various strategies have emerged that provide a path for healthcare organizations to follow in the pursuit of this goal. Below are a number of recommendations for healthcare leaders, providers, and staff to consider:4

  • Build awareness within your organization about the LGBT community and considerations for care. For example, discuss with healthcare providers and staff the difference between sexual orientation (lesbian, gay, and bisexual) and gender identity (transgender), which might be confusing to people who are not familiar with these concepts.
  • Assess current organizational practices to identify potential gaps in policies and services related to LGBT-inclusive care. Make sure policies comply with all federal and state regulations.
  • Depending on organizational size, designate a point person, office, or advisory group to oversee LGBT-related issues.
  • Include language on your facility’s website and in its marketing materials that describes the organization’s commitment to high-quality, culturally competent, patient-centered care. Make sure that marketing, advertising, and informational materials reflect diverse populations.
  • Consider creating a webpage or portal for information and resources related to LGBT care. As part of this information, offer an easily accessible directory of LGBT-welcoming providers within the organization.
  • Make patients, providers, and staff aware of your nondiscrimination and anti-harassment policies. Post these policies in visible locations.
  • Evaluate environmental factors that might present issues for LGBT patients, such as bathroom designations, rooming policies, etc. Discuss ways to adopt approaches that will create the greatest level of comfort for all patients.
  • Review codes of conduct and ethics to ensure they include expectations for respectful, courteous communication with all patients, visitors, and staff members. Organizational policies also should specify consequences for code violations.
  • Consider revising your patient forms to include (a) an option for chosen name in addition to legal name, (b) an extra, blank box for gender, which will give patients the flexibility to identify in the way that makes them most comfortable, (c) a partnership option under relationships, and (d) general wording such as “parents/guardians” rather than “mother” and “father” to accommodate same-sex parents. 
  • Do not make assumptions about patients’ sexual orientations, gender identities, beliefs, or concerns based on physical characteristics, such as clothing, tone of voice, perceived femininity/masculinity, etc.
  • Politely ask for clarification if it is unclear what a patient would like to be called or how the patient would like to be addressed. Apologize if you mistakenly refer to a patient in a way that causes offense.
  • Do not ask patients questions about sexual orientation or gender identity that are not material to their care or treatment.
  • Do not disclose patients’ sexual orientations or gender identities to individuals who do not explicitly need the information as part of the patients’ care.
  • For inpatient facilities, review visitation policies to empower patients to decide who can visit them and act on their behalf.  
  • Provide training to healthcare providers and staff on culturally competent care and organizational policies related to conduct, ethics, privacy, and communication. Training should occur at orientation and periodically thereafter to reinforce expectations and standards.
  • Understand that sexual orientation and gender identity are just two factors that contribute to an individual’s overall identity. Other factors — such as race, ethnicity, religion, socioeconomic status, education level, income, etc. — also contribute to a person’s overall experience, his/her perceptions of healthcare, and potential barriers to care.

Providing high-quality, culturally competent, patient-centered care is a complex process that requires ongoing learning and awareness of factors affecting diverse populations. Room for improvement and knowledge-building among healthcare leaders, providers, and staff should be viewed as educational and quality improvement opportunities rather than as organizational or individual weaknesses. Even healthcare organizations that have taken leaps toward improving cultural competency for LGBT patients can find new ways to address barriers to care and engage staff in improvement initiatives.

For more information about addressing cultural competency in the care of LGBT patients, see our Risk Resources: LGBT-Inclusive Care for links to a variety of informative publications and materials.

1 Gates, G. J. (2017, January 11). In U.S., more adults identifying as LGBT. GALLUP News. Retrieved from http://news.gallup.com/poll/201731/lgbt-identification-rises.aspx

2 The Joint Commission. (2011). Advancing effective communication, cultural competence, and patient- and family-centered care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community: A field guide. Retrieved from www.jointcommission.org/lgbt/

3 ECRI Institute. (2015, October). Are LGBT-inclusive approaches for patients and staff on your radar screen? Risk Management Reporter, 34(5), 6.

4 AHIMA. (2017, March). Improved patient engagement for LGBT populations: Addressing factors related to sexual orientation/gender identity for effective health information management. Journal of AHIMA, 88(3): extended online version. Retrieved from http://bok.ahima.org/doc?oid=302067; Deutsch, M. B., ed. (2016, June). Guidelines for the primary and gender-affirming care of transgender and gender nonbinary people (2nd edition). Center of Excellence for Transgender Health, Department of Family and Community Medicine. University of California San Francisco. Retrieved from www.transhealth.ucsf.edu/guidelines; ECRI Institute. (2015, October). Are LGBT-inclusive approaches for patients and staff on your radar screen? Risk Management Reporter, 34(5), 6; Hollenbach, A. D., Eckstrand, K. L., & Dreger A., eds. (2014). Implementing curricular and institutional climate changes to improve health care for individuals who are LGBT, gender nonconforming, or born with DSD. Association of American Medical Colleges. Retrieved from www.aamc.org/download/414172/data/lgbt.pdf; The Joint Commission. (2011). Advancing effective communication, cultural competence, and patient- and family-centered care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community: A field guide. Retrieved from www.jointcommission.org/lgbt/; Transgender Law Center. (2011). 10 tips for working with transgender patients. Retrieved from https://transgenderlawcenter.org/resources/health/10tips

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