In January 2010, the Joint Commission, funded by the California Endowment, held a meeting of an expert advisory board to determine strategies that would improve the health care quality of the LGBT community. The result was the article "Advancing Effective Communication, Cultural Competence, and Patient-and-Family-Centered Care for the Lesbian, Gay, Bisexual, and Transgender ( LGBT ) Community," an extensive field guide for hospitals.
As the Center for American Progress noted, "Reduced access to employer-provided health insurance, the social stigma that exists against LGBT people, and a lack of cultural competence in the health care system" has created health disparities for the LGBT community. The Joint Commission field guide lists inadequate care, inappropriate restrictions on visitation, little or no inclusion in health outreach and education, lower overall health status, higher rates of smoking, alcohol, and substance abuse, higher risk of mental illnesses such as anxiety and depression, higher rates of STDs, and increased incidence of some cancers as a few such health disparities. The field guide also notes that the specific needs of LGBT individuals are generally overlooked by the health care system.
The field guide provides specific strategies to incorporate LGBT rights into each of five key areas. It notes that "leaders set the tone for a culture that is inclusive and welcoming, a culture that promotes patient-centered care, and a culture that demonstrates equitable treatment of all patients and staff." The guide recommends that medical centers use a non-discrimination policy and an equal visitation policy; offer patients the choice of any support person; and maintain a broad definition of family as well as monitor the effectiveness of organizational efforts to improve care, provide mechanisms for reporting discrimination, implement disciplinary practices for discrimination, designate a responsible person to be accountable for promoting inclusivity, institute a high level advisory board and support staff who are particularly inclusive.
The field guide also states, "for an organization to be ready to meet patients' needs, processes must be in place to effectively communicate with patients and to provide care that is responsive to their unique needs." It advises that medical centers prominently post the non-discrimination policy or patient bill of rights, reflect LGBT patients in the waiting rooms, provide unisex bathrooms, establish equal visitation policies, and support and nurture all families as well as refrain from assumptions based on appearance, remain aware of misconceptions, biases, and stereotypes, and recognize that self-identification and behavior do not always align. It also advises that medical centers honor the individual's decision to provide information, use gender-neutral language, and listen to the patient's choice of language as well as become familiar with resources and constantly seek out new information.
As the field guide notes "a hospital's ability to provide equitable, competent, and welcoming care to all patients rests squarely on its workforce." It recommends that medical centers protect staff from discrimination and equalize health coverage and other hospital benefits as well as use inclusive language in job notices, recruit from LGBT community events, include equitable policies in recruiting materials, and train human resource employees to non-discrimination policies.
It also recommends that medical centers include LGBT issues in all employee training, offer LGBT training to key audiences such as managers, the legal department, and improvement staff, distribute information on LGBT issues to all employees, and develop a plan to address the needs of transgender employees. Finally, it recommends that medical centers vary methods used to provide training and update training regularly as well as develop an LGBT resource group, provide LGBT forums, and commemorate LGBT events.
"I see this as a hugely important step ... it is the first step in holding health care centers accountable [ for providing better care ] " said Dr. Rob Garofalo, director of adolscent HIV services at Chicago's Children's Memorial Hospital and a member of the expert advisory board, to Windy City Times. He also noted that the greater community might benefit from the better care of the LGBT individuals within their towns.
There is still a great deal of work to be done in improving the health of LGBT individuals. The field guide notes, " [ health care ] inequalities may be even more pronounced for LGBT people from racial/ethnic minorities or due to other characteristics such as education level, income, geographic location, language, immigration status, and cultural beliefs." As Garofalo told Windy City Times, strategies that will improve the health care of these specific groups are yet to be researched.
