Approved by the Board of Governors Dec. 5, 2023
Statement of the Issue
Healthcare equity for all people is a guiding principle of the healthcare management profession. Yet, recognition exists in the field that further effort is needed to bring this principle closer to reality for groups that face disparities in health and for all individuals who identify as lesbian, gay, bisexual, transgender, queer and others (LGBTQ+).
While it is difficult to pinpoint the exact number, an estimated 7.2 percent of adults—about 20 million—in the United States identify as LGBTQ+. Survey data indicates that many of them experience challenges in healthcare. For example, the most recent and still seminal 2010 survey by the national LGBTQ+ organization Lambda Legal found nearly 56% of lesbian, gay and bisexual people and 70% of transgender people have experienced discrimination while accessing healthcare in the United States. The survey also found that substantial numbers of LGBTQ+ people believe they will receive different medical treatment because of their LGBTQ+ identity; this belief was held by 29% of lesbian, gay and bisexual respondents and 73% of transgender respondents. In addition, 9% of lesbian, gay and bisexual people and 52% of transgender people believed they would actually be refused medical care because they are LGBTQ+. Transgender patients are particularly vulnerable in healthcare settings. In a 2015 survey of more than 27,000 transgender Americans, 33% of respondents who had seen a provider in the past year reported one or more negative experiences due to their transgender or gender nonconforming status.
Fortunately, some landmark and still seminal events have occurred in healthcare to help correct disparities and concerns like these. Federal regulations issued in January 2011 made equal visitation a Medicare Condition of Participation. In July of the same year, The Joint Commission began surveying LGBTQ+-inclusive patient nondiscrimination policies as conditions of accreditation. In addition to revising its standards, The Joint Commission produced an LGBT Field Guide to promote healthcare equality and support healthcare organizations in their efforts to care for LGBTQ+ patients.
More than 900 U.S. healthcare facilities participated in the Human Rights Campaign Foundation’s 2022 Healthcare Equality Index, an annual online survey to help healthcare facilities assess their practices related to LGBTQ+ patient care and workforce inclusion. While this is a 79% increase since 2014, it is only a fraction of the healthcare facilities in the United States. Clearly, advances have been made, but more work can be done in our community to further the care and inclusion of LGBTQ+ Americans.
Policy Position
The American College of Healthcare Executives believes all people have a right to equity of care. To this end, ACHE calls on healthcare executives to strengthen their commitment and lead their organizations in addressing imbalances with regard to LGBTQ+ patient care and human resource practices. Healthcare executives (and all staff along the entire care continuum) should create a culture that is inclusive and welcoming of the LGBTQ+ community and communicate zero tolerance for discrimination. ACHE encourages all healthcare executives and the organizations they represent to play a significant role in addressing this issue by pursuing plans to do the following:
- Establish and make public written policies to protect patients from discrimination based on sexual orientation and gender identity or expression.
- Establish and make public written policies to ensure equal patient visitation rights for same-sex couples, regardless of marital status, whether visiting one another or their minor children.
- Broaden the definition of “family” in policies to include individuals not legally related to the patient.
- Adopt written policies and procedures aimed at eliminating bias and insensitivity; ensuring appropriate, welcoming interactions with transgender patients; and training staff on these policies and procedures.
- Provide staff with expert training on LGBTQ+ patient care.
- Provide staff with healthcare directive compliance training that includes LGBTQ+ -specific content.
- Collect sexual orientation and gender identity data in electronic health records.
- Collect relevant LGBTQ+ data through patient surveys and community health needs assessments and incorporate the data in relevant decision making.
- Monitor, measure and report the organization’s efforts to enhance LGBTQ+ patient care.
- Establish or expand policies to protect LGBTQ+ employees from discrimination based on sexual orientation and gender identity or expression, regardless of state nondiscrimination laws. Consider applying the same protection to contractors.
- Consider adding employee health insurance coverage benefits that explicitly include coverage for services related to gender transition.
- Encourage the formation of LGBTQ+ employee groups to support LGBTQ+ employees, provide expertise to staff and raise awareness of LGBTQ+ concerns.
- Examine their own potential biases, conscious or unconscious, regarding sexual orientation and gender identity.
- Explore best practices of organizations leading efforts to foster LGBTQ+ inclusion for potential use and adoption.
By embracing the above practices, healthcare executives can play a critical role in improving patient care for the LGBTQ+ community while fostering an inclusive organizational culture for all.
Policy created: March 2013
Policy updated: December 2023