The Healthcare Executive's Role in Fostering Inclusion of LGBT Patients and Employees

March 2013

Statement of the Issue

Healthcare equality 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 a number of groups, including women and men who identify as lesbian, gay, bisexual and transgender (LGBT). It has also been acknowledged that members of this group may not receive equal treatment as patients nor as members of the healthcare workforce.

While it is difficult to pinpoint the exact number, an estimated 3.5 percent of adults in the United States identify as lesbian, gay or bisexual, and .3 percent of adults are transgender, equating to an LGBT population of approximately 9 million Americans.1 Survey data also indicates that many of them experience challenges in healthcare. For example, a 2010 survey by the national LGBT organization Lambda Legal found that nearly 56 percent of lesbian, gay and bisexual people and 70 percent of transgender people have experienced discrimination while accessing healthcare in the United States.2 The survey also found that substantial numbers of LGBT people believe they will receive different medical treatment because of their LGBT status: this belief was held by 29 percent of lesbian, gay and bisexual respondents and 73 percent of transgender respondents. In addition, 9 percent of lesbian, gay and bisexual people and 52 percent of transgender people believed they would actually be refused medical care because they are LGBT.

Fortunately, some landmark events have occurred in healthcare to help correct disparities and concerns like these. In 2010, President Obama issued a memorandum calling on the U.S. Department of Health and Human Services to protect the visitation rights of all Americans, including the LGBT community, and federal regulations issued in January 2011 made equal visitation a Medicare Condition of Participation.3 In March 2011, the Institute of Medicine issued a report on the state of research on LGBT health, concluding that more research and data collection are needed.4 In July of the same year, The Joint Commission began surveying LGBT-inclusive 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 LGBT patients.5

Since 2007 the Human Rights Campaign Foundation has annually administered the Healthcare Equality Index as a voluntary online survey to help healthcare facilities assess their practices related to LGBT patient care and workforce inclusion.6 In 2012, a record 407 U.S. healthcare facilities participated in the survey. While this represents a 40 percent increase over the prior year, there were still 18 states in which no healthcare facility participated. Clearly, advances have been made, but more work can be done in our community to further the care and inclusion of LGBT Americans.

Policy Position

The American College of Healthcare Executives (ACHE) 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 LGBT patient care and human resource practices. Healthcare executives (and medical providers) should create a culture that is inclusive and welcoming of the LGBT community and communicate a zero tolerance for discrimination. ACHE encourages all healthcare executives and the organizations they represent to play a significant role in addressing this issue by actively pursuing the following to the extent permitted by applicable law:

  • Establish and make public written policies to protect patients from discrimination based on sexual orientation or gender identity or expression.
  • Establish and make public written nondiscrimination policies to ensure equal patient visitation rights for same-sex couples, whether visiting one another or their minor children.
  • Broaden the definition of “family” in policies to include individuals not legally related to the patient.
  • Provide key staff with expert training on LGBT patient care.
  • Provide staff with healthcare directive compliance training that includes LGBT-specific content.
  • Allow LGBT patients the opportunity in the admitting/registration process to indicate they have a same-sex partner (state-registered or not) and/or are transgender (i.e., currently identify with a sex different from the one on their birth certificate).
  • Collect relevant LGBT 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 LGBT patient care.
  • Establish or expand policies to protect LGBT employees from discrimination based on sexual orientation or gender identity or expression, regardless of state nondiscrimination laws.
  • Equalize healthcare coverage and all other benefits for same-sex-partnered and transgender employees.
  • Encourage the formation of LGBT employee groups to support LGBT employees, provide expertise to staff and raise awareness of LGBT concerns.
  • Examine their own potential biases, conscious or unconscious, regarding sexual orientation or gender identity.
  • Explore best practices of organizations leading efforts to foster LGBT inclusion for potential use and adoption.

By embracing the above practices, healthcare executives can play a critical role in improving patient care for the LGBT community while fostering an inclusive organizational culture for all.

Approved by the Board of Governors of the American College of Healthcare Executives on March 8, 2013.


1Gates G.: How Many People Are Lesbian, Gay, Bisexual, and Transgender? The Williams Institute, UCLA School of Law, April 2011. (accessed July 29, 2012).

2When Health Care Isn’t Caring: Lambda Legal’s Survey of Discrimination Against LGBT People and People with HIV (New York: Lambda Legal, 2010). Available at

3See Medicare and Medicaid Programs: Changes to the Hospital and Critical Access Hospital Conditions of Participation to Ensure Visitation Rights for All Patients, 75 Fed. Reg. 70,831 (Nov. 19, 2010) (to be codified at 42 CFR pts. 482 and 485).

4IOM (Institute of Medicine). 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press.

5Joint Commission Resources, 2010, and The Joint Commission: Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community: A Field Guide. Oak Brook, IL, Oct. 2011.

6Delpercio A. and Snowdon S: Healthcare Equality Index 2012. Human Rights Campaign Foundation, 2012.

Related Resources

Healthcare Equality Index, Human Rights Campaign Foundation:

Gay & Lesbian Medical Association (GLMA):

American Medical Association GLBT Advisory Committee:

HHS LGBT health pages:

SAMHSA’s Top Health Issues for LGBT Populations Information & Resources Kit:

CAP Report on LGBT Health Disparities: