Staff at the two community hospitals in the El Camino Health system strive to help all patients heal, relieve suffering and advance wellness.
The emphasis is on “all” patients, with the goal to be inclusive and respectful of everyone seeking healthcare, said Patricia DeMellopine, MSN, RN, CNS, nursing educator in Mental Health and Addiction Services at El Camino Health in Mountain View, Calif. DeMellopine spoke last year at the American Nurses Credentialing Center National Magnet Conference about how El Camino became a leader in LGBTQ healthcare equality.
El Camino hospitals in Mountain View and in Los Gatos, Calif., have achieved the Human Rights Campaign Healthcare Equality Index LGBTQ Healthcare Equality Leader designation since 2016. That means each year the hospitals achieved a score of 100 in adopting LGBTQ-inclusive policies and practices. While 406 U.S. healthcare organizations with 100 or more employees achieved the leadership designation in 2019 and 81 of those were in California, no facilities in Idaho, Wyoming or Montana have the designation. Many states have only one or two facilities with the HEI leadership designation.
“We want to support our community so they know they can use us as a resource and trust us with care,” DeMellopine said. “Some populations may not access care. They may not feel welcomed. They might not feel someone will be compassionate toward them.”
One of those populations is the LGBTQ community. Reports from Healthy People 2020 and Institute of Medicine note glaring disparities in LGBTQ healthcare (often referred to as LGBT) community. Among those: LGBT youth are two to three times more likely to attempt suicide; men who have sex with other men account for 64% of newly diagnosed HIV cases; isolation, a shortage of social services and a lack of culturally competent providers are barriers for elderly LGBT people who might otherwise seek healthcare; and people in the LGBT community have the highest rates of tobacco, alcohol and drug use.
El Camino’s LGBTQ healthcare journey
El Camino employees formed a committee in 2015 charged with looking at the issue of how to provide equitable care to the LGBTQ community. “That committee quickly developed a charter membership that was available to all staff and employees, with voluntary attendance,” she said.
DeMellopine, who is on the committee, and colleagues started by setting out to meet HEI criteria that address nondiscrimination and staff training, patient services support, employee benefits and policies, and patient and community engagement. Using the criteria as their framework, they began looking at how the hospitals perform and where they need to make improvements.
“We don’t have a specific service line, so we’re not doing this because we’re trying to start a service line for gender-affirming surgeries or a special clinic that’s separate from everything else.” DeMellopine said. “This is all integration for us.”
The process starts with awareness about how even seemingly small biases can undermine equitable care. “Once you have awareness, then the opportunities start showing up,” she said.
One of the first changes the hospital made was on the name bands staff give parents in the maternal-child health area. The bands used to say “mother” or “father.” But those descriptions don’t fit in many cases, including if the parents are two males or females. Today’s band merely says, “parent.”
Another issue that came to the forefront: bathroom signage. El Camino has changed the signage for all single-use bathrooms to male/female, meaning any gender can use the bathroom. “Many of these things are just reflecting changing times and cultural norms that could be done regardless of the LGBTQ population,” said DeMellopine.
To create employee awareness, El Camino did staff training on transgender health and other LGBTQ topics and promoted training opportunities system-wide. One of those training opportunities is through the National LGBT Health Education Center, which offers free education, according to DeMellopine.
The training starts when nurses are in the health system’s new graduate nurse program and includes a presentation about how El Camino respects all persons and speaks appropriately to people.
Speaking appropriately is integral to equitable LGBTQ healthcare. Not only nurses but also other providers and registration staff should learn how to better address patients about sexual orientation using “sexual orientation or gender identity,” or SOGI, questioning. An example of SOGI questioning is: “Do you think of yourself as: lesbian, gay, homosexual, straight or heterosexual, bisexual, something else or don’t know?”
In educational materials aimed at helping nurses and other providers address implicit bias towards LGBTQ patients, the National LGBT Health Education Center offers this case scenario:
“A patient Aarya arrives for her urgent care appointment and appreciates when the front desk person asks for the name Aarya goes by and her pronouns. In this case, it was “Aarya,” and “she/ her/hers.” Aarya is later disappointed when the nurse practitioner asks if she “has a boyfriend,” while taking a sexual health history. The NP’s question makes the assumption that Aarya dates men and has one partner. In reality, Aarya has multiple partners, including women and men.”
The NP’s implicit bias could make Aarya feel the NP might judge her when she shares her sexual history. The NP should have asked Aarya if she is sexually active, and if so, to describe her partners. That way, the NP gives Aarya an opening to disclose that she has multiple partners of different genders. Once the conversation is started, the NP could ask Aarya to describe the types of sexual activities she engages in with her partners, in order to make recommend appropriate and needed screening tests, according to the case scenario.
As part of LGBTQ healthcare initiatives, administrative staff at El Camino also ask patients their preferred names and to note those names in the chart. They’ll say something like this: “It’s important to treat you with courtesy and respect. Do you have a preferred name that’s different from your legal name?” according to DeMellopine.
“If someone who appears to you outwardly to be a female says yes my name is Patty or someone that appears to be male says yes I prefer Patty, that’s what you’re going to put down,” she said.
A lot of the change is a result of employee input. “We have many people who self-identify as LGBTQ,” DeMellopine said. “We also have many employees who self-identify as advocates and allies or family member of someone who is LGBTQ. One of our employees delivered a child here with her female partner and they’re the ones that brought the identification band issue to us.”
Part of the process has been to examine corporate policies to make sure the terminology is correct as far as referring to staff by not just he or she, but rather as a person. The health system’s benefits include healthcare coverage for staff who are seeking gender affirming surgery.
El Camino has reached out to the LGBTQ community, including by participating at the local Pride Festival. “We had a booth to recruit employees and we had banners showing that we’re a welcoming and inclusive employer,” DeMellopine said.
Where to start?
There is help for healthcare facilities that want to provide equitable and inclusive care to LGBTQ healthcare patients and families through the Human Rights Campaign Healthcare Equality Index. Facilities can use what HEI has to offer as a guideline and customize the implementation for their facilities, according to DeMellopine.
The initiative should be aimed at creating awareness, coordinating efforts and achieving buy-in from healthcare decision makers, administration and staff alike.
“Some organizations have a committee and they get together and it’s gangbusters but then it wanes, so I think having a strong structured committee is important,” she said. “We meet monthly. The meetings have agendas. People are paid for their attendance. We have a charter and a purpose statement, and we’re supported by administration. That goes a long way for sustainability.”
Take these courses to learn more about caring for the LGBTQ community:
The Lesbian, Gay, Bisexual, Transgender, and Queer Community, Part 1
(1.5 contact hrs)
Barriers to the advancement of knowledge about sex differences in health and illness persist. This module presents an overview of the LGBTQ community and its contentious history with the healthcare systems. Definitions of key concepts related to sexuality and gender variables and general implications for clinical education, practice, and research will be discussed.
The Lesbian, Gay, Bisexual, Transgender, and Queer Community, Part 2
(2 contact hrs)
The Health and Medicine Division’s Healthy People 2020 and the Agency for Healthcare Research and Quality have highlighted the health disparities affecting LGBTQ populations. Information will be analyzed based on the four conceptual perspectives for understanding LGBTQ health suggested by the HMD: minority stress, intersectionality, life-course framework, and social ecology.
Clinical Management of HIV in Adults in the ERA of Highly Active Antiretroviral Therapy
(1 contact hr)
Newer drugs with fewer adverse effects and more convenient dosing schedules have enabled even more patients to participate in and adhere to these more effective regimens. New combinations of effective therapies, however, contribute to the clinician’s arduous task of prescribing antiretroviral medications and educating patients about these therapies. This module provides information about HIV infection and treatment.