On May 25, the New York City Health and Hospitals Corporation (HHC) became the first public healthcare system in the nation to mandate LGBT cultural competency training for all staff members.
All 38,000 employees of the HHC will now be required to participate in a training program called Reexamining LGBT Healthcare. The program was developed to begin to address recent reports that have indicated substantial disparities in healthcare for LGBT people as well as to take action on recommendations made by the Institute of Medicine and the U.S. Department of Health and Human Services.
"The New York City Health and Hospitals Corporation stands ready to respond to the diverse needs of lesbian, gay, bisexual and transgender patients under our care and lead our colleagues across the country in cultural competency," said HHC President Alan D. Aviles in the press release distributed by the HHC. "With this training, we reaffirm our commitment to serve LGBT New Yorkers—and all of our patients—in the most respectful and responsive way, while we provide safe, quality healthcare."
The National LGBT Cancer Network worked with HHC to create a 15 minute and 60 minute curriculum. Both of which are anchored by a powerful video piece titled, "To Treat Me, You Have to Know Who I Am."
"This is everybody and that's the only way change is going to happen, when our people can walk into a health facility and know that every single individual they meet, starting with the very first person, will have some training in how to respectfully welcome LGBT patients into their facility," said Liz Margolies, founder and executive director of the National LGBT Cancer Network.
The 15-minute curriculum addresses three key points: the importance of knowing who LGBT patients are, making sure that healthcare professionals do not assume heterosexuality of their patients and understanding that it is okay to feel awkward and even make a mistake in adopting a new approach.
The most important point, Margolies said, is to realize that there is a mistake in thinking "I treat everyone the same." Instead, she said that hospital staff needs to follow a policy of "treating everyone the way he or she wants to be treated."
"The default assumption, the 'I treat all people the same,' ultimately comes down to I treat everybody like they are heterosexual and that's not okay," said Margolies. "When I treat everybody the same means I allow for a broad range of gender and sexual expression and relationship forms then it's fine to treat everyone the same, but that's not what that means today."
The 60-minute curriculum, which is not mandatory, delves deeper into disparities experienced by LGBT people as well as individual and system wide changes that can be made to increase cultural competency in the healthcare environment.
Margolies hoped that other hospital systems will follow HHC's lead and adopt the LGBT cultural competency program that her organization has developed.
There are many indications that HHC will not be the only hospital to take action on the recommendations for decreasing disparities in healthcare for LGBT people. Recently, the Joint Commission, the largest organization that accredits hospitals in the country, announced that to earn accreditation a hospital is required to have a non-discrimination policy for LGBT people. President Obama's executive order on hospital visitation is also changing the landscape of patient and family rights in the healthcare environment.
The Cook County Health and Hospitals System, which employs more than 6,000 people, does do some LGBT competency training, but acknowledges it is not system wide. Sonja Vogel, public affairs for the J.H. Stroger, Jr. Hospital of Cook County, said that she expects to see LGBT competency training increase as the organization has recently hired a new director of Multicultural Affairs, Miriam Gonzalzles, who is planning on developing LGBT competency training on a broader level. Gonzalzles will most likely work with the Ruth Rothstein CORE Center, the HIV and infectious disease center, to develop the training.
"The Ruth Rothstein CORE Center already do a lot of outreach with the LGBT community," said Vogel.
Joann Montes, customer community relations coordinator for the CORE Center, explained, "In the past we've had some training on cultural sensitivity around LGBT issues. These were delivered by the ACLU and Center on Halsted addressing access to care for the LGBT community. It was open to all staff but targeted our nursing staff."
The organization is in discussion with the Center on Halstead about enhancing their training program: "In conjunction with our Consumer Advisory Board, we will be assessing our cultural sensitivity and competency with assistance from the Center on Halsted and offering more training as needed. Because we are in the planning stages of this project, we are still to decide whether we will be making this voluntary or mandatory to all staff."
In addition, the Chicago Department of Public Health is also working to fill a vacant director position for their LGBT Office of Health. Jose Munoz, deputy commissioner for community affairs of the Chicago Department of Public Health, said, "It is a priority of the commissioners [Dr. Bechara Choucair] to get the position filled."
The LGBT Office of Health does community engagement as well as trainings upon request both internally and with providers. In the past they have worked with universities, particularly with first year medical students, with clinics and health systems. Munoz said that the office is also involved with the Chicago Trans Coalition and works closely with Howard Brown.
Following the announcement by the HHC, Margolies and Scout, Ph.D, director of the Network for LGBT Health Equity, conducted a successful webinar titled "LGBT Cultural Competency Strategies" for members of the Institute for Diversity in Health Management. Scout said he was impressed with the number of participants from the Department of Health in Illinois; thirty people were on the call from that office.
He said about the HHC mandate, "It's not business as usual for the healthcare system. They are finally catching up with the 21st Century."
Scout also noted how little choice LGBT people often have in an emergency situation in deciding where to go for treatment. It is imperative to an LGBT individual's health that he or she is treated with respect every step of the way or there is a greater chance that in the future that person will not participate in his or her follow up care or will avoid seeking treatment for a future illness or emergency.
In order to really see change occur a cultural shift is necessary. HHC's decision to mandate LGBT competency training is an important step in the process. It opens the door for many patients to feel comfortable in disclosing their full health information and to speak openly with their doctor about their needs.
"It's not about sensitivity. It's about respect. It's about humanitarian response to a human being in general," Levern Jackson, family nurse practitioner, says in the video.
