The annual HEI report, published in April, is designed to combat the discrimination and lack of competency so many LGBTQ+ patients face from healthcare providers. The first survey to examine barriers to health care for this population, conducted by Lambda Legal in 2010, found that 73% of transgender respondents and nearly 29% of bisexual, gay, and lesbian respondents believed their identity would cause them to be treated differently in healthcare.
For these patients, care from specialists who understand gender identity is a necessity.
“If you have somewhere where you feel safe to access your health care, then you’re going to be able to access [more] services,” Sergio Luna, a patient navigator for Health Center Partner’s Vista Community Clinic in Southern California, told Verywell. “That can be anything, like getting your pap smear as a trans man, which might not be easy to walk into any Planned Parenthood and get.”
What Is the HEI?
The HEI is a tool the Human Rights Campaign created in 2007 to evaluate policies and practices in LGBTQ+ health care.
This year, nearly 500 healthcare facilities reached a score of 100—the highest score possible—earning the designation of “LGBTQ+ Healthcare Equality Leader.” These facilities were scored in their stellar treatment and support of LGBTQ+ patients in their community.
Facilities listed in the index have shown willingness to comply with scored criteria, thereby demonstrating their commitment to caring for all of their patients.
“In a sense, it’s almost like getting a referral from a friend; you’re able to kind of have that validity,” Luna said, explaining why facilities want to be on the Index. “It’s like Yelp for health.”
What Does the HEI Evaluate?
The HEI ranks facilities in five scoring categories. These include LGBTQ+ Patient Services and Support, Employee Benefits and Policies, Patient and Community Engagement, Non-discrimination and Staff Training, and Responsible Citizenship.
Patient Services and Support: Criteria in this section include things like having a documented plan for reducing LGBTQ+ health inequalities, providing LGBTQ+ specific medical care, promoting that care as equally as traditional care, and providing resources from allied organizations. Employee Benefits & Policies: LGBTQ+ employees must receive equal treatment when it comes to their benefits. This means insurance and bereavement policies must provide coverage for same-sex spouses and domestic partners. Workplaces that have a diversity and inclusion office to advocate for equal treatment also help organizations rank well on the HEI. Patient and Community Engagement: There are a few different ways facilities can show that they understand the needs of their LGBTQ+ patients. These include things like staff demographics and concerns that match LGBTQ+ patients, focus groups, representation on advisory boards, and LGBTQ+ research that’s health-related. Non-discrimination and Staff Training: Top leaders in the HEI have robust non-discrimination policies in place, as well as plans for how to address discrimination as it arises. Leaders provide staff with adequate training, so that they can know what practices will best help the LGBTQ+ community. Responsible Citizenship: Responsible citizenship refers to a lack of major or minor offenses.
What a LGBTQ+ Healthcare Equality Leader Looks Like
Verywell spoke with two representatives from national facilities that scored 100 out of 100 on the HEI. They explained what changes they made across the board, and how those changes impacted their community.
Intermountain Healthcare Hospitals in Utah
Utah’s Intermountain Healthcare had 13 hospitals that scored 100 out of 100 on the HEI.
“The Health Care Equality Index is not messing around when they say they want you to do something to qualify,” Jan Stucki, MPH, equity and inclusion consultant at Intermountain Healthcare, told Verywell. “They are very rigorous.”
Still, Stucki thinks Intermountain Healthcare earned points for doing something relatively simple.
“One of the things that I think is really critical that we were able to do this year is put a list online [of] healthcare providers for LGBTQ+ folks,” Stucki said. “We also created an option within our registration system for sexual orientation and gender identity.”
During the pandemic, Intermountain also had to make website changes to clarify that COVID policies included equal visitation rights for LGBTQ+ patients, something that could easily become obscure among the many restrictions.
In the future, Intermountain Healthcare plans to introduce “equity advocates” for employees or patients with an LGBTQ+ equity concern.
“Even after getting this leader status, we are very conscious of the fact that we still have a long way to go,” Stucki said. “This is a group of individuals who have significant disparity. They should be able to get affirming care in their own neighborhoods. We should be able to offer care that people are comfortable getting.”
Stony Brook Medicine in Stony Brook, New York
Stony Brook Medicine is another facility that scored a 100 out of 100 on the HEI.
“We made changes like working with the IT folks to update the medical records to be more inclusive and affirming,” Allison Eliscu, MD, co-chair of the Stony Brook Medicine LGBTQ+ Committee, told Verywell. “I had [an instance] where we were able to update [a patient’s] name in their medical records, so that even though their legal name was still on their insurance, their chosen name was right on the top of their chart. The patient had not been to the doctor in a while, then started to go because of that interaction.”
Stony Brook also ranks well for staff training. Eliscu credits education at “every level of the staff: physicians, nurses, nutritionists, front desk staff, trainees, medical students, residents, and fellows,” which “really provides cultural competency training.”
Visual changes throughout the hospital matter, too.
“We worked with maintenance folks to have signage for bathrooms, for example, to make sure we had gender neutral restrooms throughout the hospital and the Health Science Center,” Eliscu said.
