For many individuals whose gender identity (man, woman, other) or expression (masculine, feminine, other) is different from their sex (male, female) assigned at birth, receiving healthcare can be an alienating experience filled with discrimination, stigma, and barriers. While gender minorities have higher rates of physical and mental health issues than the general population, a 2015 survey found that 23% of transgender adults avoided necessary healthcare because of fear of mistreatment by providers.
To address these challenges, many health organizations are working to improve their approach to gender-affirming care, which the World Health Organization defines as a range of social, psychological, behavioral, and medical interventions designed to support and affirm an individual’s gender identity when it conflicts with the gender they were assigned at birth.
At Oracle Cerner Health Conference 2022, Danny Gladden, general manager of behavioral health at Oracle Health, welcomed Rogers Behavioral Health leaders Sarah El-Ali, solution strategist for medical staff services, and Jessica Langill, equity, diversity, and inclusion coordinator, to discuss how their organization is changing its technology, processes, and culture to advance patient care for gender minorities. Here are three key takeaways from their presentation.
1. The EHR should be more inclusive.
- When gender-minority patients at Rogers reported staff members were frequently using their dead names, incorrect pronouns, or incorrect gendered terms, the Wisconsin-based, national organization knew it had to make changes to capture data on all patients more effectively. In February 2021, the Rogers team initiated a three-phase plan that includes collecting, displaying, and analyzing patient data to enhance gender-affirming care.
“We believe that all people deserve environments where they’re respected, treated with dignity, and can be their authentic selves,” Jessica said. “We have committed to continually grow and hold ourselves accountable to being an equitable, diverse, and inclusive environment for employees while offering culturally responsive and affirming care for our patients and families.”
Rogers collaborated with its lesbian, gay, bisexual, transgender, queer, intersex, and asexual employee resource group to make the language used in electronic health records more inclusive. This entailed changing the term preferred name to chosen name and legal name to given name. They also made chosen name, given name, and pronouns required fields for registration and added new options in the dropdown menu for gender identity, sex assigned at birth, and pronouns. Throughout the patient chart, they suppressed the visibility of the given name and sex assigned at birth whenever possible. The chosen name is displayed on the banner bar instead of the given name to increase visibility at the bedside.
“We’re always leading with the chosen name and pronouns to demonstrate empathy for our patients,” Sarah said. “Research has been clear that the impact of gathering and consistently using a patient’s chosen name and pronouns is likely to make a measurable impact on the patient's overall experience with your organization. It can be the first of a string of affirming behaviors a patient observes throughout the care pathway.”
2. Clinical staff needs support to improve patient care.
- Comprehensive training is crucial to help clinicians and staff members provide high-quality, equitable, and compassionate care to all patients. The team at Rogers developed and deployed education at each phase of their gender-affirming care initiative. The training included an expectations document, FAQs, role-playing complex scenarios, scripting, engaging external experts, and more.
To address the unique needs of patients without adding time to the registration process, Rogers recommends strategies such as:
- Always asking rather than assuming
- Searching for patients by last name and date of birth instead of by given first and last name to accommodate those who go by different names
- Using gender-neutral terms/pronouns until you have verified the patient’s pronouns
- Asking questions such as: What first name should we use to address you? What name should we use for billing purposes? How do you identify in terms of gender? What sex were you assigned at birth?
These strategies and training helped Rogers increase the capture of chosen names and pronouns at registration from 52.5% to 99%.
“We delivered a person-centric, synchronous training that allowed for candid discussion and questions,” Jessica said. “We had to work closely with our admissions leadership and talent development to make sure we were putting together relevant and helpful training, and we also had to get creative around scheduling and offering training times. Before our go-live date, we measured the team's self-reported confidence and competence to evaluate for readiness.”
3. Culture shifts should also happen internally.
- To make a meaningful impact in gender-affirming care, organizations should ensure clinicians and staff members are treated equitably and supported in using their chosen names. For example, Rogers modified its standard email signature to include pronouns and encourages everyone to share their pronouns when introducing themselves to peers or patients.
“Shifting culture requires education and behavior change that’s transmitted through modeling behavior, leadership support, and widespread adoption,” Sarah said. “This was all a key factor in the success of this initiative.”
Cerner Behavioral Health solutions help organizations combine real-time clinical data across each patient’s unique mental health and primary care journey. Learn more.