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Amplifying LGBTQIA+ voices for improved health and care

Coauthored by Deirdre Mylod, PhD, Executive Director, Institute for Innovation, and Senior Vice President, Research & Analytics.

Fully understanding every patient’s experience is the heart of all the work we do at Press Ganey. Unfortunately, discrimination and insensitivity toward a patient because of their gender identity or sexual orientation isn’t unheard of in the healthcare sector. Recent data collected from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey reveals the real-life experiences of LGBTQIA+ patients. It shows us where experience gaps exist and can help hospital staff and administrators create a more inclusive environment for patients who identify as LGBTQIA+.

Overall differences in experience 

From our equity work related to patient race and ethnicity, we already know that different groups have different experiences. That is, the patient experience isn’t uniform. A new analysis of national data uncovers variations in how patients of different sexual orientations evaluate their care. Based on 68,000+ HCAHPS responses across organizations that capture information about sexual orientation, patients identifying as any sexual orientation other than cisgender or heterosexual are less likely to say that they would recommend the hospital. 

Patterns of different experiences by group: Sexual orientation

Those who identify as heterosexual make up most of the study, which means their differences compared to the entire group will be smaller. This is because the perspectives of the majority have the greatest impact on the overall results. It’s imperative to explore the opportunities that exist for all other sexual orientation identity groups.

Patients identifying as lesbian report many positive aspects of care but have more negative disparities related to nursing courtesy and listening. On the other hand, patients identifying as gay report more negative disparities related to care from their doctors.

Patients identifying as bisexual report even worse experiences. They’re least likely to recommend or give high rankings (9 or 10 out of 10) than gay or lesbian patients.

Patients who report their sexual orientation as "other” (i.e., not gay, lesbian, or straight) report worse-than-average experiences on all measures aside from the physician environment. The total number of respondents who select "other” is similar to the number who select the categories of lesbian or bisexual, indicating that it’s important for "other” to remain an option for self-identification.

The group of patients who did not feel comfortable reporting their sexual orientation and selected “prefer not to answer” on the survey report the lowest top-box scores across all measures—likely indicating that they don’t feel comfortable or safe enough to disclose this aspect of their identity. 

Highlighting insights about equity regarding gender expression

Our award-winning natural language processing (NLP) tool can surface verbatim equity-related comments/insights across a wide array of personal attributes (e.g., language, age, race, body size, ability, religion, neurodiversity, and gender and sex equity). This feature shows us how respecting a patient's gender expression—or not—impacts their experience. With it, you can learn about your patients’ experiences in their own words.  

Patients’ verbatim comments relating to equity can be positive or negative. Some representative insights from a national research sample include:  

Positive insights  Negative insights 
“I did appreciate that she gendered me correctly.” “Misgendering immediately after being corrected.”
“All of the staff used my correct pronouns, which was amazing.” “Your hospital needs to be better train on how to respect trans people and use pronouns.”
“And my sexual orientation and gender identity were not an issue.” “I was constantly misgendered and dead named.” 
“Respected my gender.” “There was a nurse that made me uncomfortable that misgendered me several times.”

Learning more from your communities

The University of Rochester Medical Center (URMC) has used the Patient and Family Advisory Councils (PFACs) to explore the experiences of the different communities the organization serves. They’ve made changes to their policies and practices based on feedback from this group and have provided educational tools to help staff remember best practices and demonstrate respectful language. This is just one example of how technology can be used to create similar affinity groups to seek feedback and crowdsource new ways of meeting more inclusive communicative needs. 

Every patient experience is a story worth listening to and acting on. Press Ganey makes it possible to seek deeper feedback about needed care enhancements from various identity groups, including patients in the LGBQTIA+ community. Join the Press Ganey Equity Partnership to discover best practices around capturing information about patients’ sexual orientation and gender identity and unlock additional resources to help combat health disparities. Technologies like NLP can push your research even further, by using AI and machine learning to uncover actionable insights from patient feedback.

Communication is key when it comes to the healthcare of all patients. But it’s important to ensure hospital staff and administration are more mindful of inclusivity when it comes to groups that often feel unheard. Taking steps like becoming more well-versed in LGBTQIA+ knowledge, using gender-neutral terminology during visits, and leading with compassion and empathy will help you foster a more welcoming environment. Beyond Pride Month, make it your goal to listen to and respectfully care for members in the LGBTQIA+ community.

To see how Press Ganey can help you collect, segment, and understand your data to consistently create positive, high-quality patient experiences for all, reach out to a member of our PX team, and we’ll be in touch.  

About the author

As Chief Nursing Officer, Jeff leads Press Ganey’s focus on improving patient and caregiver experience and developing nursing leadership at healthcare organizations nationwide. He also plays an integral role in the company’s workforce initiatives, including Press Ganey’s Workforce Well-Being Collaborative, which focuses on supporting caregivers as they deal with the ongoing challenges of the pandemic. Prior to joining Press Ganey, Jeff served in various chief nursing officer roles at both community-based organizations and major academic medical centers throughout the US. In addition, he was the inaugural Vice President of the Magnet Recognition and Pathway to Excellence programs at the American Nurses Credentialing Center.

Profile Photo of Dr. Jeff Doucette, DNP, RN, NEA-BC, FACHE, FAAN