By Christina Cordero, Project Director, Healthcare Standards Development and Brette Tschurtz, Associate Director, Department of Research
We’ve been involved in healthcare equity initiatives at The Joint Commission for decades, and inclusion of the LGBTQ+ population has always been a part of this work. While it seems hard to believe now, less than 20 years ago sexual orientation and gender identity were often overlooked in the provision of safe patient care. However, it has been exciting to see how healthcare organizations have increased their focus on the needs of LGBTQ+ patients over the years, and it is now woven into the fabric of care delivery. We should celebrate this evolution, especially during our Pride month festivities, but we still have work to do. Healthcare disparities unfortunately still exist for LGBTQ+ patients, and The Joint Commission remains committed to do our part to ensure equitable care for all.
In light of Pride month and the introduction of our new and revised accreditation standards to reduce healthcare disparities —effective January 1, 2023—we wanted to take a look back at the work The Joint Commission has done to promote healthcare equity for the LGBTQ+ community.
Nondiscrimination Standard & Field Guide
The Joint Commission began researching healthcare equity issues and looking more closely at how they were addressed in our requirements in 2003. Over the course of several initiatives, we compared our accreditation standards to the Office of Minority Health’s National Standards for Culturally and Linguistically Appropriate Services (CLAS) to identify gaps and develop accreditation standards and resource documents addressing the provision of safe, effective, culturally competent and patient-centered care, including:
- In 2011, we implemented a requirement to prohibit discrimination based on a variety of patient characteristics, including sexual orientation and gender identity or expression (Standard RI.01.01.01, Element of Performance [EP] 29).
- We released standards and resources focused on improving patient-provider communication which apply to all patients (e.g., The Roadmap -– 2010).
- Our LGBT Field Guide was designed to provide a deeper dive into the specific concerns facing the LGBTQ+ community . Of note, as the Field Guide was published in 2011, some of the laws and regulations cited and terminology and definitions used in the guide may be out of date. However, many of the basic tenets and recommendations of the document remain relevant and support our vision that “all people always experience the safest, highest quality, best-value healthcare across all settings.”
Patient Visitation & Support Individuals
Ensuring that ALL patients have access to a support individual and are aware of their visitation rights became a prominent issue for LGBTQ+ patients and families. The Joint Commission, along with many governmental and regulatory bodies, responded by developing new requirements for hospitals to modify their policies and practices to be more inclusive of LGBTQ+ patients and families.
Standard RI.01.01.01, EP 28 states: The hospital allows a family member, friend or other individual to be present with the patient for emotional support during the course of stay. Additional notes further clarify that the support individual:
- Be chosen by the patient (unless the individual’s presence infringes on others’ rights or safety, or is medically or therapeutically contraindicated)
- May or may not be the patient’s surrogate decision maker or legally authorized representative
Visitation rights were further explained in Notes added to EP 1 (written policies on patient rights) and EP 2 (informing patients of their rights). Per the Notes, hospitals that use accreditation for deemed status purposes need to:
- Have written polices to address procedures regarding patient visitation rights, including any clinically necessary or reasonable restrictions or limitations.
- Inform the patient (or support person, where appropriate) of visitation rights. Visitation rights include the right to receive the visitors designated by the patient, including, but not limited to, a spouse, domestic partner (including a same-sex domestic partner), another family member or friend. Also included is the right to withdraw or deny such consent at any time.
Leadership & Workforce Issues
The Joint Commission’s Field Guide includes recommendations for leadership and staff to advance LGBTQ+ rights in healthcare organizations. Recommended practices include:
- Integrate unique LGBTQ+ patient needs into new policies or modify existing policies
- Review nondiscrimination and visitation policies, revise the definition of family
- Demonstrate ongoing commitment to inclusivity for LGBQT+ patients and families
- Develop a mechanism for reporting discrimination or disrespectful treatment
Beyond patient care, the needs of the LGBTQ+ employees and workforce should be addressed. The Field Guide recommends:
- Equitable treatment and inclusion for LGBTQ+ employees
- Demonstrated commitment to LGBTQ+ equity and inclusion in recruitment and hiring
- Staff education on LGBTQ+ employee concerns
- Incorporation of LGBTQ+ patient care information in staff training
- Support for staff development initiatives
While many positive changes have been made, there are still many challenges to addressing the healthcare needs of the LGBTQ+ community. We recently developed a Case Study on Transgender Health Inequity to provide helpful strategies and resources for our accredited organizations, and we are excited about the release of our new standards to address healthcare disparities as a quality and safety priority (see link above). We want to partner with you moving forward In 2022 and beyond: How can we continue to improve care for LGBTQ+ patients?
Christina Cordero, PhD, MPH, is a Project Director in the Department of Standards and Survey Methods, Division of Healthcare Quality Evaluation, at The Joint Commission. She leads the development of new standards addressing health care equity and has supported past initiatives on patient-centered communication.
Brette Tschurtz, MPH, is an Associate Director in the Department of Research in The Joint Commission’s Division of Healthcare Quality Evaluation.