Few people understand the misconceptions, stigmas, and discrimination experienced by people who identify as lesbian, gay, bisexual, transgender, queer or questioning, intersex, or asexual/agender/aromantic (LGBTQIA+). And the reality is that those biases often are seen in their health care.
The National LGBT Cancer Network says that’s why many LGBTQIA+ individuals delay or avoid essential screenings and care. When they do, their health and well-being can be at risk.
To address this issue, frontline caregivers and hospital employees at UPMC Passavant are working with hospital leaders to ensure high quality, gender-inclusive care for members of the LGBTQIA+ community.
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Striving to Inspire Change
“Throughout UPMC and here at UPMC Passavant, there’s been a growing awareness that we need to confront this issue,” says Lisa Bryan-Morris, MSN, RN, NEA-BC, chief nursing officer and vice president of patient care services. “As a hospital, we’re proud of our reputation as a welcoming place for all patients. That’s why we want to better serve our LGBTQIA+ patients. We’re committed to eliminating both visible and invisible barriers to their care.”
Key to those efforts is the work of the all-volunteer UPMC Passavant Inclusion Employee Resource Group (IERG) created in 2020.
“To change our culture of care, we had to start by looking at our own personal understanding of the LGBTQIA+ community,” says Rebecca Kolb, MSN, RN-BC, a nurse educator and the group’s co-chair. “The IERG is a safe space where all caregivers at UPMC Passavant can engage in open and honest dialogue about this and other equity and inclusion issues affecting our patient care.”
The IERG represents both UPMC Passavant–McCandless and UPMC Passavant–Cranberry. Members include doctors, nurses, technicians, and staff from a wide range of departments. Bryan-Morris and Jacquelyn Demianczyk, human resources director, act as the hospitals’ executive sponsors with the support of UPMC Passavant President Susan Hoolahan, RN, MSN, NEA-BC.
“As a hospital, we know that it’s important to acknowledge mistakes have been made in order to do better in the future. No one should ever feel uncomfortable, embarrassed, or upset about the care they receive,” says Bryan-Morris.
“Working with this group has taught me a great deal about health care inequality and LGBTQIA+ care,” says co-chair Mpande Mwape, MSN, RN, MEDSURG-BC, a unit director at the hospital. “As a person of color, I appreciate those challenges. That drives me to be an advocate for improvement. It’s a journey, but we are making steady progress.”
Putting Words into Action
The IERG has identified four steps necessary to promote a more welcoming and inclusive culture for LGBTQIA+ patients.
Staff Education and Training
Staff training is the foundation of all gender-inclusion efforts at UPMC Passavant. Joy Gero, PsyD, LPC, director of population health and improvement for the Wolff Center at UPMC, has led several sessions for the hospital’s employees.
“Our office is working to address the health disparities faced by LGBTQIA+ patients at UPMC systemwide. And the real work is happening in hospitals like UPMC Passavant. It takes dedicated people at every touch point of care — from the admissions desk to the bedside — for these efforts to succeed,” says Gero. “It’s our collective responsibility as health care providers to create a better patient experience for those who identify as LGBTQIA+. We do that through added services, training, and ongoing conversations. The goal is to continually improve the quality of care, safety, and clinical outcomes for our patients.”
Working with LGBTQIA+ patients also involves a shift in the care model used by many health care providers. “We’re all taught protocols based around the sex assigned at birth,” says Gero. “Those traditional assumptions that often guide initial care can’t be applied to every patient.”
The UPMC Center for Engagement and Inclusion provides interactive microaggression training focused on the slights, insults, and prejudices typically encountered by LGBTQIA+ patients.
“When a microaggression happens, people don’t know what to do or say,” says Kolb. “In this training, we learned practical tactics to defuse a microaggression and, hopefully, help microaggressors learn the impact of their words or actions.”
“The most helpful tactic that I learned is to not be reactive,” adds Mwape. “Microaggressions are often unintentional, but they’re still hurtful. This training created an opportunity to change unconscious bias behaviors and to learn from each other.”
Surgical and post-acute care staff at UPMC Passavant–Cranberry who assist on gender-affirmation surgeries receive added in-depth training. And all staff have access to a training session on health disparities led by Tracey Conti, MD, chair of family medicine at the University of Pittsburgh School of Medicine.
Electronic Health Records
UPMC’s electronic health records (EHR) now collect sexual orientation and gender identity information, which includes a person’s chosen name and personal pronouns. “This step supports better patient-centered care for everyone,” says Bryan-Morris.
“Calling an LGBTQIA+ patient by their chosen name and personal pronouns is a real indicator of our support,” says Gero. “It eliminates the stress of repeatedly sharing that information at every health care interaction. It also opens the door to a more trusting patient/provider relationship.”
Visible Expressions of Support
Last year, the rainbow flag — a colorful symbol of gay pride and support — flew for the first time at both UPMC Passavant campuses, thanks to the IERG’s efforts.
Hospital staff members also can elect to display a gay pride pin attached to their employee ID badge. “The idea was suggested by the IERG and actually designed by my co-chair, Mpande,” says Kolb.
Signs at both hospital entrances explain the significance of this symbol. “We want everyone to know that this a place where kindness and respect are expected from all — and for all — who enter our doors,” says Mwape.
Expanded LGBTQIA+ Clinical Services
A major new initiative at UPMC Passavant addresses the region’s growing need for gender-affirming surgery. In August 2021, reconstructive plastic surgeon Brodie Parent, MD, began offering facial feminization surgery at UPMC Passavant–McCandless and outpatient top surgery at UPMC Passavant–Cranberry for transgender and gender-diverse patients, with follow-up care at UPMC Passavant–McCandless.
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