Hello from PROMO & SAGE Metro St. Louis’ LGBT Health Policy Change Project

Tracy McCreery

Manager of Public Policy, PROMO

Hi, my name is Tracy, and yes, like Scout said in his intro post, I’ve been leading an LGBT health policy change project in Missouri for the last year. It’s really been a fascinating journey, and as I get ready to end my tenure on this project (and move onto running for public office again!) I’d like to talk about some of the strategies we’ve used and the lessons we’ve learned. As you can guess, there have been a few surprises en route!

Rather than reinventing the wheel, we looked at the criteria the Human Rights Campaign (HRC) used for their Healthcare Equality Index (HEI)- a good benchmark to use for measuring policies. The HEI’s “Core Four” criteria for LGBT patient-centered care are 1. patient non-discrimination 2. equal visitation 3. employment non-discrimination and 4. training in LGBT patient-centered care.  One of the bonuses of using the HRC tool is that it has allowed for collaboration with local HRC folks. So few institutions respond, we realized one of the things we had to work on was getting more to fill out the survey. We focused on the biggest employers in the state, because the HEI looks at policies not just with consumers but with employees too.

We found a list of the 50 biggest private employers in the state, then prioritized seven of the biggest hospital systems to focus on initially. Then we started our legwork, trying to see what we could discover about their protective policies by searching online. We knew this, only one had even filled out the HEI the year before. But to our surprise, we found many more with protective policies. But frankly some of those policies existed but were not well publicized at all. You’d think if we just searched for LGBT on their website it would all come up, but that wasn’t always the case.

This led to a discussion about what were the necessary components to effective policy change. Ultimately, we all agreed — policy changes without adequate promotion aren’t real policy change at all. If a patient isn’t easily provided with the information that they have protections against discrimination, then are they really protected?

After doing this research we realized our change needed to focus on both policy adoption, and policy promotion. It seemed like getting agencies to promote policies they already had would be easy, so we tried to focus there first.

One of the challenges is finding the right person to contact at each institution who would even know the information to answer the HEI. You have to call and call and be transferred all over, it can be really challenging. The hospital that had a department focused on diversity and inclusion was the easiest, but no one else had a department like that. Overall we never found a single rule to help identify who the key person who might be in charge of adopting or promoting policies, we just called the front desk and started asking around.

Stay tuned, next post I’ll talk about our first hospital system.