LGBT Policy · Show Me MO

Missouri Case Study 4: Nudging Missouri Hospitals on LGBT Welcoming Policies

Andrew Shaughnessy, Manager of Public Policy for PROMOAndrew Shaughnessy
Manager of Public Policy, PROMO
@andrewshag

Building off of the work of Tracy McCreery, former Manager of Public Policy for PROMO, my name is Andrew Shaughnessy, current Manager of Public Policy. In the last installment of our Missouri Case study, Tracy observed firsthand the difficulty in getting Missouri-based hospitals, which clearly have LGBT friendly policies, to stand up as leaders in filling out the Human Rights Campaign’s Healthcare Equality Index (HEI). Don’t worry – this still remains the case for some hospitals – but we are seeing a positive shift from many of our targeted hospitals.

Going into this year, our work centered around hospital outreach and education around LGBT welcoming policies. We were interested to see how Senior-level Hospital Executives would react to our outreach efforts for the HEI and its welcoming policy requirements. Given the prior environmental circumstances we faced, we were pleasantly surprised by the reaction we have received thus far. From what we have heard back from our first round of outreach, we know that our work is affecting positive policy change for LGBT Missourians.

Several targeted hospitals, including two network wide hospitals, which will include 14 new hospitals to our original list, have committed to improving their LGBT welcoming policies. Out of the targeted 20 hospitals that PROMO had originally reached out to regarding HEI requirements, we have made contact with, and provide technical policy assistance to six. Three Senior-level Hospital Executives disclosed to us that our outreach efforts had ‘inspired’ them to take action and update their policies.

Now whether they chose to be recognized as ‘2014 Leaders’ will be the next challenge we face, however I can sleep easier knowing that this effort is working. Sometimes all hospitals simply need is a nudge from local LGBT organizations to start the process. Andrew Shaughnessy Manager of Public Policy, PROMO

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Missouri Case Study 3: The Hospital That Wants To Stay In the Closet

Tracey PROMOTracy McCreery
Manager of Public Policy, PROMO
The Closeted Hospital Lobby
The Closeted Hospital Lobby

A targeted hospital, when we researched online, was discovered to have what appeared to be a perfect score on the Human Rights Campaign (HRC) Healthcare Equality Index (HEI). How exciting, right? Now I just needed to find someone inside to complete the survey. I didn’t know anyone on the management team, but from my days in the legislature I’d met and worked with the hospital’s lobbyist. He had some checking to do and what he reported to me was a bit shocking but maybe not really surprising, this is Missouri after all. This hospital did not want anyone to know about their policies and so were not going to complete the survey.  No explanation was given so I can only speculate. Are they worried about anti-LGBT protesters outside their hospital? Obviously, executives at the highest level think it is important to have policies that are friendly to both LGBT patients and employees. But until those policies are promoted to patients they won’t really create any change. Our job in the next year will be to convince them that the public supports workplace fairness and an LGBT patient’s right to health care free from discrimination.

People need to know this information, so why am I being mysterious?  Because I prefer the carrot (versus the stick) approach.  I will be working with this hospital to encourage them to complete the 2014 HRC HEI.  I’m hopeful they will do it willingly this year.  Why?  Because if they don’t, HRC is going to include this hospital in the HEI 2014 anyway.  HRC staff will evaluate them vis-a-vis the Core Four criteria for LGBT patient-centered care even if they choose not to actively participate.

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Missouri Case Study 2: The Nurse Who Changed A Whole Hospital System

Icon_2011 Headshot
Sherrill Wayland
ED, SAGE of Metro St. Louis
Cochran VA
John Cochran VA Medical Center

In 2011, when “Don’t Ask, Don’t Tell’ was repealed, the Veterans Health Administration (VA) looked at ways to optimize healthcare for LGBT veterans. The VA medical centers were encouraged to participate in the HEI.  In the past, SAGE has consulted with local Veterans receiving care at the VA and helped them navigate the system. We reached out to VA and invited them to be a part of our LGBT Health Access Roundtable.

Sometimes all it takes is one person to champion a cause.  The nurse in charge of the VA LGBT Diversity Council learned of the trainings being conducted by SAGE and invited us to join the VA LGBT Diversity Council.  This Council interacts with all levels of the VA to help ensure that the local VA is meeting all requirements set forth at the federal level to ensure LGBT health access.

A critical change was recognizing that LGBT patients may have concerns related to fair treatment and access. The VA created an LGBT liaison who is available to help LGBT patients navigate the system and request a new doctor if they are not comfortable with the care being received. Over the past year, the work at the VA in St. Louis has grown to include a robust offering of LGBT Health Cultural Competency Trainings provided by VA employees and SAGE. We are currently in the process of developing a schedule of trainings for SAGE to present on a monthly basis.

SAGE recognized the VA with the first SAGE excellence in community care award at our 5th Anniversary celebration.  SAGE presented them with a plaque and asked all Veterans in the audience to step forward so the VA could see those impacted by LGBT care.

2014 is shaping up to be another good year for the VA.  They’re making plans to attend their 2nd Pride Festival, continuing to identify things they can do  to be more LGBT inclusive, and are offering ongoing LGBT health trainings.

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Missouri Case Study 1: The Almost-There Hospital

Barnes-Jewish Hospital in St. Louis
Barnes-Jewish Hospital in St. Louis

Tracey PROMOTracy McCreery

Manager of Public Policy, PROMO

Barnes-Jewish Hospital (BJH) was the single Missouri entity that filled out the Human Rights Campaign (HRC) Healthcare Equality Index (HEI) the year before. But according to the HEI, they only had two protections out of 7, yet when we looked online, we could find evidence of 5 protections out of 7. But before we go further, let me explain the seven different HEI components for 2012 (they added one more in 2013).

Healthcare Equality Index from Human Rights Campaign

1a. Patient Bill of Rights and/or nondiscrimination policy includes “sexual orientation”?

1b. Ditto “gender identity”?

1c. [added in 2013] Nondiscrimination is conveyed to patients in at least two accessible ways?

2a  Explicitly inclusive visitation for same-sex couples?

2b. Ditto same-sex parents?

3a. Equal employment opportunity policy includes “sexual orientation”?

3b. Ditto “gender identity”?

4.   Provide cultural competency training?

Luckily BJH has an office on diversity, inclusion and equity- so since the new HEI survey was open, we started calling this office to see who could fill it out, and hopefully add the additional protections we found online in the mix too. The process took longer than we’d thought. We found a liaison in the office who could fill out the HEI survey, but HRC reported that they’d filled out the same responses as the year before (thanks Shane!). It took several meetings and a series of calls, and even then, the HEI deadline almost passed and they still hadn’t entered their updates. To make things even more complicated, we were looking up protections assured by their parent company, BJC HealthCare, which had a great LGBT nondiscrimination policy which initially appeared to apply to all subsidiaries… but after meeting with Barnes-Jewish Hospital — they said it did not apply. (And to make things even more complicated, now the page with the parent corporation protections has been taken down. ← were we imagining it?)

Eventually our persistence paid off and BJH filled out the survey reporting five of the now eight categories as yes. They might have been a different five than we first thought, but the point was now one hospital system in the St. Louis region was firmly establishing itself as a leader among the pack for LGBT protections!

But at the same time PROMO was working with BJH, a private hospital, SAGE was working diligently with the largest public healthcare system in the area, Cochran VA Medical Center. Read more about that journey in our next case study.