The HEI Resource Guide is a comprehensive instructional and reference accompaniment to the Healthcare Equality Index (HEI) Survey. The HEI Resource Guide covers all of the sections of the HEI survey in great detail, providing explanations of why these policies and practices we ask about are important, example policies, links to outside resources, and more.
Here are some resources that have been curated by the HEI team to help guide your organization in LGBTQ+ patient-centered care. We hope they can help you get started on implementing best practices in equitable and inclusive care for LGBTQ+ patients. The HEI Resource Guide is also designed to help facilities better understand what is required to receive credit for each question as part of the HEI scoring criteria.
We hope you find the HEI Resource Guide helpful in taking steps to ensure equitable and inclusive treatment for LGBTQ+ patients, families and employees at your facility. If you have any further questions about the HEI, please do not hesitate to contact our team at hei@hrc.org.
The HEI 2026 implements four core objectives which are reflected in its criteria:
The questions in this criterion reflect the previous "Core Four" Leader criteria. All questions in this section are scored (5 points each, for a total of 40 points) and must be met in order to attain any tier of recognition.
The questions in this criterion all relate to best practices in the provision of LGBTQ+ Patient Services and Support. Four subsections comprise this criteria: LGBTQ+ Patient Services and Support; Gender Affirming Services and Support; Medical Decision Making; and Patient Identification and Data Collection. These criteria subsections are divided into two scoring sections for Criteria 2.
Scoring Section One consists of the first three subsections which are scored together for a maximum value of 20 points. Scoring Section Two is the last subsection, Patient Identification and Data Collection which is scored separately for a maximum value of 10 points. These two scores are combined for a maximum total of 30 points for Criteria 2.
The questions in this criterion all relate to best practices in the policies and benefits that most impact LGBTQ+ employees.
Similar to Criteria 2, there are two scoring sections in Criteria 3. The first scoring section consists of the two subsections of Equal Benefits and Additional Support for LGBTQ+ Employees.
Each subsection in this criterion is scored separately and then combined for a total value of up to 20 points for Criteria 3. The first subsection consists of 19 scored questions and a facility may either receive full or partial credit depending upon the number of initiatives a facility has in place. The second subsection’s score is dependent upon the provision of transgender healthcare benefits for employees at the facility. This practice, alone, is worth 5 points.
The questions in this criterion all relate to how a facility engages with their LGBTQ+ patients and the larger LGBTQ+ community. A maximum of 10 points are available for this section.
There are 13 scored questions in this section. To receive the full 10 points, your facility must have at least 5 of these best practices in place. Facilities with 2 to 4 of these best practices in place will receive a partial score of 5 for this criterion.
The HEI is a biennial online survey. Created in 2007, the HEI has been designed to meet the needs of all healthcare organizations seeking to provide optimal care to LGBTQ+ patients and to meet CMS and Joint Commission requirements related to this underserved population.
The HEI scoring criteria rates hospitals and healthcare facilities on policies and best practices in LGBTQ+ patient centered care in four key areas: Non-discrimination and staff training; Patient services and support; Employee benefits and policies; and Patient and community engagement.
The HEI is a biennial survey. The survey is conducted in odd years and the report is published in even years.
For the HEI 2026 report, the survey will open in August 2025.
The HEI is open to all healthcare organizations in the U.S. with 100 or more employees, whether inpatient or outpatient, network or individual facility. Inpatient facilities are particularly encouraged to participate, and constitute the majority of participants.
Clinic organizations with multiple locations such as FQHCs (and FQHC look-alikes), Planned Parenthood Affiliates and other similarly structured organizations are eligible to participate - however, they have special guidelines related to meeting the training criteria.
LGBTQ+ patients face very significant challenges in healthcare: 56% of lesbian, gay, and bisexual people report experiences of serious discrimination in healthcare, while 70% of transgender people report serious discrimination. In response, CMS and The Joint Commission have issued requirements for LGBTQ+ equity and inclusion, and expert recommendations have now emerged for LGBTQ+ patient-centered care.
The HEI enables healthcare organizations to assess their own policies and practices vis-à-vis these requirements and recommendations, and equips them with the training and resources they need to remedy gaps. It also enables organizations to receive public recognition for their commitment to equity and inclusion.
Hundreds of healthcare organizations nationwide have participated in the HEI to:
And HEI participants enjoy these unique benefits:
As an online survey, participation in the HEI requires a login. If your organization does not already have a login, you can register to receive one and view the HEI survey with no obligation. The HEI can be completed by any number of people within an organization, as--the HEI login can be shared,—but each organization is asked to designate an “official submitter” to review and submit the HEI.
Organizations answer a series of questions about LGBTQ+ policies and best practices and are required to upload supporting documentation to validate many of their responses. Participating organizations will receive a summary of their score after the HEI staff has reviewed their submission and will have an opportunity to provide additional information or supporting documentation to address any deficiencies.
The HEI, including the extensive training offered to participating organizations, is currently offered free of charge, as an educational program of the HRC Foundation.
All organizations participating in the HEI may register staff for acclaimed, expert online training—in fact, training is required to be awarded HEI Leader status. Complete details are available within the HEI.
Survey participants that receive the highest score in the HEI Scoring Criteria are designated as a Leader in LGBTQ+ Healthcare Equality. The Leader designation signals to LGBTQ+ patients and allies that the healthcare facility has gone beyond the foundational elements of LGBTQ+ patient-centered care and adopted a number of LGBTQ+ policies and practices. Prior to the release of the HEI report, Leaders receive the coveted HEI Leader logo for their use, as well as extensive resources for publicizing their achievement and conducting outreach to LGBTQ+ community members.
HEI staff will notify all survey participants whether or not they have received Leader status once the review of that facility’s survey is complete.
Yes, the vast majority of organizations participate in every HEI survey. The HEI is revised each cycle to incorporate new issues and resources related to LGBTQ+ patient-centered care, and the HEI designations are determined by an organization’s responses to the HEI in that cycle.
Yes, depending on your health system structure. For the HEI 2024, we developed a system survey tool that allowed health systems to submit information for multiple hospitals using one survey. Certain policies and practices must be aligned within each hospital to utilize the system survey tool. There are other limitations related to how many, and geographically diverse the hospitals can be covered by the system survey tool.
The HEI is primarily intended for inpatient facilities that provide general medical and surgical care. However, specialty hospitals may also be covered by your system tool. Outpatient facilities and other parts of your health system are not eligible to participate in the HEI.
Not necessarily. While you may utilize the system tool to submit your survey information, each hospital must still independently meet the HEI criteria. The system tool is designed to be flexible to account for differences in clinical offerings and employee, patient, and community engagement that may occur in different hospitals and/or geographic market regions. Therefore, health systems can have hospitals end up with different scores and designations if some of the hospitals do not meet the HEI criteria to the same extent as other hospitals.
Each hospital must independently meet the training requirement. While the same training options may be utilized across your health system, we cannot count training hours on the health system level.
For the HEI system survey tool, we are defining a geographic market region as anywhere patients would be able to go to any of the local area hospitals and where they would be likely to find their local pride celebration and/or other LGBTQ+ community events.
For the HEI 2024, the maximum number of hospitals that could be covered by one system survey tool was 30 and each tool covered up to 4 geographic market regions. For the HEI 2026, these numbers may be increased.
No. Each health system can determine which hospitals will be covered under each system survey tool. Only those hospitals that are covered under the system survey tool will be eligible to receive a score and possible designation.
Prior to the launch of the survey, we will reach out to each health system to confirm which hospitals should be covered under the system survey tool. We are happy to meet with large health systems that may need to utilize more than one system survey tool to determine the best structure for them. In addition, there will be a way to make updates in the survey tool itself.
Beginning in 2026, health systems with 5 or more participating hospitals will be required to utilize the system survey tool to submit their HEI survey(s) as long as they meet the alignment requirements.
You can watch this webinar from the HEI 2024 about the system survey tool or review the slides here.