At this level, healthcare facilities are early in their inclusion journey and have demonstrated that they have key foundational policies in place for LGBTQ inclusion. These policies focus on Patient Non-Discrimination, Equal Visitation and Employee Non-Discrimination--where each must be codified and communicated publicly. Healthcare facilities must also provide some training in LGBTQ culturally competent care*. To achieve this tier of recognition, a healthcare facility must receive full credit for all of the questions in Criteria 1 - Non-Discrimination and Staff Training.

*Training options (that include CME/CEU credits) are available to facilities that complete the survey.

At this level, in addition to meeting the Foundational Tier of Recognition, Top Performer healthcare facilities have demonstrated that they have adopted a minimum number of LGBTQ inclusive policies and practices in the areas of LGBTQ Patient Services and Support, Employee Benefits and Policies and Patient and Community Engagement. To achieve this tier of recognition, a healthcare facility must receive full credit in Criteria 1 and at least partial credit in Criteria 2, 3 and 4 and obtain an overall score of between 80-95.

At this level, Leader healthcare facilities demonstrate true leadership in adopting LGBTQ policies and practices. To achieve this tier of recognition, a healthcare facility must receive full credit in Criteria 1, 2, 3 and 4 and meet the criteria for provision of transgender inclusive health insurance--obtaining a top score of 100.

Up to 10 points

1. LGBTQ-inclusive Patient Non-Discrimination Policy
   • Policy must include the terms “sexual orientation” and “gender identity and expression” (or “gender identity”)
2. Patient non-discrimination is communicated to patients and staff
   • Policy is shared in two ways with the public, typically online and in-print
   • Policy is shared with staff in at least one way

View Patient Non-Discrimination Resources for Healthcare Facilities

Up to 10 points

1. Equal Visitation Policy
   • Policy must allow the patient’s visitor of their choice
2. Equal Visitation Policy is communicated to patients and staff
   • Policy is shared in two ways with the public, typically online and in-print
   • Policy is shared with staff in at least one way

View Equal Visitation Resources for Healthcare Facilities

Up to 10 points

1. LGBTQ-inclusive Employment Non-Discrimination Policy
   • Policy must include the terms “sexual orientation” and “gender identity or expression” (or “gender identity”)
2. Employment Non-Discrimination Policy is shared with the public
   • Policy is shared with the public in at least one way

View Employment Non-Discrimination Resources for Healthcare Facilities

Up to 10 points

1. Training in LGBTQ Patient-Centered Care
   • For new facilities or those that have not previously met the training requirement, key senior executives must complete the LGBTQ Patient-Centered Care: An Executive Briefing training provided by the HEI
2. Returning facilities that have previously met the Executive Briefing requirement must complete a minimum number of on-going staff training hours in LGBTQ-related topics
   • Facilities with up to 500 staff members must complete a minimum of 25 hours of on-going training
3. Facilities with 500 or more staff members must complete a minimum of 50 hours of on-going training
4. HEI training options promoted to staff
   • · Facilities must make the training options available through the HEI known to staff throughout their facility

View Staff Training Resources for Healthcare Facilities

Scored best practices include:

• Facility has a written strategy or plan for reducing health disparities specifically among LGBTQ patients and/or explicitly incorporates LGBTQ patients into a plan for reducing all patient disparities
• Facility has an internal planning or advisory committee focused on LGBTQ patient care issues
• Facility makes LGBTQ-knowledgeable and -friendly providers known as such to interested patients or provide a confidential mechanism to make LGBTQ-specific referrals
• Facility provides certain LGBTQ-specific clinical services
• Facility has an externally promoted LGBTQ-specific clinic
• Facility has an externally promoted LGBTQ-focused office, advocate or LGBTQ-specific patient navigator
• Facility’s website provides educational LGBTQ-related health information and/or links to LGBTQ health education or service resources from outside organizations
• Facility creates and distributes either an LGBTQ health education brochure or print materials about specific health topics affecting LGBTQ people (distinct from an LGBTQ services brochure for marketing purposes)

View LGBTQ Patient Services Resources for Healthcare Facilities

The Transgender Patient Services and Support section utilizes best practices from The Joint Commission and other sources to enhance care for transgender patients, who often encounter discomfort and bias when receiving care.

Scored best practices include:

• Facility has a written policy (or policies) that specifically outline procedures aimed at eliminating bias and insensitivity, and ensuring appropriate, welcoming interactions with transgender patients
• Facility offers certain transgender-specific clinical services
• Facility has an externally promoted multidisciplinary gender clinic for either adults and/or youth (distinct from a general LGBTQ clinic)
• Facility has a program or position to provide patient navigation/advocacy services specifically to transgender patients
• Facility provides all gender restrooms in public areas for patients and visitors and/or have clearly posted signage indicating a policy that allows individuals to use the restroom that aligns with their gender identity

View Transgender Patient Services Resources for Healthcare Facilities

Patient Self-Identification is important for healthcare facilities to provide patients with the opportunity to be identified as LGBTQ in health records, if they so wish. Adding LGBTQ self-identification options to an electronic health record system is a significant step a facility can take to help end LGBTQ health disparities with LGBTQ self-identification options.

Scored best practices include:

Collecting information about sexual orientation and gender identity through the following:

• Electronic health record (EHR) system offers explicit options to capture patient’s current gender identity—when it differs from the patient’s sex assigned at birth.
• A two-question process is used to collect gender identity information (i.e. first asking current gender identity and subsequently asking sex assigned at birth)
• Staff Training is provided specifically about how to collect and record gender identity data in facility’s EHR system
• EHR system captures the patient’s pronouns in use AND prominently displays these pronouns in the banner or a pop-up easily accessible for front line staff and providers
• EHR system captures the patient’s name in use if it differs from their legal name AND prominently displays this name in the banner or a pop-up easily accessible for front line staff and providers
• EHR system offers an explicit way to capture a patient’s organ inventory
  
• EHR system offers explicit options for capturing a patient’s sexual orientation if they choose to provide it
• Staff Training is provided specifically outlining LGBTQ status as confidential patient information in accordance with HIPAA protections

Providing LGBTQ-family inclusive health records with:

• EHR system offers explicit options for recording a patient’s parents are inclusive of same-sex parents and other diverse families
• EHR system offers explicit options for recording relationship status with an un-married partner

View Patient Self-Identification Resources for Healthcare Facilities

The Medical Decision Making section highlights the right of patients to designate the person of their choice, including a same-sex partner, to make medical decisions on their behalf if they ever became incapacitated. Unfortunately, healthcare organizations have sometimes failed to honor LGBTQ patients’ medical decision making rights. As noted by CMS in 2011 regulations, it should be easier for family members, including same-sex partners, to make informed care decisions for incapacitated loved ones.

Scored best practices include:

• Organization explicitly informs patients of their right to designate a person of their choice, including a domestic partner, as medical decision-maker
• Organization offers employee training related to medical decision making that includes LGBTQ specific information
• Facility has a policy or official practices related to the treatment of intersex children that delays medically unnecessary procedures until the patient is old enough to make an informed decision (new)
  

View Medical Decision Making Resources for Healthcare Facilities

Scored best practices include:

Equal Benefits

• The health insurance policy’s definition of spouse includes same-sex spouses AND the same documentation is required for enrollment of same and different-sex spouses
• Healthcare benefits are provided to domestic partners
• FMLA-equivalent benefit allows employees to take family and medical leave to care for domestic partners as well as the children of a domestic partner, regardless of biological or adoptive status
• Bereavement leave benefit includes the event of the death of a domestic partner or the partner’s immediate family

Additional Support for LGBTQ Employees

• Facility adopts written gender transition guidelines documenting supportive policies and practices on issues pertinent to a workplace gender transition
• Facility officially recognizes an LGBTQ employee resource group
• Facility’s diversity & inclusion office, diversity council or working group focused on employee diversity specifically includes LGBTQ diversity as part of its mission
• Anonymous employee engagement or climate surveys allow employees the option to identify as LGBTQ
• Anonymous employee engagement or climate surveys include question(s) related to LGBTQ concerns
• Confidential human resources information system (HRIS) captures sexual orientation and/or gender identity (if voluntarily disclosed) along with other demographic information such as race and gender
• Facility commemorates an LGBTQ Awareness Day for employees at the facility
• Facility has explicitly LGBTQ-inclusive hiring efforts
• Facility has openly LGBTQ people serving in high-level visible leadership positions

View Employee Benefits & Policies Resources for Healthcare Facilities

The question in this subsection is scored independently and must be met in order to attain Leader status.

Healthcare benefits impacting transgender employees

• Facility provides at least one health plan to all employees that affirmatively and explicitly covers medically necessary health services for transgender people, including gender transition-related treatment
  

Scored best practices include:

LGBTQ Community Engagement and Marketing

• Facility supports one or more LGBTQ related events or initiatives in the facility’s service area
• Facility engages in LGBTQ-inclusive marketing or advertising to the LGBTQ community
• Facility created/uses an LGBTQ-specific logo
• Facility has publicly supported LGBTQ equality under the law through local, state, or federal legislation or regulations

Understand the Needs of LGBTQ Patients and Community

• Patient satisfaction surveys allow patients the option to identify as LGBTQ
• Patient satisfaction survey include LGBTQ-related questions
• Facility works with external LGBTQ organizations or community members to assess and address LGBTQ health needs or concerns
• Facility includes external LGBTQ community member(s) on a governing or community advisory board
• Facility supports LGBTQ health-related research

View Patient & Community Engagement Resources for Healthcare Facilities

Scores on this criterion are based on information that has come to HRC Foundation’s attention related to topics including but not limited to:

• Revoking LGBTQ-inclusive policies or practices;
• Facilitating the continued practice of healthcare providers that provide or promote LGBTQ related treatment or services to that have been discredited by mainstream medical and mental health organizations, including, but not limited to, “conversion therapy”;
• Engaging in proven practices that are contrary to the facility's written LGBTQ patient or employment policies;
• Advocating for public policies or regulations that would be detrimental to LGBTQ equality and/or health;
• Directing charitable contributions or other public support to organizations whose primary mission includes advocacy against LGBTQ equality or care.

Prior to applying the point deduction, the HRC Foundation will make every attempt to work with the organization to resolve the concerns. If it is necessary to apply the point deduction, it may be reflected in a current or future score, depending on the situation. If applied to a current score, HEI Leader in LGBTQ Healthcare Equality status will be suspended or revoked as necessary. If at any time after losing points on this criterion, a healthcare facility changes course and satisfies the HRC Foundation’s noted concerns, HRC Foundation will re-evaluate the criterion for that facility.

HRC realizes that no institution is perfect and that situations may arise where an individual or small group act in a way that is not in alignment with the organization’s policies and commitment to LGBTQ equality and patient care. This criterion is not intended to penalize an organization in those situations where an isolated negative action takes place, provided that the organization addresses the situation and takes action to ensure that their commitment to LGBTQ patient care remains uncompromised.

In the cases where HRC would consider applying the responsible citizenship deduction based on the actions of one individual employed by the hospital, health system or affiliated university, we would only do so after looking at the totality of the situation and considering the following factors:

• The breadth and depth of the action(s) by the employee and the potential damage that could be done to the LGBTQ community.
• The environment, context and history of the organization as it relates to the actions of the employee.
• The response of the organization and whether or not they have responded in a way to mitigate the harm caused by the actions.

This criterion is rarely used and only one hospital, Johns Hopkins Hospital, has received this point deduction.

Learn Why They Received the Deduction