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A New Level of Acceptance in Assigning Hospital Beds to Transgender Patients

June 28, 2021

On its journey to cultural humility, Hartford HealthCare has instituted a bed assignment policy that considers the unique needs of transgender patients. “One of the mantras of practicing cultural humility vs. cultural competence is realizing that ‘every bed has its own story,’ vs. defining patient needs based only on assumptions about preferences based on race, ethnicity, sexual orientation, gender identity or other factors,” said Gerard Lupacchino, senior vice president of human experience at Hartford HealthCare. The system has been evolving from cultural competence to cultural humility, a place where leaders and colleagues commit to being lifelong learners about others and their “unlimited combination of traits, needs and life experiences,” Lupacchino said. Part of the commitment is acknowledging that an individual’s conscious and unconscious biases can inform reactions and, therefore, the care patients receive, he said. “It’s about the level of acceptance humans have toward others’ differences,” he explained. “Cultural competency was the buzz word in the 1980s and 90s, and what’s required by law. Cultural humility is going one step further and admitting that ‘I can never know everything about another person, and my best work starts with curiosity and compassion.’” A major step on this journey was establishing a policy for assigning hospital beds to transgender patients. Beds were traditionally assigned according to gender assigned at birth, placing males in semi-private rooms with other males and females with other females. Transgender patients have a gender identity that is not fully congruent with their assigned sex at birth. Some may have had surgical intervention to align their minds and bodies, but not all have taken such steps. “We had limited guidelines for transgender patients prior to this, with the Institute of Living being the primary leader in this work,” Lupacchino said, referring to the policy that took two years to standardize across the system. The project involved behavioral health, patient experience, human resource, ITS and clinical partners, as well as transgender patients and customers and input from other healthcare systems further along the journey. Understanding that 70 percent of transgender patients have experienced some level of discrimination in the healthcare system – with 23 percent admitting they do not see a physician for fear of being mistreated – Lupacchino said it became imperative to adjust basic processes such as bed assignments at Hartford HealthCare. The new policy, put in place last fall, begins with the caveat that, as with all patients, clinical symptoms and needs will always override personal preference of room assignment. The policy stipulates that the system’s commitment is “to identifying gender-affirming room assignments when hospitalization is indicated . . . transgender patients will be assigned to rooms based on their self-identified gender, regardless of whether this is consistent with their physical appearance, surgical history, genitalia, legal sex, sex assigned at birth or name and sex as it appears in hospital records.” If needed and one is available, the patient can be assigned a private room, Lupacchino said. The policy reinforces this accommodation for any patient, including a transgender patient who requires a private room in response to safety concerns. To help with bed assignment, the system added data fields in its EPIC medical record system called “Sexual Orientation and Gender Identification (SOGI)” that can be filled in if a patient offers the information. The fields include sexual orientation, gender identity, sex assigned at birth, preferred pronouns and steps taken or planned to transition. “It’s becoming an open conversation so we can identify their comfort level and how they want to be referred to,” he said, adding that, “I suspect we will get to the point where registration colleagues will ask all patients and customers for their gender and sexual identity. This is emerging as standard practice in most larger systems and is an important step in creating an equitable experience for our transgender patients.” As an additional outcome from this work, the team advanced a subtle yet substantial modification to the patient bill of rights posted throughout the system. “Creating a safe environment to receive care is directly connected to our ability to create a safe environment to provide care,” Lupacchino said. In the past, the bill of rights prohibited discrimination against any patient being cared for at Hartford HealthCare. In the current bill, it states: “Hartford HealthCare does not tolerate discrimination against any person, including patients and team members, on the basis of race, color, national origin, ethnicity, culture, disability, age, sex, religion, socioeconomic status, sexual orientation, gender identity or expression, or any other characteristic protected by law.” Lupacchino said he and the Human Experience team believe that, “Cultural humility is a lens we need to use not only with our patients and customers, but with each other as well. It’s just one way we can support the outstanding DEAI work underway across the organization.”