2. Problem Statement
▪ LGBT individuals experience discrimination
▪ 56% of LGB experience discrimination
▪ 73% of Transgendered felt they faced discrimination (Hanneman, 2014)
▪ Patients & staff feel unable to reveal they are LGBT.
▪ Patients unable to trust medical professionals
3. PICOT Question
▪For LGBT patients, would specialized
diversity training aimed towards working with
the LGBT community, compared to the
current generic diversity training, reduce the
perceived rate of discrimination within health
care?
5. Objectives of Solution
▪ Increase the diversity training
▪ Decrease the perceived rate of discrimination based on being LGBT
▪ Increase the rate of LGBT community members seeking out health care services.
6. Pre & Post Test Scales
Heterosexual Attitude toward
Homosexuality Scale
▪ 21 question Likert-scale
▪ Ask questions pertaining to attitudes
toward homosexuality and homosexual
acts
Sample Questions
▪ I would look for a new place to live if
I found out my roommate was gay.
▪ Gays dislike members of the
opposite sex.
▪ The love between two males or two
females is quite different from the
love between two persons of the
opposite sex.
Larsen, Reed, & Hoffman, 1980.
7. Implementation
▪ Pilot program to be implemented in local medical center
▪ Mandatory training to all employees
▪ Data collection & comparison of LGBT admittance
▪ Utilize ARCC model
8. ARCC Model
▪ Advancing Research & Clinical Practice Through Close Collaboration
▪ Assess culture in organization
▪ Strengths & Barriers of Organization
▪ EBP Mentorship
▪ Successful implementation of EBP
Melnyk, Fineout-Overholt, Gallagher-Ford, & Stillwell, 2011
10. Timeline
2 Month Before Program Start
▪ Reach out to LGBT
advocates/educators -
▪ Gather information on LGBT patient
satisfaction and admittance rate -
▪ Meet with educators to discuss
desired topics to be covered
▪ Interview local medical centers
3 -4 Weeks before Program start
▪ Send out memos and emails/ post
fliers
▪ Finalize training class schedules
▪ Begin sign up
▪ Select pilot medical center
11. Timeline Cont.
Program Start – 3 Months
▪ Give pre-test and interviews to staff
▪ Training classes – 3 months
▪ Begin close up -1 week before end
▪ Administer post-test and final
interviews
1-2 Week After
▪ Collect all data
▪ Send data to be analyzed
▪ Send out evaluations to staff
▪ Receive feedback
12. Timeline Cont.
▪ Receive data analysis
▪ Meet with training facilitators to revise topics covered and handouts
▪ 4-6 months after completion – gather information on LGBT patient satisfaction
and admittance rates.
13. Barriers to Implementation
▪ The staff refusal to take part in the training sessions.
▪ Religious beliefs of workers hinder attendance
▪ Lack of financial support
▪ Possible protest from other community sects.
14. Proposal Budget
Description Amount
Interviewer $1,890
Training Facilitator/Trainer $10,000
Data Analyst $3,000
Workbooks $7,000
Misc. Handouts $300
Refreshments $3500
Computer Provided by facility
Projector Provided by facility
Sound System Provided by facility
Total $25,690
15. References
▪ Hanneman, Tari. (2014). Healthcare equality index 2014: Promoting equitable and
inclusive care for lesbian, gay, bisexual and transgender patients and their
families. Retrieved from Human Rights Campaign Foundation website: http://hrc-
assets.s3-website-us-east-
1.amazonaws.com//files/assets/resources/HEI_2014_high_interactive.pdf
▪ Larsen, K. S., Reed, M., & Hoffman, S. (1980). Attitudes of heterosexuals toward
homosexuality: A Likert‐type scale and construct validity. The Journal of Sex
Research,16(3), 245-257. doi:10.1080/00224498009551081
▪ Melnyk, B.M., Fineout-Overholt, E., Gallagher-Ford, L., & Stillwell, S.B. (2011).
Models to guide implementation of evidence-based practice. In Evidence-based
practice in nursing & healthcare: A guide to best practice (2nd ed., pp. 241-275).
Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins.
Editor's Notes
Hello. My name is Melissa Munoz, and today I will be covering a topic that I have felt very strongly into researching: discrimination in the health care.
In an article published in 2014, Hanneman stated that 56% of the gays, lesbians, and bisexuals had experienced discrimination within the healthcare field. Additionally, 73% of transgender individuals felt that they would face discrimination and would be treated differently. Patients and physicians alike reported feeling uncomfortable with the current standing of the healthcare system and feared coming out as an individual within the LGBT community. Patients fear seeking any needed medical attention as they are often turned away, misdiagnosed, or completely ignored by medical professionals. With the past struggles that we as a society have overcome in order to eliminate discrimination, it is bewildering that a remaining area where discrimination remains would be one that is responsible for life and death decisions.
While it may be difficult to remove discriminatory beliefs completely, we can work to stop these tendencies from causing further harm through training. This raises a question: for LGBT patients, would specialized diversity training aimed towards working with the LGBT community, compared to the current generic diversity training, reduce the perceived rate of discrimination within health care? To answer this question, we would need to create a specialized training curriculum dedicated to helping healthcare workers to work with members of the LGBT community and measured the perceived discrimination they experience.
Health care professionals will be required to attend and complete a training seminar session that would last between two and four hours in length. The training will be expected to be completed within three months from program start date to allow all staff a chance to attend a training session without affecting the facilities work load and to avoid staffing conflicts. All healthcare workers, such as physicians and nurses, as well as administration and other staff, will be expected to complete the training sessions. In addition, the training sessions will cover various definitions, social issues that are special to the LGBT community, and increase awareness of legal issues regarding LGBT individuals and couples, especially in regard to health care decisions. The goal will be to educate health care professionals to an extent that will allow them to be understanding to those that seek their help.
Many health care providers do not have proper training to deal with LGBT community issues and needs. The objectives of the solution are three-fold; firstly, to increase the amount of diversity training. Medical professionals have to compete so many hours of continuous learning each year, this will also help fulfill that requirement. Secondly, the rate at which LGBT patients feel they are being discriminated against should decrease. Throughout various studies, medical professionals’ knowledge about the LGBT community was a big factor in how patients felt about the worker. Lastly, the goal is to increase the awareness of LGBT issues and to reach out so that LGBT individuals will start seeking (or start reaching out for) needed medical care.
To help measure the effectiveness of the program, a Likert-scale, which is a scale which uses fixed choice response formats and are designed to measure attitudes and opinions of the respondents, will be used before training sessions and after the program has been completed. Likert-scales measure the levels of agreement/disagreement so they may be studied. The Heterosexual Attitude toward Homosexuality seeks to determine a heterosexual person’s attitudes and beliefs about homosexuality. The answers range from “Strongly Agree” to “Strongly Disagree” and contain questions such as “Homosexuals should be forced to have psychological treatment” and “If I were a parent, I could accept my son or daughter being gay”. While these may not seem like questions that are pertinent to the medical field, they are important to gauge a person’s beliefs and to determine where a group (as a whole) stands on homosexuality. This scale has been used for many studies in different fields and has proven to be both valid and reliable.
Implementation of such a program would require a pilot program to be performed with a local and willing medical center. To determine the success of this project, the rate of admittance of LGBT patients will be compared before and after the completion of the training. A memo will be sent out to all employees to inform them of the new training program and that it will be mandatory for everyone to participate and complete the program. Sign ups will start a minimum of one week for the program starts. An outside organization that is an LGBT advocate group will be contracted to assist with creating the curriculum, create training materials, and conduct the training. To strengthen the implementation of the program, we will also be utilizing the ARCC model to build a culture of acceptance within the facility.
ARCC stands for “Advancing Research and Clinical Practice through Close Collaboration” and is based on a mentorship framework to assist advanced practice nurses in implementing EBP, or evidence based practice, within an organization. The first step in the ARCC model is an assessment of the organization’s culture and readiness for EBP so that EBP facilitators and barriers can be identified. EBP mentors are then developed and placed within the healthcare system to work directly with point-of-care staff to foster their knowledge, beliefs and skills in evidence-based care. EBP mentorship has been shown to lead to a more successful implementation and maintenance of the practice.
When identifying the strengths and barriers, physical resources are not the only aspects that should be looked at. Sometimes organizations do not have an EBP culture or the knowledge of how to maintain the systems. With the use of mentors, this can be fixed. Mentors can be found at workshops or other organizations and can help to build necessary skills to assist with implementing change. When there are mentors there is an increase in the change of EBP implementation, which has been proven to lead to higher satisfaction rates in workers and, in this case, will lead to LGBT patients feeling more welcomed and included in the medical facility.
Preparation is one key factor to the success of a training program. Before implementation, we would need to make sure that our base is first established and a curriculum will need to be created. Two months before implementation, LGBT patient satisfaction and admittance rate information will need to be gathered, and educators and LGBT advocates would need to be assembled to discuss the topics that the training will cover. This is also the time to research and interview potential medical facilities to act as the pilot location for the program. Approximately three to four weeks prior to implementation, a facility would need to be selected to allow time for the staff to be informed of the mandatory training. Memos, emails, and fliers will be created to create awareness of the program to allow for classes to be scheduled.
Once the program begins, the base evaluations will need to be taken through pre-tests and interviews to the staff. During the three month program, training classes will be undertaken, and post-test and final interviews will close the training portion of the program. It may take approximately one to two weeks to collect all of the data to send out for analysis. Feedback will also be reviewed for the purpose to enhance the program going forward.
After receiving the completed analysis of the program, a meeting with the training facilitators will be used to revise covered topics and training materials. To view the perceived effectiveness of the program, LGBT patient satisfaction and admittance rate information will be collected again about half a year after the completion of the program and be compared to the data will be compared to the data collected prior to implementation.
With any program, there will be barriers that may hinder the desired outcome. The biggest concern would be anything that would stop the staff from participating, whether it be refusal from the staff members themselves or the inability of the program’s administration to secure the finances necessary to implement the training.
Here is a breakdown of the original estimations for this training project, including salary for program staff to cost of training materials for a facility of 3500 employees (estimated based on employment figures for a local medical center). These costs are figured to alleviate as much financial pressure away from the pilot medical center for a better chance at a successful implementation. Future programs may not need workbooks or handouts and training could be moved to online courses, and refreshments during training would become the responsibility of the facility.
