LGBTQ+ community members face unique challenges when accessing healthcare. Lack of knowledge among providers about the LGBTQ+ community leads to stigma, discrimination, and stereotypes that result in higher risk for cancers and substance abuse and higher rates of smoking. Poor health outcomes occur for multiple reasons—clinicians don’t know the best way to collect accurate health information and LGBTQ+ members don’t feel safe sharing personal health information. The best way for health systems to improve healthcare delivery for the LGBTQ+ community is to rework the way they collect sexual orientation/gender identity data and educate clinicians about the health disparities LGBTQ+ members face.

1. Many Health Systems Are Failing the
LGBTQ+ Community—Two Ways to Improve

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Healthcare in the LGBTQ+ Community
For any healthcare consumer, finding the
right provider can be difficult. For members
of the LGBTQ+ community, this challenge
is amplified.
LGBTQ+ healthcare is multifaceted and
LGBTQ+ members often struggle for equity
in the U.S. healthcare system due to
stigma, stereotyping, lack of understanding,
or discrimination, contributing to increased
health risks and worse outcomes.

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Healthcare in the LGBTQ+ Community
As a member of the Health Catalyst
Queers and Allies affinity group—a group
aimed at better understanding and
including members of the LGBTQ+
community—I want all my teammates to
feel valued, included, and empowered
to succeed.
The Queers and Allies group gives me an
opportunity to increase awareness about
the issues members of the LGBTQ+
community face and learn how to create
a safe environment in which they feel
accepted, valued, and supported.

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Lack of Knowledge About the LGBTQ+ Community
Compromises Healthcare Delivery
I was recently talking with one of my teammates
about my early learning experiences as a newly
graduated registered nurse providing care to a
transgender patient.
At that time, my peers and I received little to no
training about caring for transgender people with
respect and sensitivity.

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Lack of Knowledge About the LGBTQ+ Community
Compromises Healthcare Delivery
In this instance, the patient’s medical record
had two choices for “sex”—male or female.
The “male” option was marked, along with
the patient’s legal male name, rather than
her preferred female name.
The first day I cared for her, I addressed her
by her legal male name, inadvertently
upsetting her.

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Lack of Knowledge About the LGBTQ+ Community
Compromises Healthcare Delivery
There was nowhere to document her preferred
female name, no mechanism for communica-
ting this information to the other staff, and no
effective way to prevent additional stress for
the patient as members of the care team
repeatedly addressed her using the incorrect
name and pronoun.
Ultimately, we hung a sign inside the patient’s
room—a common workaround for nurses
when we lack effective methods for handing
off critical information—with the patient’s
preferred name and pronouns in bold font.

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LGBTQ+ Members Experience Stigma,
Discrimination, and Increased Health Risks
As I reflect on this early nursing experience, I
can identify many points throughout the
patient’s journey in which the health system,
my colleagues, and I failed her.
Unfortunately, this patient’s experience is not
uncommon for members of the LGBTQ+
community seeking medical care.

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LGBTQ+ Members Experience Stigma,
Discrimination, and Increased Health Risks
This story illustrates the challenge
healthcare providers face and the critical
need to collect accurate sexual orientation
(SO) and gender identify (GI) information to
assess a person’s health and provide
competent care.
Without this information, providers struggle
to effectively identify health risks, offer the
right treatment, and address common health
disparities in the LGBTQ+ community.

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LGBTQ+ Members Experience Stigma,
Discrimination, and Increased Health Risks
According to the Office of Disease Prevention and Health Promotion, LGBTQ+
people “face health disparities linked to societal stigma, discrimination, and
denial of their civil and human rights.” Some of these disparities can have
harmful, far-reaching effects on health:
Lesbians are more likely to
have risk factors for breast
cancer and less likely to
get preventive screenings
for breast and cervical
cancer.
Gay men have a higher
risk of HIV and other
sexually transmitted
diseases (STDs),
particularly among
communities of color.
Transgender individuals
are less likely to have
health insurance and have
a higher prevalence of
HIV/STDs as well as
mental health issues and
suicide.
Depression, illegal drug
use, risky sexual behavior,
and suicidality are even
higher among gay and
bisexual youth and among
transgender individuals
who are rejected by their
families.
Transgender women may have a
higher risk of breast cancer.
Lesbians experience higher rates of
substance abuse and smoking.
Gay men have increased risk for
prostate, testicular, and colon cancer.

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LGBTQ+ Healthcare Dependent on Accurate Data
To reduce—and ultimately eliminate—
SO/GI disparities, organizations must
provide a welcoming, safe environment in
which LGBTQ+ people trust the healthcare
providers enough to share their SO/GI
information.
Despite recommendations to collect SO/GI
data in the EHR from the National Academy
of Medicine, the Joint Commission, and the
Health Resources and Services, most
healthcare organizations do not have a
system that accurately captures this data.

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LGBTQ+ Healthcare Dependent on Accurate Data
Without the SO/GI data, providers can’t
effectively identify and address LGBTQ+
patients and their unique health needs.
It is imperative that health systems
understand which questions to ask and the
respectful way in which to ask, rather than
using the default, outdated questions that
only have answers like male or female.

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The CDC Advises on the Best Way to Collect Sexual
Orientation/Gender Identity Data
The CDC recommends that health systems
ask an updated list of questions and
responses that replace basic questions like,
“Sex: male or female?” on patient
information forms and in the EMR.
Asking SO/GI questions provide more
relevant clinical data, particularly for
transgender patients.
To prevent distressing a patient (like I once
did), organizations should also ask, and
document, the name the patient would like
to have appear on their health record and
the preferred pronouns (he/him, she/her).

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The CDC Advises on the Best Way to Collect Sexual
Orientation/Gender Identity Data
Sexual Orientation
Do you think of yourself as: Straight or heterosexual.
Lesbian or gay.
Bisexual.
Queer, pansexual, and/or questioning.
Something else; please specify: _______.
Don’t know.
Decline to answer.
>
>
>
>
>
>
>

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The CDC Advises on the Best Way to Collect Sexual
Orientation/Gender Identity Data
Gender Identity
Do you think of yourself as: Male.
Female.
Transgender man/trans man/female-to-male (FTM).
Transgender woman/trans woman/male-to-female (MTF).
Genderqueer/Gender nonconforming neither exclusively
male nor female.
Additional gender category (or other); please
specify: ______________________.
Decline to answer.
What sex was originally listed on
your birth certificate?
Male.
Female.
Decline to answer.
>
>
>
>
>
>
>
>
>
>

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Trust Proves Key to Collecting Accurate Health
Information, Providing Patient-Centric Care
The challenge of providing care to LGBTQ+
members also highlights the role of trust in
the clinical setting. If patients do not trust
providers or health systems, medical efforts
are futile.
However, if health systems and providers
take measures to learn more about
marginalized groups, like the LGBTQ+
community, address them with preferred
names, and collect information in a
sensitive way, trust will start to build.

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Trust Proves Key to Collecting Accurate Health
Information, Providing Patient-Centric Care
When patients trust their providers and health
systems, they disclose honest, accurate
information about their gender, sexual orientation,
lifestyle, and even feel safe to ask questions.
With this increased knowledge, clinicians can
provide more targeted care to the patient and
provide comprehensive care—considering
factors, like lifestyle, that they may not have
known before—and help each patient reach
optimum health, while breaking down stigmas
about the LGBTQ+ community at the same time.

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For more information:
“This book is a fantastic piece of work”
– Robert Lindeman MD, FAAP, Chief Physician Quality Officer

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More about this topic
Link to original article for a more in-depth discussion.
Many Health Systems Are Failing the LGBTQ+ Community—Two Ways to Improve
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Improve Patient Satisfaction: 5 Things Healthcare Organizations Can Learn From Disney
Josh Ferguson APRN, ACNP, ANP-BC, VP of Clinical Outcomes Improvement
How Great Patient Satisfaction Metrics Can Be Achieved in a Regional Medical Center
Greg Stock, MPA
Identifying Vulnerable Patients and Why They Matter
KimSu Marder, RN, CCM, Lead Care Manager
How to Use Data to Improve Patient Safety (Executive Report)
Stan Pestotnik, MS, RPh, Patient Safety Products, VP

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Other Clinical Quality Improvement Resources
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Heather Schoonover is the Vice President of Customer Success at Health Catalyst and is
responsible for ensuring customer outcomes, including the development of strategies for
driving and communicating customer outcomes. Heather has more than 20 years’
experience in nursing and healthcare. Prior to joining Health Catalyst, Heather was the
director of professional practice at PeaceHealth and was responsible for improving patient
safety and outcomes, organizational outcomes, leader and staff competency, and the nurse practice
environment. Heather has held adjunct nursing faculty positions and pro tem appointments on the
Washington State Nursing Care Quality Assurance Commission, the State regulatory board of nursing.
Heather obtained a Master of Nursing from Washington State University and is board certified by the
American Nurses Credentialing Center as a clinical nurse specialist in public and community health.
Heather is a Clinical Nurse Specialist Institute Fellow and has been honored to be the recipient of
leadership awards from both Sigma Theta Tau, the International Honor Society for Nursing, and the
Northwest Organization of Nurse Executives.
Heather Schoonover, MN, ARNP-CNS, PHCNS-BC, FCNS

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Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
Health Catalyst is a mission-driven data warehousing, analytics and outcomes-improvement company
that helps healthcare organizations of all sizes improve clinical, financial, and operational outcomes
needed to improve population health and accountable care. Our proven enterprise data warehouse
(EDW) and analytics platform helps improve quality, add efficiency and lower costs in support of more
than 65 million patients for organizations ranging from the largest US health system to forward-thinking
physician practices.
Health Catalyst was recently named as the leader in the enterprise healthcare BI market in
improvement by KLAS, and has received numerous best-place-to work awards including Modern
Healthcare in 2013, 2014, and 2015, as well as other recognitions such as “Best Place to work for
Millenials, and a “Best Perks for Women.”