Transcription
Creating an Inclusive Environmentfor LGBTQ PatientsJoanne Glusman, MSW, LSWEileen Phillips DNP, RN, NE-BC
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Main Line HealthCourtesy KF Smith3
Main Line Health – Diversity, Respect and Inclusion4
Main Line Health5
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Main Line Health – Diversity, Respect and Inclusion7
Main Line Health – Diversity, Respect and InclusionSeparate curriculum created for Inclusive Offices /Providers ALL staff & providers Physician/PA/NP LGBTQ 101 Hormone therapy Language Screenings Pt experience Consents Important stats Surgery options Legal issues Additionalprocedural options Creating inclusivity8
Main Line Health9
Main Line HealthBuild through a wide-angle lens. Marketing Signage Web Content Expand Surveys Restrooms EPIC e10
Main Line HealthThe only thing constant in life is change11
Main Line Health12Change Management “The oldest and strongest emotion of mankind isfear, and the oldest and strongest kind of fear is fear ofthe unknown.” H.P. Lovecraft No matter how well you plan for change you shouldalways expect surprises. We fear change at work for a variety of reasons. Thesefears are often associated with fear of failure, fear ofcriticism and fear of the unknown.
Main Line Health13
Epic Implementation Decision Making GovernanceStrategic Oversight Establish PIVOT vision and strategyProvide final decision making for escalated decisionsManage high-level risk identification and mitigation10%Decisions12Executive Steering CommitteeOperations CommitteeOperational Oversight and Advisory Advisory Committees Advisory CommitteesProvide directions and decisions to support integrated patientcentric operationsAddress escalated decisions presented from AdvisoryCommittees, Project Teams and SMEs“Clearinghouse for ESC”Provide operationally-focused input that drives decision makingbased upon workflow and policy and procedure impactsUnderstand high-risk workflows and key metrics that pertain totheir areaProvide expertise on process and roject Teams/SMEsProject Teams and Subject Matter Experts Responsible for build and work flow decisions, issue and riskmanagement based on guidance from Advisory Committees65%DecisionsProject PMO RiskInpatientApplications/SMEsAccess EsTrainingAncillaryApplications/SMEsBI & ReportingProvide program and project specific standards, processes andtools to manage and support successful executionProject Management OfficeTechnical
Main Line HealthDesigning the Electronic Health Record Integrated health record– Big Bang on March 3, 2018– 5 Hospitals, 96 practices, Urgent Care, 4 Health Care Centers Engage the 'right' people Are they on board?– Setting aside personal feelings– Only considering how it affects their departments– Can they see the big picture?15
Main Line HealthDecision making and discussions pre-Epic build Reviewed information from:– Epic, Elsevier, IOM 2020, Fenway Health, Gay and Lesbian MedicalAssociation (GLMA), Joint Commission (TJC) Met with operational SME's and Epic analysts:– What will be asked– By whom– When in the process– As meetings progressed, identified additional applications needingto be part of the discussion. In particular, Finance, Legal andAmbulatory16
Main Line Health – Diversity, Respect and InclusionSex, Gender and SexualIdentification QuestionsEpicElsevierCPMFenwayGLMATJC15Question tobe Used"Who shouldask?xRegistration /Scheduling / PATActs as preferred name butremoves the word "preferred"xRegistration /Scheduling / PATRegistration already collects thisinformationxRegistration /Scheduling / PATRegistration already collects thisinformation from the ID.CommentsSEX, NAME & PRONOUNSQUESTIONS1. Name: Preferred Name How do you want to beaddressed? Name UsedxxxName (What would you like to becalled?)2. Legal Name: xxNot needed as a data fieldbecause this is part of theregistration processWhat is your legal name?3. Legal Sex: Current practice is to just ask"what is your sex" What was your sex assigned atbirth? M/F/Unknown, not recordedon Birth certificate, choose not todisclose, uncertain What was your sex assigned atbirth? M/F What sex were you assigned onyour original birth certificate?xxxx17
Main Line HealthExpectations At Launch - March 2018 All registrars to ask preferred name Patient facing material such as ID bands, AVS, Daily Plan of Carewould print both name and "preferred name" Gender Identity is shown in the Ambulatory snapshot and sidebarreports, if collected Pronouns and gender identity questions to be asked by IP nurse Preferred name and pronouns would be displayed in header nextto name, if collected18
Main Line Health – Patient Profile19
Main Line HealthChallenges and Opportunities for the Epic Build Upgrade planned for Spring 2019 Pushed back to Fall 2019 Finance / Billing– How will changing names affect billing and insurance?– Claims rejection may be a dissatisfier for patients– "Just wait till the upgrade“ Third party systems– Blood bank Opinions– Not all decision makers were on the bus– "The transgender population is such a small number; can't we justwait to see the changes in the upgrade?"20
Main Line HealthWorkflow challenges/lessons learned post launch Preferred name not always being asked at registration, or noteasily visible Challenges for the transgender population– ID bands print with preferred name in "quotes" Ex. Jones, Mary"John"– Radiology and Lab slips don't have preferred name- Patients beingouted (safety issues) in waiting rooms In-basket did not show preferred name or pronouns for those makingphone calls Provider notes have incorrect pronouns throughout MyChart has no gender identity, pronoun or sex at birth questions Central registration or the front desk did not have access to enter genderidentity information if the patient offered23
Main Line Health – Ambulatory24
Main Line HealthWork Arounds established for Transgender Patients Inclusive Care practices and Registration– Registered patients by putting their preferred name in the Namefield– Name on ID entered in Alias/Preferred field Billing was challenged on the back end to reconcile name,preferred name and insurance However, this is reconciled currently for divorced, recently marriedpatients with name differences upon registration25
Main Line HealthShort term fixes before the Upgrade Highlight preferred name in the header Re-educate registration regarding collection of preferred name forALL patients Change radiology and lab slips to contain preferred name Educate all ancillary and ambulatory staff to use preferred namewhen calling for patients26
Main Line HealthShort Term Fix27
Main Line HealthNext steps: Continued Education Develop scripts for education increasing comfort level All MLH staff to attend full day DRI education- 1000 havealready attended Provide short video demonstrations on how to ask questions suchas preferred name, pronouns, gender, and sexual orientation Provide demos as well if a patient or family gives pushback Provide open forum opportunities for a "no dumb questions"conversation if employees are truly going to widen their lens28
Main Line HealthNext steps: Electronic health record Re-establish the SOGI decision-making body Take as many upgrade changes as possible Be progressive in our thinking Budget for tablets at points of entry for self-identification Add SOGI questions to MyChart and Self Check In29
Main Line Health"Progress is impossiblewithout change, and thosewho cannot change theirminds cannot changeanything."George Bernard Shaw30
Main Line Health – Diversity, Respect and InclusionContact Information:Eileen Phillips DNP, RN NE-BCphillipse@mlhs.orgJoanne B. Glusman MSW, LSWglusmanj@mlhs.org31
Main Line Health – Diversity, Respect and Inclusion4. GENDER QUESTIONSEpicWhat is your gender? F/M/Genderqueer ornot exclusively male or female / binary /CisElsevierCPMFenwayGLMATJCxDo you identify as transgender ortranssexual?Are you transgender? No, Yestransgender M to F, Yes-Transgender F toM, Transgender, Yes-do not identify as Mor F"Who shouldask?CommentsNursing / Provider/ MA"Recommend askingpost-registration, inprivate, by a clinician begin by asking an openended question - wouldyou like to discuss yourgender identity? If yesthen document in thisflowsheet - Includedefinitions in the rowinformation for cliniciansMyChart: Questionsshould be included in theMyChart Portal forpatients"x"What is your current gender identity? (withChoices) Male Female Trans Man TransWoman Male-to-Female(MTF)/Transgender Woman Female toMale (FTM)/ Transgender ManGenderqueer, neither exclusively male norfemale Non-binary Gender fluidOther, pleasespecify: Decline toanswer "What is your gender? M/F/Transgender Mto F, transgender F to M, otherQuestion tobe Used32xxxxxxx
Main Line Health – Diversity, Respect and Inclusion5. PRONOUNSEpicElsevierCPMPreferred Pronouns-(open ended blank)Patient's pronouns: she/her/hers; he/him/his;they/them/theirs; patient's name; decline toanswerxPronoun preferenceFenwayGLMAxxTJCQuestion tobe Used"Who should ask?xNursing / Provider / MAxAny clinician completing thepatient historyxAny clinician completing thepatient historyComments"Recommend adding ""Other:please specifiy"" to allow for afree text option Also could bean option to ask this on theMyChart patient portal"x6. TRANSITION QUESTIONSSteps taken to transition-presentationaligned with gender identity; preferred namealigned with gender identity; legal namealigned with gender identity, legal sexaligned with gender identity; medical orsurgical interventionsxDo not ask - part of medical and surgicalhistory7. ORGAN INVENTORYOrgans the patient currently has: breasts,cervix, ovaries, uterus, vagina, penis,prostate, testesxOrgans present at birth or expected at birthto develop: same as current organs, breasts,cervix, ovaries, uterus, vagina, penis,prostate, testesxOrgans hormonally enhanced or developed:breastsxOrgans surgically enhanced or constructed:breasts, vagina, penisxDo not ask - would already be part ofmedical and surgical history3333
Main Line Health – Diversity, Respect and Inclusion8. RELATIONSHIP QUESTIONSEpicProblems affecting how you see yourself as aman/woman and or relationship with partnerElsevier CPMFenwayGLMATJCQuestion to beUsed"Who should ask?34CommentsxDo not ask - not medically necessary - similarquestions asked in patient's social history alreadyxAny clinician completingthe patient historyxAny clinician completingthe patient historyxAny clinician completingthe patient history9. SEXUAL ORIENTATION QUESTIONSDo you consider yourself to be: Straight, gay orlesbian, bisexualxSexual Orientation identity: Bisexual, gay,hetero/straight, lesbian, Queer, Other-feel free toexplain, Not sure, Don't knowPatients sexual orientation: Lesbian or gay,straight, bisexual, something else, don’t know,choose not to disclosexxxDo not ask - not medically necessaryADDITIONAL QUESTIONS10. CARE PERSONALIZATION QUESITONSWhat information would help us give you morepersonalized care?Is there anything about yourself or those you careabout that would help us take better care of youIs there anything else we have not discussed thatyou would like to tell me so that we can besensitive/responsive to your needs? (U of Pquestion)xSexual activity - currentlypart of the social history,can satisfy this need
Creating an Inclusive Environment for LGBTQ Patient
