At UPMC Passavant, frontline caregivers and hospital employees are working with hospital leaders to ensure high quality, gender-inclusive care for members of the LGBTQIA+ community.
Few people understand the misconceptions, stigmas, and discrimination experienced by people who identify as lesbian, gay, bisexual, transgender, queer or questioning, intersex, or asexual/agender/aromantic (LGBTQIA+). And the reality is those biases often are seen in their health care.
The National LGBT Cancer Network says that’s why many LGBTQIA+ individuals delay or avoid essential screenings and care. When they do, their health and well-being can be at risk.
“Throughout UPMC and here at UPMC Passavant, there’s been a growing awareness that we need to confront this issue,” says Lisa Bryan-Morris, MSN, RN, NEA-BC, chief nursing officer and vice president of patient care services. “As a hospital, we’re proud of our reputation as a welcoming place for all patients. That’s why we want to better serve our LGBTQIA+ patients. We’re committed to eliminating both visible and invisible barriers to their care.”
Key to those efforts is the work of an all-volunteer UPMC Passavant Inclusion Employee Resource Group (IERG) created in 2020.
“To change our culture of care, we had to start by looking at our own personal understanding of the LGBTQIA+ community,” says nurse educator Rebecca Kolb, MSN, RN-BC, the group’s co-chair. “The IERG is a safe space where all caregivers at UPMC Passavant can engage in open and honest dialogue about this and other equity and inclusion issues affecting our patient care.”
The IERG represents both UPMC Passavant–McCandless and UPMC Passavant–Cranberry. Members include doctors, nurses, technicians, and staff from a wide range of departments. Bryan-Morris and Jacquelyn Demianczyk, human resources director, act as the hospital’s executive sponsors with the support of UPMC Passavant President Susan Hoolahan, RN, MSN, NEA-BC.
“As a hospital, we know that it’s important to acknowledge mistakes have been made in order to do better in the future. No one should ever feel uncomfortable, embarrassed, or upset about the care they receive,” says Bryan-Morris.
“Working with this group has taught me a great deal about health care inequality and LGBTQIA+ care,” says co-chair Mpande Mwape, MSN, RN, MEDSURG-BC, a unit director at the hospital. “As a person of color, I appreciate those challenges. That drives me to be an advocate for improvement. It’s a journey, but we are making steady progress.”
Putting Words Into Action
The IERG has identified four steps necessary to promote a more welcoming and inclusive culture for LGBTQIA+ patients. They are:
Staff Education and Training
Staff training is the foundation of all gender-inclusion efforts at UPMC Passavant. Joy Gero, PsyD, LPC, director of population health and improvement for the Wolff Center at UPMC, has led several sessions for the hospital’s employees. “Our office is working to address the health disparities faced by LGBTQIA+ patients at UPMC systemwide. And the real work is happening in hospitals like UPMC Passavant. It takes dedicated people at every touch point of care — from the admissions desk to the bedside — for these efforts to succeed,” says Gero.
“It’s our collective responsibility as health care providers to create a better patient experience for those who identify as LGBTQIA+. We do that through added services, training, and ongoing conversations. The goal is to continually improve the quality of care, safety, and clinical outcomes for our patients.”
Working with LGBTQIA+ patients also involves a shift in the care model used by many health care providers, she adds. “We’re all taught protocols based around the sex assigned at birth,” says Gero. “Those traditional assumptions that often guide initial care can’t be applied to every patient.”
The UPMC Center for Engagement and Inclusion provides interactive microaggression training focused on the slights, insults, and prejudices typically encountered by LGBTQIA+ patients.
“When a microaggression happens, people don’t know what to do or say,” says Kolb. “In this training, we learned practical tactics to defuse a microaggression and hopefully, help microaggressors learn the impact of their words or actions.”
“The most helpful tactic that I learned is to not be reactive,” adds Mwape. “Microaggressions are often unintentional, but they’re still hurtful. This training created an opportunity to change unconscious bias behaviors and to learn from each other.”
Surgical and post-acute care staff at UPMC Passavant–Cranberry who assist on gender-affirmation surgeries receive added in-depth training. And all staff have access to a training session on health disparities led by Tracey Conti, MD, chair of family medicine at the University of Pittsburgh School of Medicine.
Electronic Health Records
UPMC’s electronic health records (EHR) now collect sexual orientation and gender identity information, which includes a person’s chosen name and personal pronouns. “This step supports better patient-centered care for everyone,” says Bryan-Morris.
“Calling an LGBTQIA+ patient by their chosen name and personal pronouns is a real indicator of our support,” says Gero. “It eliminates the stress of repeatedly sharing that information at every health care interaction. It also opens the door to a more trusting patient/provider relationship.”
Visible Expressions of Support
Last year, the rainbow flag — a colorful symbol of gay pride and support — flew for the first time at both UPMC Passavant campuses, thanks to the IERG’s efforts.
Hospital staff members also can elect to display a gay pride pin attached to their employee ID badge. “The idea was suggested by the IERG and actually designed by my co-chair, Mpande,” says Kolb.
Signs at both hospital entrances explain the significance of this symbol. “We want everyone to know that this a place where kindness and respect are expected from all — and for all — who enter our doors,” says Mwape.
Expanded LGBTQIA+ Clinical Services
A major new initiative at UPMC Passavant addresses the region’s growing need for gender-affirming surgery. In August 2021, reconstructive plastic surgeon Brodie Parent, MD, began offering facial feminization surgery at UPMC Passavant–McCandless and outpatient top surgery at UPMC Passavant–Cranberry for transgender and gender diverse patients, with follow-up care at UPMC Passavant–McCandless.
The Healthcare Equality Index (HEI)
The Healthcare Equality Index (HEI) is the national LGBTQ benchmarking tool that evaluates a health care facility’s policies and practices when it comes to equity and inclusion of their LGBTQ patients, visitors, and employees. In 2022, both UPMC Passavant campuses were again recognized as an ”LGBTQ+ Healthcare Equality Leader” — achieving the highest score possible.
A Patient Perspective
Luca Salerno was scheduling consultations for gender-affirming top surgery in early 2020 when the pandemic hit. “Once hospitals started reopening, I learned that the surgeons I was considering now had years-long waiting lists,” he says.
A new search led the 38-year-old dad and scientist to Brodie Parent, MD, a reconstructive plastic surgeon who recently joined the UPMC Department of Plastic and Reconstructive Surgery after completing his fellowship. He is also an assistant professor at the University of Pittsburgh School of Medicine’s Department of Plastic Surgery. “While Dr. Parent didn’t have years of established results, I was impressed by his good, kind bedside manner,” says Luca. “He also shared information about the top-notch surgeons he trained under and did surgery with during his fellowship.”
Luca, a former UPMC employee, had surgery to achieve a chest that better aligned with his identity as a transgender male. “There are many reasons people need or want this surgery,” he says. “People use visual cues to form an assessment of you, and my cues presented conflicting messages. It all boiled down to being better able to live as my gender in a body that’s more comfortable for me.”
Dr. Parent says he was first introduced to gender-affirmation surgery during his fellowship and he’s glad it’s now part of his practice. “I had the opportunity to work with and get to know a number of transgender individuals. I recognized the great need for this care, and I found that I really enjoyed working with transgender patients,” he says.
He also finds it satisfying as a surgeon. “Many of the patients I consult with were ready to have this surgery 10 years ago. When it’s over, there’s almost a sigh of relief — like a weight has been lifted from their shoulders,” says Dr. Parent.
His first day at UPMC Passavant, Dr. Parent saw the rainbow flag flying outdoors. “I thought, ‘Ah — I’m at the right place!’”
He praises UPMC Passavant’s senior administration for their top level support. “Having support at all levels is very important,” Dr. Parent says. “Like me, the more exposure my staff has to individual LGBTQIA+ patients, the more they realize that these are folks just trying to live a life where they don’t get stared at. I know I can firmly plant this practice here and be confident that my patients will get good care and not be discriminated against for the surgery they’re getting.”
For Luca, life after surgery has been a lot easier to navigate. “It’s been really good. The outcome is exactly what I had hoped for somebody of my age and body type,” he says.
He wants people to know that gender transitioning and affirmation surgery isn’t about standing out or being treated differently. “In fact, it’s just the opposite,” says Luca. “We’re normal people who want to live a normal life. This surgery lets us be treated as any person wants to be treated — in accordance with our identity.”