The Courage to Ask: Advancing LGBTQ+ Healthcare through Honest Conversations

Have you heard of the quote "Absence of evidence does not mean evidence of absence?" Basically, just because we don't have any evidence that something exists, doesn't mean it doesn't. It just means we don't have any evidence either way. It's a phrase that often comes up in conversations about evidence for treatment in healthcare settings. (Cochrane has done a great blog on this which?you can read here).

We were in a meeting recently where a director said "We don't have any reports of our LGBTQ+ patients receiving poor treatment from us." When we dug a little deeper, it turns out, they'd never actually?asked?their LGBTQ+ patients about their experiences. Now, almost 25% of LGBTQ+ people have?witnessed discrimination or negative remarks about LGBT people?from healthcare staff, but that doesn't tally with the number of complaints that feature a patient's sexual orientation or gender identity as a hallmark of the complaint.

Why not?

Sexual orientation and gender identity don't often feature in a complaints process unless specifically captured as part of the complaints process. Even then, LGBTQ+ people have said that they?don't bother escalating complaints?because:

1. They'd have to out themselves to do so and it may not be safe or possible for them to do so
2. They have concerns about their complaint not being taken seriously
3. There are concerns about their care being affected if they were to make a complaint

So, if we don't ask the questions, and we don't capture the response, we face the conundrum- the absence of evidence does not mean evidence of absence. Or, as we like to call it, the Ostrich Effect. Sticking your head in the sand and pretending it's not happening- not a tactic that's going to prove successful in the long term.

Think about your practice complaints procedure. Do you capture diversity data for your patients to see if this is a factor in the process? If we were to ask you now whether your LGBTQ+ patients experience better or worse service in your healthcare setting in comparison to their cisgender-heterosexual counterparts, would you be able to answer this with evidence to back up your response?

Asking these questions of your LGBTQ+ patients isn't opening the door to a raft of new complaints, it?is?showing that you want to know and understand the experiences of those seeking care at your practice, including those from minoritised groups. That's where growth happens, right? It's where plans can be put in place to meet specific needs, and create better experiences for everyone within your setting- patients, their families and friends, your colleagues and beyond.

We're in the middle of a large project with an NHS Trust, and will soon be releasing a survey to look at the experiences their LGBTQ+ service users have when seeking care with them. We commend them for their willingness to ask these tough questions, knowing the answers will likely prove difficult reading. It's not easy to do this. It's easy also to focus only on the negative and yet there's often glimmers of hope and positive practice in these exercises too- we're also expecting to hear some success stories too, episodes where LGBTQ+ patients have felt their specific needs have been met, where they've been treated with dignity and consideration, or where staff have gone above and beyond to make them feel welcome!

If we don't ask the questions, we won't know where we're doing well, and where we need to improve, right?

So think about it. Consider a quick investigation yourself.

• When was the last time you audited your files to assess the diversity profile of your patient base? (Side note- if your patient base lacks diversity, it could be a good opportunity to do some community outreach and improve that!)
• Have you ever surveyed your patients or staff to understand their experiences with your clinic? If so, did you capture the data to understand the specific experiences that people from minoritised groups have with your clinic?

It doesn't take long to do, and it can identify some really interesting results.

For example, we recently helped a clinic in Sussex with a patient experience survey and found that:

• Evening appointment times were often booked up by patients who worked during the day, but this also meant that people with caring responsibilities couldn't get appointments at those times either.
• Their website stated that they may need to get changed into a gown for an assessment. A trans person was therefore put off from attending an appointment as they didn't want to have to remove their binder.

Simple solutions can be put in place to address these concerns- but?we have to ask the questions first!

If you'd like some help carrying out an Equality, Diversity and Assessment review in your practice or healthcare organisation, please drop us a line at [email protected] and let's get the ball rolling.