Healthcare Equality Index

HEI Frequently Asked Questions

The annual Healthcare Equality Index (HEI) is used by inpatient and outpatient healthcare organizations nationwide to strengthen the care they give LGBT patients and reach out to this long overlooked group.

To view or participate in the HEI, which is free of charge, just register your healthcare organization. And if your questions aren’t answered below, don’t hesitate to contact HEI staff.

What is the HEI?
Why should our organization participate?
What’s involved in participating? Is there a fee?
What kinds of organizations can participate?
What’s the schedule and deadline?
How can we access free HEI training?
What does it mean to be an HEI Leader?
Do organizations participate every year?
Can we see the HEI?

What is the HEI?

The HEI is an annual online survey. Created in 2007, the HEI has been designed to meet the needs of all healthcare organizations seeking to provide optimal care to LGBT patients and to meet CMS and Joint Commission requirements related to this underserved population.

In the first criterion of the HEI, participating organizations are asked to document whether they meet the Non-Discrimination and Staff Training Criteria, formerly known as the "Core Four" criteria, for LGBT patient-centered care, which incorporates CMS and Joint Commission requirements. In this section, organizations are also given the opportunity to enroll staff members at all levels for free, expert training in LGBT care. Responses to the Core Four questions are listed by organization in the HEI 2016 annual report and determined whether organizations were designated as 2016 "Leaders in LGBT Healthcare Equality."

The other criteria of the HEI, formerly known as the Additional Best Practices Checklist, is designed to familiarize organizations with a wide range of recommended practices in LGBT patient-centered care, so that they can identify and remedy gaps. Originally, responses to these questions were not shown by organization in the HEI report since they were aggregated and did not affect Leader status. During the 2015 survey year, which provided data for the HEI 2016, responses were returned to participating organizations in a unique, customized analysis to be used for benchmarking, needs assessments, and strategic planning.

After nine years of promoting LGBT inclusive care, the HEI has shown great success in getting hospitals and other healthcare facilities across the nation to adopt the LGBT inclusive policies included in the HEI 2016's “Core Four” Leader Criteria. Having the policies in place from the Non-Discrmination and Staff Training criteria, formerly the "Core Four," is foundational, but in order for healthcare facilities to provide truly inclusive LGBT patient-centered care, they must also adopt many of the policies and practices found in the other criteria of the HEI survey. Therefore, beginning in 2016, the HEI will be a scored index which will give greater weight to the full range of policies and best practices covered in the HEI survey.


This coming year, in order for a facility to become a "Leader in LGBT Healthcare Equality," they will need a score of 100 by implementing best policies and practices from the new HEI Scoring Criteria at their facility. Leaders are featured in the HEI annual report and website, and receive a coveted logo and outreach tools that they can use to publicize their commitment to equity and inclusion.

Learn more about the new HEI Scoring Criteria

Why should our organization participate?

LGBT patients face very significant challenges in healthcare: 56% of lesbian, gay, and bisexual people report experiences of serious discrimination in healthcare, while 70% of transgender people report serious discrimination. In response, CMS and The Joint Commission have issued requirements for LGBT equity and inclusion, and expert recommendations have now emerged for LGBT patient-centered care.

The HEI enables healthcare organizations to assess their own policies and practices vis-à-vis these requirements and recommendations, and equips them with the training and resources they need to remedy gaps. It also enables organizations to receive public recognition for their commitment to equity and inclusion.

Hundreds of healthcare organizations nationwide have participated in the HEI to:

  • Increase patient safety and satisfaction
  • Comply with CMS and Joint Commission requirements
  • Minimize risk and maximize quality
  • Enhance their reputation for equity and inclusion

And HEI participants enjoy these unique benefits:

  • Access to free, expert online training for staff at all levels
  • Customized analysis of potential gaps, with resources for addressing them
  • Public recognition for their commitment to equity and inclusion
  • Tools for outreach to LGBT community members

What’s involved in participating? Is there a fee?

The HEI, including the extensive training offered to participating organizations, is offered free of charge, as an educational program of the HRC Foundation. 

Participation in the HEI requires a login. If your organization does not already have a login, you can register to receive one, which will enable you to view the HEI with no obligation.

The HEI is designed to be highly accessible and easy to use. The first section on Non-Discrimination and Staff Training asks participants to show that they meet foundational criteria incorporating CMS and Joint Commission requirements, and also offers the opportunity for free expert training. The subsequent criteria, previously known as the Additional Best Practices Checklist, allows organizations to see a broad range of policies and practices for LGBT patient-centered care, assess their own policies and practices and identify any gaps in patient and employee care. Beginning this survey year, the HEI will be a scored index, using the new HEI Scoring Criteria to reach a score of 100 points. Facilities who reach 100 points will be designated as a "Leader in LGBT Healthcare Equality."

Help text and other resources are plentiful within the HEI, and HEI staff are always available to assist. The HEI can be completed by any number of people within an organization--the HEI login can be shared—but each organization is asked to designate an “official submitter” to review and submit the HEI.

HEI staff review HEI submissions on a rolling basis, contacting participating organizations with any questions before providing all participants with a custom analysis of their responses. This analysis highlights their responses to all scored questions in the HEI that determine HEI Leader status, and includes a wealth of information for strategic planning vis-à-vis LGBT care.

What kinds of organizations can participate?

The HEI is open to all healthcare organizations in the U.S. with 100 or more employees, whether inpatient or outpatient, network or individual facility. Inpatient facilities are particularly encouraged to participate, and constitute the majority of participants.

What’s the schedule and deadline?

In the past, the HEI collected data, issued the HEI report and designated leaders all in the same year. For example, for the HEI 2014, data was collected from February through August 2014 and our Leader facilities were designated "2014 Leaders in LGBT Healthcare Equality." Beginning with the HEI 2016, the HEI collected data in one calendar year (June through October 2015) and then issued Leader status and the HEI report in the following year, 2016.

The HEI survey is currently closed.  The HEI 2017 survey session will open in Summer 2016 with a survey deadline in late Fall 2016. 

How can we access free HEI training?

All organizations participating in the HEI may register staff for acclaimed, expert online training—in fact, training is required to be awarded HEI Leader status. Complete details are available within the HEI.

What does it mean to be an HEI Leader? When will we know if we are a Leader?

Survey participants that meet the new HEI Scoring Criteria are designated as a Leader in LGBT Healthcare Equality. The Leader designation signals to LGBT patients and allies that the healthcare facility has meet the foundational elements of LGBT patient-centered care.  Prior to the release of the HEI report, Leaders receive the coveted HEI Leader logo for their use, as well as extensive resources for publicizing their achievement and conducting outreach to LGBT community members.

HEI staff will notify all survey participants whether or not they have received Leader status once the review of that facility’s survey is complete.

Do organizations participate in the HEI every year?

Yes. The HEI is revised annually to incorporate new issues and resources related to LGBT patient-centered care, and Leader status is determined each year by an organization’s responses to the HEI in that year.

Can we see the HEI?

The HEI 2016 report describes the HEI's questions and methodology. The full online survey can be viewed by any organization that registers for an HEI login, with no obligation to participate.