Testimonials From Leaders in LGBT Healthcare Equality

	Leader: AIDS Care Location: Rochester, N.Y. Size: 96 full-time employees Years rated in HEI: 1 Years as Leader: 1

As an organization founded in the earliest days of the AIDS epidemic, AIDS Care has always understood that lesbian, gay, bisexual and transgender communities face unique barriers and challenges when trying to access health services. AIDS Care has long-endeavored to ensure that not only are we sensitive to the needs of this population, but that we also help to build the capacity of other service providers in our region to serve them as well.

Our experience in doing this work has often taught us that the path to full and authentic inclusion of LGBT people into care begins with recognizing that there are several problems: Disparities exist in access to health services, treatment within care settings is often unequal or absent, and these realities can create negative health outcomes for our patients that should prompt changes and improvements. Providing the data and sharing personal narratives is usually a powerful and effective way to elicit this realization in mainstream providers. The next step, however, is to actually implement changes that create a more inclusive environment and that improve patient access and care.

When one considers the volume of policies/procedures implemented within most care settings, the Healthcare Equality Index sets out to assess a very small number by comparison; and yet the very policies and practices promoted by the HEI can themselves provide a framework for thinking about an organization's commitment to LGBT inclusion and care. Very basic changes can certainly have a dramatic impact. Some of the policies/practices from which we have most benefited, and for which we frequently advocate with other providers, include:

• Adopting patient and employee non-discrimination policies that cover sexual orientation and gender identity/expression
• Expanding definitions of "family" and "parent" to include LGBT people
• Evaluating intake and record-keeping paperwork to make sure that it captures our patients' sexual orientation, gender experience and family situation
• Offering employee benefits packages that cover LGBT families
• Implementing ongoing trainings and conversations with our staff about LGBT issues

These changes have had a positive impact on many levels at AIDS Care, and all departments have ultimately worked together to improve access and care for our LGBT patients. For example, establishing good human resource guidelines has certainly created an environment where we have many LGBT and LGBT-friendly employees. The philosophy of inclusion within our organization extends beyond our paper policies and is put into practice daily by our employees. The inevitable outcome has been attracting more LGBT consumers whose involvement in our agency has further built an inclusive culture and has led AIDS Care to becoming a center of excellence in care for LGBT people. At AIDS Care, we frequently hear about our quality of care from those we serve. We are now thrilled to see this highlighted in the HEI.

Erik Libey
Associate Director of LGBT & Rural Services
AIDS Care

	Leader: Baystate Health Location: Springfield, Mass. Size: 6,578 full-time employees, 774 beds Years rated in HEI: 2 Years as Leader: 2 (as individual respondent, Baystate Medical Center, in 2010)

Baystate Health, based in Springfield, Mass., is a private, not-for-profit health system, and one of the largest in New England, serving a population of 800,000 residents in western Massachusetts. It is the region's largest private employer, recognized nationally for quality and patient safety, with the region's only academic medical center and 774 beds at its three hospitals. In addition, our health centers, medical practices and the many entities of Baystate Health represent our vibrant communities and serve our diverse patients throughout the region.

We appreciate the recognition we received in 2010 for Baystate Medical Center as one of eight hospitals in the country to achieve the distinction of the Human Rights Campaign Foundation's Best Healthcare Facilities for LGBT Families. In 2011, we are proud to be recognized as a Leader in LGBT Healthcare Equality, and have expanded this achievement to additional Baystate Health entities, including Baystate Franklin Medical Center and Baystate Mary Lane Hospital.

As our workplace, community and patient base change due to demographic shifts, diversity and inclusion is not simply a good thing to do, but has become a key business imperative. Baystate Health is committed to fostering an environment of diversity, inclusion and cultural competence, where all employees are appreciated, fully engaged and motivated to provide the best health care, and where patients and families feel valued and included. With policies in place to ensure a welcoming environment for lesbian, gay, bisexual and transgender patients and families, we continue our journey to translate these policies into practice. To accomplish this, we offer education on LGBT issues in the workplace for all employees as well as offer in-service, customized programs about transgender healthcare designed to meet the specific needs and requests of clinical departments. Examples of these sessions include transgender cultural competence training:

• At Baystate High Street Health Center, LGBT patients at our health centers are met by front-line staff who participated in transgender-specific cultural competence training.
• With our pre-admission team as a key point of entry for all surgery patients, we developed and delivered an in-service cultural competence training to ensure that communications with LGBT patients would meet the needs of both our staff and patients.
• Set in the rural town of Greenfield, Mass., our community hospital's Emergency Department nurses recognized an opportunity to improve care and compassion to our patients and engaged in transgenderspecific training to increase cultural competency.

The success of our educational efforts resides in the ability of each person at Baystate Health to develop a skill set to better foster inclusion and cultural competence. We want to better understand and maximize the unique strengths of employees, especially as they meet the needs of a changing community and workplace – including patients, families, visitors, fellow employees, volunteers, community members and suppliers.

We expanded our outreach efforts to promote diversity and inclusion beyond our current workforce. Because of our efforts, prospective candidates can easily see that we foster an environment in which everyone feels welcome and valued, in which different perspectives and experiences are not only accepted, but embraced.

We take time to celebrate with our community, and each year are fortunate to bring hundreds of employees together to participate in the Northampton LGBT Parade and Rally, one of the biggest LGBT Pride events in New England. We are committed to providing the best healthcare, and this can only be done in an environment that treats all patients with dignity and respect – an environment we take pride in providing at Baystate Health.

Visael "Bobby" Rodriguez
Chief Diversity Officer
Baystate Health

	Leader: Beth Israel Medical Center Location: New York, N.Y. Size: 7,420 full-time employees, 1,111 beds Years rated in HEI: 2 Years as Leader: 2

The LGBT Committee at Beth Israel Medical Center (a member of the Continuum Health Partners hospital network) was formed in 2008 as a subdivision of the hospital's Diversity Council. The goal of the committee is to maintain a culture of inclusion within which all lesbian, gay, bisexual and transgender patients and staff feel that they are in a safe, supportive and non-judgmental setting. The committee also sponsors competency training, which involves educating all associates on LGBT-specific issues, such as terminology and history, as well as the applicable local and state laws affecting LGBT people with regard to healthcare.

Our accomplishments thus far include:

• Beth Israel received a perfect rating on the Human Rights Campaign Foundation's Healthcare Equality Index in 2010 and 2011. The HEI is a well-recognized measure of how LGBT-friendly a hospital's policies and practices are.
• CHP forms a team of approximately 125 associates to participate in the New York City Pride Parade annually.
• Beth Israel participated in the NYC Bar Association/Columbia Law School 2011 citywide survey of hospital policies and practices governing patient care for transgender individuals.
• The committee developed a list of "Top 10 Provider Tips for Serving the LGBT Patient Population" based on available literature from reliable sources, such as the Gay and Lesbian Medical Association. This list is currently included in the orientation package for all newly hired employees of the medical center. The tips list (as well as other resources) remains accessible to providers and staff via the medical center's intranet website.
• In recognition of 2010 National LGBT Health Week, members of the committee provided a panel presentation regarding issues related to LGBT medical and mental health at KPMG, LLP headquarters.
• Based on The Joint Commission requirements and to further our efforts to serve an increasing diverse patient population, the committee coordinates ongoing LGBT sensitivity trainings at the hospital and its affiliated locations. This serves to encourage awareness and sensitivity toward the LGBT patient population. Transgender patient sensitivity trainings for all staff have been conducted; because of its success, requests for additional trainings have been received.
• The committee coordinates ongoing social networking events for all CHP LGBT associates and allies. All staff (including staff from our affiliate hospitals) are invited, through blast e-mails, to attend these events. The events have been well attended, and attendance has increased by at least 25 percent each time.

Being recognized as a Leader in LGBT Healthcare Equality by the HRC Foundation is a powerful tool to assist the LGBT Committee in engaging straight allies throughout Beth Israel. Every physician, nurse and staff member understands best care practices, and wants to provide quality care to every patient, regardless of diversity status.

Since formally creating a comprehensive, hospital-wide cultural diversity initiative six years ago, Beth Israel has implemented programs and policies to encourage associates to be comfortable with diversity and develop an appreciation for difference. As part of this work, our committee remains strong in its resolve to realize a healing working environment throughout Beth Israel Medical Center, where tolerance and acceptance of gender, sexuality, race, religion, gender identity and gender expression is the norm.

Michael Graziano, M.P.A.
LGBT Committee Co-Chair
Beth Israel Medical Center

Rolston Cyril Watts, Ph.D.
LGBT Committee Co-Chair
Beth Israel Medical Center

	Leader: Brigham and Women's Hospital Location: Boston, Mass. Size: 14,867 full-time employees, 777 beds Years rated in HEI: 2 Years as Leader: 1

At Brigham and Women's/Faulkner Hospitals, we dedicate ourselves to providing the highest-quality care in a supportive environment that embraces diversity and respects all people. We are proud that our ratings in the Healthcare Equality Index reflect our dedication to these values.

Participating in the HEI has helped us translate our long-held values into action. At both hospitals, we clarified the language in our policies to ensure our dedication to the dignity of all our families was clear, making our support of transgender people and all lesbian, gay, bisexual and transgender families explicit. These policies are now plainly visible to all who come to our distributed campus locations for care or to visit loved ones who are here.

Our participation in the HEI has also prompted us to increase our efforts in training medical staff about the unique health needs of LGBT people. To ensure that current and future providers provide competent care to LGBT people, we not only offered additional training to our staff and providers at Brigham and Women's, but also collaborated with our colleagues at Harvard Medical School to provide additional teaching of medical students about these needs. At Faulkner Hospital, the HEI has stimulated discussions about opportunities to expand educational offerings on LGBT topics.

Our community of providers and staff is significantly enhanced by its diversity. We strive to celebrate that diversity and foster it as part of our core mission. BW/F Hospitals have long supported the inclusion of domestic partners and same-sex spouses in our benefits plans. Since the start of our participation in the HEI, we have increased our efforts to develop and strengthen our LGBT employee resource group to better serve the needs of our dedicated caregivers and those who support them. This group has provided a place for the LGBT members of our community to meet and to celebrate the diversity that makes our institution strong. As part of National LGBT Health Awareness Week, the group has organized a series of events to bring attention to issues of importance across our entire community and has collaborated with organizations in Boston. In June, this group represented BW/F in the Boston Pride march.

BW/F Hospitals are proud of our ratings in the 2011 HEI, as we are proud of the people who have worked to make that possible. We thank the Human Rights Campaign Foundation for its efforts in preparing this index and the encouragement it provides to those who value their LGBT staff and who work to improve the care they provide to LGBT patients.

Michael Gustafson, M.D., M.B.A.
Senior Vice President for Clinical Excellence
Brigham and Women's/Faulkner Hospitals

	Leader: California Pacific Medical Center Location: San Francisco , CA Size: 2,775 full-time employees, 855 beds Years rated in HEI: 1 Years as Leader: 1

California Pacific Medical Center, part of the Sutter Health network, has been serving San Franciscans for more than 150 years. It has a long history of supporting the lesbian, gay, bisexual and transgender community. With four hospital campuses – one located in the Castro District famously represented by Harvey Milk – CPMC offered compassionate care during the earliest days of the AIDS crisis and opened Coming Home Hospice to offer dignity for terminally ill patients. For years, we have partnered with local LGBT-community organizations, including the San Francisco LGBT Center and the Lyon Martin Clinic, the country's first clinic to focus on lesbian and transgender health issues. Additionally, we have fostered a culture of inclusiveness for staff and offer fully paid health benefits for domestic partners and their families.

Despite our proud tradition of serving the LGBT community and our long-standing non-discrimination protections for employees and patients, the Healthcare Equality Index survey helped us realize that our written policies regarding patient visitation rights did not fully reflect our anti-discriminatory values and practices. The Human Rights Campaign Foundation provided valuable resources for us to develop an LGBT-inclusive definition of "family" in our visitation policies – a definition we hope will be adopted by every hospital in the nation. By formalizing our practices in writing, we are taking another step toward ensuring that each of our patients gets an equal level of high-quality, compassionate care.

We are proud to now be included among the HEI's Leaders in LGBT Healthcare Equality, but by no means do we feel that our work is done. The survey has encouraged us to further reflect on our LGBT-inclusive practices and continually seek out opportunities for improvement, even in areas where we have received credit on the survey.

Our goal is to be a model of inclusiveness for medical centers as well as employers across the country – because it's the right thing to do for our patients, our employees and our community.

Judy Li, Ph.D.
Vice President – Health System Innovation and Community Benefit
California Pacific Medical Center

	Leader: Chase Brexton Health Services Location: Baltimore , MD Size: 220 full-time employees Years rated in HEI: 2 Years as Leader: 1

In 1978, a group of gay men and a handful of volunteer healthcare providers gathered at the Gay and Lesbian Community Center of Baltimore and founded what would one day be known as Chase Brexton Health Services. At that time, traditional medical care treated lesbian, gay, bisexual and transgender individuals with, at the least, shaming care – and often worse. The need was clear: a safe place for the LGBT community to receive medical care. And, in 1978, this small group of people took a brave step toward meeting that need.

For 33 years, Chase Brexton Health Services has continued to work toward meeting that need. We've expanded far beyond the volunteer-run clinic of our founding. Today, we are a Joint Commissionaccredited, Federally Qualified Health Center serving more than 17,000 patients at four unique sites in the state of Maryland. We provide medical and dental care for adults and children, mental health services, transgender care services, substance abuse services, HIV and hepatitis C infectious disease care and wraparound programs, case management services, a discounted pharmacy for our patients, and more. With every step we've taken, we have fought to remain true to our founding, by providing a safe, supportive, inclusive environment for LGBT individuals to receive high-quality healthcare.

In 2011, the need for dedicated safe spaces still exists. For LGBT and other individuals who do not follow socially sanctioned sexual and gender ideas, accessing healthcare can be a disturbing experience. The policies and practices promoted by the Healthcare Equality Index deal directly with discriminations found in the field. The HEI formally challenges the medical world to recognize, address and respect the healthcare needs and human rights of its patients – all its patients.

But more than just acting as a challenge, the HEI provides the groundwork to enable change to occur. Without laying blame, the HEI provides the tools for medical systems to survey current practices, address inequities and become educated about the needs of LGBT communities. It provides a process that gives healthcare an opportunity to become all it can be, to do no harm by understanding harm on a broader scale and to honor all.

At Chase Brexton, we have been a provider of LGBT care for more than 30 years. Our staff and our board are highly representative of our LGBT communities. And, every staff and board member, no matter what their sexual orientation or gender identity, shares the focus of the mission and vision of Chase Brexton to be renowned as a prominent healthcare provider for the LGBT community. We use the HEI as a guideline for our work; it is a fantastic way to ensure – using a key from the world beyond our walls, beyond our patients and beyond our communities – that we are doing all we can to meet the needs of our communities and to communicate to our patients our beliefs and their rights.

As a historically LGBT provider, we are extremely grateful to have the HEI to review and survey our operations to ensure we are providing the best possible care for all our patients.

Alicia Gabriel
Marketing Manager
Chase Brexton Health Services

The George Washington University Hospital is a 371-bed academic medical center located in downtown Washington, D.C. We serve a diverse population that includes our neighbors, international patients and national leaders. The hospital is located just a short walk from Dupont Circle, a vibrant neighborhood known for lesbian, gay, bisexual and transgender-friendly businesses and residents.

LGBT employees, physicians and patients have long been a valued and vital part of our community, and we've considered the hospital to be accessible and sensitive to the needs of the LGBT community. For more than a decade, GW Hospital has advertised with "Other Pages," an LGBT area guide, and it currently is the only D.C.-area hospital to do so. In response to a growing patient population of lesbian couples giving birth at the hospital, the hospital targeted obstetrics services to prospective lesbian mothers and broadened the language in its literature to be more family-centered. Reflecting the diversity of our employees, a hospital chaplain performed one of the first gay marriages in D.C. between two of our male staff members. The outpatient psychiatry department has physicians dedicated to caring for the unique needs of LGBT patients.

Participation in the Healthcare Equality Index, however, has spurred us to further consider our policies for inclusiveness. For example, we recognize the importance of patients having those closest to them nearby, whether they are facing a serious illness or routine surgery. When we completed the survey for the first time in 2009, our visitation policies, while liberal, did not include non-discrimination language, which we have subsequently added. We've also amended our equal opportunity employment policy language to include "gender expression." Revising the language to some of our policies helps ensure that the atmosphere of inclusiveness that we've championed is in fact the standard of care for our patients and their families.

We're proud to participate in the HEI and appreciate how the Human Rights Campaign Foundation has challenged us to do more to ensure that all patients receive the superb level of care we pride ourselves on.

Trent Crable
Chief Executive Officer
The George Washington University Hospital

	Leader: Group Health Location: Seattle, WA Size: 7,784 full-time employees, 326 beds Years rated in HEI: 4 Years as Leader: 3 (as individual respondent, Group Health Central Hospital, in 2009 and 2010)

Group Health is proud to be among the Leaders in LGBT Healthcare Equality, having achieved credit for all applicable criteria in the Healthcare Equality Index 2011 report. And we are especially proud that we achieved that distinction this year not only for Central Hospital, but for our other 26 medical facilities as well.

Group Health provides medical coverage and care to more than 674,900 residents in Washington state and North Idaho who are covered by health plans offered by Group Health Cooperative or its subsidiaries. Nearly two-thirds of members receive care in Group Health-operated medical facilities. We have a total staff of 9,461 (7,784 full-time employees), including our Group Health physician group.

Group Health exists to create better health for our patients and the communities we serve. From the beginning, Group Health has attracted caring, innovative people who step up to ask: "What's next for our patients' health?" We view close collaboration and respect – with our colleagues and our patients – as critical to creating better health. And we provide staff with challenging, rewarding careers and opportunities to grow and help us improve – making a real difference in the lives of those who depend on us.

While Group Health has long been a sponsor of lesbian, gay, bisexual and transgender organizations and events in our community, we feel that meeting the criteria of the HEI is one very visible and effective way to ensure that we are truly inclusive and respectful of all our employees and our patients. Group Health believes in workplace equality, regardless of sexual orientation or gender expression or identity. For the past several years, we have had a recruitment booth at the annual conference of the Gay and Lesbian Medical Association. Our LGBT & Allies Staff Resource Group supports Group Health's goals of fostering diversity and inclusion. This emphasis on diversity and inclusion helps attract and retain high-quality employees and medical staff in every discipline and area of our organization. And since most of our employees have their health coverage through Group Health, they can be confident that we meet the HEI's criteria for visitation rights and patient non-discrimination policies.

A few years ago, one of our executive leaders interviewed for a position at Group Health. He wasn't sure what Group Health's position on diversity was at the time and was reluctant to ask. Now, with participation in the HEI, Group Health proudly displays the HEI "Best Healthcare Facility for LGBT Families" trademark for 2010 at our hospital campus, and looks forward to displaying the 2011 logo at every one of our medical facilities. No one will have to wonder what Group Health's position on diversity is when they seek a job or need healthcare.

James Hereford
Executive Vice President
Group Practice Division
Group Health Cooperative

Desi Bailey, M.D.
Chief of Hospital Staff
Group Health Central Hospital

	Leader: Oregon Health & Science University Hospital Location: Portland, OR Size: 13,608 full-time employees, 534 beds Years rated in HEI: 2 Years as Leader: 1

Oregon Health & Science University is the state's only academic health center, bringing together patient care, research, education and community service to improve the health and well-being of all Oregonians. Diversity is essential to realizing our multifaceted mission – the ability to see things from the perspective of others is the foundation of compassion and a hallmark of innovation. We are committed to ensuring: 1) that lesbian, gay, bisexual, transgender and queer patients and their families are welcomed, respected and provided culturally competent care and 2) that LGBTQ employees are engaged as partners in recruitment, organization-wide professional development and community outreach.

While OHSU has long valued diversity and inclusivity, the Healthcare Equality Index provided us with a clearer roadmap to help ensure our policies were explicitly inclusive in wording and practice. We are proud to say that OHSU patients have a right to and do receive culturally considerate and respectful care that fosters their comfort and dignity and that is free from discrimination based on sexual orientation and gender identity/expression. We also work to ensure that hospital visitation policies include a definition of family that recognizes non-registered domestic partners and both different-sex and same-sex significant others. The concept of parenthood is liberally construed for visiting minor children, including same-sex parents, among others.

OHSU also integrates information about LGBTQ health concerns into our training programs – our Cultural Competency Foundations course has reached more than 6,000 employees. CultureVision, an online resource that provides detailed information for more than 50 different culture groups and that is designed to help healthcare professionals raise awareness about cultural differences, offers a substantial section featuring LGBTQ-specific healthcare issues. This site was visited more than 10,000 times by the OHSU community in 2010. OHSU also sponsored the global launch of the "Cultural Detective: Lesbian, Gay, Bisexual and Transgender Cultures" workshop series at OHSU last year. We additionally completed an OHSU-wide diversity climate survey, which included an assessment of LGBTQ issues, in order to address the needs of our employees and students.

As Portland's largest employer, and the fourth-largest in Oregon (excluding government), OHSU takes pride that our equal opportunity policy is now inclusive of both sexual orientation and gender identity/ expression. We have offered same-sex benefits to our employees since 1998. OHSU also supports LGBTQ healthcare professional and student interest groups on campus and participates actively in LGBTQ community outreach events.

OHSU sponsors an employee resource group, OHSU Pride, that has been active on campus since 2007. OHSU Pride fosters an inclusive environment that promotes LGBTQ wellness, education, research and advocacy within OHSU and across the community. Building for the future, we will track and assess the experiences of LGBTQ employees, students and patients to make recommendations on best practices for patient care, employee retention and cultural competence educational curricula.

We are proud of our commitment to the LGBTQ community and will continue creating an inclusive environment for our patients, employees and the larger community.

Norwood Knight-Richardson, M.D., M.A., M.B.A.
Vice President and Chief Administrative Officer, Chief Diversity Officer
Oregon Health & Science University Hospital

	Leader: Park Nicollet Methodist Hospital Location: St. Louis Park, MN Size: 878 full-time employees, 426 beds Years rated in HEI: 2 Years as Leader: 1

Park Nicollet is an integrated clinic and hospital system providing care in a very high-quality, competitive healthcare marketplace. Minnesota prides itself on its healthy population, and we are privileged to serve a wide range of patients, including an active lesbian, gay, bisexual and transgender community in the Twin Cities and beyond.

There is a conspicuous void of Healthcare Equality Index survey respondents in the Midwest. Since the survey began, only two other survey respondents in Minnesota have joined Park Nicollet in completing this survey. Park Nicollet provides state-of-the-art, non-discriminatory care for family building and gynecologic care, offers HIV care for men and women – including during pregnancy – and operates a large transgender clinic. At Park Nicollet, we recognize the diverse needs of all of our patients and the communities we serve, and believe that the LGBT community is valued both as consumers of healthcare and as employees and team members of our organization.

Participating in the HEI 2009 survey provided a framework for improvement at Park Nicollet and informed us what is important to this population. We had already internalized and practiced much of what is asked for, but we can always improve, and we have!

As a physician leader of an inclusive healthcare organization, and a professional colleague of many talented LGBT clinicians and ob-gyns who have helped women and their partners experience the joy of childbirth, I am proud to work for an organization that values and respects everyone in our community.

Janette H. Strathy, M.D.
Chair, Park Nicollet Clinical Board of Governors 2010
Park Nicollet Methodist Hospital

	Leader: Rush University Medical Center Location: Chicago, IL Size: 8,669 full-time employees, 676 beds Years rated in HEI: 3 Years as Leader: 3

At Rush University Medical Center, providing medical care and service that recognizes and respects the unique nature and needs of all people – including lesbian, gay, bisexual and transgender individuals – is inextricably linked to the medical center's strategic goals.

Rush's vision is to be the medical center of choice for the Chicago area and one of the very best clinical centers in the United States. We are nearing the completion of a state-of-the-art new hospital that will open in January 2012 to better serve our patients. In order to accomplish these objectives, we not only provide the high level of excellence in clinical service for which Rush is nationally known – we also provide these services in a manner that understands, accepts and affirms the individual circumstances of each patient. This approach is reflected in the cultural competency training Rush provides to our staff. The staff of all Rush inpatient units and clinics receive information about providing culturally sensitive and appropriate care.

These expectations are reinforced during twice-yearly rounds at all inpatient, outpatient and procedural areas. During these visits, clinicians chosen at random are asked how they would respond to a hypothetical transgender patient with multiple differentiating attributes. Key measures of the staff's cultural competency are that they adhere to the patient's designation of a significant other as a family member for purposes of medical decision-making and that the patient's name of choice be entered into the patient's medical record and used by staff.

Patient care areas are scored based on staff members' abilities to identify these and other provisions necessary to provide culturally sensitive care in the patient scenario presented. If the patient care area is not compliant with standards, the unit or clinic contact is asked to complete a corrective action plan. I am proud to say that the compliance rates for the cultural competence portions of visits completed from January through April of this year were 100 percent for our inpatient units and 93 percent for our outpatient units.

Rush emphasizes culturally competent care, because we recognize that we need to understand and work with our patients as unique individuals in order to provide them with the very best care. We realize that our patients must feel personally comfortable with their care providers in addition to being confident in our medical abilities.

This approach also reflects Rush's commitment to a culture of inclusion, where personal differences are not just accepted, but understood, respected and valued. Rush's non-discrimination policy specifically forbids discrimination, harassment or unequal treatment in 14 categories, including sexual orientation and gender identity and/or expression. Our policies define "family members" to include any person with whom a patient has a significant relationship, ensuring that same-sex partners and parents have the identical rights as different-sex partners and parents with regard to patient visitation and decisionmaking about their partner's or child's medical care.

In addition to being a medical center of choice, Rush's goal is to be an employer of choice, and our commitment to inclusiveness also is evident in our employee health benefits. More than a decade ago, Rush became one of the first medical centers in Chicago to offer same-sex domestic partner benefits to employees. Rush took proactive steps and made the financial commitment to provide these benefits because we equally value all of our employees and their relationships and seek to support their needs.

In these and other ways, we affirm to all of our patients, visitors and staff that they belong at Rush and will be treated accordingly. It is our hope and expectation that this consideration will contribute to them choosing Rush as the place they want to be for their care and their employment. Being included among the Human Rights Campaign Foundation's Leaders in LGBT Healthcare Equality for the third consecutive year is an important affirmation of this effort, and one we are proud and grateful to receive.

Larry J. Goodman, M.D.
Chief Executive Officer
Rush University Medical Center

	Leader: San Francisco General Hospital and Trauma Center Location: San Francisco, CA Size: 4,157 full-time employees, 548 beds Years rated in HEI: 2 Years as Leader: 1

San Francisco General Hospital and Trauma Center is a general acute care hospital, owned and operated by the City and County of San Francisco Department of Public Health. Since its establishment in 1854, providing care to 400 people that year, SFGH has evolved into a major academic tertiary care medical center. SFGH has gradually expanded and modernized its hospital facilities, providing the community with a complete range of emergency, trauma, inpatient, primary care, specialized medical and surgical services, and diagnostic and rehabilitation services. In addition to being the only trauma center (Level 1) in the City and County of San Francisco, SFGH has a full complement of mental health care, from psychiatric emergency services and acute inpatient psychiatric care to mental health rehabilitation and post-hospitalization care. Today, SFGH cares for more than 100,000 individuals each year.

As the county facility for the city and county of San Francisco, SFGH's mission is to provide quality healthcare and trauma services with compassion and respect to patients that include the city's most vulnerable. Like the city of San Francisco, SFGH's patient population consists of a large percentage of ethnic minorities: Caucasians 24 percent, Hispanics 31 percent, African-Americans 18 percent, Asian/ Pacific Islanders 21 percent, Native American less than 1 percent, and Others/Unknown 5 percent. More than 30 percent of SFGH's patients' primary language is not English. Financially, 66 percent of SFGH's patients are uninsured or on Medicaid.

Besides being considered one of the best public hospitals in the nation, SFGH is recognized as a world leader in the field of HIV/AIDS medicine. SFGH Unit 5B was the site of the world's first in-patient facility devoted exclusively to HIV/AIDS patients, as its Ward 86 outpatient clinic handled the flood of new cases. Last year, SFGH's Positive Health Program (Ward 86) continued to provide outpatient care to more than 3,000 patients.

With its diverse patient population and history of serving the lesbian, gay, bisexual and transgender population, SFGH is an institution where diversity is respected and where equality is valued. In completing the Healthcare Equality Index survey, however, we realized that although SFGH and its staff are fully committed to non-discrimination practices for both patients and staff, the institutional policies were not totally indicative of our practices. This year, SFGH revised its policies to more fully reflect our values. We developed an online course for all staff on cultural understanding, as well as a new-employee orientation session on this topic.

It is SFGH's goal that the benefits of developing cultural understanding for our patients and for our workplace are recognized and honored. Part of this includes ensuring that staff and providers consider their own cultural and family experiences and reflect on how this affects our assumptions about other cultures, and that we work to identify culturally sensitive practices that improve cross-cultural communication in our health care settings.

Iman Nazeeri-Simmons
Chief Quality Officer
San Francisco General Hospital and Trauma Center

	Leader: St. Luke's-Roosevelt Hospital Center Location: New York, NY Size: 5,746 full-time employees, 1,028 beds Years rated in HEI: 1 Years as Leader: 1

Several years ago, St. Luke's-Roosevelt Hospital Center joined a corporate umbrella with other New York City hospitals to achieve economy of scale while maintaining our very different identities. Continuum Health Partners Inc. includes both St. Luke's-Roosevelt and Beth Israel Medical Center, and together, we serve a large part of Manhattan. This includes a significant portion of the city's lesbian, gay, bisexual and transgender and HIV-infected communities, which we serve through partnerships with LGBT community organizations, and our large AIDS and Comprehensive Care Centers.

Last year, BIMC was recognized by the Healthcare Equality Index as a top performer, based on the efforts of its Diversity Council LGBT subcommittee. St. Luke's-Roosevelt also maintains Diversity Councils, and the St. Luke's Site Council invited the co-chairs of BIMC's LGBT Committee to a meeting to describe how they achieved this recognition. It was at that meeting, as a direct result of BIMC's HEI recognition, that St. Luke's began its own LGBT & Friends subcommittee. The committee's mission: "1) to work with administrative leadership to ensure hospital policies are LGBT-inclusive; 2) to function collaboratively with the hospital to provide a welcoming environment for LGBT staff, patients, families and friends as a means to deliver equitable health care; and 3) to liaise with the LGBT community in promoting [SLRHC] as an LGBT-friendly organization. As such, we are committed to educating clinical and administrative staff about the unique health and mental healthcare needs of LGBT patients and families."

Of course, it is wonderful to have an identifiable LGBT presence in the workplace, one that is recognized and supported by hospital administration. But it is also exceptional what LGBT & Friends has already accomplished, including participation in a hospital Health & Wellness Fair; the addition of LGBTsupportive language to a hospital Diversity Council slide presentation on respect and inclusion; and a staff education event that focused on LGBT youth and the language of bullying, and that featured a presentation of the documentary, "Stand Up to Suicide," regarding LGBT teen suicides. We have also received administration and Institutional Review Board approval to conduct a staff survey to quantify our LGBT employees and assess LGBT-related experiences and attitudes.

More specifically, in our efforts to make St. Luke's-Roosevelt an HEI Leader, LGBT & Friends has been instrumental in having hospital center policies revised to provide important protections to LGBT employees and patients. Our administration, employees and patients are diverse, and our unwritten policies have always been inclusive. But while many of our written policies already protected based on sexual orientation and gender, none expressly protected based on gender identity and expression. We now have revised affirmative action, equal employment opportunity, employee non-discrimination/ non-harassment and patient visitation policies. We have also instituted a brand-new patient nondiscrimination/ non-harassment policy that not only includes sexual orientation and gender expression or gender identity, but also states that a patient's preferred gender will be respected and the patient will be referred to by their name of choice whenever feasible.

Our focus this year was largely defined by the HEI rating criteria, and we plan to address more of the HEI goals during the coming year. We also now have an institutional infrastructure to support meeting The Joint Commission's new recommendations for LGBT inclusiveness. We look forward to sponsoring and participating in many future educational and social events and to further promoting a safe and productive environment for LGBT employees and patients.

Members of LGBT & Friends
St. Luke's-Roosevelt Hospital Center

	Leader: UCSF Medical Center Location: San Francisco, CA Size: 5,821 full-time employees, 722 beds Years rated in HEI: 4 Years as Leader: 4

UCSF Medical Center is proud to be a Leader in LGBT Healthcare Equality, achieving credit for all rated criteria in the Healthcare Equality Index for the fourth consecutive year. The HEI has been a key component of our efforts to provide equitable, inclusive, knowledgeable and welcoming care to lesbian, gay, bisexual and transgender patients and their families and has motivated UCSF to seek out additional opportunities to meet LGBT health needs.

For example, I believe it is critical for academic medical centers to equip future health professionals with the training necessary to provide competent, sensitive care to LGBT patients and their families. Our health professional schools have taken this responsibility seriously, and have developed a variety of LGBT curricular offerings, coupled with co-curricular educational events.

UCSF has also sought other opportunities to go beyond the HEI's core criteria to achieve LGBT health equity and inclusion. We provide health coverage for employees' same-sex domestic partners, as well as transgender health coverage for employees and their covered family members. We also give patients the opportunity to identify themselves as LGBT, offer an online list of LGBT healthcare providers at UCSF, and use our patient satisfaction survey to determine whether LGBT-related needs are met. In addition, UCSF Medical Center provides employees with an inclusive language policy to guide their interactions with LGBT patients and houses the nation's only LGBT center in a healthcare or health education setting.

These, and other, LGBT health initiatives have been an effective complement to the HEI in ensuring that we provide the best possible care to LGBT patients and their families. They have enabled us to reduce risk, reach out to an important segment of the local population, and maximize patient safety and satisfaction. We are grateful to the HEI for providing both education and inspiration in this vital work.

Mark Laret
Chief Executive Officer, UCSF Medical Center and UCSF Benioff Children's Hospital
Chair-Elect, Association of American Medical Colleges

	Leader: University of California Davis Medical Center Location: Sacramento, CA Size: 6,615 full-time employees, 613 beds Years rated in HEI: 1 Years as Leader: 1

University of California Davis Medical Center, located in Sacramento, Calif., promotes a safe and supportive healthcare environment for lesbian, gay, bisexual, transgender and intersex patients, staff, students, residents and physicians and enhances their visibility and inclusion as part of the UC Davis community.

We achieve this through a patient bill of rights that includes a non-discrimination policy for sexual orientation and gender identity, an explicitly inclusive hospital visitation policy that defines "family" or "immediate family" as any person who plays a significant role in an individual's life and an LGBT-inclusive non-discrimination and equal employment opportunity policy.

Our unwavering commitment to equity and social justice guides us to continually strive to deliver better, more efficient, more personal and more equitable health care.

Just as it is helpful for a clinician to know a patient's race, ethnicity and preferred language, knowing a patient's sexual orientation or gender identity gives health professionals important insight into their patients' lives, which in turn helps clinicians make more informed diagnoses and recommendations.

As part of our vision for a healthier world through bold innovation, we are working to collect sexual orientation and gender identity information in our patients' electronic health records. This effort will help to reduce health disparities for this population and enhance the quality of care LGBTI individuals receive. It is the first coordinated effort to use technology to enhance health and reduce disparities for these individuals.

The LGBT communities have specific health concerns and suffer from health disparities. For example, recent research from the Center for American Progress, "How to Close the LGBT Health Disparities Gap," found that LGB adults are more likely to have cancer than their heterosexual counterparts. The same study also shows that LGB youth are more likely to be bullied by their peers, consider or commit suicide, experiment with drugs and alcohol, and be obese than heterosexual youth.

To ensure success in capturing sexual orientation and gender identity information in our electronic health records system, we have developed training modules for educating health providers about the need to discuss this personal topic. The training facilitates better understanding of the experiences of LGBTI individuals and enables our care providers to initiate dialogue with our patients. Our efforts will ultimately enhance the quality of the care LGBTI individuals receive.

UC Davis Medical Center's excellence depends on inclusion and diversity, and I am proud of the achievements we have made, and continue to make, to ensure improved health for all.

Ann Madden Rice
Chief Executive Officer
University of California Davis Medical Center

	Leader: UW Medicine Location: Seattle, WA Size: 18,300+ full-time employees, 1,144 beds Years rated in HEI: 2 Years as Leader: 1

UW Medicine is proud to be one of the Leaders in LGBT Healthcare Equality in the clinical care sites of our health system. As the only academic healthcare system in the Pacific Northwest, we have a long history of inclusiveness and a mission of serving people from all walks of life. Our established practice and culture of inclusion and service ensure equality in employment and in our interactions with our lesbian, gay, bisexual and transgender patients and families.

It is extremely important to our leadership that our policies reflect these beliefs. With the guidance of the Healthcare Equality Index, our team reviewed all of our relevant policies, with particular focus on four critical measures: patient non-discrimination, visitation, cultural competency training and employment nondiscrimination. The HEI guidelines were a wonderful resource to help us successfully align our policies with our existing practices and values.

Hospitals and clinics must create a safe and welcoming environment for patients, their significant others and their families. Patients measure the quality of their healthcare through the lens of how they are treated. Everyone deserves access to high-quality care free from discrimination.

The Joint Commission has announced that patient non-discrimination standards will now be part of the accreditation process. We applaud this move, because it is, simply, the right thing to do. Not only do our healthcare professionals recognize the needs of the LGBT community, they also strive to improve the interactions that LGBT members experience in our medical centers and clinics in the future.

To that end, UW Medicine researchers recently received a grant to study decision-making by same-sex partners of patients dying in critical care settings. The study is nationwide, and the information gathered will help better prepare healthcare professionals for working with same-sex couples during emotional and stressful times in the healthcare setting.

UW Medicine is honored to join the growing number of hospitals and healthcare organizations across the country recognized for striving to provide the highest-quality healthcare for all in a compassionate and professional manner, free of discrimination based on a person's beliefs, gender identity or sexual orientation.

Johnese Spisso
Chief Health System Officer, UW Medicine
Vice President for Medical Affairs, University of Washington

	Leader: Whitman-Walker Health Location: Washington, DC Size: 139 full-time employees Years rated in HEI: 1 Years as Leader: 1

For more than 30 years, Whitman-Walker has made a commitment to serve individuals with high-quality, culturally competent care, with a special expertise in lesbian, gay, bisexual and transgender health issues. This remains at the core of our mission every day.

The best measure of our success in this endeavor resides in the words of two of our major stakeholder groups: our patients and our employees. The three stories below highlight our dedication to serving the LGBT community.

Since our founding by, and for, the LGBT community in 1978, Whitman-Walker has strived to be a leader in high-quality and affirming healthcare, all the while adapting to this community's changing needs and the evolving needs of the healthcare marketplace.

Raymond C. Martins, M.D.
Chief Medical Officer
Whitman-Walker Health