Inclusivity Training Ensures Compassionate, Respectful Care for All Patients

Three years ago, ClinicPride, Cleveland Clinic’s LGBTQ employee resource group, began offering inclusivity training to promote delivery of culturally competent care for all patients, including lesbian, gay, bisexual, transgender and queer/questioning individuals and their families.

“One of the main messages we are trying to communicate is that everyone deserves to be treated with dignity and respect and to be treated as a whole person,” says Joshua Snowden, JD, MHA, director of global contracting for Cleveland Clinic and co-chair of ClinicPride. “Patients feel most comfortable and engaged in their own care delivery when they know there’s a culture of inclusivity.”

The objectives of the two-hour training sessions are to:

• Increase awareness of LGBTQ language, vocabulary and concepts.
• Provide a culture of safety and quality for caregivers, patients, their family members and visitors.
• Apply empathy and practice intentional inclusion.

To date, ClinicPride has conducted more than 670 hours of training across the Cleveland Clinic health system.

Nurses are early adopters of inclusivity training

Prior to launching the training, an external trainer helped the employee resource group design the program, which is facilitated through ClinicPride’s 300-plus members. It is separate from mandatory programs offered by Cleveland Clinic’s Office of Diversity and Inclusion or human resources departments.

“What’s unique about our diversity and inclusion training is that it’s on a volunteer basis, led by caregivers and for caregivers,” says Snowden. “Individuals can attend trainings and, if they are interested, there’s a process to shadow and observe further sessions, go through onboarding and work with a coach so they can ultimately be facilitators.” ClinicPride currently has approximately 20 volunteer trainers, including Snowden.

From the beginning, the Zielony Nursing Institute has supported ClinicPride’s inclusivity training. Nursing professionals ranging from licensed practical nurses to RNs and advanced practice nurses have participated in sessions held specifically for nursing units or in multidisciplinary sessions.

One of the first groups to embrace the training were surgical nurses. For instance, Snowden and Vivian Yu from Cleveland Clinic Community Care co-led a session for nurses at main campus who care for transgender post-operative patients. They conducted the session at 5:30 a.m. to accommodate night shift nurses, then held a follow-up training session a month later. ClinicPride has completed more than 20 trainings reaching 400-plus perioperative nursing caregivers.

Candid conversations and role-playing scenarios

The goal of the training is “to foster an environment where people can ask open, candid questions and talk about their own personal experiences,” says Snowden. The sessions begin with discussions, then include role-playing scenarios so participants can practice interactions specific to their healthcare setting, where they might be working with or caring for someone with a diverse background from a sexual orientation or gender identity standpoint.

Snowden says one of the discussion components that is particularly helpful for participants is introduction of the Genderbread Person, a graphic resembling the gingerbread person that helps people easily understand the differences between gender identity, gender expression, attraction and anatomical sex. “It really resonates with nurses and other clinical caregivers who don’t think about this all the time,” says Snowden. “It’s a visual representation of the different spectrums and how one doesn’t necessarily translate into or impact the others.” For instance, a person’s gender identity may not match their anatomical sex.

The scenarios vary depending on the group. A common one included in nurse training is how to greet a new patient for the first time if you are unsure of their background. “Even though it might be slightly uncomfortable for you, introduce yourself and your preferred pronouns: ‘Hi, my name is Josh, and my preferred pronouns are he/his/him. How about you?’” recommends Snowden. Or, instead of asking someone if they have husband or wife, ask if they have a partner.

The training also includes practical advice, such as documenting information in the electronic medical record (EMR). For example, if a patient who is transitioning has had a surgery or is on hormone therapy, this impacts their medical care and must be accurately recorded in the EMR. Cleveland Clinic’s EMR includes a sexual orientation and gender identity module. “Having that be part of standard practice – and not making assumptions based on someone’s exterior characteristics – is so important,” says Snowden.

At the conclusion of the training, participants receive a badge with the Cleveland Clinic logo and a rainbow flag underneath. “It’s our way to display to fellow caregivers, patients, family members and visitors that this is a safe space and the wearer is someone who is comfortable engaging in conversations around sexual orientation and gender identity,” says Snowden.

Impacting patient care in the future

Snowden encourages other healthcare systems to consider offering inclusivity training. “It doesn’t have to be a grandiose top-down effort with extensive financial commitments or resources,” he says. With support from leadership, it can be a grass-roots employee effort offered in small bits during huddles, for example.

“The point of the training is to raise the standards of care that all clinical caregivers are able to provide,” says Snowden. “When you have the right intent, heart and mindset all centered around respect, then you will build a lot of trust with patients. And that will make all the difference going forward.”