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SAN DIEGO — The high scores of CommonSpirit Health hospitals on an index that rates LGBTQ+ friendliness reflect the system's efforts to put out the welcome mat, says Shelly Schlenker, executive vice president and chief advocacy officer.

The Healthcare Equality Index is based on evaluations by the Human Rights Campaign Foundation, which funds advocacy efforts on behalf of lesbian, gay, bisexual, transgender and queer people. The foundation describes the index as a "rigorous benchmarking tool that evaluates health care facilities' policies and practices related to the equity and inclusion of LGBTQ+ patients, visitors and employees." The 2024 index lists scores for 1,065 hospitals or federally qualified health centers.

Schlenker noted that CommonSpirit includes Catholic and non-Catholic hospitals. Forty-five of the system's about 150 hospitals are on the index. All CommonSpirit hospitals on the index are scored as either "equality leader" or "high performer," the highest rankings.

During a session at the 2024 Catholic Health Assembly and in later comments, Schlenker discussed the monthslong process involved in a Healthcare Equality Index application. Despite the undertaking's demands, she said CommonSpirit considers the effort essential as a system committed to treating every patient with dignity and respect.

"We serve everyone, just like all of you do, inclusive of background or beliefs, but we need to say it to the LGBTQ+ community and prove it so that they can hear," she told her audience.

Underpinnings of effort
Being on the forefront when it comes to equality in care for LGBTQ+ patients is a continuation of other historic efforts by the Catholic health ministry, Schlenker said. She mentioned, for example, that the ministry was the first to respond to the nation's HIV/AIDS crisis.

"If you look at all of the major clinics that were stood up, both on the West Coast and on the East Coast, at the beginning of the epidemic, many were tied to religious orders and Catholic systems because it was about meeting the need," she said.

She also shared that she feels it is important for CommonSpirit and other Catholic systems to stand with the LGBTQ+ community. She cited various findings from the Center for American Progress, a progressive think tank, such as that 20% of youth in that community are threatened with or injured by a weapon and that adults who identify as LGBTQ+ are more likely than others to delay or not seek medical care.

Protections, progress
Sheila Stinson, CommonSpirit director of engagement management, also spoke at the Assembly session. Stinson guides hospitals through the application work required to get onto the Healthcare Equality Index.

She discussed the criteria the index covers. The index's website explains the criteria this way:

• Ensure foundational protection for patients, visitors and staff in patient and staff policies and provide cultural competency training on LGBTQ+ inclusion.
• Demonstrate progress toward inclusion on LGBTQ+ patient care and support.
• Cultivate an inclusive workforce by providing LGBTQ+ inclusive employee support and benefits.
• Demonstrate public commitment to the LGBTQ+ community.

Applications for the index are submitted every other year. Stinson said the process of applying is best started by a hospital the December before an application year. One of the first steps she takes is to meet with the hospital president and to request a facility lead for the process.

"This needs to be someone who is not afraid to speak up, who is not afraid to learn and is not afraid to help us make change as we move forward," Stinson said.

In the spring of the application year, she meets with the facility lead to discuss the process, including how much work is involved, and to set expectations. Stinson said the time requirements for training and information gathering vary. One big factor is whether a hospital is making its first application, which is more time consuming because a new framework is being established. Once that framework is in place, the reapplication process is simpler.

Also in the spring, a hospital making its first application must submit the names of five executives — from the C suite, nursing, registration, patient experience or human resources — who will undergo mandatory training on LGBTQ+ patient-centered care. The training, developed by the Human Rights Campaign, lasts two hours and 45 minutes. It must be completed before the application is submitted in the fall.

Keys to success
Stinson said the application itself involves confirming or establishing LGBTQ+-friendly policies and practices. To get a high ranking, a hospital must show in its application that leaders are trained on those policies and practices.

Among the keys to succeeding in the process and achieving a high score, Stinson said, are for hospitals to be open to learning, have a strong executive sponsor or champion, and designate a system lead to manage the process and hold office hours to walk through the application with everyone involved.

An especially important aspect, Stinson and Schlenker said, is that the people filling out the application for a hospital understand and agree on policies and answer the questions related to those polices in a standard way. Examples of such policies are offering an LGBTQ+ patient advocate and implementing standardized family and bereavement guidelines that recognize same-sex couples and children of same-sex couples.

"It is an important dialogue internally, both with leadership and our facilities, to get everyone to understand that this is what we can do, and this is within the scope of the Ethical and Religious Directives (for Catholic Health Care Services)," Schlenker said. "Every CommonSpirit hospital is dedicated to providing high-quality primary and secondary care to all patients who come in our doors, inclusive of LGBTQ+ patients."

Final scores on the index get posted in the spring after the applications are submitted.

Commitment to accompaniment
To boost its LGBTQ+-friendly efforts, CommonSpirit has created a systemwide steering committee to ensure standardized training and policies related to best practices for preferred pronouns, gender-neutral restrooms, and family visitation. The policies and trainings count toward the continuing education requirements of Healthcare Equality Index applications.

"We know that discrimination and the social determinants of health disproportionately impact LGBTQ+ patients," Schlenker said. "No one should be afraid to seek the care they need."

CommonSpirit started its index applications at its hospitals in California. The system has since widened the process to its hospitals in Nevada, Arizona and Washington state. It also has facilities in 20 other states.

"The HEI process underscores our commitment to accompaniment for our LGBTQ+ patients," Schlenker said. "Every day across our ministry, members of the LGBTQ+ community seek care in our facilities, and everyone deserves to be treated with dignity and respect."