The Healthcare Equality Index (HEI), which was discussed in a June 16, 2010 post, is an annual survey by the Human Rights Campaign Foundation that evaluates healthcare facilities on their policies and practices related to lesbian, gay, bisexual and transgender (LGBT) employees, patients, and families.  The HEI has been described as a benchmarking tool for identifying best practices in this field.  The Joint Commission, which accredits hospitals, has commended the HEI for its role in the Commission’s effort to improve healthcare for all and increase healthcare institutions’ commitment to prohibiting discrimination based on age, race, ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation, and gender identity or expression. Following is an interview with the editor of the HEI, Tom Sullivan.

Q. What impact do you think the HEI has had?

 A.  We initiated the HEI project in 2007 in response to what we called the patchwork of protections for LGBT hospital patients and employees, with a lot of gaps where there were simply no protections at all.  The goal was to understand what hospitals were doing in this area, increase their awareness of the issues facing the LGBT community as hospital patients and employees, and hopefully begin to close some of the gaps.  In the few years since the first survey, we have succeeded beyond our expectations.  This year, information about the publication of the  HEI was sent to almost 65,000 people in our e-mail database, in addition to mainstream media and specialized reporters who cover healthcare or LGBT issues.  Market research by Witeck Combs Communications/Harris Interactive found that 64% of gay and lesbian adults say that when selecting a product or service, if all other considerations are equal, they will select the brand that has a reputation for being more gay friendly.  Considering that the same organization estimated LGBT buying power at $759 billion in 2009, I would say the potential impact is huge.

Q. What did the 2010 survey results show?

 A.  We highlighted  42 healthcare facilities that answered “yes” to all of the questions in the survey (more about the criteria later), but generally we found that healthcare facilities do not have policies that adequately provide equal treatment to LGBT employees, patients, and their families.  For example,  the  survey of a representative sample of the largest healthcare facilities in the U.S. found that 40% of those selected for review do not include sexual orientation in their Patients’ Bill of Rights or non-discrimination policies, and 93% don’t include gender identity.  There is also an alarming lack of equality in visitation access.  Approximately 70% of healthcare facilities that participated in the survey do not have policies explicitly providing same-sex couples and same-sex parents the same visitation rights as other couples and parents.

Q.  Do you think the annual HEI survey on these issues was a factor in President Obama’s request for regulations regarding equal visitation and decision-making rights for same-sex couples and parents?

A. Well, we can’t take credit for that,  but we believe that the HEI has increased awareness of these issues.  Also, as part of the HEI project, the Human Rights Campaign Foundation, which sponsors the HEI, has developed model policies that we have provided to healthcare facilities and organizations, and the Joint Commission.  Even though it is not to be implemented until January 2011, at the earliest, we are pleased that Standard RI.01.01.01 of the Joint Commission's new "Elements of Performance".pdf includes prohibition of discrimination based on sexual orientation and gender identity or expression.

Q. What criteria do you use to evaluate healthcare facilities?

A. The survey focuses on five general areas:

• Patient Non-Discrimination Policies
  • Patients’ Bill of Rights and/or non-discrimination policy includes “sexual orientation”
  • Patients’ Bill of Rights and/or non-discrimination policy includes “gender identity or expression” or “gender identity” 
• Visitation Policies
  • Visitation policies allow same-sex partners/spouses the same visitation access as opposite- sex spouses and next of kin
  • Visitation policies allow same-sex parents the same visitation access as opposite-sex parents for their minor children 
• Decision-Making Policies
  • Recognize advance healthcare directives allowing same-sex partners/spouses decision making authority for their partner/spouse under care
  • Written policy allows same-sex parents the same rights as opposite-sex parents for medical decision-making for their minor children 
• Cultural Competency Training And Client Services
  • Provide cultural competency training addressing sexual orientation and healthcare issues relevant to lesbian, gay and bisexual community
  • Provide cultural competency training addressing gender identity and healthcare issues relevant to transgender community 
• Employment Policies And Benefits
  • Equal employment opportunity policy includes “sexual orientation”
  • Equal employment opportunity policy includes “gender identity or expression” or “gender identity”
  • Domestic partner health insurance benefits are offered

Q. How do you select or obtain participants for the survey?

A. The process has changed and developed over time.  Initially, in 2007 we purchased a database of 6000 hospitals from the American Hospital Association and sent out survey questionnaires to administrators at the 970 hospitals on the list that had more than 300 in-patient beds. We received responses from 78 participants. In subsequent years, in addition to sending survey questionnaires to prior participants, we have done more personal and focused outreach to hospitals and other healthcare facilities through conference attendee lists, diversity groups within hospitals and healthcare organizations, and other sources that have demonstrated an interest in these issues

Q. Has participation in the survey increased?

A. Since the survey was initiated just four years ago, participation has more than doubled.  The 2010 survey had 178 respondents.  Because of the media coverage of the HEI,  President Obama’s request for regulations, and the new standards issued by the Joint Commission, many more hospitals and other healthcare facilities are contacting us to ask about participation in next year’s survey. 

Q. How can a healthcare facility become a survey participant?

A. All U.S. healthcare facilities, including hospitals, clinics, long-term care and assisted living facilities, and any other healthcare institution, are eligible to participate.  Authorized representatives, typically Human Resources, Staffing, or Marketing Managers, of any of these types of organizations interested in participating in the study should e-mail hei@hrc.org.  Usually, the web-based survey is sent to participants in October with responses due by the end of December.

Q. If you are only assessing healthcare facilities that voluntarily participate in the survey, aren’t you getting a more favorable view of protections available to LGBT patients and employees than may actually exist?

A. We recognized that, and that’s why the 2010 HEI also includes a separate assessment of  a representative sample of 200 of the largest healthcare facilities that had a patients’ Bill of Rights or non-discrimination policy, with at least one healthcare facility from each state. 

Q. What do you expect to see in the future?

A. Given the new proposed visitation-rights regulations that we understand HHS (the Department of Health and Human Services) will be publishing next week, and the new non-discrimination standards issued by the Joint Commission,  healthcare facilities that haven’t done so will need to evaluate and update their policies to include provisions regarding equal rights for LGBT patients, families, and employees.  We anticipate increased participation in the HEI and that many more healthcare facilities will be able to answer “yes” to our survey questions.