In this second letter about one of our eight Trust Practice Challenge winners, we are highlighting and reflecting on what we can discover about building trust.
UnityPoint Health – Prairie Parkway in Cedar Falls, Iowa has integrated an LGBTQ clinic into its family medicine clinic, serving a population of more than 40,000 including students from the University of Northern Iowa, a state school in the area. The clinic is open two evenings per month from 5 to 7 p.m. and is staffed by full-time employees of other UnityPoint Clinic locations who work there in addition to their regular duties at their “home clinics.”
The clinic focuses on creating a welcoming, comfortable environment for people in the LGBTQ community. Team members are trained to query patients about pronouns and their preferred name, a small but affirming step for patients who identify as transgender or gender-fluid. The competencies identified for this practice include:
- Mindset: showing up with the intention to adapt the care experience to be personal and comfortable for everyone served.
- Openness: to sensitivity and bias awareness.
- Mutual support and accountability: through taking the time for reflections in huddles before and after clinic. At the close of the day, clinicians and staff share “joy bombs” and “pain spots” (rapid-cycle process improvement).
The authors of this practice reflect on how “there has been a legacy of poor experiences in healthcare for the LGBTQ community. In addition to social, legal, and structural discrimination, there is a lack of cultural competence within the healthcare experience. This exacerbates health disparities for the LGBTQ community.” To combat this, staff members attend one to two-hour Safe Zone training sessions—sensitivity and bias-awareness instruction that equips them with the correct skills and language and enables them to create a mutually accountable culture.
What is particularly noteworthy, as the authors state, is that the practice is so powerful it provides a framework for all clinical practice. The key elements of the practice—compassion, multi-disciplinary teamwork, robust huddles, story-telling and person-centered care–—can be applied everywhere.
The lessons about building trust from the Prairie Parkway LGBTQ Clinic include:
- The importance of knowing your patients, respecting them and knowing how to address them.
- The need to address gender bias as essential to quality and equitable care.
- The power of huddles and reflection to build trust and a shared understanding among team members.
- The importance of education and training in sensitivity and bias awareness.
- The applicability to all populations, particularly those who have historically been subject to discrimination and bias such as gender, racial and ethnic groups.
- The importance of caring and compassion for your patients and team members.
Daniel B. Wolfson
EVP & COO, ABIM Foundation