The Macy Foundation is delighted to join the national celebration of Pride Month! In this June edition of the Macy Notes blog, President Holly J. Humphrey takes the opportunity to chat with Stephan Davis, DNP, MHSA, NEA-BC, CENP, CNE, FACHE. As Assistant Professor and Director of the Master of Health Administration Program at the University of North Texas Health Science Center, Dr. Davis is an accomplished healthcare leader, nursing professional, and educator with a keen focus on increasing diversity—in all forms—within the health professions and public health. He was recently appointed to a three-year term on the American College of Healthcare Executives (ACHE) Council of Regents where he will work to promote diversity in the governance of ACHE with respect to race, ethnicity, gender, religion, age, sexual orientation, and diverse abilities.
Building a health care system that ensures equitable access and utilization means addressing the specific and distinct health needs of different communities and individuals. What should health professions educators be doing to ensure that future practitioners are able to meet the needs of LGBTQ+ persons and ensure a health care system which does not reinforce societal biases and stressors that in fact exacerbate health concerns? Are there specific initiatives and programs taking place right now that are strong models for achieving health equity for LGBTQ+ persons?
While we have come a long way with regard to LGBTQ inclusion in healthcare environments for patients, there is tremendous work to do for both consumers and providers of healthcare services. In many healthcare organizations and institutions of higher learning, we do not collect sexual orientation and gender identity (SOGI) data in demographic questionnaires for applicants, students, faculty, or staff. Without this information, we are not able to assess the climate for gender and sexual minorities within our institutions. While many organizations have begun incorporating these types of questions for patients, this is not a universal practice, even a decade after the publication of the Joint Commission Field Guide for LGBT Patient and Family-Centered Care.
The Human Rights Campaign’s Healthcare Equality Index (HEI) is a voluntary survey for health systems and hospitals to assess their practices related to LGBTQ+ inclusion for patients and members of the workforce. For organizations that meet all of the criteria, leadership designation in LGBTQ healthcare equality is awarded by HRC. Unfortunately, there are many parts of the country, including the region where I currently reside, where there are no designated leaders in LGBTQ healthcare equality. Without designated health systems and hospitals that have met the criteria, it may be unclear for members of the LGBTQ community which health systems and hospitals they can feel comfortable selecting to receive services or in the case of clinicians and leaders, where they should choose to work.
In addition to shorter-term goals to create more inclusive environments through initiatives such as the HEI, healthcare organizations and academic institutions should proactively work to increase accessibility of education and professional advancement for segments of the LGBTQ population where there is little to no representation in the workforce. In many parts of the country, it may not be uncommon to see “out” white gay men leading and practicing within healthcare organizations, for instance, but it is rare to encounter trans healthcare professionals and leaders, particularly among racial minorities. Hopefully as we increase the visibility of trans healthcare leaders and practitioners, such as the recent appointment of Dr. Rachel Levine to the Office of Assistant Secretary of Health, more members of transgender and non-binary communities will be able to see themselves working and thriving within the health professions.
Last year you were invited to serve as a conferee on the Macy-sponsored conference on Addressing Harmful Bias and Eliminating Discrimination in Health Professions Learning Environments which issued a broad set of recommendations for the future. Now, just over one year later, attention to issues of diversity, equity, and inclusion are even more heightened than ever. How do we move forward to achieve real and lasting equity in health professions education and health care?
I believe the work from the Macy Foundation conference and our report of recommendations is even more relevant and important than when we convened in February 2020. Over the past year, we have seen Black lives abruptly ended due to police brutality, communities of color disproportionately impacted by the most severe consequences of COVID-19, and Asian Americans being made the targets of hate crimes across the country. While all four of the recommendations from the Macy Foundation conference are critical to advancing diversity, equity, inclusion, and belonging in health professions learning environments, my highest priority from a healthcare leadership perspective and in academic administration is recommendation four, which addresses increasing faculty and leaders from marginalized and excluded populations. I strongly believe that we will not achieve meaningful progress with regard to creating more inclusive education and practice environments or comprehensively change curricula without diverse leaders and educators in positions of power and influence. The recommendation is critical in order to ensure diverse workforce and leadership representation from the patient’s bedside to the health system boardroom. While we often focus on diversifying the clinical workforce, we must also address the lack of diverse representation in leadership and governance to ensure organizational cultures that are truly inclusive throughout the continuums of clinical practice, research, education, and management.
This year, Arkansas passed legislation which would curtail and limit the kind of care that doctors can offer transgender people under 18 as well as legislation allowing doctors to refuse treatment due to religious or moral objections. How should health systems and health professionals respond?
Health systems and health professionals should band together in solidarity to call for the repeal of this discriminatory and dangerous legislation. Trans youth are at higher risk than their cisgender peers for mental and behavioral health challenges and suicide. To deny treatment that we know could be beneficial to the mental health and well-being of trans youth is unethical. It also is inconsistent with the moral codes and oaths of the major health professions, where we promise to not cause patient harm (non-maleficence), to respect the patient’s right to self-determination (autonomy), and to do what is going to ultimately benefit or improve health and well-being for the patient (beneficence). Additionally, this type of legislation interferes with patient-provider relationships and the self-governance and independence of health professions.
Last year marked the 50th official LGBTQ+ Pride celebration in the U.S., although many were not able to celebrate as planned on account of the pandemic and quarantine restrictions. What do you think would be a fitting option in this year to celebrate Pride and promote equality for all LGBTQ+ people? What does Pride month mean to you as a health care professional?
As a Black member of the gender and sexual minority community as well as a healthcare leader and educator, Pride is about being able to bring more of my authentic self to the organizations I serve. For me, it is also about advocating as an ally for the segments of the LGBTQ community that have less privilege in society, such as transgender individuals.
Pride is usually one of my favorite times of year, so last year’s in-person celebrations being cancelled was certainly disappointing. June of last year was also a very sad time, particularly for BIPOC LGBTQ individuals, as we began to have heightened national dialogue on systemic racism in the wake of the murder of George Floyd. I have been pleased to see many Pride flags expand the rainbow colors to include Black and brown, a visual representation of the community’s intent to stand in solidarity with racial minorities in the fight against racism.