OR Excellence Awards: Diversity, Equity & Inclusion: Optimal Care for All

At Dignity Health Saint Francis Memorial Hospital, inclusive language is the centerpiece of a renowned gender care program that ensures every patient who walks through its doors receives the best possible care.

Dignity Health Saint Francis Memorial Hospital (SFMH) in San Francisco has served as a beacon of hope for patients in the transgender community for nearly a decade. In 2016, the hospital launched the Gender Institute to deliver compassionate, high-quality and affordable health services to gender-diverse patients and their families. In 2021, SFMH became the first hospital internationally to achieve accreditation as a Center of Excellence in Gender Affirmation Surgery by the Surgical Review Corporation. But it’s not what SFMH is doing that earned the hospital the 2023 OR Excellence Award for Diversity, Equity & Inclusion, it’s how the work is being done.

Jessica Gruendler, DNP, RN-BC, CPHQ, CNOR, senior director of operations and perioperative services at SFMH, puts this sentiment a bit more succinctly. “Our policies and processes don’t only apply to facilities that want to start their own gender identity surgery program,” says Dr. Gruendler. “The principles of care are geared toward educating any hospital or surgery center on something they may not be familiar with. It’s about moving people away from the political aspect of treating the transgender community and bringing it back to providing the best patient care we possibly can.”

Jaimie Weber, MBA-HM, MSN-Ed, RN, PHN, NEA-BC, CCRN, CNOR, nurse manager of perioperative services, likens the work SFMH does with its high population of gender-diverse patients to what providers have done in the past to improve pain control and pain documentation. “Pain is subjective — your level five pain may not be the same as my level five, but we teach our nursing staff that the pain is whatever the patient says it is,” says Ms. Weber. “Your gender identity is no different. It’s not for me to judge; it’s my duty to meet our patients where they’re at and ensure their needs are met to the best of my ability.” While caring for patients to the best of your ability is the standard of any good provider, the stakes are higher when you’re caring for a population that’s associated with several bleak statistics regarding their experiences within the healthcare system. Consider the following: One in three trans people avoid seeking medical care due to discrimination, one in two educate their medical providers about trans health and, most disturbing of all, 41% of trans people have attempted suicide.

SFMH staff is doing its part to change those numbers for the better. It ensures its inclusive care efforts employ a variety of practices aimed at making patients as comfortable as possible. This isn’t simply a tactic to bolster patient satisfaction; it’s a proven way to get the type of information needed to provide the best care for any marginalized patient population.

“We know that if patients don’t feel safe — whether it’s about someone just respecting their preferences or if there’s a cultural disconnect with a patient from a different country — they tend to just shut down and don’t give you any information,” says Dr. Gruendler. “Or they just say ‘Yes’ to everything, and you don’t get a good patient history. That’s why it’s so important to open up the communication.” SFMH does this by adhering to this strategy:

• Ask for patient’s name and pronouns every time.
• Document this information in the EMR.
• Offer an aqua band to all patients that makes their name/pronouns visible to providers.
• Use the patient’s chosen name and pronoun (even if it doesn’t match the ID).

The tone of this strategy is set from the start. “We don’t use ‘preferred pronouns.’ We ask, ‘What are your pronouns?’” says Ms. Weber. “It’s no different than when there’s a Robert who likes to go by Bob. Across the board, it’s helpful to find language that’s geared toward creating an inclusive program that extends to all our patients and visitors.”

SFMH also uses misgendering as a quality metric. “We understand nurses don’t intend to cause harm to that patient, but it can be a triggering event, and we want to correct any mistakes,” adds Ms. Weber. Documentation is also crucial. “Part of the program is asking every patient every time because we can do the EMR documentation, which displays on the bar,” says Dr. Gruendler. “We’re doing medical record reviews because we’re finding that physicians in their H&Ps — or some of their other documentation — tend to misgender patients, and we want to be part of the corrective process.”

SFMH also hired a navigator to assist pre-admission nurses, guiding patients through the clinical pathway and serving as added support. Dr. Gruendler says many of SFMH’s practices were started as a necessity, as 50% of its surgery schedule involves gender-affirming surgeries. “The program was born out of the need, but now it’s becoming a community standard for offering a gender-care program, whether you’re doing surgery or not,” she says. OSM