(59) Gender affirming ob/gyn care: a department-wide quality improvement (QI) project

Background: A busy ob/gyn department will care for gender-expansive patients in multiple clinics and across subspecialty services. Our goal is to provide sensitive and competent care to gender expansive patients, who will report satisfaction rates >80% at clinic visits by 24 months from project start.

Methods: This multi-intervention quality improvement project consists of overlapping plan-do-study-act (PDSA) cycles. We designed a 60-item online patient survey of the “welcomeness” of the clinic that was accessible from the clinic waiting area, exam rooms, and bathrooms. We reviewed all intake forms for seven ob/gyn specialty clinics for inclusion of three-item sexual orientation and gender identity (SO/GI) fields, pronoun identification, and partner-inclusive language. Staff were strongly encouraged to participate in a 1-hour training program and complete pre- and post-training questionnaires.

Results: In the first 12 months, 100 staff participated in LGBTQ+ training and completed pre-training surveys. Only 27% reported formal training in LGBTQ+ competency in the prior to 2 years. When asked if LGBTQ+ training should be mandatory department-wide, 68% strongly supported, and 15.5% somewhat supported this. The most frequently identified barrier to caring for LGBTQ+ patients was “fear of making a mistake or offending a patient” (67%). Of note, “conflicting values or morals” was only noted by 6.4% of respondents. Of all participants, 37 (37%) completed a post-training survey. 100% of these respondents reported that the training was very or somewhat relevant to their daily work, and 100% felt comfortable providing services to LGBTQIA+ patients; however, 7 (20%) still did not feel comfortable asking and sharing pronouns. As a result, we organized two additional interactive workshops focused on correct pronoun usage that were attended by 20 staff members.

There have been 74 patient responses. At the front desk, 47% of respondents were not asked pronouns or their pronouns were not used correctly; however, providers correctly used pronouns for 87.5% of respondents but only 2 patients (6%) were asked. Most respondents (64%) felt that the clinic environment (signage, pamphlets, etc.) was very or somewhat inclusive, 33% felt neutral, and 2.8% not very or not at all inclusive. Inclusivity of providers and staff ranged from 78-98%.

Conclusions: This expansive, department-wide QI study highlights the importance of collecting multi-source data to guide cross-disciplinary QI interventions. Our orthogonal data sources affirm two priorities for the improvement components this project: increasing pronoun documentation and use, and improving the physical clinical environment.