Engaging with Members to Develop a Person-Centered Transgender Care Program

Abstracts from the Kaiser Permanente2018 National Quality Conference


Felipe Dest, MHA; Erica Metz, MD; James Kelleher, RN;
Stephanie Detlefsen, MD; Erin Waters


From Northern California, Northwest

Background: Kaiser Permanente (KP) is dedicated to providing care to the diverse members and communities we serve. Involving members in designing care and services ensures that we are meeting their health care needs in a meaningful way. A recent survey by the National Center for Transgender Equality (NCTE) illuminated that 23% of transgender people avoided health care in the previous year because of fear of being mistreated; 33% had a negative experience receiving health care in the previous year related to being transgender; and 90% of transgender people surveyed believe there are not enough providers adequately trained to care for them. Both the KP Northwest (KPNW) and KP Northern California (KPNC) Regions engaged with members; through the CoDesign process, members helped to inform what services and performance improvements were needed to deliver high-quality, affirming care to transgender members.
Methods: KPNW: The Gender Pathways Clinic did not have adequate resources to meet the growing demand of members seeking transgender care. It was difficult for new members to find resources online. Patient partners and staff identified improvements, developed action plans and measures, and conducted tests of change. These are now in place with future plans to create a full-time patient advisory council. KPNC: Problem: There is no mechanism to engage with transgender members to ensure the care program we are building serves them and meets their needs. Intervention: Develop multiple mechanisms for patient engagement (Focus Groups, Councils, CoDesign Teams, Peer Navigation). Comparison: No engagement. Outcome measures: Implementation of improvement efforts that members identify as valuable to them.
Results: KPNW: Within the past year, 2 new members are now participating in the CoDesign meetings, making a total of 5 members. In addition, the clinic has been able to hire 2 pediatric providers, 1 licensed professional counselor, and 1 physician. The Community Navigator for the clinic has gone out to 38 different health care groups to educate staff about transgender care and promote the clinic. There is now a Web site for our patients and a folder for new members that can be customized on the basis of the needs and interests of each member. There is a plan to conduct prototype testing with new members to evaluate all the educational material that has been developed. NCAL: 1) Operational improvements (eg, a change in welcome scripting at the injection clinic); 2) informed meaningful implementation (eg, informed implementation strategy of training program by identifying high-need departments); 3) environmental improvements (eg, provided significant consultation on art and signage for new clinic).
Discussion: 1) Understand the importance of inviting patients to design solutions early and often, 2) apply tools to engage in CoDesign with members and communities to build a care program that meets their needs, 3) develop tactics to transform information systems and create scalable trainings to increase culturally responsive skills for staff and providers, 4) build a framework for providing multidisciplinary care, 5) apply learnings from the KPNW and KPNC paths, challenges, and successes.

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