JustUs Health CI Report – Final

What has been most instrumenta to your progress?

One specific activity that was crucial to making progress over the course of the grant was working with the provider advisory board. The conversations and discussions that the provider advisory board engaged in were crucial to understanding what knowledge, resources, and connections providers have and what they’d want to better serve transgender and gender non-conforming people. The interdisciplinary nature of the advisory board allowed different ideas and experiences across different areas and systems of health care to be in dialogue as we thought about ways to better connect providers with each other and with the knowledge and resources they needed. The advisory board was adamant that any project shift away from a gatekeeping model of trans health and embrace transparency and collaborative care. They were very opposed to any project that would block trans people from accessing resources. What emerged was an idea for a hub website that would have contacts and resources for providers and also for transgender and non-binary and other lesbian, gay, bisexual, and queer people. The advisory board also helped to work through what core functions and uses the website should have.

Finding the company Software for Good was instrumental to developing the resource hub website. Software for Good develops web and mobile applications for organizations working toward positive environmental and social change. Their method is very iterative. We initially went to them saying we wanted an app and certain features in a website, but they had the advisory board and key people from JustUs Health join in on a few exploratory sessions to really understand what problem we were trying to solve. They did some helpful user research, surveying providers about what tools and connections they have and would want, and also talked to transgender and non-binary people about what sort of resources they would want online. The design process felt very collaborative and we appreciated working with a company that really took the time to understand what and why we wanted to build a new tool. They also helped us be realistic in what we could accomplish with the time and resources we had available.

Key lessons learned

We learned that increasing the amount of LGBTQ content in pre-professional healthcare training programs is much harder than just dropping in a content module. We had initially attempted to convene a broad group of faculty and curricula decision makers from a variety of healthcare disciplines and schools to discuss what LGBTQ content they included and to advocate for more LGBTQ content. We were successful in connecting with a group of nursing faculty. However, other than one person from a physicians assistant program we failed to connect with any other types of healthcare/medical education. From our discussions with the nursing and PA faculty members we did learn that different licensing bodies have different requirements, and that professional bodies also sometimes have recommendations and standards on working with LGBTQ. We learned that it takes a lot more work to connect with the key decisionmakers on curriculum requirements. The PA member and one of the nursing faculty did go on to work on a proposal for an interdisciplinary training module that’s in the process of looking for funding, we’re happy that emerged even though we aren’t directly involved.

A key lesson that we learned was the importance of giving our advisory board members plenty of time to build relationships with each other as a group. Some of the participants knew each other already, but some were new to each other. Encouraging cross-disciplinary discussions with an open mind for how a different discipline might approach a health care question was illuminating for the providers, and also helpful for us as we think about what information and connections we can provide and facilitate going forward. The amount of knowledge that was able to be pooled was helpful not just for this specific project, but also offered us unique insights into how we are offering continuing education trainings and other outreach to providers.

Reflections on the community innovation process

Collaboration was key to completing our work, and also knowing that we might not be engaged in a fully linear process. Throughout the process with the advisory board we often went through a cycle of discussion, idea generation, identifying our top options, and then repeating the process to work through how providers are currently connected and how they would like to be connected, what resources they have and what they wished they had. Even though our efforts to get more LGBTQ content into pre-professional education failed, we did learn a lot about the different fields of study and about the differences in licensure requirements vs. program content requirements. Knowing that we learn from failure and can fail falling forward, so to speak, gave the advisory board more freedom to explore solutions. Collaboration continued to be crucial once we identified that we wanted to build a digital tool, and if we hadn’t found a company that worked as collaboratively as Software for Good we would not have ended up with the same product. Collaboration with the advisory board also helped us build our plan for launching the hub.

Other key elements of Community Innovation

There weren’t any elements not included in the community innovation process that were instrumental to completing our work.

Progress toward an innovation

We are closer to achieving an innovation in how providers are able to connect to each and how LGBTQ people are able to find resources and information about accessing health in Minnesota. We’re closer because we’ve gathered information, generated solutions, and are on the cusp of being able to test out our hub. We still haven’t seen how it goes long term, and there are certainly going to need to be adjustments as we go, but it’s exciting.

While we didn’t make as much progress towards getting more LGBTQ content into pre-professional health care training, we are closer than when we started the grant. We have a better understanding of more of the challenges and barriers to getting LGBTQ content into healthcare professionals’ education. Previously we were only approaching LGBTQ training as a continuing education add-on. We’re now better situated to deepen the connections we’ve made with nursing faculty and branch out from there to other areas of practice.

What it will take to reach an innovation?

For a huge getting more LGBTQ education into healthcare education, we need to have a clearer sense of who sets the criteria for each area of practice for what students need to learn before they graduate. We would need to figure out where we can build relationships to shift the curriculum requirements to include LGBTQ content. We also would need to keep up on what curriculum has been developed and continue to identify gaps. Both our advisory board discussions and our discussions with the nursing and PA faculty members highlighted the need for LGBTQ-inclusive content in an array of places in training. There need to be scenarios with LGBTQ patients that aren’t necessarily there for something related to their sexual orientation or gender identity, there needs to be information generally on LGBTQ people to reduce bias and stigma, there needs to be trans and non-binary specific considerations for transition-related medical care. It doesn’t feel like we’ve narrowed down to a key solution yet that would address these multiple issues.

What’s next?

Right now, we are finishing up the resource hub website and adding in resources. We plan to slowly recruit providers, with a larger push in conjunction with our online professional development Opportunity Conference in November before we do a larger launch to transgender, non-binary, and LGBQ communities. We’re still having discussions with some of the advisory board members who were interested in curriculum development, but that’s very much slowed down by the pandemic and the fact that we aren’t sure our next steps yet. We are considering what it would look like to have more LGBTQ content requirements for continuing education credits, similar to policies that California and Washington D.C. have passed. We’re going to see how our digital Opportunity Conference goes, and keep working on ways to connect providers to the resources and knowledge they need to work with trans and non-binary patients.

If you could do it all over again…

I would tell myself to start much earlier on figuring out how to connect with folks in health care education, and to consider narrowing the scope to nursing/PA programs. This would’ve helped have more time to figure out key decision-makers and to possibly have started generating more ideas for how to get LGBTQ content to people studying to work in healthcare.