What patients deserve: Welcoming and inclusive care settings

First impressions are everything. When patients enter your office, they want to feel valued and at ease. Creating a welcoming and inclusive care setting is exactly what they desire. It’s also what they deserve.

Tesiah Coleman, MSN, WHNP-BC, AGPCNP-BC, CLC is an educator at Violet, providing comprehensive in-person and virtual care to support the physical, mental, and emotional health of women and TGNC patients. As a nurse practitioner, she spends a lot of time thinking about how the physical environment of where she works not only impacts staff, but patients too. "At Tia, I am lucky to work with a team dedicated to making our facilities more inclusive for all identities."

How leadership and the entire care team can improve care settings for patients.

It goes without saying that attending a health care appointment can be anxiety-inducing. As soon as a patient crosses the threshold into your office, what they see first can make or break patient satisfaction and retention.

Are the amenities clean? Are the bathrooms inclusive? How’s the seating arrangement?

Take note. Imagine how someone would feel coming to their next appointment.

Tia has locations in some of the most culturally diverse cities in the country, from Los Angeles to New York City. Tia has recognized that creating an inclusive care setting is the baseline for ensuring patients feel like they belong.

Here are some of my favorite aspects of Tia clinics:

• Visible pronouns → We have a lovely care team wall in our San Francisco clinic that not only shows the images and names of providers but includes their pronouns, too. Normalizing pronoun use in a clinical setting is important for opening dialogue between clinicians and patients about gender identity, and respecting the many gender expressions that come into our “medical home for women.” In a masked world, having full-face pictures is also invaluable for further personalizing the care experience.
  

• Living rooms → After checking in, patients can relax in our comfortable living room. Framing and designing this space as a room for living, not waiting, has helped in dismantling the typical “cold” or “impersonal” clinical office experience. The “living room” includes one of my favorite parts of the clinic: a learning library! That is where our team’s favorite books live, related to reproductive justice, feminism, psychological wellness, health and healing, and science-backed natural medicine practices. Our specially-curated library gives patients a chance to peruse before their appointments, and hopefully spark inspiration for their next read while giving them insights into our personal values and interests as clinicians and health care staff!
  

• Reimagined patient gowns → We’ve created a comfortable robe that helps patients feel covered, confident, and warm during their visit. As a provider, these gowns are great for providing thorough breast exams while keeping the patient as covered as possible. No more flimsy and uncomfortable paper gowns designed for limited body types!

Of course, the ability to do this comes from a position of privilege largely dependent on the clinic’s and community’s access to resources. It is important to note that while Tia is working towards transformative health care for all women, they do not currently serve Medicaid patients. A population Tia is diligently working to reach.

Overall, Tia clinics are designed to feel personal, warm, and cozy for any person inclusive of all identities. This helps to create an environment of openness and humanity before you even enter the exam room. Once you enter the exam room, Tia prides itself on creating judgment-free care experiences with providers who make trust and active listening a top priority. After all, we believe that you are the expert on your own body.

Both high-income and low-income healthcare organizations need TLC.

Before Tia, I worked in community healthcare. That is where I began to think about how the physical space impacts patients and reflects inequities. From my own previous experience working at a low-resourced community health center, the attention to patient comfort and clinic aesthetics was just not there. Because we simply didn’t have the resources.

Working in an environment with outdated equipment, no natural light, and often-times broken exam tables, impacted patients, providers, and health care staff. My colleagues and I deeply believed—and still do—that ALL patients, regardless of identity or socioeconomic status, deserve to have access to beautiful, inclusive spaces.

It has been reported that hospitals and family doctors, the mainstays of health care, are pulling out of low-income city neighborhoods, where the most culturally diverse populations live. Even if the funding isn’t there and the staff is ready to leave for more affluent neighborhoods, how can health care orgs, such as low-resourced community centers, ensure that there’s a good environment for culturally diverse patients?

Culturally diverse patients aren’t receiving the care they deserve. The way health care organizations look reflects the crisis.

There are clearly inequities in health outcomes for culturally diverse patients:

• Higher proportions of BIPOC communities are less likely to have access to quality care compared to white communities. BIPOC populations are also more likely than white populations to report that they believe they would have received better care if they had been of a different race or ethnicity.
• When there’s access to care, Black patients are 10 percent less likely to be admitted to hospitals compared to white patients.
• In a 2020 national survey conducted by CAP Action, 24% of LGBTQ individuals “reported some form of negative or discriminatory treatment from a doctor or health care provider.” Additionally, racial discrimination is the most commonly reported type of discrimination in healthcare settings. Patients who live at the intersection of LGBTQIA+ and BIPOC identities can be faced with discrimination in reaction to multiple parts of their identities.
• People who say they mistrust health care organizations are less likely to take medical advice, keep follow-up appointments, or fill prescriptions, and, therefore, they’re much more likely to be in poor health.

Caring for culturally diverse populations includes ensuring the amenities and facilities are as clean, welcoming, and inclusive as any other facility in more privileged communities. Or else, they may feel like second-class citizens and may include that in their decision to stop attending doctor’s visits altogether. Conversely, highly resourced care settings may be the least inclusive, offering little attention to inclusion in their facilities.

Improving care settings improves the situation.

3.5M potential life years can be saved by just closing the gap on racial disparities in health care alone. In doing so, inclusive care can also save the health industry $100B.

According to the Lown Institute Hospital Index, both the most and the least inclusive hospitals are typically in the same neighborhood. The group awarded higher scores if the hospital served a greater proportion of non-white Medicare patients compared to the demographics of its surrounding community.

When many of the least and most inclusive hospitals are in the same neighborhood, both can likely benefit from assessing if their facilities are welcoming, warm, and inclusive. But for different reasons.

The most inclusive hospitals may be hit with high turnover and less funding, manifesting in a shabbier environment. The least inclusive can include the wealthiest hospitals that are state-of-the-art. Improving care settings—either by giving some TLC to the decor or ensuring there are inclusive bathrooms—is a worthy investment of time, energy, and resources to benefit patient satisfaction, retention, and, possibly, health outcomes.

Patients deserve inclusive care, and that includes being able to walk into their doctor’s appointments feeling confident in their health care org’s amenities and facilities.

Here are some tips to improve the environment of care settings for culturally diverse patients:

• Post signs and symbols for inclusion and belonging. Signs and symbols of inclusion aren’t supposed to be performative. They’re a beacon of safety and belonging for patients who often face discrimination in care settings. Post a Pride flag in your office and examination rooms. Change the bathrooms to be gender-neutral. Redo your marketing and intake forms to have gender-inclusive language. Pin your pronouns to your lab coat, scrubs, lanyard, or wherever else you see fit. You can also post them on digital directories or in telehealth/Zoom calls. The list goes on. Every space can become inclusive.
• Attend to what needs to be fixed. If there’s a broken chair in the waiting room and a budget, it should get fixed or replaced, eventually. If there’s something exclusionary about your facilities, try to make it more inclusive.
• Make amenities warmer and cozier. This may seem arbitrary, but how often are care settings described as “cold”? Too often, hospital settings lack the reassurance patients desire. How much more satisfied would patients become if examination rooms included decor, blankets, and other comforts? And if there’s no budget, how can some of those items come through donations?
  
  According to the Building Better Building Beautiful Commission and Create Streets, there are three key reasons for making care settings more pleasant:
  • Patients recover more quickly in beautiful surroundings.
  • People work more effectively in beautiful surroundings.
  • Beautiful buildings support civic pride, which is good for neighborhoods.
• Ensure cleanliness. This one seems to be a no-brainer for examination rooms, but there are moments for some facilities when the waiting room, or even the parking lot, becomes unkempt. These spaces matter too and it’s vital for patient trust and satisfaction to ensure a standard for the entire facility.

Creating a good healthcare environment is not only about aesthetics. It includes putting up posters, signs, and other emblems to signal inclusivity and belonging, but, most importantly, your care team must understand patients’ needs. And the real key to success is appropriate training for the care team to provide quality care rooted in racial justice and intersectionality.

This article was written in partnership with Violet. Violet is the first cultural competence credentialing, upskilling, and care coordination platform for clinicians. Research shows that inclusive care is proven to generate better health outcomes and Violet’s platform is the first step to building health equity for all.