Amplifying LGBTQIA+ voices for improved health and care
Coauthored by Deirdre Mylod, PhD, Executive Director, Institute for Innovation, and Senior Vice President, Research & Analytics.
Fully understanding every patient’s experience is the heart of all the work we do at Press Ganey. Unfortunately, discrimination and insensitivity toward a patient because of their gender identity or sexual orientation isn’t unheard of in the healthcare sector. Recent data collected from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey reveals the real-life experiences of LGBTQIA+ patients. It shows us where experience gaps exist and can help hospital staff and administrators create a more inclusive environment for patients who identify as LGBTQIA+.
Overall differences in experience
From our equity work related to patient race and ethnicity, we already know that different groups have different experiences. That is, the patient experience isn’t uniform. A new analysis of national data uncovers variations in how patients of different sexual orientations evaluate their care.-Based on 68,000+ HCAHPS responses across organizations that capture information about sexual orientation, patients identifying as any sexual orientation other than cisgender or heterosexual are less likely to say that they would recommend the hospital.-
The patients who are more likely to recommend a hospital are those who felt respected—and that holds true across the board. Analyzing responses across five service lines (ambulatory surgery, emergency department, inpatient, MD, and outpatient), significant positive correlations between respect-related items and "Likelihood to Recommend" (LTR) emerge.
When patients feel truly seen, heard, and respected, it stays with them, and it shapes how they talk about their care. As we reflect on Pride and patient identity, this underscores the fact that when care environments are genuinely welcoming and respectful to all—regardless of sex, gender, or sexuality—patients notice, and they respond.
Patterns of different experiences by group: Sexual orientation
Those who identify as heterosexual make up most of the study, which means their differences compared to the entire group will be smaller. This is because the perspectives of the majority have the greatest impact on the overall results. It’s imperative to explore the opportunities that exist for all other sexual orientation identity groups.
Patients identifying as lesbian report many positive aspects of care but have more negative disparities related to nursing courtesy and listening. On the other hand, patients identifying as gay report more negative disparities related to care from their doctors.
Patients identifying as bisexual report even worse experiences. They’re least likely to recommend or give high rankings (9 or 10 out of 10) than gay or lesbian patients.
Patients who report their sexual orientation as "other” (i.e., not gay, lesbian, or straight) report worse-than-average experiences on all measures aside from the physician environment.-The total number of respondents who select "other” is similar to the number who select the categories of lesbian or bisexual, indicating that it’s important for "other” to remain an option for self-identification.
The group of patients who did not feel comfortable reporting their sexual orientation and selected “prefer not to answer” on the survey report the lowest top-box scores across all measures—likely indicating that they don’t feel comfortable or safe enough to disclose this aspect of their identity.
Highlighting insights about equity regarding gender expression
Our award-winning natural language processing (NLP) tool can surface verbatim equity-related comments/insights across a wide array of personal attributes (e.g., language, age, race, body size, ability, religion, neurodiversity, and gender and sex equity).-This feature shows us how respecting a patient's gender expression—or not—impacts their experience.-With it, you can learn about your patients’ experiences in their own words.
Patients’ verbatim comments relating to equity can be positive or negative. Some representative insights from a national research sample include:
| Negative insights- | Positive insights- | |
| Broad culture of respect | “Staff needs to be educated on LGBTQ issues.” | "Also, I was particularly impressed by the check-in staff's sensitivity to LGBTQ+ folks when screening for pregnancy tests.” |
| Respecting sexual orientation |
“I received treatment from a nurse practitioner and a registered nurse that was homophobic.” “I think there needs to be better training of front desk staff regarding transgender, intersex, nonbinary, or otherwise non-conforming identities.” |
“Very gender affirming.” “He is especially sensitive to the needs of the transgender community.” “As a trans person, I never know if people will misgender me or ask me about my scars, etc. Tyler used my correct name and didn't react poorly when he saw my top surgery scars.” “She was the first provider that educated me on trans health issues rather than the other way around.” |
| Lack of process to ensure use of correct pronouns and names | “The front desk staff misgendered me on checkout when they didn't have access to my chart or identification.” | “Friendly, and uses correct pronouns in charting.” |
| Intentional choice to use certain pronouns and names |
“The receptionist who checked me in aggressively misgendered me with Mr. and Sir.” “Nursing and reception staff misgendered me even with access to my identification and chart, which have my gender and pronouns on them.” |
"She respected my genderfluid identity and used correct pronouns after I mentioned them to her.” |
| Ability to correct misuse of pronouns and names | “The person who did this glanced in my direction quickly after using the wrong pronouns in a way that seemed like she was aware of the mistake, but quickly moved on without addressing it on any level.” |
“The gentleman who did my check-in was quick to catch the deadnaming and correct to Barbara.” “He also asked what to call me and apologized for possibly misgendering me last time, showing for one thing that he read the gender part of my bio, which most providers before haven't!” |
Learning more from your communities
The University of Rochester Medical Center (URMC) has used the Patient and Family Advisory Councils (PFACs) to explore the experiences of the different communities the organization serves.-They’ve made changes to their policies and practices based on feedback from this group and have provided educational tools to help staff remember best practices and demonstrate respectful language.-This is just one example of how technology can be used to create similar affinity groups to seek feedback and crowdsource new ways of meeting more inclusive communicative needs.
Every patient experience is a story worth listening to and acting on. Press Ganey makes it possible to seek deeper feedback about needed care enhancements from various identity groups, including patients in the LGBQTIA+ community. Join the Press Ganey Equity Partnership to discover best practices around capturing information about patients’ sexual orientation and gender identity and unlock additional resources to help combat health disparities. Technologies like NLP can push your research even further, by using AI and machine learning to uncover actionable insights from patient feedback.
Communication is key when it comes to the healthcare of all patients. But it’s important to ensure hospital staff and administration are more mindful of inclusivity when it comes to groups that often feel unheard. Taking steps like becoming more well-versed in LGBTQIA+ knowledge, using gender-neutral terminology during visits, and leading with compassion and empathy will help you foster a more welcoming environment. Beyond Pride Month, make it your goal to listen to and respectfully care for members in the LGBTQIA+ community.
What this means for the next generation of healthcare workers
Millennials and Gen Z now make up half of the healthcare workforce. Yet, despite their growing presence, our “Healthcare employee experience 2025” report reveals 38% of Gen Z employees are leaving their roles, compared to 22% of millennials.
These numbers point to more than just generational churn—they reflect a real shift in expectations. Early-career professionals are prioritizing more than a salary. They want a workplace that aligns with their values, one that prioritizes equity, purpose-driven work, inclusive culture, strong supervisor relationships, career development, and better work–life balance.
When values like DEI are visible, intentional, and woven into an organization, it sends a powerful message about culture: you matter here. For younger generations, that message resonates deeply. It builds trust, strengthens commitment, and creates the kind of environment that supports long-term growth and retention. Organizations that embrace this approach won’t just keep pace with the future—they’ll lead it.
To see how Press Ganey can help you collect, segment, and understand your data to consistently create positive, high-quality patient experiences for all, reach out to a member of our PX team, and we’ll be in touch.
This article was originally published on June 27, 2027, and updated June 20, 2025.