Fostering Belonging in Gender Diverse People

Most of us know what it’s like to feel truly seen by at least one other person. It creates a sense of camaraderie, of validation, and of being part of a community.

Too often, though, people who are transgender, non-binary or gender diverse experience the opposite. Being referred to by a name or pronouns they no longer use can make someone feel invalidated and like they don’t belong.

Fostering inclusivity and belonging for gender-diverse employees and patients is one of the many reasons that several efforts have been underway throughout UW Medicine to give people the tools and space to express their true identities in our hospitals, clinics, labs, classrooms, exam rooms and virtual environments.

Behind the Name in Use initiative

How do you know what name to call your patient? As of January 30, 2024, you can find their name in use at the top of their storyboard in Epic and on patient wristbands.

Epic still uses “preferred name” to describe the field where this information is entered, so registration staff are instructed to ask the patient about their name in use and document it in Epic’s “preferred name” field.

The Name in Use initiative was started to better reflect the fact that the name someone goes by is their name and should be respected. Assuming someone’s legal name is the name they go by runs the risk of deadnaming them, which means referring to them by a name that they do not identify with – which is an invalidating, dehumanizing and unsafe experience for the person being deadnamed.

Someone’s name in use may be different from their legal name, and there are times when knowing this is necessary to provide medical care, so there is a separate designation labeled “legal name” that employees may need to refer to in specific instances, such as before drawing labs or transfusing blood products. This is in accordance with hospital safety policies. In Epic and on patient wristbands, the patient’s legal name shows up just below their name in use.

These may seem like small changes, but they require a fundamental shift in the approach to patient registration. Considerable work went into ensuring these changes are consistently implemented across all hospitals and clinics. The efforts were led by Angad Singh, MD (he/him), a family medicine doctor who also serves as the associate chief medical information officer for Ambulatory Care and Health Equity, along with Holly Bowles, a clinical informaticist, and Jeni Bay, who was the project manager.

Equally as important to helping validate patients’ identities is learning how to ask them for their name in use and legal name respectfully and sensitively and not making assumptions about someone’s identity. This isn’t just about making someone feel welcome – it’s also about patient safety, says Darlin Lozano (they/she), program manager for 2SLGBTQ+ Healthcare in the Office of Healthcare Equity.

“By prioritizing gender-affirming care as the standard practice, we are not only centering the experiences and needs of transgender individuals but also extending vital support to various other demographics, including survivors of domestic violence or abuse. This shift towards inclusivity and sensitivity in healthcare has far-reaching positive effects beyond the transgender community,” says Lozano.

But it’s also important to recognize the unique role validating someone’s identity has for gender diverse patients as a tool for suicide prevention. Suicide is already a top cause of death among youth and young adults ages 10-24, with LGBTQ+ youth four times more at risk. Among adults, transgender and non-binary people are more likely to experience poor mental health, think about suicide or attempt suicide. Gender-affirming care has been shown to significantly improve life satisfaction.

“Implementing these changes stems from our commitment to reducing suicide rates and fostering a deeper understanding of the profound impact of deadnaming and misgendering on individuals’ psychological well-being,” Lozano says. “It reflects our dedication to promoting mental health and creating a more inclusive and supportive environment for all.”

Making pronouns more pronounced in introductions

Establishing gender-affirming care as the standard of practice begins by creating an environment in which patients – and colleagues – feel recognized and respected. This starts with addressing people by using their shared pronouns and name.

The Office of Healthcare Equity offers an easy way to do this: introduce yourself and your pronouns first: “Hi, my name is __________, and my pronouns are ________. Can you share with me your name and pronouns?”

If someone’s legal name is different than the name they provide, there’s a way you can respectfully address that: “I see that your name in use is different from your legal name. I am able to note both your name in use/lived name and legal name in Epic so that we can address you consistently by your name, as well as have your wristband display your name. Would you like me to do that?”

Robin Lorenz (they/them), a senior training specialist has worked on documentation, Epic trainings and promotion of training modules from the National LGBTQIA+ Health Education Center to help employees learn how to interact with patients about name in use and pronouns.

“One of the most vulnerable roles I’ve had in my life is that of a patient, so having been in that situation, if there was something I could do as staff to make people feel more welcome, I’d do it in a heartbeat,” they say. “Someone using your name in use and pronouns can make you feel better and make it less stressful.”

Lorenz also hopes these discussions about how to talk with and refer to patients will encourage employees to follow the same practices for their colleagues, knowing firsthand how invalidating it is not to be identified correctly by others at work.

“After I changed my pronouns in 2020, I had a manager who continued to mispronoun me; it was distressing to me, it got to be so depressing and so frustrating, it felt very disrespectful,” they say. “What I hope with the changes being made in our system is that people understand the reason why we have to change, and I hope what we’ve crafted gives them the tools and shows them they can do these things right away.”

Expanding transition services for transgender and non-binary employees

Over the past few years, Human Resources has also done work to make sure employees who are transitioning have the resources and support they need.

They created a website page that explains need-to-know resources, how-tos (like how to change your name in Workday), a sample workplace transition plan and more.

“If employees are in a decision-making place around transitioning, we want people to know this resource is available. We want them to know that if something in the work environment is holding them back, we’re happy to work with them to make that transition easier and provide support based on what their needs are,” says Jennifer Petritz (she/her), employee relations director for Human Resources.

The resources aren’t just for people who want to make their transition public in the workplace but also for colleagues and managers to learn how to offer support.

Why words, names and pronouns matter

Transgender and gender diverse people face discrimination and invalidation which creates an unsafe environment. Using someone’s correct name and pronouns and supporting them in the workplace, may seem like small actions, but they can have a big impact on someone’s wellbeing and sense of belonging.

“These changes are a move toward grounding ourselves in seeing the humanity in each person. The hope is this is not necessarily where the conversation ends, but rather a starting point for greater learning and understanding,” Lozano says.

Get more gender inclusivity resources at the Transgender and Gender Non-Binary Health Program website.