Because any discussion on the quality of care provided for LGBT communities is, by necessity, a discussion of cultural competence, quality indicators should be functional measures of this competence.

The central mission of accrediting bodies such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the National Committee for Quality Assurance (NCQA), and the Commission on the Accreditation of Rehabilitation Facilities (CARF) is to establish standards for what they consider the key functions of substance abuse treatment centers and indeed all health care organizations. These standards provide frameworks for quality improvement that can be adapted to the specific task of improving service to LGBT individuals. In addition to ensuring a comprehensive approach, the use of standards provides the added bonus of assisting the organization during external surveys and reviews.

The outline that follows shows how JCAHO standards can be used to address quality improvement with respect to service to LGBT individuals. Standards developed by NCQA or CARF could be used similarly. Adapting the standards is fairly straightforward. For example, standards for leadership are directed at how well an organization plans, structures, and delivers its services to meet the needs of its users, who are defined by the demographics of people in the service area. This means that the organization should both know about and appropriately serve LGBT individuals within its service area.


• Do needs assessment and planning activities include LGBT clients in the community? Is their inclusion proportional to the percentage of the population they represent?

• How does the organization design services to meet the needs of the LGBT community, and how well are these services delivered?

• How effectively does leadership identify and cultivate community resources for LGBT clients?

Human Resources

• How does the organization measure and improve the competency of its staff in serving LGBT clients?

• What kinds of educational and training activities address these competencies?

Patient Rights and Organizational Ethics

• Are LGBT clients’ cultural, psychosocial, spiritual, and personal values respected?

• Do LGBT clients’ significant others or support people participate in care decisions?

• Do LGBT clients receive information about their condition that recognizes their special circumstances and helps them make informed decisions?

• Do policies and procedures for LGBT clients address circumstances in which care will not be given because their condition or lifestyle conflicts with staff members’ values, ethics, or religious beliefs?

• How are privacy rights of LGBT clients protected?

Education of Patients and Families

• Are educational materials appropriate and relevant for LGBT clients?

• Are educational programs accessible to LGBT clients’ significant others and support people?

Assessment of Patients

• Are relevant medical issues and social issues effectively and comfortably identified for LGBT clients?

Care of Patients and Continuum of Care

• How do care plans demonstrate sensitivity to the needs of LGBT individuals?

• Do discharge plans take into account the lifestyles and personal support systems of LGBT clients?

Management of Information

• Is the information system set up to collect data important to LGBT clients?

• Do assessments of information requirements include the special needs of LGBT clients, the providers serving them, and other service agencies?

• Does the information system facilitate tracking performance and outcome data for the LGBT client base?

Performance Improvement

• Do aspects of the performance improvement plan include specific monitors of and quality improvement activities aimed at services for LGBT clients?