A variety of means can be used to monitor progress with respect to quality improvement goals.
Client feedback is a very valuable source of information in the initial assessment phase of the project, in monitoring progress, in identifying specific areas that need improvement, and in soliciting suggestions on how improvements could be made. Client satisfaction surveys can include questions to assess the LGBT friendliness and competence of the staff and facility. Questions can be indirectly worded, as seen in the sample survey form (exhibit 16–1).
Another tool that might prove useful is the guest client—a volunteer who visits the facility, uses some aspect of care, and then reports his or her experiences. Guest client activities can range from a simple phone call for information to completing a formal intake. Participation in group therapy is probably not appropriate. It is important to inform staff that such a program is being implemented and present it as a way of gathering information rather than as a way of checking up on people. If the agency is unable to find appropriate volunteers, seek assistance from local LGBT social service agencies or other organizations.
Exit interviews and patient satisfaction interviews are also excellent ways to obtain direct feedback and solicit suggestions. All clients should be asked routinely to participate in these interviews, not just openly gay, lesbian, transgender, or bisexual clients. Questions on the staff’s comfort with issues pertinent to gender or sexual activity should be posed to all clients and in such a way that the sexual orientation of the client is not an issue. The interviews should also include questions to assess the staff’s comfort with LGBT issues. This can be their last opportunity to communicate acceptance and willingness to discuss LGBT concerns. It should be made clear to clients that refusal to participate will not affect treatment in any way and that any comments will be kept in the strictest confidence.
Additional strategies could include using focus groups run by staff or local advocacy organizations and examination of service utilization patterns to determine whether LGBT clients are missing appointments, dropping out early, or showing a high incidence of complaints and grievances.
Information from all of these sources should go regularly to the quality improvement committee and clinical and administrative leadership. As significant issues are identified, they should be incorporated into the agency’s quality improvement strategies. Again, assistance from LGBT advocacy groups and other LGBT treatment programs will be valuable in addressing specific issues. As with any quality improvement effort, continuous reassessment of the available data or information is essential to maintaining positive ongoing results.