Signals of safety: LGBT visibility at work


My blog inspiration today comes from an exchange this morning on Twitter. The original tweet was from @radiographerben who posted a poll asking if people would be comfortable wearing a pin “advertising” their sexual identity and/or gender orientation like staff at Marks and Spencer in the UK are able to do.  There were a few options from “sure” to “er, no”! Comments varied from my straight out “hell yes” to more cautious responses, including @SophiaEThom’s concern about dealing with possible reactions from patients. The badge in question identifies the wearer as a member of the LGBT+ at M&S employee network and supports Stonewall’s amazing Come Out for LGBT campaign which encourages visibility in all areas of life.

Stonewall (a UK group who support LGBT people) also run a Diversity Champions program for workplaces.  They cite that LGB employees who are comfortable being out at work are 67% more likely to be satisfied with their sense of achievement and trans employees 77% more likely to be satisfied with job security.  While this type of initiative and workplace training is becoming more common in the private sector, healthcare workplaces are slower to catch up. Often the focus is on improving LGBT patient experiences, and there is a lot of work to do in this area. When we look at LGBT staff, the picture is less clear. Being out at work is important, but how out are we when we work with patients? Do we think, like one physician participant in a UK study that:

 The hospital is not ready…for a camp acting doctor…because it brings sexuality into the public eye, and is the workplace the right place to do that? I think the answer is no because it’s at the expense of the patients.

LGBT staff routinely manage their identities at work, in a way that some other marginalised groups aren’t able to. We have the choice (usually) to come out or not – to pass or tone down our sexual identity. The idea of wearing a badge or other signifier bypasses that choice and makes our identity visible, which can sometimes feel uncomfortable.

So, why bother? If we set aside the evidence that being open about who we are makes for a better work experience – why should we be open around and with patients?  As Sophia said, this brings an element of risk. Why open ourselves up to the possibility of a negative reaction, despite all our equality policies, diversity mission statements and the general feeling that it’s 2017 – and OK to be whoever we want to be? One reason might be that it makes it a little bit easier for our LGBT patients.

The 2011 Institute of Medicine report suggests that the barriers to equitable health care that LGB people face can “profoundly affect their overall well-being”. Our LGBT patients often feel invisible in a system that doesn’t see them for who they are.  We know there are steps we can take to make this better; one is having visible LGBT staff to care for them.  A nice example is this blog post by Roger Newman, a gay man living with cancer, discussing his experience in hospital:

I hardly dared mention a partner and I even found myself begging him not to kiss me when he visited me. His response, as expected, was ‘bollocks to ‘em, I love you’, but on his visits I could see the eyes taking it all in; sorting and codifying the resulting information. I found myself telling him that it was OK for him because he could take our lifestyle back home with him whereas I was left to deal with the consequences. I was profoundly disturbed by having these feelings and I felt guilty about them, but the fact was that there I felt and believed myself to be different. I pondered how much I would have loved to have had some ‘out’ LGBT staff around me, so that I didn’t feel so isolated and had more confidence to be me. Just someone with a ‘Me Too’ badge on them, would have helped.

I’ve also written about this before, and in talks I have used a clip from the Macmillan “LGBTQ experiences of cancer care” video series where Lesley (a lesbian living with ovarian cancer) discusses her discomfort with knowing some of her nurses were lesbian but closeted, when she could have used the support.

My research is about how the identity disclosure decisions we make at work might affect relationships, with our colleagues and also (perhaps more importantly) with our patients.  As I read through my interview transcripts, the daily (and often unrecognized) work we do to tone down our queerness is a common theme.  But my participants realize that our difference can make, well, a difference.  In an older post I quoted a paper by Riordan who wrote that LGB healthcare professionals may use their identity as a “signal of safety” to flag to LGBT patients that they are understood – in my opinion the use of a badge or lanyard is just that.

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After the interviews


The feeling I brought back from my initial interviews was how much of grad work is done in the spaces between our normal lives. My cohort knows the reality of taking on a full time doctorate on top of …well, life I suppose. We’ve struggled with deadlines, negotiated our inevitable absences for family commitments and furtively checked work emails during lectures. We are all tired, maxed out and scraping by–it’s normal. Doing the actual research bit, talking to other busy humans and relying on their friendship and generosity as I asked them nosy and intrusive questions, that was a whole other level!

I had badgered my participants with emails, consent forms and FaceBook messages ahead of time – trying to explain that this wouldn’t just be one meeting and done. At a very conservative guestimate I told them it would take up at least 10 hours of their time. Two face to face discussions, reviewing the transcripts, commenting on the transcripts, looking at my interim texts and working with me to shape a coherent and (hopefully) engaging story from their three individual narratives.

To further complicate things, I’ve never done this before. I feel like I am making it up as I go. It’s hard to project a feeling of authority and confidence when I really have no idea what I will expect of them two months from now, nine months from now? More emails? Phone calls? Skype? Individually? Together? My results section will be this co-joint narrative – but as I slog through the hours of transcription I still have no solid idea what that will involve.

I found myself working in the physical and emotional spaces that were left, full of uncertainty—in the coffee shop at the end of the shift, the room found at the busy conference just behind the registration desk with the loud air conditioning, and the friend’s house with the borrowed tea and cookies. My friends, my participants, made room in their lives for me—they drove miles to talk, rearranged meetings to spend an hour sharing coming out stories and arranged child care. I was acutely aware of their lives outside the coffee shop or the living room—they were all juggling prosaic day to day appointments with emotionally demanding major life events. Before the tape was turned on, and lingering after we had finished, we reflected on how young we had been when we first met, and we shared our battle scars.

It is always an honour and a responsibility to hear and share stories doing research, but a humbling realisation to begin to confront the issues that enrich and complicate working with friends. Lisa Tillmann-Healy (2003) places relational ethics and “friendship as method” as a feminist practice with its belief that “the personal is political” and commitment to empowerment and social change. Friendship as method involves hope, caring, respect and justice. This kind of research is intensely personal, done with love, I didn’t really understand that before but I realise it now.

Image: Church Street (Toronto) cross walk