‘Anything is helpful’: examining tensions and barriers towards a more LGBT-inclusive healthcare organization in the United States

ABSTRACT

Semi-structured interviews (N = 34) were conducted with employees at a healthcare organization to explore their perspectives on LGBT (lesbian, gay, bisexual, and transgender) inclusion in their workplace. When lacking both comfort and a vocabulary with which to discuss issues relevant to LGBT patients and staff, employees constructed comparisons by using other groups and events as stand-ins for experiences that were unfamiliar. From employees’ reflections, three dialectic tensions emerged: (1) desire for change and uncertainty about change; (2) preserving competent appearances and knowledge gap awareness; and (3) direct and indirect appraisals. The interplaying discourses that surfaced within the organization set the stage for impending inclusion initiatives. This study contributes to theorizing on dialectical tensions by examining the interplay of order and disorder activated by indirect appraisals and resistance by omission.

KEYWORDS:

• Relational dialectics theory
• organizational change
• LGBT
• provider-patient communication

Acknowledgements

We owe sincere thanks to two anonymous reviewers for providing insightful comments that shaped our earlier drafts. We also thank Kate Balling (University of South Florida) for careful reading and helpful comments on the manuscript. The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 Hand-written demographic forms were collected at the conclusion of the interviews with six open-response questions eliciting gender, ethnicity, age, sexual orientation, and tenure at the clinic. Collapsed position categories (medical assistants, administration, etc.) are those that the clinic uses internally and were provided by the CfC.