[Special Feature: Toward a Campus of Mutual Support] Eriko Kato: Realizing a Shinanomachi Campus that Respects Sexual Diversity — Activities Toward Creating an Environment of Safety and Trust

2023/03/07

At the Shinanomachi Campus and Keio University Hospital, the Diversity Working Group, operating under the Medical Quality Improvement Promotion Committee, is leading efforts to create an environment that respects sexual diversity. We established a policy stating: "At the Shinanomachi Campus, we strive to create a safe and reliable environment where everyone who works, studies, or visits respects each other's sexual diversity." In response, the hospital website declared: "All faculty and staff will work together to ensure that everyone who uses our hospital respects each other's sexual diversity, and to develop as a hospital where patients can receive medical care with peace of mind." We began with initiatives aimed at hospital users. The catalyst for this activity was a single "suggestion letter" from a patient. Until then, the hospital had no established policy regarding sexual diversity, and we handled requests from patients generally referred to as sexual minorities on an individual basis. However, changes in social awareness and actual patient feedback made us realize the need to improve the hospital's internal systems and reform the awareness of our faculty and staff to realize the hospital's philosophy of "providing patient-centered medical care." We concluded that this was not an issue that could be left unaddressed. In February 2021, we started as a working group of four volunteers. Later, we were joined by other volunteer staff, including Dr. Tomonobu Hasegawa, Vice Director of the Hospital and Director of the Center for Disorders of Sex Development, who supported this activity. We also welcomed Dr. Shoko Sasaki (Clinical Psychologist and Part-time Lecturer in Pediatrics) as an advisor and began by learning and understanding together. Since January 2022, as mentioned above, these efforts have evolved into official activities under the Medical Quality Improvement Promotion Committee, and we are currently addressing various issues. Below, I would like to introduce our specific initiatives.

To deepen the understanding of sexual minorities among faculty and staff, we utilized the time during department and section head meetings to provide management with learning opportunities, with the cooperation of former Administrative Officer Matsuda. This fiscal year, we asked our advisor, Dr. Sasaki, to serve as a lecturer, and all faculty and staff attended the seminar as a mandatory hospital requirement. In the seminar, she gave lectures on themes such as (1) why hospitals based on the premise of sexual diversity are needed, (2) elements of sexual diversity, and (3) re-examining heteronormativity and the gender binary within the hospital. Incorporating examples of initiatives from Western hospitals, I believe it served as an introductory session to gain correct knowledge and an opportunity to think about the future state of the hospital.

When visiting the hospital, patients are asked to fill out a common medical questionnaire and department-specific questionnaires. We reviewed the items in these questionnaires and modified them so that individuals who have changed their gender or experience gender dysphoria can indicate so. By reflecting this information in electronic medical records and arrival reception sheets, we built a system that eliminates the need to ask about gender repeatedly. Additionally, we removed gender notation from the wristbands that patients wear for medical safety during hospitalization.

Fortunately, in the new hospital building (Building 1), multifunctional toilets were installed in the outpatient areas, and the inpatient areas did not differentiate toilet use by gender. Therefore, as long as guidance was provided smoothly, the environment regarding toilets did not require particular modifications. On the other hand, since changing rooms were separated by gender, we arranged them so that private rooms could be used. To ensure this stance is easily communicated, the hospital's declaration was posted at outpatient counters and on digital signage, and also featured in the public relations magazine for patients. Since January 2023, following the Tokyo Partnership Oath System, we have also updated forms and guidelines for informed consent, establishing a system where partners can support patients.

The core of this initiative regarding gender identity is "don't say unnecessary things, don't ask unnecessary things, and if you must ask, keep it to a minimum." The primary targets are patients, their families, and partners. The first impression a person has of a medical institution is determined by the response of the healthcare providers. Based on that impression, there is a high possibility that the individual will judge how much they can talk about their gender or sexuality, which changes the relationship with hospital faculty, staff, and healthcare providers. There are still many challenges to becoming a hospital that can respond flexibly with sexual diversity in mind, and we will continue our activities. Furthermore, in the future, we intend to expand our initiatives beyond the hospital to include everyone who uses the Shinanomachi Campus, including faculty, staff, and students. We intend to promote diversity while listening to your voices.