Pride, trust, and safety culture in healthcare

By Jeff Doucette, SVP and Chief Nursing Officer, and Deirdre Mylod, PhD, SVP, Research and Analytics, Press Ganey

Safety is a promise to our patients and providers. Yet for many people in the LGBTQIA+ community, healthcare settings can feel uncomfortable—or even unwelcoming.

This Pride Month, we have an opportunity and obligation to examine how safety is experienced across the continuum of care. Creating environments where every person feels respected, protected, included, and valued is foundational to the Human Experience of healthcare. Nobody will trust a system if they don’t feel safe in it.

At a time when healthcare organizations are working relentlessly to strengthen relationships with the communities they serve, safety offers a powerful lens for action. When patients feel safe—both physically and psychologically—they are more likely to engage in their care, communicate openly with clinicians, and trust the healthcare system.

The same is true for the workforce. Teams thrive when people can bring their authentic selves to work, knowing they will be safe and supported. In doing so, organizations build social capital, creating the connections and trust that help people stay engaged and committed.

Safety: More than a clinical outcome

At Press Ganey, we’ve spent years studying the connection between patient experience, workforce culture, and clinical outcomes. One finding has remained consistent: Perceptions of safety are among the strongest predictors of trust.

When people feel unsafe, confidence erodes. Communication suffers. Engagement declines. And patients are 2.5–3x less likely to recommend the care they receive.

Historically, much of this improvement work has focused on inpatient settings. But safety is just as critical in ambulatory and medical practice environments, where relationships are often ongoing, and where many patients build their most enduring views of the healthcare system.

Our latest analysis reinforces just how powerful safety perceptions can be. Among more than 14 million medical practice patient surveys, patients who reported that staff did an excellent job protecting their safety awarded a “Likelihood to Recommend” (LTR) score of 94.3. For those who did not give a top-box safety rating, that number dropped to 33.5. Similar patterns emerged in inpatient care: 84.9 vs. 34.0, respectively.

Safety, therefore, becomes not simply a compliance measure or operational metric, but is a defining element of the patient experience.

Safety shapes everything else

Patients who perceive that staff work well together, communicate effectively, and consistently demonstrate respect are also more likely to feel safe. Likewise, when safety perceptions decline, trust in the organization often declines alongside them.

This relationship is particularly important for LGBTQIA+ patients, who may already carry concerns about stigma, bias, or whether they will be fully accepted within a healthcare setting. Even small signals—whether intake forms reflect diverse identities, whether preferred names and pronouns are respected, whether clinicians communicate with empathy—can influence whether a patient feels welcomed and protected.

For healthcare leaders, this underscores an important reality: Creating safety is the product of culture and every department’s responsibility.

LGBTQIA+ patients don’t experience healthcare the same way

One of the hurdles in advancing health equity is recognizing that the LGBTQIA+ community is not monolithic.

An analysis of approximately 29,000 LGBTQIA+ patient responses from more than 4 million surveys shows meaningful differences in experiences across sexual orientation and gender identity. Some cohorts—including patients who identify as lesbian, gay, or transgender—reported experiences that were comparable to or better than their peers at the same organizations. However, patients who identify as bisexual, pansexual, asexual/aromantic, or female—reported less favorable experiences across key measures.

Importantly, patients’ perceptions of safety emerged as a critical differentiator.

In medical practice settings, bisexual patients were among the groups most likely to report suboptimal safety experiences, with nearly 15% not providing a top-box response to the safety question. Nonbinary and genderqueer patients also reported lower perceptions of safety.

These findings remind us that equity work requires nuance. Looking only at aggregate performance can obscure important differences in how specific populations experience care.

LGBTQIA+ employees face different workplace realities

Healthcare organizations can’t separate the patient experience from the experience of those who care for them. The same culture that shapes how patients feel also shapes how employees feel—and how they engage and connect at work.

In our workforce research, we examine several key dimensions of the employee experience:

• Engagement: An employee’s emotional connection to their organization and work.
• Alignment: The strength of an employee’s connection to leadership, mission, and organizational goals.
• Resilience: The ability to recover, adapt, and thrive through workplace challenges.
• Decompression: The ability to disconnect from work, recharge, and return refreshed.

LGBTQIA+ employees across several key workforce indicators report lower scores on engagement, resilience, and decompression, while activation is the one area where scores are slightly higher (4.55 vs. 4.53). Encouragingly, both groups reported improvements across all four measures between 2024 and 2025, suggesting progress while also highlighting continued opportunities to strengthen support, belonging, and well-being for LGBTQIA+ team members.

This is where social capital becomes especially important. Social capital is built through everyday interactions—leaders who listen, colleagues who support one another, and teams bring people together. These experiences create the trust that helps people collaborate effectively and navigate challenges. And when those things are in place, people tend to stay.

5 strategies for healthcare leaders

This June, we celebrate the resilience, contributions, and lived experiences of LGBTQIA+ individuals. And we embrace Pride Month as a call to action.

Healthcare organizations can strengthen perceptions of safety for LGBTQIA+ patients and team members by focusing on several key areas:

1. Listen intentionally. Collect and analyze demographic data where appropriate, including sexual orientation and gender identity information, to better understand how experiences differ across populations.
2. Build and prioritize psychological safety. Foster environments where patients and employees feel comfortable speaking up, asking questions, and expressing concerns without fear of judgment.
3. Invest in inclusive communication. Equip leaders and caregivers with the skills needed to communicate respectfully and effectively with people of all identities and backgrounds.
4. Use data to drive improvement. Measure perceptions of safety alongside traditional quality and experience metrics. What gets measured gets improved.
5. Lead with belonging. Policies matter, but culture matters more. Every interaction should reinforce the message that people are seen and heard, valued, and respected, strengthening the trust and relationships behind social capital.

The goal of Pride Month is to recognize differences and cherish and celebrate each and every one, affirm their dignity, and help bring healthcare closer to fulfilling its promise of compassionate, equitable care for all.

Safety is one of the most powerful experiences we can create. And it’s one of the most meaningful gifts we can offer.

So this Pride Month, let’s recommit to making safety visible, measurable, and universal. Because every person deserves to know that when they walk through our doors, they belong.