The TRANS-SAFE Patient Safety Learning Lab: Systems Improvement for Psychosocial Safety in Transgender Care

This patient safety learning laboratory (PSLL) will address the intersection of two major gaps in the science of
patient safety: 1) psychosocial patient harm / avoidable patient suffering, and 2) patient safety for transgender
individuals. It will leverage an interdisciplinary team of clinical and systems improvement experts to make an
innovative, and sustainable contribution to AHRQ’s patient safety mission. It will also address AHRQ’s call for
health services research to advance health equity. Transgender individuals are an AHRQ priority
population. We will also address intersectional impacts of transgender status by targeted recruitment from
additional AHRQ priority populations: low-income individuals, minority groups and people with disabilities.
Psychosocial harm has been largely neglected in the science and practice of patient safety, despite evidence of
its pervasive and consequential impact. The TRANS-SAFE PSLL will advance patient safety science by
identifying and addressing the systemic causes of psychosocial harm in perhaps the most vulnerable patient
population–transgender people. Because of widespread stigma, many transgender individuals live on the
margins of society, facing discrimination, exclusion, and violence. Transgender and gender non-binary (TGNB)
individuals also experience mistreatment in the healthcare system, leading to direct (psychosocial) harm and
indirect physical harm. >30% of transgender individuals report delaying or not seeking care due to discrimination,
which may lead to diagnostic delays and preventable disease progression. As a result, they experience poor
health compared to “cisgender” (non-transgender) people. This PSLL will improve patient safety for the
transgender population through 3 specific aims: Aim 1: Identify the contributing factors leading to avoidable
patient suffering in transgender individuals [Problem analysis]. Apply human factors, improvement science,
risk management, and biopsychosociotechnical systems approaches to conduct a human-centered problem
analysis that identifies determinants of avoidable patient suffering in transgender individuals, including issues
such as misgendering, disrespect, abuse, and “getting lost in the system.” Aim 2: Co-design human-centered
solutions to prevent and mitigate avoidable patient suffering in transgender individuals [Design,
development]. Engage with the full range of stakeholders in an iterative process of co-design and development,
using both new and proven tools to produce interventions that address the systemic determinants of
psychosocial harm in transgender individuals. Aim 3: Evaluate the effectiveness of proposed interventions
in real and simulated and clinical environments [Implementation, evaluation]. Test the interventions
designed in Aim 2 in both actual practice settings and in simulation to evaluate effectiveness, acceptability,
usability, implementability, and sustainability. An innovative dissemination approach (a certification program
in partnership with the World Professional Association for Transgender Health) will facilitate widespread and
sustainable impact.

Grant Number: 5R18HS029299-03
NIH Institute/Center: AHRQ
Principal Investigator: Jennifer Anger