Search the website

Sexual orientation in the workplace

June 2005

Guidance for equal opportunities policies and implementation
Homophobia, societal attitudes and the workplace
Homophobia can manifest itself in a number of different forms. The Project for Advocacy, Counselling, and Education (PACE) explains that homophobia is often ‘based on the belief that heterosexuality is the only normal, valid, and moral basis for partnerships’.[Go to reference 15]. The degree to which this attitude is present in the work environment varies. There may be some workplaces where prejudice and discrimination against lesbian, gay and bisexual workers have been infrequently challenged in the past. Changing the homophobic culture of a workplace will be a challenge in some organisations. It will require healthcare organisations and providers to demonstrate strong but sensitive leadership.

‘Coming out’ and its impact on the work environment
Each employer needs to give consideration to how the work environment could be improved to provide a safe and supportive place for doctors and other healthcare workers who might choose to ‘come out’ (tell other people about their sexual orientation). The decision about whether or not to ‘come out’ is a difficult and ongoing decision process for many lesbian, gay and bisexual doctors. It involves continuously weighing-up the risks and benefits of telling people. This may include consideration of possible patient reactions and fear of detrimental effects on career advancement or career options. Lesbian, gay and bisexual doctors will vary in their degree of confidence about coming out. Isolation is a common theme discussed by lesbian, gay and bisexual doctors, so some find it helpful to contact the organisation GLADD, where they can meet others for social events and support. Not being ‘out’ at work can create additional stress and anxiety for doctors in an already stressful job. If they fear a homophobic reaction, or that people will not be comfortable with their sexual orientation, they will edit what they disclose about their personal lives, partner, or even where they go and what they do in their social lives. This can lead eventually to feelings of isolation and maybe even withdrawal from the normal ‘banter’ which can occur in the workplace.

One study has outlined the concerns that lesbian, gay and bisexual medical students may have about their future as doctors.[Go to reference 16]

- If I come out during medical school will it affect my grades or my ability to get into a competitive residency programme?

- Will I have the support of my classmates, or will I be ostracised?

- Can I be a paediatrician, gynaecologist, or urologist?
- If I become a specialist, will my openness negatively affect referrals to me from colleagues?

- Will patients shun me?

- Can I practise in a small town, or am I consigned to a large metropolitan area?

GLADD surveyed its membership and found that 76 per cent of respondents thought that it was important to be ‘out’ at work. However, only 39 per cent were ‘out’ to close work colleagues and only one per cent were ‘out’ to their superiors. Only 27 per cent of respondents identified that they had not experienced any problems at work relating to their sexual orientation.[Go to reference 17]. The nature of
the work environment has a huge impact on whether a doctor has the confidence to ‘come out’ at work. Clear messages from colleagues using gender-neutral terminology when enquiring about partners, and the efforts of people to demonstrate their lack of prejudice can be a huge relief and make ‘coming out’ much easier. Lack of prejudice can also be stated more formally through equal opportunities statements in adverts, contracts and policies.

There are very few resources that negotiate the impact of ‘coming out’ at work on a doctor, although GLADD has tried to raise the profile of this problem in order to help others.[Go to references 18,19 ]. General advice on ‘coming out’ is available from a variety of sources including the Human Rights Campaign in the US. [Go to reference 20]. The Stonewall website also gives information and contact details on a variety of UK organisations that provide information, advice and support to younger and older lesbians, gay men and bisexuals.[Go to reference 21].

Devising and implementing an equality and diversity strategy that addresses sexual orientation
Doctors as managers should ensure that sexual orientation is included in equal opportunities policies and procedures. In addition to the moral arguments, implementing an equality and diversity strategy encompassing sexual orientation is important both to ensure compliance with the law and to meet General Medical Council (GMC) requirements that state:

‘You must always treat your colleagues fairly. In accordance with the law, you must not discriminate against colleagues, including those applying for posts, on grounds of their sex, race or disability. And you must not allow your views of colleagues’ lifestyle, culture, beliefs, race, colour, gender, sexuality, or age to prejudice your professional relationship with them.’ [Go to reference 22].

Many doctors have roles in which in-depth knowledge and a heightened awareness of employment legislation are necessary. Most general practitioners (GPs) are employers of their own staff and other doctors have management positions in hospital or primary care trusts. Trusts and employers should have up-to-date information on the current legislative spectrum of employment regulations and requirements, including the Employment Equality (Sexual Orientation) Regulations 2003. In the absence of any guidance issued by the Department of Health, GLADD has produced specific guidelines for GP practices, trusts and medical schools. [Go to reference 23].

Aspects of sexual orientation should be built into existing, effective equal opportunities strategies, monitoring policies and complaints procedures. In the case of monitoring, sexual orientation may be seen as more sensitive than other aspects of diversity. Some individuals will not be comfortable disclosing their sexual orientation, which obviously affects organisations’ ability to carry out diversity monitoring. To work towards effective monitoring, employers should begin by making an effort to educate staff about sexual orientation issues and should work towards creating a safe environment for all employees. Once a bold statement of support for lesbian, gay and bisexual employees is made, either through posters or information leaflets, and a contact person identified, employees will be more likely to come out. Organisations and employees have a collective responsibility to combat homophobia in the workplace.

The following examples provide some guidance for establishing and implementing equality and diversity policies.

10 key action points to managing diversity
1 Understand the law: it is illegal to discriminate in employment or training on the basis of sexual orientation.

2 Act now: ensure that policies and procedures comply with the new regulations.

3 Communicate the changes: explain the anti-discrimination laws to staff to ensure compliance with the regulations.

4 Make the business case for diversity: diversity is an opportunity for the organisation, not a threat.

5 Build a culture of respect: create a safe environment where equal treatment is given to all staff.

6 Recruit fairly: ensure fair selection criteria are applied consistently.

7 Tackle harassment and bullying: allow staff to feel confident using procedures even if it means revealing their sexual orientation.

8 Review terms and conditions: ensure policies that give rights to a married partner explicitly state that they are also available to same-sex partners or nominees of the employee’s choice.

9 Manage performance fairly: decisions should be based only on merit and competence.

10 Monitor and evaluate your policies and practices: ensure no unfair discrimination is going on and policies are working effectively while providing a safe environment for gathering information.

Source: Stonewall (2004) [Go to reference 24]

Key aspects for a successful equality strategy
- Allocate responsibility to ensure that equality and diversity is prioritised. Senior managers and representatives from across the organisation should be invested in the strategy.

- Consult with staff.

- Implement an equal opportunities policy (which includes sexual orientation).

- Implement a harassment policy and procedure with the option of monitoring.

- Ensure that complaints and grievance procedures are known throughout the organisation to be effective and confidential.

- Raise staff awareness of the legislative changes and the policies within the organisation.

- Develop a training strategy to increase staff awareness of equality and diversity issues generally and within the medical workforce specifically.

- Conduct exit interviews with employees who are leaving the organisation with a member of staff not responsible for managing that staff member.

Department of Health guidelines for England
The NHS plan (2000) introduced an ‘Improving Working Lives (IWL) Standard’ in England. This Standard makes it clear that every member of staff in the NHS is entitled to work in an organisation that can demonstrate its commitment to, among other things, encouraging diversity and tackling discrimination, harassment and bullying. The IWL Standard also allows NHS employers and staff to measure the effectiveness of their human resources policies and practices. [Go to reference 25]

To assist in meeting the goals of IWL, the NHS has developed a programme known as Positively Diverse. This aims to promote and measure cultural sensitivity and to mainstream equality and diversity in the day-to-day work environment. NHS Employers, part of the NHS Confederation, has responsibility for leading the implementation and dissemination of IWL and Positively Diverse. The networks are there to encourage confidential reporting of, and prompt action to address, harassment and bullying in the workplace. NHS employees and managers should ensure their Positively Diverse initiative covers sexual orientation issues equally. The Positively Diverse Field Book provides tools, techniques and practical solutions for implementing IWL. [Go to reference 25]. The Department of Health maintains a Good Practice Database to share examples of good practice. [Go to reference 26]

Positively Diverse: example of innovative practice
In the Pink, a lesbian, gay and bisexual support group for staff was established to promote equality and diversity in the Leicestershire Health Community. The group started in response to a series of homophobic incidents and the need to address the difficulties experienced by gay staff who worked with gay service users or carers. It provides:

- confidential space for discussion of common issues

- peer support and education to address homophobia in the workplace

- promotion of positive images of diversity

- a networking forum for colleagues who work with, or who have a special interest in, lesbian, gay or bisexual service users.

Outcomes of the work include raised awareness, increased staff confidence, increased user/carer confidence in services, production of literature enhancing communication, and partnership working with Social Services. [Go to reference 27]

Source: Good practice database at www.info.doh.gov.uk.

Scottish Executive Health Department
The NHS in Scotland has specific equal opportunity policies for its employees. Its statement of intent declares that the NHS in Scotland will ‘ensure the prevention and elimination of discrimination’ between persons on grounds of sex or marital status, on racial grounds, or grounds of disability, age, sexual orientation, language or social origin, or other personal attributes. [Go to reference 28]. This policy encompasses recruitment, selection, promotion, education and training, and family friendly policies. It includes monitoring requirements though these do not extend to monitoring sexual orientation.

Personal anecdotes
Some of the personal anecdotes below may be useful when thinking about implementing equality and diversity policies.

Include sexual orientation specifically in job adverts, equal opportunities policies and grievance procedures
- ‘Job adverts and job documentation for posts I’ve taken up have always displayed an equal opps commitment including sexual orientation.’
- ‘My current GP practice changed its harassment, bullying and equal opportunity statement to include sexual orientation, which helped me to feel supported.’

An open and positive environment can have many benefits such as making staff feel welcome
- ‘After joining my current GP practice I saw another lesbian GP was open about her relationships and sexuality. The staff and other doctors treated her equally. Her commitments to her partner and son were regarded as they would be if she were heterosexual. The fact this doctor had “come out” gave me confidence to do the same with less apprehension.’

- ‘After I had “come out” to one GP in a previous practice, I was uncertain about what type of reaction I might receive from the others. I asked the GP to keep the information confidential until I felt confident enough to “come out” to the others. He did do this and I therefore maintained control and “came out” to the others later, when I felt it was needed.’

Don’t make assumptions and be inclusive
• ‘Knowing that I was gay, one of the partners in a previous practice asked if I wanted to bring anyone along to a practice social event. I think it was likely to be a discreet way of telling me my sexuality was accepted.’

Source: Anonymous (2004) personal communication