A Strategy for Fenway Health’s Transgender Health Program
Healthcare is a basic right. Since 1998, Fenway Health has grown to serve the transgender community with healthcare, education, research, and advocacy. Since 2004, the Transgender Health Program at Fenway Health has been a multidisciplinary, integrated service line offering primary care.
• “Over 27% of trans/nonbinary people have been denied health care.
• Nearly 21% of trans people report being subjected to harsh or abusive language from a health care professional.
• Over 20% of trans people have been blamed by healthcare professionals for their healthcare conditions.”[i]
These populations must stay protected and connected to the Transgender Health Program because of their increased healthcare discrimination risk. These populations, as part of the Lesbian, Gay, Bisexual, and Transgender (heretofore referred to as LGBT) community, are most impacted among this community facing discrimination:
◦ Lack of accessibility to adequate health insurance and treatment
◦ Social stigma
◦ Rejection by family and community members
◦ Abuse, neglect, and violence
◦ Unequal treatment in the legal system.[ii]
MARKET CONDITIONS
Since the COVID-19 pandemic began to impact the economy, there has been a steady decrease in business opportunities, eventually leading to a near recession. This has steadily led to a series of lower economic highs and lower economic lows. For Fenway Health’s Transgender Health Program, this means increasing prices for all competitors in the industry, all for the same care that will significantly impact the price-sensitive customer. The different competitors retain and strengthen an oligopoly in the market conditions, where several influential players sell differentiated and identical products. The competitive market in Boston has led to increased prices across the industry.
To accomplish its goals in the present market conditions and into the future, Fenway Health’s Transgender Health Program should continue offering differentiated and identical offerings to its customers. Because its services line is intersecting many services lines, it does not cost much to keep it running. It does provide additional revenue by inviting more opportunities to create income from pre-existing service lines. Because it is a community research and education-based program, the service line provides a reputational improvement to the organization as part of its differentiation strategy. In the future, the service line should advance to more hospital-related offerings, including surgical and urological care, to compete with the differentiation strategies of some of its top competitors.
THE COMPETITION
Fenway Health’s Transgender Health Program ascribes to a differentiation strategy by being the only LGBT-focused organization offering an extensive research and education program. It describes its competitive offerings as a “Model of integrated, community-based LGBT care, education, and research.”[iii] Its mission is to understand the community and strive to spearhead more opportunities in the future. Fenway Health’s current competitive advantage is that the entire organization is LGBT-centered, with LGBT staff and clinicians who commit to serving the needs of the transgender community. This allows more in-depth focus for the Transgender Health Program to navigate transgender health overall from a community perspective. Donor, legal, and governmental supporters can understand that this focus will improve the patient experience to build more opportunities to understand and improve upon transgender health challenges and outcomes. Fenway Health’s Transgender Health Program also specializes in services for transgender youth.
Fenway Health’s Transgender Health Program currently offers healthcare designed for transgender people in the following areas:
· Gender-affirming-hormone therapy
· Medical care
· Behavioral Health
· Adult and youth services
· Support groups
· Transgender Health Research Program
· OB/GYN & Urology
Fenway Health Transgender Health Program’s strengths against competitors focus on community research, behavioral health, and youth and adult services.
Fenway Health Transgender Health Program’s competitors understand that providing the best transgender health requires addressing transgender medicine’s interdisciplinary intersectionality with social, psychological, legal, and community-specific healthcare. They share some standard services, each competing in particularities from the next. While this is a high-level descriptor, each competitor has a selection of services, ranging from surgical, medical care and other social resources. Successful competitors understand that their mission should include a deep understanding of the needs of their communities from a healthcare perspective. Competitors stand apart from Fenway Health because some of them offer surgical services. Competitor organizations also stand apart from Fenway Health because they are not LGBT-centered places but have other renowned focuses.
Brigham and Women’s Hospital’s Center for Transgender Health, as a primary competitor, offers surgical and medical care and patient resources. Because their organization is not LGBT focused, they do not have an extensive research program like Fenway Health. They explicitly detail their transgender-focused primary care, including pelvic, pregnancy, fertility, skincare, and hair removal. Brigham and Women’s Hospital’s Center for Transgender Health also connects to Harvard’s Medical School, allowing access to state-of-the-art resources and networks.
Other competitors focusing on transgender health with different offerings in the area are:
Boston Medical Center, MassGeneral Hospital, Beth Israel Deaconess, Sydney Borum Jr. Health, Planned Parenthood, Tufts Medical Center, and Boston Children’s Hospital. Competitors perform these services for the primary interest of the patient’s care. Organizations that provide transgender health also must recognize the risk of controversy due to far-right public dissent. Boston Children’s Hospital, among other organizations, has faced threats from public protests regarding youth and their family access to transgender healthcare.[iv]
Fenway Health can expand its services by offering the following services to its Transgender Health Program:
· Surgical care
· Voice care: Speech-language therapy
· Emergency care
· Urology
· Organizational affiliation with a world-class medical school
· Commitment to healthcare for all
Fenway Health should advance its commitment to OB/GYN and other primary care needs. Similarly, it should grow to be able to provide surgical care focused on the needs of transgender people. Along with surgery, it can spearhead emergency care for its populations. Like Beth Israel Hospital once treated those ethnically Jewish people of Boston who did not have access to adequate care from other hospitals in the area, Fenway Health can also learn from its focus on treating the historically underrepresented minority LGBT population. From its beginnings as a small clinic, Fenway Health and its Transgender Health Program have grown to serve larger local people and their allies. With these recommendations, Fenway Health can continue to grow to serve all of Boston’s communities in the decades to come. They can continue to bring genuine awareness to the importance of healthcare for everyone.
THE VALUE CHAIN
Improvements to the value chain require Fenway Health to “[o]ptimize supplier network, Control costs, forecast demand more accurately, gain a fuller view of supply chains, manage inventory, supplier relationships and risk more effectively.”[v] Primary activities to be improved on are identified by patient outcomes per unit of cost include (in order of margin):
· Monitoring and Preventing (Inbound Logistics)
· Medical history, screening, identifying physical and mental health risk factors, and dysphoria prevention programs
· Diagnosing (Inbound Logistics)
· Medical history, specifying, organizing tests, interpreting data, consultation with experts, and determining the treatment plan
· Preparing (Operations)
· Choosing the TPH team, pre-intervention preparations, pre-treatment
· Intervening (Operations)
· Ordering and administering hormone drug therapy, performing procedures, and performing counseling therapy
· Continued Treatment (Outbound Logistics/Marketing & Sales)
· Inpatient recovery, outpatient rehab, outpatient therapies, therapy fine-tuning, developing a long-term plan
· Monitoring and Managing (Service)
· Monitoring and managing the patient’s condition, monitoring compliance with therapies, and monitoring lifestyle modifications.
These primary activities refer to the economic activities at Fenway Health’s Transgender Health Program.
Secondary activities include (in order of margin):
· Informing and engaging
· Prevention and screening, education and counseling, pre-intervention educational programs, patient compliance counseling, and monitoring
· Measuring (Human resources and Technology Development)
· Tests, imaging, outcomes, patient records, management
· Accessing (Procurement)
· Sites of care: office visits, lab visits, hospital visits, patient transport, visiting nurses and health workers, remote consultation.
These secondary activities represent supporting activities to the primary activities at the healthcare organization’s integrated service line.
THE FUNCTIONAL STRATEGIES
Fenway Health’s Transgender Health Program’s functional strategy has strengths in certain areas but can be improved in other areas, like technology. The practical strategy fits on the level of the four types of strategy. At the top is the corporate level, followed by the business level, then the functional status, and ending with the operational level strategy. Within the functional group, strategies are marketing, finance, human resources, technology, production, and research and development. Some of the vital areas of functional methods are its research and education-based focus.
Another strong point is that its marketing is geared toward the non-binary and transgender community, with community members participating in advertisements and media.[vi] Another opportunity would be to expand the audience by adding allied community members to the marketing: allied marketing. This would widen the interested public to use the available services and support the transgender-focused program available even if they are not transgender.
Technology also provides an area for functional strategy improvement. Recently Fenway Health moved its electronic patient information records to MyChart.[vii] This has created chaos for the organization to transfer data to the new system. It would be helping to create an internal system that moves critical elements of the patient file to the new system before sharing with patients. This technological change creates a backup of patient information and requests. Specifically, for the transgender community, it requires patients to answer extended questions to recertify personal and sometimes sensitive information about their gender identity. For example, a transgender person will be asked for medical purposes the gender they were assigned at birth, even though they identify today as the opposite or another gender. More trust vital to the community could be built with a more robust technological transformation infrastructure to create a seamless experience for transgender patient experience.
While human resources focus on ensuring a fair experience for employees from finding, hiring, training, and employee support, they could improve on the experience by focusing on the transgender experience. While many transgender people expect that not everyone they encounter at a hospital will not be transgender like them, those who work with them must understand in depth how to value their diverse experience of encountering adversity when needing adequate healthcare. The best way to do this is to hire more transgender staff in the intersectional service lines that interact with the Transgender Health Program. This ensures that transgender people receive the care that they deserve without questioning if those healthcare professionals can provide it.
STRATEGY ALIGNMENT
Fenway Health’s Transgender Program’s strategic alignment should consider the requirements before implementing change as involving strategy development and strategy implementation of the following:
· Culture and shared belief
· Change readiness
· Priorities
· Common goals
· Individual contribution
· Organizational capabilities
· Translation goals
· Decision making
· Fit with the organization
· Support of systems
· Communication
· Strategy formulation
· Impact
· Understanding
· Quality communication.[viii]
Strategy alignment improvements should follow the corporate strategy of inclusive health for every community member. Fenway Health is associated with Beth Israel Lahey Health. Beth Israel Lahey Health is committed to whole-person community care for everyone and diversity, equity, and inclusion. While Fenway Health is a small health center, it has many affiliations to expand its impact on inclusive community health. Other affiliated strategic business units (SBU)s following the corporate strategy include intersecting and independent units. Fenway Health is a relatively small clinic compared to Beth Israel Lahey Health. Therefore, it benefits from affiliating with a large hospital with many strategic business units, “…[r]esearch affiliations include Massachusetts General Hospital, Brigham and Women’s Hospital, and Brown University Medical School.”[ix]
Fenway Health commits itself to serving healthcare as a right, not a privilege. This slogan was created by students in 1971 when the health center opened to community members. Fenway Health is a Beth Israel Lahey Hospital Community Care Alliance Affiliate with The Dimock Center, Charles River Community Health, and South Cove Community Center. The community care centers are part of the more extensive network of strategic business units, including hospitals, primary care centers, home care and assisted living centers, urgent care centers, behavioral health service centers, Joslin Diabetes Center, and more affiliates.[x]
AREAS FOR IMPROVEMENT
By expanding into a hospital in the long-term, Fenway Health will be able to address the real concerns of the communities it serves adequately and the broader population for access to affordable healthcare, more patient-centered and research-based care, and more generally as their slogan proudly regards, “health care is a right, not a privilege.” In the upcoming decades, Fenway Health’s Transgender Health Program should allow for growth to enter more intersecting service lines of a hospital. With Fenway Health’s focus on caring for marginalized populations, it has become a leader in ethical care. Its expertise in the HIV epidemic has informed the health center to become a critical responder in the current COVID-19 pandemic. The Transgender Health Program, as part of Fenway Health, should begin to independently offer surgical care as it transitions to adding a surgical care unit. It should begin to offer emergency care for all those patients who require adequate care from their community.
It can successfully improve its service line by following improvement guidelines across its value chain to reduce inefficiencies. Fenway Health should actively prioritize its supplier network, reduce costs, forecast demand, have a deep understanding of supply chains, strictly manage inventory, and manage supplier relationships more efficiently.[xi]
Fenway Health’s Transgender Health Program can successfully improve its service line by investing in advancements to its functional strategies by integrating the transgender patient experience. When considering human resources, it should involve more transgender and gender-diverse employee initiatives in its intersectional service lines to improve the patient outcome when applied in the Transgender Health Program. It should enhance its technology experience for transgender patients by seamlessly integrating an experience that more efficiently recognizes the preferred identity markers of transgender patients. It can do this by implementing behind-the-scenes updates to patient files that allow integrated access from the dated electronic patient records to the updated records on MyChart.
It can successfully improve its service line by following strategic alignment. As an affiliate of Beth Israel Lahey Hospital, it should align closely with the corporate strategy. It can successfully improve strategic alignment by implementing successful strategy development and strategy implementation. Fenway Health’s Transgender Health Program should follow the critical areas for effective strategy implementation: these seven factors are strategy, structure, systems, style, staff, skills, and subordinate goals.[xii] It has grown over decades from a small community clinic. Its services for transgender patients have developed to include more services, clinicians, and facilities. As Fenway Health Transgender Health Program’s ability to make more of an impact develops, it will find new opportunities to become a leader in new strategic areas. Because Fenway Health’s Transgender Health program is at the intersection of many service lines, it is essential to “clarify and translate the perspective and strategy; links and relations, planning and goal-setting and strategic feedback and learning.”[xiii]
In conclusion, some opportunities remain to be exploited by Fenway Health’s Transgender Health Programs. Some of these opportunities can be implemented tomorrow; others could take decades to move to scale. As a Beth Israel Lahey Health affiliate, the service line must stay true to the hospital’s strategy while not impeding on its other strategic business units. For the service line to advance, it should consider its integral role in the integrated service lines at Fenway Health. It should improve its position through differentiation to resemble the top competitors by transitioning to hospital services that understand transgender health and hospital services for all the community populations in Fenway, Boston, and abroad.
ENDNOTES
[i] Health Care. MTPC. (2020, December 21). Retrieved November 21, 2022
[ii] Physician assistant studies: LGBTQI+ Resources for Providers & Patients. LibGuides. (n.d.). Retrieved November 27, 2022
[iii] Meyer, K. H. et al. (2004). Fenway Community Health’s Model of Integrated, Community-Based LGBT Care, Education, and Research
[iv] Becker, K. M. K. (2022, September 18). Protesters confronted by counter-protesters outside Boston Children’s Hospital. NBC Boston. Retrieved December 11, 2022
[v] Supply Chain Challenges Guide. RSM US — audit, tax, consulting services for the middle market. (n.d.). Retrieved December 11, 2022
[vi] Rosiles, S., & Fuentes, A. (2022, December 3). Transgender Care. 1 hour. Interview.
[vii] Rosiles, S., & Fuentes, A. (2022, December 3). Transgender Care. 1 hour. Interview.
[viii] Franken, H. (2021, June 8). How about strategy? — learning about strategic alignment. Bizzdesign. Retrieved December 11, 2022
[ix] Care & Services. Fenway Health: Health Care Is a Right, Not A Privilege. (2022, November 29). Retrieved December 11, 2022
[x] Care delivery. Beth Israel Lahey Health. (n.d.). Retrieved December 11, 2022, from https://www.bilh.org/caredelivery
[xi] Supply Chain Challenges Guide. RSM US — audit, tax, consulting services for the middle market. (n.d.). Retrieved December 11, 2022
[xii] Kalali, N. S., Anvari, M. R. A., Pourezzat, A. A., & Dastjerdi, D. K. (2011, October 7). Academic journals — African journal of business management — why does strategic plans implementation fail? A study in the health service sector of Iran. African Journal of Business Management. Retrieved December 11, 2022
[xiii] Kalali, N. S., Anvari, M. R. A., Pourezzat, A. A., & Dastjerdi, D. K. (2011, October 7). Academic journals — African journal of business management — why does strategic plans implementation fail? A study in the health service sector of Iran. African Journal of Business Management. Retrieved December 11, 2022
[xiii] Medical care of trans and gender diverse adults — Fenway Health. (n.d.). Retrieved November 21, 2022
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https://www.masstpc.org/health-care/
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Retrieved November 27, 2022, from
https://libguides.usd.edu/c.php?g=752846&p=7509535
Rosiles, S., & Fuentes, A. (2022, December 3). Transgender Care. 1 hour. Interview.
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