Date of Award

2025-05-24

Degree Name

PhD Nursing

Dissertation Committee

Sheree Scott, PhD, RN, AGCNS-BC, CMSRN, CNL, Chairperson; Cynthia D. Connelly, PhD, RN, FAAN, Committee Member; Caroline Etland, PhD, RN, CNS, ACHPN, Committee Member

Keywords

transgender, gender diverse, health disparity, gender inclusivity, leadership readiness, change implementation

Abstract

Background: Transgender and gender-diverse (TGD) individuals face persistent stigma and systemic discrimination across multiple societal domains, with healthcare settings—intended as safe spaces—often being among the most harmful. Despite increased visibility of TGD populations and growing research on their health inequities, inclusive healthcare remains insufficiently addressed by many healthcare leaders, adding to the urgency to advance equitable, inclusive care. Additionally, structural cisnormativity and binary gender frameworks continue to perpetuate misinformation, erasure, and health disparities. Addressing these entrenched barriers requires systemic reform rooted in cultural humility, inclusive practices, and a commitment to dismantling cisnormative bias within healthcare delivery and policy. This study aims to examine leadership readiness for change toward inclusive healthcare policy and practice by exploring the relationships among change commitment, change efficacy, and the degree to which healthcare leaders value the experiences of TGD communities.

Study Population: The study population consisted of healthcare leaders, in varying leadership roles, varying systems of care, and varying geographic locations who completed an online survey.

Purpose/Aims: The purpose of this study was to identify the potential impact that leadership readiness to change has on the pervasive nature of systemic barriers to improved patient health outcomes for TGD patients by exploring the relationships among select demographics, leadership characteristics, readiness to change scores, and attitudes and beliefs towards transgender and gender diverse populations.

Methods: A descriptive correlational cross-sectional design study was conducted. An investigator-designed survey guided by implementation science and Weiner’s (2009) theory of organizational readiness for change was deployed online between December 2024 and February 2025. A convenience sample of 103 participants across systems of care was collected and analyzed.

Results: Healthcare leaders indicate readiness to integrate inclusive healthcare strategies for TGD population, as evidenced by high average agreeability scores on both standardized instruments—Organizational Readiness for Implementing Change (ORIC) and Transgender Attitudes and Beliefs Scale (TABS). Bivariate statistics revealed significant group differences between ORIC and participant education, as well as between TABS and religious affiliation, geographic location, gender identity, education, leadership role, hospital type, and tenure within an organization. Linear regression analysis indicated predictors (education, leadership role, hospital type, TABS human value) explained 25.4% of the variability in readiness to change among participant leaders; predictors (gender, religion, education, leadership role, tenure, hospital type, geographic location) explained 42.3% of the variability in leaders' attitudes and beliefs.

Implications: Organizational readiness for change is a multi-level, multifaceted construct that must uniquely appraise and address perceptions of key determinants and be responsive to their unique demands. Healthcare leaders indicate readiness to integrate inclusive healthcare strategies for TGD population, however, awareness of complex interactions between contextual readiness and content agreeability is critical when considering change related to TGD populations. Further, readiness does not necessarily translate into effective action, as individual beliefs, implicit biases, and structural barriers may still hinder meaningful progress.

Keywords: transgender, gender diverse, health disparity, gender inclusivity, leadership readiness, change implementation

Document Type

Dissertation: Open Access

Department

Nursing

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