WASHINGTON – President Obama’s decision Thursday night to grant same-sex couples hospital visitation rights is the latest and most visible example of a strategy to make concrete steps toward equality for gays and lesbians without sparking a broad cultural debate or a fight with Congress.

The approach has angered some of the president’s fiercest supporters, who are eager for bold change, but other politically savvy activists have encouraged Obama to act in small ways to reshape government rules and regulations on behalf of gays and lesbians.

Soon after Obama’s election, staffers from the Human Rights Campaign (HRC) presented the transition team with a list of 70 actions the president could take without congressional approval.

Over the next several months, the administration quietly began acting on the recommendations: The State Department started issuing embassy ID cards to same-sex partners of diplomats; Housing and Urban Development ended discrimination in housing assistance programs; HHS pledged to change its policies regarding HIV-positive visitors and immigrants.

And then, last May, HRC staffers got a call from Obama’s legal office. Top officials in the White House had seen a gut-wrenching story about a lesbian couple who had been kept apart in the hospital when one collapsed and died. It was time to act, they decided.

Nevertheless, the issue of hospital visitation languished for months as the White House got pulled deeper into the health-care debate and other issues.

Kevin Cathcart, the executive director of Lambda Legal, which had filed a lawsuit on behalf of the Florida couple, said he repeatedly raised the issue with White House officials in telephone calls, private conversations and group meetings.

And then, several activists were invited to a March 9 meeting at the Old Executive Office Building. Members of the White House counsel’s office were there, along with officials with the Office of Public Engagement. They discussed the ramifications of government action on the hospital issue. West Wing officials made it clear that things were about to move quickly.

Around the same time, other officials began talking to hospitals with religious affiliations to gauge their reactions.

Josh Dubois, who is in charge of the president’s outreach to the religious community, called Sister Carol Keehan of the Catholic Health Association. Her response was positive.

Friday, the CHA issued a statement saying Obama’s memorandum “reaffirms these basic human rights for each person at most critical points of their lives.”

Despite the concerns of some gays and lesbians, officials at Washington area hospitals say they rarely encounter situations in which gay couples have been kept apart.

Visitation limits apply only to hours and the number of people in a room, they say.

Bill Robertson, president of the Adventist Healthcare system, said the faith-based organization “does not impose our world view relative to any range of things, other than that people deserve compassion and the best of care.”