Inclusive leadership in healthcare: Because no one is big enough to be independent of others

Inclusion is an important topic that the leaders at Mayo Clinic and leadership development practitioners are deeply passionate about. As advocates and allies, leaders are called to embody inclusivity and invited to join in the learning journey.

Mayo Clinic’s founder, Dr. William Worrall Mayo, said, “no one is big enough to be independent of others.”1 This sentiment is especially poignant when speaking about inclusive leadership in healthcare today. Merriam-Webster denotes that, “to be inclusive one must be broad in scope, cover or intend to cover all items, costs, or services, and include everyone.”2 Thus, leaders must invite everyone in, drawing upon the unique talents and experiences of team members, patients, and members of the collective community.

We are motivated to create a resource for leaders, by our intrinsic values, our organizational values, as well as the external environment. External environmental factors include the complexity and challenges of the U.S. healthcare system such as reduced reimbursements, staff shortages and burnout, technology changes, information security issues, regulatory burden and legislative uncertainty. As such, inclusion is important at the micro (individual) as well as the macro (organizational and national) levels, particularly in today’s volatile, unpredictable, ever-changing healthcare landscape.3 Inclusivity is not only right for right now; it also supports our vision for where we hope to go next.

Inclusion as a leadership strategy

The rationale to focus on inclusion as an organizational strategy is embedded in the history of the Mayo Clinic. Dr. William Worrall Mayo’s eldest son, Dr. William J. Mayo, stated three conditions he believed to be essential for the future success of Mayo Clinic:

1. Continued pursuit of the ideal of service and not profit
2. Continued primary and sincere concern for the care and welfare of each individual patient
3. Continued interest by every member of the staff in the professional progress of every other member.

Inclusion is also embedded in the Mayo Clinic 2030 Strategy through the advancement of people, innovation, and the environment with a focus on staff engagement and empowerment of everyone.

The strategic focus is on Mayo Clinic patients and staff; attracting, retaining, and appreciating multiple populations and groups because, “when we listen and celebrate what is both common and different, we become a wiser, more inclusive and better organization.”4 Inclusion is a leadership competency, a change management strategy, a way to enhance well-being, and ultimately strengthen our organizational culture. Leaders rely on the wisdom of the team, the wisdom of the crowds around us, and the wisdom of our communities.5 Inclusive leaders ensure they take actions together.

Building a diverse perspective by focusing on equity and inclusion brings all talent to the table. Additional competencies and capabilities emerge, including those that have been shaped by our experiences, backgrounds, education, habits and challenges. Current healthcare challenges require high-functioning teams with members who bring complementary capabilities, a deep commitment to the team’s mission and mutual accountability to their collective personal growth and success.6

Learning to be an inclusive leader: Five strategies

We lead ourselves through learning, by developing relationships and organizations by achieving excellence.7 The following five strategies support the development of an inclusive leader:

• Understanding the language of inclusivity
• Recognizing inclusivity as a leadership competency
• Understanding the barriers to inclusivity
• Cultivating an environment of psychological safety
• Aligning inclusive behaviors with organizational values.

1. Understanding the language of inclusivity

A comprehensive literature search conducted using key terms and concepts of equity, inclusion and diversity identified more than 150 articles published within the past 10 years. An analysis of the keywords was conducted, and the reflected themes are illustrated as a crossword puzzle in Figure 1. 

Courageous dialogue requires an understanding of the language and an acknowledgment that words matter and have impact. Rabbi Joseph Telushkin’s 2019 book, Words That Hurt, Words That Heal, provides guidance on the importance of choosing the right words to improve our relationships and gain insight about how others experience us when communicating.8

Action: Review the words in the crossword illustration and mark the words that are unfamiliar or cause you to pause. We invite you to explore further and create a list of inclusive language you will listen for and become more curious about in your leadership practice.

2. Recognizing inclusivity as a leadership competency

The National Center for Healthcare Leadership (nchl.org), the American College of Healthcare Executives (ache.org), MGMA (mgma.com) and other professional associations identify competencies required for effective healthcare leadership. To expand upon these competencies, the authors of this article believe that inclusivity is an essential characteristic for increasingly diverse leadership communities.

Inclusive leaders are reflective, self-aware and curious. They benefit from understanding their comfort with their emotional intelligence capabilities of self-awareness, self-management, social awareness, and relationship management as described by Goleman, Boyatzis and McKee,9 and the various models described in the extensive literature on emotional intelligence. Similarly, the competency of inclusivity will be enhanced by considering the impact of cultural influences on leadership style. Professional behaviors are impacted by cultural norms and include one’s source of identity, tolerance for ambiguity, time sensitivity and other cultural differences.10 

Self-reflection, humility, and curiosity are key leadership characteristics, whether leading a national team or international team of professionals. When reviewing one’s level of inclusivity, self-assessment reflection questions offer a starting point for goal setting and development action planning.

Action: Review and write responses to the reflection questions below, then create goals and actions based on your responses.

• How am I including key people in decision-making?
• How am I thinking of everyone’s needs on the team?
• Who is going to be impacted by the decisions made?
• How am I considering everyone’s sense of belonging?
• How am I creating a safe place for the team to voice their opinion?
• How am I valuing the opinion of everyone and carefully considering their opinions?
• How am I taking an inclusive approach in my interactions and dealings with others?
• How am I evaluating team effectiveness with cultural norms and behaviors that exist within the team in mind?

3. Understanding the barriers to inclusivity

How we interact with those around us is impacted by who we are, which is impacted by the nature of bias. Our reactions are influenced by our experiences, memories, associations, interpretations, values and other sources of bias.11 An inclusive workplace makes people feel safe, valued and fully engaged. It provides an atmosphere where they can be fully themselves in ways that recognize and appreciate their full range of social identities.12

Action: Understanding the potential barriers to inclusivity from these biases can help address potential blind spots. Review Table 1 and determine which strategies you would like to incorporate into your leadership practice.

Each strategy is tied to an element that embodies an action of inclusion, which can be demonstrated in any leadership role. By using these strategies, inclusion can be infused into leadership development initiatives and competency building. 

4. Cultivating an environment of psychological safety

Psychological safety is “a belief that one will not be punished or humiliated for speaking up with ideas, questions, concerns or mistakes.”13,14

Action: Review the ways in which inclusive leaders cultivate an environment of psychological safety15 and create a plan for incorporating the following behaviors into your leadership practice: 

• Being approachable and accessible
• Inviting participation to hear all voices, to see self-expression and to optimize collaboration
• Shaping the culture with a focus on right intent
• Recognizing the impact of hierarchy/status
• Empathetic listening
• Being mindful of labels
• Being aware of unconscious bias
• Being willing to be vulnerable, highlighting failures as learning opportunities.

 
Psychological safety can also be enhanced through the art of asking humble questions to draw someone out and demonstrate an interest in the other person.16 This genuine interest in the other person is a hallmark of a truly inclusive leader.

5. Aligning inclusive behaviors with organizational values  

Inclusive leaders align behaviors with the organizational mission and values. Values, as principles or standards of behavior, define what is important and provide guidance in making decisions, and are, ultimately, the ideals of the organization. Mayo Clinic has identified these values through multiple models that define the approach to caring for patients, leadership competencies, safety and professionalism. However, the Mayo Clinic values are the foundation, starting with “The needs of the patient come first” and the following eight organizational values (Table 2).

Inclusivity can be a framework for focusing on the unique needs of each patient, inviting and acknowledging diverse perspectives of others, leveraging the individual passion and talent of each and every colleague and supporting each other, promoting a respectful and trusting environment, embracing diversity and open communication.

Action: Review your organization’s values and consider how each of those values aligns with inclusive behaviors. Engage in a discussion with your team about this alignment.

Conclusions

• “Life’s most persistent and urgent question is: What are you doing for others?” — Dr. Martin Luther King Jr.
• “In America our idealism is not unusual, nor does it differ much from that of the medical faculty of other countries; if we excel in anything, it is in our capacity for translating idealism into action.” — Dr. Charlie, Mayo Clinic

Reflecting on these two quotes offers us the opportunity to contemplate, are we considering everyone? Are we creating space for meaningful work that develops individuals to reach their potential and engage in what is most meaningful to them? Are we matching individual passions and talents with organizational and societal needs?

An organizational culture represents the collective and unconscious, the intangible and unspoken, as well as the accumulated learning through generations that results in the expression of our history. It defines our reality, how we make sense of our environment, and is an expression of our values manifested through language and symbols.

Culture is the organizational immune system and social glue, and it is the unique strategic asset that differentiates.17 Leaders must embrace inclusivity as essential to an evolving culture that invites everyone to the table, listens to all voices, and integrates various experiences to optimize potential and cultivate organizational ideals.

The authors acknowledge our colleagues at Mayo Clinic for providing inspiration for this article.

Notes:

1. Mayo Clinic. “Mayo Brothers’ Wisdom.” Available from: mayocl.in/3nmxngV.
2. ”Inclusive.” Merriam-Webster. Available from: bit.ly/3FAn3Jx.
3. France T, Menaker R, Thielen KR. “The importance of a radiologist-administrator partnership to future health care.” Journal of the American College of Radiology, 16(8), 1114–1118.
4. Reilly K. “How LinkedIn’s HR Chief is Changing the Diversity Conversation with ‘Belonging.’” LinkedIn Talent Blog. Jan. 9, 2017. Available from: bit.ly/32QPRNa.
5. Gardenswartz L, Rowe A. Diverse Teams at Work. Irwin, 1994.
6. Menaker R, Djonne MA, France T. “Reflections on leadership: Approaches to enhance effectiveness.” MGMA Connection. July 2021. Available from: mgma.com/leaders-july21.
7. Menaker R. “Leadership strategies: Achieving personal and professional success.” Journal of Medical Practice Management, 31(6), 336-339.
8. Telushkin J. Words that hurt, words that heal revised edition: how the words you choose shape your destiny. William Morrow Paperbacks, 2019.
9. Goleman D, McKee A, Boyatzis RE. Primal leadership: Realizing the power of emotional intelligence. Boston: Harvard Business School Press, 2002.
10. Hughes RL, Ginnett RC, Curphy G. Leadership: Enhancing the lessons of experience. Boston: McGraw-Hill/Irwin, 2011.
11. Hogan Assessment Systems. “What is Unconscious Bias?” Sept. 21, 2021. Available from: bit.ly/3KhobW2.
12. Hogan Assessment Systems. “Improving Diversity and Inclusion: Practical, Evidence-based Recommendations.” July 21, 2020. Available from: bit.ly/3tCEUgK.
13. Edmondson AC. Teaming: How organizations learn, innovate, and compete in the knowledge economy, 2012.
14. Edmondson AC. The fearless organization: Creating psychological safety in the workplace for learning, innovation, and growth. Hoboken, N.J.: John Wiley & Sons, 2019.
15. France T, Matt-Hensrud N, Menaker R, Peters M. “Cultivating psychological safety: Activating humanness in healthcare.” MGMA Connection. July 2020. Available from: mgma.com/psychsafety.
16. Schein EH. Humble inquiry: The gentle art of asking instead of telling. San Francisco: Berrett-Koehler Publishers, Inc., 2013.
17. Flamholtz E, Randle Y. Corporate culture: The ultimate strategic asset. Stanford University Press, 2011.