The importance of inclusion

For practicing physicians, inclusivity proves critical. Not because of HR mandates. Not because it’s a good thing to do.

Inclusivity improves your patients’ care. It enables you to be a better doctor. Rising complexity, rapid change and treating far-flung patients mean physicians need information from all angles of care.

Physicians need to know that everyone participating in your patients’ care can tell you vital information. They must feel safe and comfortable communicating with you, even if it’s bad news.

But many people won’t talk to physicians. Many don't know their observations may be important. Some don't think they have responsibility beyond their specific task. Some expect they’d be ignored. Many are afraid.

Hierarchies, tenure, specialties, functions, as well as gender, race, age, etc. have long prevented clinicians and staff from talking civilly and candidly with one another. Many withdraw or stay silent rather than risk stepping outside one’s identity.

How in the world can physicians get critical information and insights when so many people think no one wants to hear from them? When they’ve long been excluded? When they don't feel safe to speak up?

Genuine inclusivity makes you better together. Real inclusivity unlocks the information, insights and generosity of your care group. The eyes, ears and ideas of people from all angles of patient care prove essential to optimize patient outcomes.

One physician alone can no longer treat patients safely and successfully. There are far too many locations, details and possibilities for one person to know everything.

For safe, quality care now, everyone who ‘touches’ your patients’ care must feel safe from biased or hurtful treatment. They need to feel valued in your care mission.

Candid communications and everyone feeling part of the care project improve care.

• Inclusivity improves safety.
• It enhances patients’ experience.

True inclusivity makes the care group more efficient. It enables physicians to be the excellent clinicians they trained to be.

The two essential elements of genuine inclusivity are psychological safety and feeling one belongs.

Psychological safety means that everyone feels comfortable talking and participating. Especially when the contribution involves an error or problem. They believe they’ll be listened to and treated respectfully and fairly.

With psychological safety, your group can name difficult problems like racist, sexist or other exclusionary attitudes. They’ll step across discomfort because they believe that together they can productively discuss the problem.

Bias and exclusion deeply hurt people. For some it takes courage to simply show up at work. The fear of being belittled or ignored stops people from naming bias. For people to feel safe,

• Everyone understands that unfairness, racism, sexism and bias based on unalterable characteristics prevent safe, quality care and are not acceptable.
• Everyone trusts that their participation will be met with reasonable responses. They’ll be heard.
• The care group knows that “nothing [happens] about me without me.”
• Everyone trusts those involved in care to protect their safety and place in the care project.

When people feel they belong in the care group,

• Everyone sees their connections and interdependencies with others. This collaboration requires constructive communication, particularly something goes wrong.
• They understand that inclusivity creates a bigger pie. Resources are not taken from them. Inclusivity does not make anyone lesser.

Inclusivity enables everyone to feel valued, so they can be themselves.

In the midst of complexity and raging uncertainty, diversity in identity, experience and thinking improves decisions and outcomes. It’s an asset.

• Care staff are willing to risk asking questions and speaking up.
• They feel valued for the resources they bring.

Without it, the fears and bad feelings from entrenched exclusion and disrespect create unnecessary risks to care reliability. They introduce undesired variation that threatens safety. Physicians need prompt callbacks from specialists.

Transport staff, housekeepers, CNAs, rehab facility PTs, receptionists and staff at other facilities also know or see things that may prove critical to care.

The MD notices her patient’s tremor. Did the new medication cause it?
The nurse doesn’t know when the tremor started.
However the housekeeper noticed it when she cleaned before the new meds.
She didn't think it was her place to say anything.

Everyone in the care group is your lookout across time and space in unpredictable, complex care.

To persuade the care group to communicate candidly requires reducing entrenched exclusion.

Physicians prove powerful in creating inclusivity. Physicians create the expectations, decisions and communications that engage everyone in care. They model the intention and words daily.

While pre-judgment runs deep, there are many simple yet powerful ways to promote genuine inclusivity (despite daily pressures).

• A few words, behaviors or actions can change things when consistent over time.
• Small questions or comments can be done quickly in the hallway, around the bedside.

Foster inclusivity tomorrow by:

• Checking in with each person in your care group, even just to ask, what’s new.
• Call them by name.

Show them you see them. Start a relationship with them.

This goes a long way toward genuine inclusivity. It increases the chances they’ll talk to you about your patient.

You’ll unleash people’s energies and dedication. When you cultivate conditions for everyone to thrive, they suffer less. And you generate more generosity and commitment from the care group.

A bonus benefit for your patients: your care group is more willing to offer help, creating seamless care.

Genuine inclusivity improves your patients’ care and enables you to be the fine physician you trained to be.