An inclusive organizational culture, or the lack thereof, affects job performance, emotional well-being, and workforce engagement, according to a study published in JAMA Network Open.

Researchers administered a weekly email calls for anonymous narratives about the inclusion — or lack of inclusion — within the respondents’ work environments. Two open-ended stimulus questions were answered via an email link sent on June 1, 8, 15, and 22, 2016. The study solicited responses from employees, faculty, and students from multiple hospitals, health sciences schools, and outpatient facilities.

A qualitative analysis was performed on 315 completed narrative responses submitted by 113 health care employees, 3 system executives, 97 academic faculty members, 99 students or trainees, and 3 participants with undisclosed positions. Demographic data reported by the study population identified the participants as 59.7% female, 3.2% transgender/queer, 12.1% non-Hispanic black, 48.3% non-Christian, 9.8% with a primary language other than English, and 4.4% with a disability.

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Study results indicated 6 key factors that affected perceptions of inclusion (or lack of inclusion) within health care organizations: presence of discrimination; silent witness; effectiveness of organizational leadership and mentors; interplay of hierarchy, recognition, and civility; support for work-life balance; and perceptions of exclusion from inclusion efforts. Respondents who experienced the lack of inclusion reported feeling stressed, anxious, hopeless, isolated, and expendable. This ultimately created a negative effect on their job performance and well-being.

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One common theme among respondents was the lack of effective formal channels to address challenges with interpersonal dynamics and workplace culture. Strategies for a more inclusive work environment also emerged from the narratives, including positive examples of inclusion. Most respondents referred to the influence of a systemic culture on personal and group interactions, and recommended improvements to organizational culture (focusing on leadership training), expanding collegial networks and mentorship programs, and advocacy campaigns.

Narrative responses were collected from a regionally specific set of health care organizations, which limited the study’s ability to generalize findings. Another limitation was potential selection bias in the email call for narratives, in which an underrepresented sample of respondents in executive leadership positions or who identified as heteronormative Christian non-Hispanic white males was included.  

The 6 factors identified in this study were shown to concretely contribute to an inclusive workplace culture, and provided tangible strategies to improve workplace inclusion efforts. Results indicate that interplay among health care professionals can affect employee job performance and emotional well-being, and suggested that promoting inclusion within work and learning environments can improve overall employee wellness and retention of a diverse workforce.


Aysola J, Barg FK, Martinex AB. Perceptions of factors associated with inclusive work and learning environments in health care organizations [published online August 3, 2018]. JAMA Network Open. doi: 10.1001/jamanetworkopen.2018.1003.