Inclusion Is Important ... but How Do I Include? a Longitudinal Study on the Effects of Inclusive Leadership on Hospital Innovation, Job Satisfaction, and Perceived Quality of Care

Background: As health care organizations become increasingly more diverse, health care leaders are recognizing the need to create inclusive workplaces, where everyone feels valued to express who they are, yet little is known about how leaders can foster inclusion. Although growing evidence supports workplace inclusion as a critical factor in promoting equal opportunity, equity, and justice in organizations, scarce research has examined how leaders can create inclusive work environments. Thus, this study is one of the firsts of its kind to conceptually and empirically test a model of inclusive leadership. Based on transformational leadership theory this study examined a multilevel longitudinal model of the relationships between inclusive leadership, climate for inclusion, innovation, job satisfaction, and perceived quality of care in a diverse urban health care environment.

Method: Data were collected at three time points at 6-month intervals from a diverse urban pediatric hospital department. Of 300 employees at Time 1, 277 agreed to participate in an initial demographic survey (92% response rate) and 213 (71% response rate) in the main survey. Of 330 employees at Time 2, 292 agreed to participate in the demographic survey (88% response rate) and 245 in the main survey (74%); for Time 3, 259 participants agreed to participate in the demographic survey (78% response rate) and 239 (72%) in the main survey. This department featured 21 separate work groups with an average of about 10 employees per group (SD = 6.58, Range = 5‒25). Longitudinal multilevel path analysis was conducted using Mplus 6.1 statistical software. ICC and Awg statistics were used to support aggregating the data to the group level. All measurement tools were previously validated by other research.

Results: The sample was diverse on multiple categories, for example in terms of racial and ethnic diversity, 41% of respondents self-reported as Asian, 21% as Caucasian, 20% as mixed race or other, 14% as Latino, and 4% as African American. Model fit indicated an excellent fit to the data. Results from the multilevel longitudinal path analysis indicate several direct and indirect effects. There were significant direct effects between inclusive leadership at Time 1 and inclusion at Time 2 and innovation at Time 3. Likewise there were significant indirect effects between inclusive leadership at Time 1 and innovation, job satisfaction, and perceived quality of care at Time 3, through its influence on increasing inclusion at Time 2.

Discussion/implications: Findings highlight the critical role of inclusive leadership in creating just and inclusive workplaces. This is one of the first studies to conceptualize and empirically measure inclusive leadership and to connect this with increased inclusion, innovation, job satisfaction and health care quality in a diverse work environment. Thus, leaders striving to increase equal opportunity, justice, and equity in their organizations can do so through increasing feelings of inclusion. Results highlight specific leadership behaviors that help foster inclusion and can be used to develop leadership interventions that create just and inclusive workplaces that reap the benefits that can come from having an inclusive workplace (e.g., innovation).