Enhancing Belonging in Healthcare: A Commentary on Strategies for Organizational Leadership

Abstract

Belonging is a human necessity, fostering psychological safety and self-actualization. The importance and benefits of belonging are well documented, and there is a growing body of research emphasizing the role belonging plays in the workplace and its effects on employees and companies alike. Due to the unique stressors and barriers present in healthcare, a lack of belonging among employees is not uncommon. This paper explores how cultivating an inclusive environment transforms healthcare delivery and highlights tangible strategies leaders in healthcare can utilize to enhance belonging for staff and ultimately the patient populations they interact with. Because belonging is multifaceted and highly individualized, effective strategies include people-centered approaches that prioritize physical and mental well-being, career-advancing initiatives, empathetic leadership and robust support systems. The importance of analyzing systems that either promote or inhibit belonging, specifically by examining existing organizational policies and practices through an equity lens, is also discussed. By prioritizing diverse perspectives and implementing tailored interventions, healthcare organizations and committed staff can create a culture where both patients and professionals feel valued, leading to enhanced well-being, improved patient outcomes, and equitable healthcare delivery.

Introduction

Understanding Belonging

Belonging is a fundamental human need that stems from our desire for community acceptance, connection, and inclusion. True belonging is achieved when a person feels psychologically, emotionally, and physically safe. Three major environmental factors create belonging: comfort to be one’s authentic self, connection to others, and contribution to meaningful work.¹ These factors are interdependent and must all be present to create a true culture of belonging.¹

Belonging is a need in all human relationships and communities but has a particular significance in the workplace. When a person feels that they belong in a workplace they feel that their employer sees them, understands them, and values their contributions.² The Society for Human Resource Management identifies belonging as: feeling encouraged and recognized for contributions and perspectives, feeling the freedom to be one’s authentic self at work without consequences, and the ability to develop trusting, caring relationships with colleagues.³

In addition to its significance in the overall workplace, belonging is fundamental to the function of healthcare organizations. It is an indispensable element that fosters trust, resilience, and better health outcomes for patients and healthcare professionals alike.^4–6 Healthcare necessitates cultivating a sense of belonging, which forms the foundation of compassionate care, equitable treatment, and organizational success. From the patient’s perspective, feeling a sense of belonging within healthcare settings enhances trust in providers, adherence to treatment plans, and overall well-being.⁶ Similarly, healthcare professionals benefit from a supportive and inclusive workplace that fosters engagement, reduces burnout, and enhances the quality of care.^4,5 Healthcare organizations and their staff working side-by-side to prioritize belonging can achieve better health outcomes, improve patient satisfaction, and increase employee retention rates.

Enhancing belonging may help enable organizational excellence. Organizations with a high sense of belonging among employees have 50% lower turnover rates, 75% fewer sick days, and 56% higher job performance resulting in a substantial increase in annual savings.^3,7 While enhancing workplace belonging is not a fix-all, organizational performance can be negatively affected when employees feel a lack of belonging.^4,5 According to the Harvard Business Review, team members who felt excluded from team dynamics were less likely to work hard to advance the team’s goals, even if it meant a personal sacrifice, such as reduced earnings.⁷ Enhancing belonging is a paramount component to the success of any organization.

Increasing belonging is essential to equity, inclusion, and diversity efforts. According to research, employees who feel they belong are 9 times more likely to say that their organization treats people the same way irrespective of their race.⁷ This statistic highlights a significant distinction in belonging. Organizations can easily overlook gaps in belonging, leaving historically marginalized groups feeling unsupported and unwelcome in the workplace.

A lack of belonging, also known as belonging uncertainty, is an experience that transcends demographics as individuals from all backgrounds can struggle to feel a sense of belonging in the workplace. A 2023 assessment by WebMD Health Services found that 57% percent of employees surveyed do not feel that their employer ensures belonging.³ Employees from underrepresented backgrounds often report a lower sense of belonging than other groups. A study of college-educated professionals cited in the Harvard Business Review found that Black women and Asian women reported the lowest sense of belonging.⁸ This void is crucial for organizations to address as lacking a sense of belonging has been shown to result in lowered self-efficacy and negatively impact performance.⁸

The challenges of building and maintaining a culture of belonging are exacerbated by the high-stress environment of healthcare.^9,10 A study of hospital medicine and emergency medicine healthcare professionals identified several barriers to feeling that they belong at their organization, including: differences between day and night shift resources, high turnover rates, prejudice and safety concerns from patients, lacking connection with administration, and emotional exhaustion resulting from the increased stressors of the COVID-19 pandemic.¹⁰

Healthcare leaders must consider the unique challenges that clinical settings bring, and how to implement belonging interventions that take these environments into account to achieve excellence and better meet the needs of both staff and patients.¹⁰

Results

Strategies for Enhancing Belonging

There are multiple approaches employers can utilize to increase belonging for employees at their organization. These approaches ultimately share one common theme, they put people at the center. People-centered design of belonging initiatives prepares them for success.

Employers often are unable to anticipate which employees lack a sense of belonging. Studies have failed to predict a single determinant for a decreased sense of belonging, but we know recognizing belonging is important to staff of all backgrounds and identities.^9,11 Thus, organizations need to be aware of the different factors that shape a person’s identity and their feeling of belonging.^10,11 They must also recognize the specific needs and experiences of each employee and think about what systems need to be in place to address the needs of their teams. To understand employee sentiments around belonging, employers may choose to conduct pulse surveys or focus groups on randomized groups of staff of all identities and at all levels within the organization.

An intriguing practice of improving employees’ belonging called “Net Better Off (NBO)”, is a measure that is associated with increasing the chance that the employee feels a connection to the organization by two times.¹² Several factors contribute to leaving employees NBO, including: creating work environments that support physical well-being, building a sense of community regardless of work location, supporting mental health, providing compensation and benefits that meet the challenges of today’s world, and enabling people to develop skills to advance their careers.¹²

According to this, leaders who are aiming to leave their teams NBO must be invested in learning not only about the individual lives of each employee but also about the forces and factors that individuals face outside of work, such as systemic racism. These leaders are encouraged to: empower their teams to advance their careers, communicate transparently and empathetically, and hold each other accountable for recognizing the contributions of all team members.¹²

Organizations should expect leaders to cultivate these skills and offer chances for both emerging and seasoned leaders to improve these competencies. This includes developing formal frameworks to assess the current state, the ideal state, and opportunities for improvement.¹²

Belonging is inextricably tied with diversity, equity and inclusion efforts. Belonging initiatives serve as a pathway to create more inclusive environments and disrupt systemic inequities.^9,11 To effectively enhance belonging, healthcare leaders should start with a thorough audit of existing policies and procedures to identify and address biases and structural inequities within the organization.¹² This process requires a comprehensive, systems-oriented approach to evaluate the overall health of the workplace.^12,13 A broad range of metrics should be analyzed including policies and procedures, job descriptions, compensation structures, and promotion practices.^13,14 Additionally, examining branding, signage, and various sources of employee feedback – such as grievances and exit interviews – can provide valuable insights about the organizational culture to address gaps and promote a more equitable workplace.^13,14

In addition to internal policy reform, healthcare organizations must implement formal channels and actionable efforts to combat inequities. Equally important is ensuring employees are recognized for their contributions and feel valued, as this fosters a deeper sense of belonging.^13,14 Establishing robust support systems, creating opportunities for employees to forge meaningful connections with one another, and providing avenues for personal and professional growth are all strategies can help create more inclusive and supportive environments.

Another major positive influence on an employee’s belonging is having both a friend and a mentor at work. Employees who report having a close friend and mentor at work are 21% more likely to report feeling that they belong.¹⁵ Friendship in the workplace can support not only belonging also wellbeing. Oftentimes, friendship develops organically with mentor-mentee relationships, further enhancing the positive impacts of mentorship.^15,16 To capture these benefits, some organizations are implementing initiatives to create formal mentorship programs that match employees with mentors who have similar lived experiences.¹⁷ Other organizations focus on building coaching programs matching mentees and mentors based on the skills and competencies that an employee wants to develop.^18,19 Regardless of the specific approach taken to building a mentorship program, intentional connection of mentees and mentors is paramount.^18,19 Having a strong, invested mentor of any background builds a culture of enhanced belonging.

Even brief belonging interventions can lead to positive outcomes. A study of Black college students who were assigned to a narrative intervention to utilize shared experiences to show that belonging uncertainty in school is common resulted in students enhancing their GPAs, self-assessed health, and subjective happiness, with fewer doctors’ appointments.²⁰ A powerful tool in driving belonging initiatives includes individuals who can become allies to those with belonging uncertainty.²¹ These individuals often have experienced not feeling comfort, connection, or contribution in their environment, but have a desire to change this experience for others. Successful belonging initiatives empower allies to: share common experiences and perspectives, navigate difficult community dynamics, and develop a shared vision for the future.²¹

The unique challenges of healthcare teams must also be considered in any belonging initiative. Healthcare-specific belonging initiatives are successful when they: focus on common values and goals, promote communication, support, and encouragement across teams and units, and develop a shared vision for the future.^3,11,12,22

These interventions often focus on grounding initiatives that bring teams back to why they pursued a career in healthcare. This can take a variety of forms but should ultimately connect individuals with people from across professions and care teams.^12,22 Employers may consider implementing cohort-style leadership development programs, whereas staff are provided external coaching and career guidance in psychological safe spaces among their colleagues. Such interventions can provide staff with an opportunity to detach from high-stress work environments and identify and pursue their career aspirations.²²

Discussion

Patient Impact

Belonging is an essential aspect of patients’ care journeys. From a patient’s perspective, belonging is about feeling seen, heard, and valued throughout their care journey.^6,14,23 It’s the sense of being an integral part of the care process, where patients feel respected, understood, and cared for beyond their medical condition, creating an environment of empathy, dignity, and inclusion. This involves: trust and safety in the care provided, understanding and empathy from healthcare professionals, active involvement in decisions regarding their health, cultural sensitivity and respect for individual backgrounds, continuous support and advocacy, and seamless continuums of care.^6,14,23 Additionally, increased representation of staff members is vital as it helps patients feel welcomed, comfortable, and understood, contributing to a greater sense of belonging and engagement in their care journey.²³

Lack of belonging can be detrimental to a patient’s health. For example, a study of the outpatient population in the Veterans Health Administration found that lacking a sense of belonging led to lower patient engagement and patient attendance.²³ Patients are less likely to adhere to treatment plans when they lack a sense of belonging as part of their healthcare.²³ Just as it is important to recognize the unique factors that shape employee experiences in and outside of work, it is essential to consider the same factors for patients as individuals.

Care teams that foster a sense of belonging for team members are best able to create an environment of belonging for their patients. Creating a culture and expectation of curiosity, communication, support, and belonging within a workplace helps increase patient belonging.

Conclusion

The pivotal role of belonging in healthcare cannot be overstated. Its impact on patient outcomes, healthcare professionals’ well-being, and organizational success is undeniable. Fostering a culture of inclusivity and understanding within healthcare settings is not just desirable; it’s imperative. Implementing strategies to enhance belonging within the workplace invites healthcare leaders to lean into understanding the lived experiences of their staff and take a systematic approach to disrupting inequities through formal channels such as policy change in compensation structures, in addition to providing opportunities for employees to make meaningful connections and advance their careers. By prioritizing belonging, healthcare organizations and committed staff can achieve better outcomes, enhance patient satisfaction, and bolster employee retention rates. Understanding the multifaceted nature of belonging, addressing disparities, and implementing tailored strategies are vital steps toward creating a healthcare landscape where everyone feels valued, supported, and empowered. Ultimately, a culture of belonging is not merely a goal; it’s the cornerstone upon which compassionate, equitable, and exemplary healthcare is built. The current manuscript limits its scope to the implications on patient care within the field of healthcare. Future research should focus on other sectors, mechanisms that can help enhance belonging over time within the workplace, and differences in sense of belonging among employees at different levels.

Acknowledgments

We extend our thanks to Mayo Clinic’s Office of Equity, Inclusion and Diversity and IGNITE MED for providing expert coaching for women in medicine.

Disclosure

The authors report no conflicts of interest in this work.

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