Being Inclusive: how inclusive practice goes beyond retention

In this series we’re exploring how to transform the wellbeing and retention for newly recruited international colleagues. Within a context of many other solutions, we’re answering how creating a compassionate, inclusive culture – starting within each person – contributes to belonging, a sense of connection, being valued, and growth within healthcare teams.

This article looks at how inclusive practices are integral to retention of the workforce, with a particular focus on international recruitment.

Introduction

We each have a role to play in retention which goes beyond convincing people not to leave. An alarming 32.3% (nearly 1 in 3) of respondents to the NHS Staff Survey (2022) said they ‘often think about leaving this organisation’. Furthermore, despite almost half of nurses and midwives being trained outside the UK (NMC data report, 2021-22), there has been limited attention to supporting long term retention of internationally recruited healthcare professionals (International Journal of Nursing Studies, 2022). Retaining staff is about enabling people to feel valued, a sense of belonging, safe, supported, fulfilled, and have opportunity to grow and contribute within their place of work.

There are many different areas of action to support retention within care, namely: compassionate leadership, flexible working, fair pay, development opportunities, schemes, programs, engagement opportunities, and workplace culture. We believe that culture change goes beyond the idea of retention as a statistic and considers the quality of experience, starting within each person’s contribution. In this article, we’re focusing on how being inclusive is integral to supporting and empowering staff beyond their retention, as well as creating a solid foundation for newly recruited healthcare professionals from overseas.

Aligned with their “People Promise”, the NHS agreed that one of their key ambitions is to ‘have more people, working differently in a compassionate and inclusive culture’. As well as to ‘improve staff experience’, help them feel ‘valued’, ‘happy at work’, and be ‘supported to achieve their individual ambitions in the workplace’. To affect sustainable culture change and to consistently enable these experiences (from the recruitment process all the way to leadership level); person by person; action by action; we each create this compassionate and inclusive culture which contributes to ours and our colleagues’ retention. Here, let’s continue the conversation about inclusivity in the workplace, developing our understanding and offering some inclusive practices.

Being inclusive

Inclusive practices help to transform wellbeing, engagement, and retention because they remove barriers for people with “difference” and allow more people to engage with their organisations and make unique contributions. Being inclusive requires bringing awareness to how other people experience the world and then taking on new practices which support, include, and empower the diversity of experiences. We all can be categorised by various qualities, conditions, and experiences, as well as intersections of these experiences. These categories indicate our differences of experience to one another, and the unique ways we experience and perceive the world around us. However, we also recognise the value in identifying shared experiences, especially those qualities or conditions which make us “different”. Being part of peer-networks where people can come together through their differences provides opportunity to experience belonging and celebrate their uniqueness, as well as decreasing feelings of alienation or isolation.

Being inclusive is better when proactive than reactive, whilst understanding that inclusive practice is always evolving. Inclusive practices should be present pre-recruitment and should be a constant expansion of listening to new experiences and making change. This might be putting name pronunciations and pronouns in email signatures; it might be setting up a social group for people who speak the same first language that isn’t English; it might be ensuring your training and development opportunities are inclusive for those with learning disabilities; it might be asking the question on forms ‘what else can we do to support and include you?’.

Practicing Inclusive Mindset

What beliefs are foundational to being inclusive?

To avoid inclusive practices being hollow tick-box exercises, we might hold the belief that every single person has a unique and wonderful contribution to make and understand that, if they are supported through inclusive practices, ensuring unnecessary barriers are removed, they can bring all of their potential to brighten and diversify the team for the greater good of the organisation, and the patients.

Self-Awareness of Bias

What is an inclusive practice your colleagues have taken on – or could take on – which influences your sense of belonging and inclusion?

(Good quality) listening itself could be considered an inclusive practice. When we talk about really listening, we require a level of self-awareness to notice the biases, judgements, and assumptions that arise as someone shares. Listening requires us to override these thoughts to stay present with someone’s sharing.

Considering this in the context of listening to someone of a marginalised group, it might be that the listener has an unconscious bias (as we all do) which contains ableist, racist, ageist, or sexist assumptions which, if left unaware and unprocessed could contribute to a feeling of alienation or harm for the marginalised person. Here, self-awareness of our thoughts and bias and an ability to choose our next thoughts and how we act is key to creating an inclusive environment. In other words, the elements that make a person a better listener also make a person more inclusive (overriding thoughts, assuming you do not know, listening with curiosity to understand).

Proactive Inclusion of Diversity

It shouldn’t always have to take a marginalised person to speak up to be included. It takes a lot for someone to speak up in the face of fear, shame, victim-blaming narratives, and possible abuse. This is why being proactively inclusive (seeking to understand different experiences, privileges, and disadvantages) enables colleagues to feel valued and be included.

For example, the social model of disability, which is ‘a way of viewing the world, developed by disabled people’, suggests that it is the environment which disables a person from engaging with life, rather than their physical condition. (Scope, 2024) Firstly, we must recognise that each of us have impact and influence over other people’s quality of experience, through our choices of action. Then, if we are aware of the diversity of experience and harmful attitudes or mindsets, we can make appropriate changes to remove unnecessary barriers to inclusion. We all have a part to play in creating compassionate and inclusive cultures.

In the NHS Staff Survey, ‘More than 1 in 8 NHS staff (13%) reported experiencing discrimination at work’ furthermore, Black and minority ethnic staff are ‘‘nearly a quarter as likely to be a senior manager than white staff’. Upon reading this,

• What schemes could be implemented (or already are) to support people who experience discrimination?

• What training and development opportunities could be invested in proactively as part of onboarding and beyond?

• How could a compassionate and inclusive leader be in support of their Black, Asian, and ethnic minority (a.k.a. global majority) colleagues?

For an organisation to maintain their inclusive culture where all are heard, seen, celebrated, and supported, inclusive practice requires proactive thinking, good listening, and compassion within all members of staff. There is strong evidence that a ‘more diverse workforce results in improved staff outcomes, retention and engagement’. For this to happen successfully and sustainably, inclusive practices must be present at all levels of the organisation.

Innovative Support and Development Opportunity

Experiencing a sense of isolation, alienation, or feeling left out is not uncommon in the first few months upon arrival in the UK for healthcare colleagues from overseas. In addition to possible language barriers, the cultural differences between colleagues, and added challenge of settling into a new working environment, can impact a person’s sense of belonging and wellbeing. It is vital to offer international colleagues an inclusive, diverse space where they can be acknowledged and celebrated for their unique contribution.

Talent for Care provides innovative experiential learning programs to transform the wellbeing, engagement, and retention of the health and social care workforce in the UK. Participants are introduced to new ways of thinking about relationships and communication, as well as ongoing, supportive practices in listening, processing, and relating to themselves, the world, and those around them.

New Horizons is a new, innovative support and development program for international healthcare professionals. The program is an opportunity for participants to share experiences, discuss new ways of thinking, develop skillset and learn new practices, and be heard and supported. Participants will strengthen their sense of belonging within a peer network of other newly recruited overseas professionals, supported by direct involvement from line managers, and be led by an experienced facilitation team.

The learning is experiential where the conversations themselves are generative and success is measured by the transformational impact upon the participant’s life. In our experience, the most reliable outcome measures come from participant feedback and self-assessment, which we capture through a simple, robust and anonymous framework, via an end of program questionnaire on MS Teams. We ask all participants for their consent to share their anonymised feedback.

At Talent for Care, we’re always evolving our inclusive practices, researching and proactively listening to needs of our participants so we can provide appropriate support, and all can access the opportunities. We value every person’s unique experience; everything they bring is a contribution. We do our best to learn how to support people so that contributing to the program is accessible to them.