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Leadership in the NHS
  1. Roger Kline
  1. Business School, Middlesex University, Barnet, London, UK
  1. Correspondence to Roger Kline, Business school, Middlesex University, Barnet, London NW4 4BT, UK; roger{at}

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Inclusion: essential leadership prerequisite or optional extra?

In healthcare, leadership is decisive in influencing the quality of care1 and the performance of hospitals.2 How staff are treated significantly influences care provision and organisational performance so understanding how leaders can help ensure staff are cared for, valued, supported and respected is important. Research suggests ‘inclusion’ is a critical part of the answer.

Inclusion may be regarded as the extent to which staff believe they are a valued member of the work group, in which they receive fair and equitable treatment, and believe they are encouraged to contribute to the effectiveness of that group. Inclusive workplaces and teams value the difference and uniqueness that staff bring and seek to create a sense of belonging, with equitable access to resources, opportunities and outcomes for all, regardless of demographic differences. Inclusive organisations are more likely to be ‘psychologically safe’ workplaces where staff feel confident in expressing their true selves, raising concerns and admitting mistakes without fear of being unfairly judged.3

In hospital settings, managing staff with respect and compassion correlates with improved patient satisfaction, infection and mortality rates, Care Quality Commission (CQC) ratings and financial performance4 as well as lower turnover and absenteeism. By contrast, ‘disrespect’ in medicine is a threat to patient safety because ‘it inhibits collegiality and cooperation essential to teamwork, cuts off communication, undermines morale and inhibits compliance with and implementation of new practices’.5 Yet, 24% of NHS staff in England report that they are subject to bullying, harassment or abuse by fellow workers and managers, impacting on increased intentions to leave, job satisfaction, organisational commitment, absenteeism, presenteeism, productivity and the effectiveness of teams, costing the NHS at least £2.28 billion annually.6 The NHS has an extraordinarily diverse workforce, but workforce and NHS staff survey data show many staff experience systematic discrimination in …

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

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