Inclusion: The Starting Point for Effective Teams

What is Inclusion?

Inclusion refers to the behaviors and social norms intended to ensure that people feel welcome, are treated fairly and respectfully, and have the same chance to contribute.

Why is Inclusion Important to Multi-Stakeholder Teams?

What is Tokenism?

Tokenism is inviting only one person of a certain race, age group, gender, or health condition to the table to give the appearance of inclusion. In these situations, the person may feel they were invited only to meet a requirement and not because their perspective is valued or will be considered.

Stakeholders are invited to partner on a study to influence the research in meaningful ways. Stakeholders should feel their involvement is more than a funding requirement, and not "tokenism."

Stakeholders who do not feel included may not:

  • Take part in discussions.
  • Feel comfortable offering a different point of view from others on the team.
  • Volunteer to do more for the team.

People who do not feel included lose interest in the project and are less likely to stay on the team.

Resources to Create an Inclusive Team

The following provide information and resources that organizers and team members can use to create an inclusive environment:

  • Addressing bias and exclusion. Bias can influence the way we interact with others.
  • Establishing and maintaining trust. Trust among team members is a critical element of an inclusive environment.
  • Enabling multiple points of view. Multiple perspectives are necessary to create a study informed by stakeholders’ experience and knowledge.

Addressing Bias and Exclusion

What is Bias?

Examples of Bias

Assuming that…

  • People of a certain race are intelligent or unintelligent.
  • People with more education or financial security are hardworking and people with less education or financial security are lazy.
  • Younger people have more ability than older people.
  • Men are more committed to their careers than women.

Bias is prejudice in favor of or against a thing, a person, or a group compared with another, usually in a way considered to be unfair. Bias is based on our positive or negative associations with someone’s or something’s characteristics.

We rely on our assumptions and past associations to make sense of new experiences. However, our assumptions about others may be inaccurate.

When Bias Becomes a Problem

Bias can lead to discrimination, which is the act of treating people differently based on their personal characteristics such as their age, race, or gender. Discrimination can mean denying someone the opportunity for a job, education, or housing. But it also can be more subtle, such as disregarding someone’s opinion or avoiding interactions with someone based on their personal characteristics.

Because it influences behavior, bias can lead to stakeholders feeling unwelcome and discourage them from sharing valuable insights.

How Can Research Teams Overcome Bias?

Organizers and team members can take four important steps to reduce the effects of bias:

Become Aware of Bias.

Most people are unaware of their bias. Becoming aware of personal bias and making changes to behavior can feel uncomfortable. However, recognizing your biases and the ways those biases affect interactions with people who are different is the first step in creating an inclusive team environment. Recognize when you are most likely to make incorrect assumptions about others. This is more likely to occur when:

  • Information about other people is incomplete.
  • People have a lot to think about all at once.
  • There are time constraints.
  • People are overconfident about their objectivity.

Get to Know the Person.

  • Focus on the individual stakeholder or team member, not the group that person represents.
  • Make a point of forming relationships with team members and stakeholders with backgrounds that differ from yours.
  • Keep an open mind about each person on the team.
  • Find things that you have in common with others on the team.
  • Seek information that helps you challenge your own biases.

Replace Behaviors that Exclude Others.

Below are examples of how small actions or behaviors can include rather than exclude others.

Exclusive Behavior Inclusive Behavior
  • Not greeting someone or including them in a conversation.
  • Making a point to greet someone and include that person in the conversation.
  • Not acknowledging someone’s comment or contribution.
  • Paraphrasing or repeating someone’s comment and verbalizing the value of their contribution to the project.
  • Interrupting someone who is speaking.
  • Allowing someone to finish their thought completely before responding.
  • Minimizing or dismissing someone’s observation or opinion.
  • Acknowledging the person’s idea or opinion and communicating how it is being considered.
  • Focusing your attention only on those you know well.
  • Intentionally seeking out others who you do not yet know.
  • Expressing criticism to others of someone’s work or ideas.
  • Asking someone about their process or approach to the work.
  • Making jokes about someone’s personal characteristics.
  • Finding opportunities to show respect to someone for their individuality.

Contribute to an Inclusive Culture.

Research teams and individuals can take a variety of actions to promote inclusion, including the following:

  • Have team members make a formal commitment to be inclusive of others and take steps to make it happen.
  • Create social opportunities for teams, such as a dinner for team members to get to know each other outside of the study.
  • Use ice breakers at the start of meetings for people to share something about themselves.
  • Hold a team discussion on implicit bias and the potential effects it can have on the team; invite the team to brainstorm potential biases that it might face.
  • Encourage team members to take the Implicit Association Test (IAT):
    • The IAT measures biases that people hold and is available for free.
    • Team members can take this test on their own (and they do not need to share their results with anyone).
    • Taking the IAT can help team members become aware of their own unconscious biases.

Learning Resources

Fostering an Inclusive Team Culture ACTIVITY GUIDE WITH WORKSHEET

Leads teams through an activity to discuss what makes each team member feel welcome or unwelcome and develop inclusive team practices.

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Where PCOR Should Begin VIDEO

Researchers provide suggestions about how to approach patient-centered outcomes research (PCOR), including understanding and addressing the historical context in which it is conducted, listening to patients and communities and asking them to be part of the process early on.

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How to Be More Inclusive TIP SHEET

Provides actionable guidance to help individuals practice inclusive behaviors so that all team members have an equal chance to contribute.

View Tip Sheet

Addressing Bias and Exclusion FURTHER READING LIST

Provides links to publicly available resources on addressing bias and exclusion in team meetings and activities to benefit from diverse teams.

View Further Reading List

Establishing and Maintaining Trust

Trust between organizers and stakeholders creates strong, inclusive partnerships.

"The glue that holds all relationships together—including the relationship between the leader and the led—is trust, and trust is based on integrity."

Brian Tracy, international human development consultant

Team members build trust with one another when:

  • All members sincerely want to collaborate.
  • Leadership is transparent and honest.
  • Leadership is ethical.
  • Leadership anticipates the needs of team members.
  • Team members see value in each other’s roles.
  • Team members have the information and resources they need to work.
  • Team processes invite diverse opinions and ideas to be heard and considered.
  • The team acknowledges contributions and gives credit.
  • The team has shared goals and objectives.
  • Team members feel they can be themselves without judgment.

What Can All Team Members Do to Establish and Maintain Trust with Each Other?

  • Communicate openly, honestly, and often about:
    • Intentions and interests.
    • Changes in schedules and plans.
    • How well processes are working.
    • Successes and failures.
    • Concerns about trust.
  • Be consistent and reliable.
  • Keep the promises you make.
  • Express needs openly and directly.
  • Establish processes for expressing disagreement.
  • Take personal responsibility rather than blaming others.
  • Consider the listener when speaking and using verbal and non-verbal communication.

Trust is not a one-time event but a process that must be continually renewed. Trust can break down. When it does, it must be repaired.

Learning Resources

How to Establish and Maintain Trust TIP SHEET

Explains why establishing trust among members is important to a team, and outlines specific actions that individuals can take to gain team members' trust.

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Establishing and Maintaining Trust SCENARIO

Provides an opportunity to learn about behaviors that can help create trust on teams through real-world examples.

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Insights from Researchers and Stakeholders on Establishing and Maintaining Trust QUOTES

Presents insights from researchers and stakeholders from PCORI-funded teams – in their own words – about how they have successfully established and maintained trust within their team.

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Enabling Multiple Points of View

“When [this] application was written, it was written with input from people who had the condition, from clinicians, from researchers, from community members, from people who run major organizations. And that in a nutshell is what I think has created the foundation of our work and why this has been so successful.”

PCORI-funded principal investigator

Why is it Important to Have Multiple Points of View on the Team?

The main objective of stakeholder engagement is to broaden the team’s perspective. Having a diversity of voices allows the team to:

  • Bring multiple perspectives, experiences, and concerns to research studies.
  • Establish research questions that are relevant, useful, and important.
  • Consider how to make findings relevant to multiple audiences, including patients.
  • Solve problems based on first-hand knowledge, such as how to recruit underrepresented voices.

How Can Research Teams Make Sure Every Voice on the Team is Valued?

Respecting every voice is critical for the team to realize the full value of a diverse membership. Doing so can be difficult, especially when team members have different perspectives. Remember, the more comfortable team members feel sharing their ideas, the more the team will hear a variety of perspectives and solutions. Team organizers can show that all voices are valued in many ways, including the following:

  • Identify stakeholder perspectives and their value to the team.
  • Clearly state that all team members are encouraged to speak, and all ideas are welcome.
  • Make sure every team member has the background information they need to feel prepared to contribute.
  • Set clear expectations about the desired outcomes of every discussion.
  • Emphasize the importance of actively listening and paying attention to each other.
  • Find connections between the different points of view.
  • Hold time for one-on-one meetings for stakeholders who need additional time or explanation to prepare for or process a meeting.

Learning Resources

Valuing All Voices CHECKLIST

Provides a list of reflection questions that individuals and teams can use to make sure they are valuing all voices.

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Enabling Multiple Points of View SCENARIO

Provides an opportunity to learn about behaviors that can encourage or discourage multiple points of view on a team through real-world examples.

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Creating Partnerships for Better Engagement VIDEO

A researcher shares the value of creating partnerships between different stakeholders — patients, community partners, and researchers — to facilitate better engagement in healthcare research.

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Impact of Engaging Patients with Asthma as Partners in PCOR VIDEO

A physician talks about the importance of engaging patient partners from Hispanic, Latino, and African-American groups in his PCORI-funded study, which is comparing asthma treatments in these populations.

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Enabling Multiple Points of View FURTHER READING LIST

Provides links to publicly available resources on enabling multiple points of view in team meetings and activities to benefit from diverse teams.

View Further Reading List