Fostering a sense of belonging is important for equitable care and starts with considering how people’s lived experiences and biases (implicit and explicit) inform interactions that affect health equity (2,3). Exploring and documenting the ways in which clinical communities create a culture of belonging while simultaneously honoring the intersections of people’s lived experiences in the clinical setting is important to advance health equity-driven practices.Belonging in the Clinical Setting
So, what does it take to foster a sense of belonging for all in clinical settings?
Fostering a sense of belonging beyond DEI requires a commitment to action that focuses on assessing and demonstrating what “belonging” means to different people. There is a call from health equity communities to practice more action-oriented and sustainable DEI initiatives that cultivate effective demonstrations and narratives of belonging in the clinical setting. This requires a sustained effort by all kinds of clinicians to address health inequities and bias in the healthcare system. This also requires significant changes in the medical education system so that future clinicians are equipped to do the same. Further, academic advisors and their clinical partners can foster belonging in the medical education system by modeling belonging.
As we all know, clinical settings were tested during the pandemic. Still now, exacerbated tensions due to COVID-19 are intact (4, 5). The concept of “do no harm” must evolve to explicitly include avoiding harm across the many dimensions of wellness (6). For this to occur, we need a new concept of “clinical community”, which is inclusive of community residents and centers the importance of collaborations and interactions between clinical settings (e.g., local hospitals, clinical practices, community health centers) and the communities they serve, as well as between different professions within the healthcare system (7). This new concept of “clinical community” will give voice to patients and other community members in designing policies and interventions that consider their needs, values, and priorities (7).
In fact, prior to the pandemic, being part of the “clinical community” started before a person walked through the physical doors of a clinical space. Thus, much of the emphasis put on implicit bias training prioritized the notion that health starts where we live, work, and age. . However, the front door to the “clinical community” changed and became a virtual portal. More training is needed to address implicit bias among frontline workers within the new virtual front door environment. For example, “patient portals” are often in English only, texting is often without language options, and even phone trees skip over options once you choose a language other than English. These situations are all too common and create barriers, stunt feelings of belonging, and contribute to harm in the process of accessing care.
So, where do we start to foster belonging in clinical settings?
Practices that can Advance Belonging
While community needs and priorities should ideally inform all kinds of practices and policies to advance a sense of belonging in clinical settings, here are a few starting points that may provide a platform for reflection and further action.
First, host listening sessions for community residents who can raise action-oriented sustainable equity practices. These community-based practices center community resident voices to foster practical applications and demonstrations of belonging, which can restore medical trust.
Second, consistently demonstrate clinical staff belonging by convening different departments from within the institution (e.g., community health, language services, and DEI professionals, medical students) in all phases of the clinical decision-making processes that inform policies, guidelines, and regulations of the clinical environment and system. If belonging has been enmeshed in the policies, systems, procedures, and interactions between departments and other members of the “clinical community”, the recovery time from tense situations should be shorter when these situations arise.
Third, define the expectations of the clinical and academic community advisor in medical/ clinical education settings. This includes empowering students to participate in developing goals for their journey, setting healthy boundaries, affirming their culture and values, and feeling a sense of belonging before they enter the profession.
Fourth, it is important to have inclusive onboarding practices for clinical staff in which implicit bias training can be translated into cultural context. Namely, center the fact that the physical and virtual doors are only representative of the navigating process a patient had to follow prior to deciding to enter the clinical space and interact with a provider. The training should be informed by and inclusive of multiple perspectives including, but not limited to, diversity of languages, religions being observed by patients, neuro and physical diversity, cultural differences, history and past experiences of specific communities, and the organizational culture of different departments within the clinical practice including medical students. Training should always include ways to utilize technology or other patient access points, so all people in the “clinical community” can consistently feel a sense of belonging.
