Toward More Inclusive Healthcare Organizations: Lessons from a Participatory Case Study and a Conceptual Framework Proposal
Main Article Content
Abstract
Introduction: Inequalities and discrimination against historically marginalized groups (HMGs) persist in Quebec’s (Canada) healthcare system. In response, healthcare institutions have implemented equity, diversity, and inclusion (EDI) initiatives based on diverse experiences, but these efforts remain insufficiently analyzed and documented.
Objective: This article documents an initiative that led to the development of an EDI action plan in a healthcare institution in Quebec. The article aims to identify lessons learned from a participatory approach with stakeholders in developing such an EDI plan.
Method: Single, instrumental case study design informed by conceptual perspectives on inclusive organization, stakeholder participation, and the organizational learning process.
Results: The findings highlight several key lessons from the hospital’s participatory approach, including the importance of knowledge sharing and communicating opportunities for EDI development, consulting healthcare staff about their EDI experiences, and co-constructing a shared understanding through collaborative decision-making processes. These elements ultimately supported the institutionalization of the approach and the adoption of an EDI action plan.
Discussion and Conclusion: The article proposes a reference framework for a participatory approach and organizational learning process in EDI. This framework contributes to advancing both theoretical and practical knowledge in the field.
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References
Act respecting equal access to employment in public bodies. CQLR, c. A-2.01. https://www.legisquebec.gouv.qc.ca/fr/document/lc/A-2.01?langCont=en
Adamson, M., Kelan, E., Lewis, P., Śliwa, M., & Rumens, N. (2021). Introduction: Critically interrogating inclusion in organisations. Organization, 28(2), 211–227. https://doi.org/10.1177/1350508420973307
Akhmouch, A., & Clavreul, D. (2017). Towards Inclusive Water Governance: OECD Evidence and Key Principles of Stakeholder Engagement in the Water Sector. In E. Karar (Ed.), Freshwater Governance for the 21st Century (pp. 29–49). Springer International Publishing. https://doi.org/10.1007/978-3-319-43350-9
Bahrini, S. (2022). Étude de la diversité et de l’équité d’accès des candidats au niveau de l’admission des facultés franco-québécoises de médecine selon divers scénarios de pondérations des outils d’évaluation [Dissertation, Université de Montréal]. Papyrus. https://umontreal.scholaris.ca/server/api/core/bitstreams/66a2924c-207a-403b-b565-e5a755bcd261/content
Béguerie-Goddaert, C., & Brière, S. (2025) Rapport de consultation au CHU de Québec-Université Laval pour la réalisation d’une collecte de données liée au développement de son plan d’action en équité, diversité et inclusion, Québec.
Blanchet Garneau, A., Bélisle, M., Lavoie, P., & Laurent Sédillot, C. (2021). Integrating equity and social justice for indigenous peoples in undergraduate health professions education in Canada: A framework from a critical review of literature. International journal for Equity in Health, 20(1), 123. https://doi.org/10.1186/s12939-021-01475-6
Brière, S., Auclair, I., Keyser-Verreault, A., Laplanche, L., Pulido, B., Savard, B., St-Georges, J., & Stockless, A. (2022). Biais inconscients et comportements inclusifs dans les organisations. Presses de l’Université Laval.
Centre intégré de santé et de services sociaux de Laval. (2025). Politique sur l’équité, la diversité et l’inclusion (EDI) (Publication No. 268-2025-DSPub). https://www.lavalensante.com/fileadmin/internet/cisss_laval/Employes_medecins/Ressources_humaines/Politiques_et_procedures/268-2025-DsPub_Politique-Equite_diversite_inclusion_EDI.pdf
Centre intégré universitaire de santé et de services sociaux de l’Estrie – Centre Hospitalier Universitaire de Sherbrooke. (2022). Politique sur l’équité, la diversité et l’inclusion (Publication No. B001–POL-04). https://www.santeestrie.qc.ca/clients/SanteEstrie/A_propos/fondement/B001_Politique_EDI_CIUSSSE-CHUS.pdf
Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l’Île-de-Montréal. (2023). Politique équité, diversité et inclusion. Bureau du président-directeur général adjoint. https://ciusss-centresudmtl.gouv.qc.ca/sites/ciussscsmtl/files/media/document/PO_1000_010.pdf
Combs, G. M., Milosevic, I., & Bilimoria, D. (2019). Introduction to the Special Topic Forum: Critical Discourse: Envisioning the Place and Future of Diversity and Inclusion in Organizations. Journal of Leadership & Organizational Studies, 26(3), 277–286. https://doi.org/10.1177/1548051819857739
Crossan, M. M., Lane, H. W., & White, R. E. (1999). An Organizational Learning Framework: From Intuition to Institution. Academy of Management Review, 24(3), 522–537. https://doi.org/10.2307/259140
d’Agincourt‐Canning, L., Ziabakhsh, S., Morgan, J., Jinkerson‐Brass, E. S., Joolaee, S., Smith, T., Loft, S., & Rosalie, D. (2024). Pathways: A guide for developing culturally safe and appropriate patient‐reported outcome (PROMs) and experience measures (PREMs) with Indigenous peoples. Journal of Evaluation in Clinical Practice, 30(3), 418–428. https://doi.org/10.1111/jep.13947
Dahl, K., Larivière, N., & Corbière, M. (2020). L’étude de cas. Illustration d’une étude de cas visant à mieux comprendre la participation au travail de personnes présentant un trouble de la personnalité limite. In M. Corbière & N. Larivière (Eds.), Méthodes qualitatives, quantitatives et mixtes, 2e édition: Dans la recherche en sciences humaines, sociales et de la santé (pp. 89–112). Presses de l’Université du Québec.
Daley, A., Brotman, S., MacDonnell, J. A., & St Pierre, M. (2020). A Framework for Enhancing Access to Equitable Home Care for 2SLGBTQ+ Communities. International journal of environmental research and public health, 17(20), 7533. https://doi.org/10.3390/ijerph17207533
Dorsey, A., Lee, R., Zheng, W., & Fassiotto, M. (2022). Best practices and a working model for promoting inclusion of women in healthcare leadership. Journal of Hospital Administration, 10(6), 12–18. https://doi.org/10.5430/jha.v10n6p12
Downey, S. N., van der Werff, L., Thomas, K. M., & Plaut, V. C. (2015). The role of diversity practices and inclusion in promoting trust and employee engagement. Journal of Applied Social Psychology, 45(1), 35–44. https://doi.org/10.1111/jasp.12273
Facal, J. (2024, February 16). Une nouvelle religion au CHU de Québec. Le Journal de Québec. https://www.journaldequebec.com/2024/02/17/une-nouvelle-religion-au-chu-de-quebec
Ferdman, B. M., & Deane, B. (2014). Diversity at Work: The Practice of Inclusion. John Wiley & Sons. https://doi.org/10.1002/9781118764282
Froese, I. (2025, August 7). Un patient autochtone a été victime de racisme, reconnaissent les autorités après sa mort. Radio Canada. https://ici.radio-canada.ca/nouvelle/2184000/stephen-rockwell-cancer-racisme
Galindo, G. & Surply, J. (2013). Quel processus d’apprentissage de la gestion du fait religieux dans les entreprises françaises ? Management international / International Management / Gestiòn Internacional, 17, 37–49. https://doi.org/10.7202/1015810ar
Gillespie, J. J., Dunsire, D., & Luce, C. B. (2018,). Attaining gender parity: Diversity 5.0 and 10 Best Practices for Global Health Care Organizations. The Health Care Manager, 37(3), 195–204. https://doi.org/10.1097/hcm.0000000000000221
Goldkuhl, G. (2012). From Action Research to Practice Research. Australasian Journal of Information Systems, 17(2), 57–78. https://doi.org/10.3127/ajis.v17i2.688
Josselin, M.-L. (2021, October 1). Joyce Echaquan: le racisme est une des causes de la mort. Radio Canada. https://ici.radio-canada.ca/espaces-autochtones/1828421/coroner-joyce-echaquan-atikamekw-rapport-gouvernement-racisme-lacunes
Kalich, A., Heinemann, L., & Ghahari, S. (2016). A Scoping Review of Immigrant Experience of Health Care Access Barriers in Canada. Journal of Immigrant and Minority Health, 18(3), 697–709. https://doi.org/10.1007/s10903-015-0237-6
Kayingo, G., Bradley-Guidry, C., Burwell, N., Suzuki, S., Dorough, R., & Bester, V. (2022). Assessing and benchmarking equity, diversity, and inclusion in healthcare professions. JAAPA : official journal of the American Academy of Physician Assistants, 35(11), 51–54. https://doi.org/10.1097/01.JAA.0000885184.50730.94
Khuntia, J., Ning, X., Cascio, W., & Stacey, R. (2022). Valuing Diversity and Inclusion in Health Care to Equip the Workforce: Survey Study and Pathway Analysis. JMIR Formative Research, 6(5), e34808. https://doi.org/10.2196/34808
Kline, R. (2019). Leadership in the NHS. BMJ Leader, 3(4), 129–132. https://doi.org/10.1136/leader-2019-000159
Kurzawa, J., Danseco, E., Lucente, G., Huang, C., Sundar, P., & Allen-Valley, A. (2022). Advancing racial equity, diversity, and inclusion in Ontario’s child and youth mental health sector: Perspectives of agency leaders. Canadian Psychology / Psychologie canadienne, 63(4), 500–510. https://doi-org.acces.bibl.ulaval.ca/10.1037/cap0000336
Leslie Dan Faculty of Pharmacy. (2021, December 16). Equity, Diversity and Inclusion Strategic Plan. University of Toronto. https://www.pharmacy.utoronto.ca/sites/default/files/2022-09/EDI%20Report%20FINAL%202.pdf
Lingras, K. A., Alexander, M. E., & Vrieze, D. M. (2023). Diversity, Equity, and Inclusion Efforts at a Departmental Level: Building a Committee as a Vehicle for Advancing Progress. Journal of Clinical Psychology in Medical Settings, 30(2), 356–379. https://doi.org/10.1007/s10880-021-09809-w
Luasa, S. N., Ryan, N., & Lynch, R. (2023). A Systematic review protocol on workplace equality and inclusion practices in the healthcare sector. BMJ Open, 13(3), e064939. https://doi.org/10.1136/bmjopen-2022-064939
Massari, S., Galli, F., Mattioni, D., & Chiffoleau, Y. (2023). Co-creativity in Living Labs: Fostering creativity in co-creation processes to transform food systems. JCOM, 22(3), A03. https://doi.org/10.22323/2.22030203
Ministère de la Santé et des Services sociaux. (2025). Plan d’action à l’égard des personnes handicapées 2024-2025. Bilan 2023-2024. Gouvernement du Québec. https://cdn-contenu.quebec.ca/cdn-contenu/adm/min/sante-services-sociaux/publications-adm/plan-action/PL_24-824-10W_MSSS.pdf
Mor Barak, M. E. (2015). Inclusion is the Key to Diversity Management, but What is Inclusion? Human Service Organizations: Management, Leadership & Governance, 39(2), 83–88. https://doi.org/10.1080/23303131.2015.1035599
Nguyen, M., Dent, R., Fancher, T. L., Soriano, A. J., Green, C. K., & Henderson, M. C. (2023). Revolutionizing Health Professions Admissions to Achieve an Inclusive Workforce. Annals of Family Medicine, 21(Suppl 2), S75–S81. https://doi.org/10.1370/afm.2922
Nishii, L. H., & Rich, R. E. (2014). Creating inclusive climates in diverse organizations. In B. M. Ferdman & B. R. Deane (Eds.), Diversity at work: The practice of inclusion (pp. 330–363). John Wiley & Sons. https://doi.org/10.1002/9781118764282.ch11
North York General Hospital. (2022). Equity, Diversity and Inclusion Framework 2022-2025. https://www.nygh.on.ca/wp-content/uploads/2024/01/NYGH-EDIReport-Final-External-22_LOW.pdf
Paillé, P., & Mucchielli, A. (2012). L’analyse qualitative en sciences humaines et sociales. Armand Colin.
Palmer, C. G., Fry, A., Libala, N., Ralekhetla, M., Mtati, N., Weaver, M., Mtintsilana, Z., & Scherman, P.-A. (2022). Engaging society and building participatory governance in a rural landscape restoration context. Anthropocene, 37, Article 100320. https://doi.org/10.1016/j.ancene.2022.100320
Pearson, A., Srivastava, R., Craig, D., Tucker, D., Grinspun, D., Bajnok, I., Griffin, P., Long, L., Porritt, K., Han, T., & Gi, A. A. (2007). Systematic review on embracing cultural diversity for developing and sustaining a healthy work environment in healthcare. International journal of evidence-based healthcare, 5(1), 54–91. https://doi.org/10.1111/j.1479-6988.2007.00058.x
Pino-Jones, A. D., Cervantes, L., Flores, S., Jones, C. D., Keach, J., Ngov, L. K., Schwartz, D. A., Wierman, M., Anstett, T., Bowden, K., Keniston, A., & Burden, M. (2021). Advancing Diversity, Equity, and Inclusion in Hospital Medicine. Journal of hospital medicine, 16(4), 198–203. https://doi.org/10.12788/jhm.3574
Public Health Agency of Canada. (2020). Social determinants and inequities in health for Black Canadians: A snapshot (Publication No. 200157). https://www.canada.ca/content/dam/phac-aspc/documents/services/health-promotion/population-health/what-determines-health/social-determinants-inequities-black-canadians-snapshot/health-inequities-black-canadians.pdf
Rosenkranz, K. M., Arora, T. K., Termuhlen, P. M., Stain, S. C., Misra, S., Dent, D., & Nfonsam, V. (2021). Diversity, Equity and Inclusion in Medicine: Why it Matters and How do We Achieve it? Journal of Surgical Education, 78(4), 1058–1065. https://doi.org/10.1016/j.jsurg.2020.11.013
Rosetti, I., Bertrand Cabral, C., Pereira Roders, A., Jacobs, M., & Albuquerque, R. (2022). Heritage and Sustainability: Regulating Participation. Sustainability, 14(3), 1674. https://doi.org/10.3390/su14031674
Shahi, A., Karachiwalla, F., & Grewal, N. (2019). Walking the Walk: The Case for Internal Equity, Diversity, and Inclusion Work Within the Canadian Public Health Sector. Health Equity, 3(1), 183–185. https://doi.org/10.1089/heq.2019.0008
Shore, L. M., Cleveland, J. N., & Sanchez, D. (2018). Inclusive workplaces: A review and model. Human Resource Management Review, 28(2), 176–189. https://doi.org/10.1016/j.hrmr.2017.07.003
South-Paul, J. E., Roth, L., Davis, P. K., Chen, T., Roman, A., Murrell, A., Pettigrew, C., Castleberry-Singleton, C., & Schuman, J. (2013). Building diversity in a complex academic health center. Academic medicine : journal of the Association of American Medical Colleges, 88(9), 1259–1264. https://doi.org/10.1097/ACM.0b013e31829e57b0
Stanford, F. C. (2020). The Importance of Diversity and Inclusion in the Healthcare Workforce. Journal of the National Medical Association, 112(3), 247–249. https://doi.org/10.1016/j.jnma.2020.03.014
Tricco, A. C., Bourgeault, I., Moore, A., Grunfeld, E., Peer, N., & Straus, S. E. (2021). Promouvoir l’équité entre les genres en médecine. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 193(18), E664–E671. https://doi.org/10.1503/cmaj.200951-f
Université de Moncton. (2024). Notions clés de l’EDI. https://www.umoncton.ca/edi/node/57
Université Laval. (2026). Concepts clés en EDI. https://www.ulaval.ca/equite-diversite-inclusion/concepts-cles-en-edi
Yin, R. K. (2018). Case study research and applications: design and methods (6th ed.). SAGE.