Cultivating an Inclusive and Engaged Healthcare Workplace: A Systematic Literature Review of Diversity, Equity, Inclusion, Leadership, and Organizational Determinants

Abstract

Background: The health care sector is increasingly acknowledging that diversity, equity and inclusion (DEI) are critical building blocks of a high-performing and resilient workforce. Importantly, this well-articulated institutional commitment to diversity does not always translate into more inclusive and engaged workplace cultures within healthcare organisations–with downstream impacts on their job satisfaction, retention and psychological safety, which ultimately affects patient-care quality.
Purpose: This systematic literature review (SLR) investigates the interplay between diversity, equity and inclusion practices, employee engagement, leadership behaviour and organisational policy to develop engaged and inclusive healthcare workplaces while mapping implementation barriers and research gaps prevalent in this literature.
Methodology: This review is reported in accordance with the PRISMA 2020 reporting guideline (Page, 2021). An automated search was performed through Dimensions. AI bibliometric database (search date: 2 February 2026), which identifies records that contain the constructs of employee engagement and well-being among allied healthcare professions, with publication years from 2005–2025 and document type – journal articles only; results in n = 2500. Following Thomas and Harden (2008), records were screened against pre-specified eligibility criteria (date range 2015–2025, healthcare-workforce context, intersection of a DEI with an engagement/well-being signal or relevant organisational-policy and leadership signals, and workforce-relative rather than patient-only relevance) for thematic synthesis, yielding n = 242 studies.
Results: Though the systematic/integrative review (n = 83) and qualitative (n = 70) study designs were most prevalent, 242 studies were included. Thematic mapping affirms five convergent domains: (1) DEI policy and practice; (2) employee engagement and its reciprocal relationship with perceived inclusion; (3) workforce well-being, the most cited theme (n = 186 studies); (4) leadership styles—inclusive, transformational, strengths based (n = 111 studies); and (5) organisational-policy mechanisms including diversity training, cultural-competence programmes and structured retention strategies to target at-risk groups of employees n=56 studies).
Research Gaps: The cross-sectional, qualitative and review-based study designs predominate in the literature (only 4 RCTs and 4 mixed-methods studies identified); longitudinal evidence on the lasting impact of DEI interventions is scarce; comparisons across cultures and health systems are limited beyond that provided by the Anglophone countries spanning just two continents; and “inclusion” and “engagement” are operationalised inconsistently across studies, limiting comparability.
Future Directions: Future research should emphasise longitudinal, quasi-experimental designs; cross-national comparative studies that move beyond the current high-income Anglophone paradigm; technology-enabled DEI interventions; and integrative models connecting inclusion, psychological safety and workforce mental health.
Practical Implications: Health system managers and policymakers should institutionalise DEI via leadership accountability structures, embed cultural-competence training in continuing professional development (CPD), deploy data-enabled equity audits, and sustain policy alignment with socialisation practices at the frontlines of care to develop durable, evidence-based inclusion policies.