Have you ever heard of “the ketchup question”?

Writer Dexter Thomas explained it well in his story for the Los Angeles Times about tech’s diversity problem, where he starts off asking, “Where do you keep your ketchup?”.

If you’re like most people in the U.S., odds are that you keep your ketchup in the refrigerator. But depending on where you grew up, you might keep it in the cupboard. Imagine that you reach for the ketchup bottle and find it empty. You need a substitute sauce, and you grab whatever is nearby. If that bottle is in the refrigerator, you may opt for mayo. But if it’s in the cupboard, the seasoning closest at hand might be malt vinegar, or Tabasco, or salt and pepper.

A slight difference in perspective can lead a co-worker toward a completely different solution that might never occur to you. That extra perspective could lead to a new idea that could take your company to the top. But without a diverse team, it’s gonna be mayo every time.

The ketchup analogy is traditionally used in the technology industry to communicate the value of diversity. Workforce diversity has been seen as a way for organizations to increase their competitive advantage, improve performance, and ultimately increase organizational sustainability (Roberson, Holmes, & Perry, 2017). However, achieving a diverse workforce and obtaining the potential benefits of diversity is not just about recruiting and hiring a diverse team. To fully experience the benefits of diversity, leaders need to create a workplace wherein members of that diverse team feel appreciated and encouraged to share their perspectives. In other words, they must feel included.

Otherwise, it’ll be mayo every time.

A recent review and meta-analysis found inclusion to be key to channeling diversity into positive organizational outcomes (Mor Barak et al., 2016), however; little is known about how leaders can foster inclusion, particularly in complex organizational systems such as healthcare. Thus, in the current study, “Inclusion is important but how do I include…” I wanted to examine how leaders foster inclusion and whether inclusion was in fact related to innovation.

I collected survey data at three time points six months apart from a highly diverse sample in a nonprofit hospital located in the western region of the United States. As part of the larger study (in forthcoming publications), I also conducted several one-on-one interviews with hospital staff members to get their perspectives on how leaders foster inclusion. In addition, I conducted several organizational observations to better understand what I was hearing in the interviews and what the survey data was trying to tell me.

I sat in employee break rooms and watched who sat next to who. I attended organizational meetings and observed who spoke and who was invited to speak. I observed how various leaders interacted with their employees. And it wasn’t until then that I saw for myself, through organizational observations, what the survey and interview data were saying: leaders who help every organizational member feel valued for who they are as a person, and not just for the job positions they fill, help increase feelings of inclusion.

When employees feel valued for their personal characteristics, and that they are regarded as important members of the team, they are more willing to speak up and share their perspectives with others, which is critical to fostering innovation. When inclusion and innovation work together, employee job satisfaction and quality of care improve.

Based on previous work by Nembhard and Edmonson (2006), I empirically tested whether leader engagement behaviors fostered feelings of inclusion 6 months later. Based on the study findings, I offer the following advice for leaders striving to increase feelings of inclusion among their employees:

1) Encourage everyone to take initiative in critical work-related processes and decision making.

2) Seek the input from members of all educational backgrounds and job positions when making important work-related decisions

3) Express equal value and appreciation for the ideas and opinions given from all organizational members.

When leaders engage all organizational members in critical work-related processes, regardless of individual job positions, this increases feelings of inclusion and the willingness of organizational members to share ideas with one another, thereby fostering an innovative work climate. Inclusion and innovation then worked together to increase employee job satisfaction and perceived quality of care provided to patients.


  • Dr. Brimhall is an Assistant Professor in the Department of Social Work at the College of Community and Public Affairs and a Faculty Fellow of the Bass Center for Leadership Studies in the School of Management at Binghamton University the State University of New York. Dr. Kim Brimhall’s research focuses on improving organizational outcomes and employee well-being through leadership and management that create socially just, equitable, and inclusive work environments. Extensive research shows that organizations who foster an inclusive environment, where everyone feels valued and appreciated, experience the benefits of improved organizational retention, performance, innovation and quality of care offered to clients. In addition, helping employees feel valued increases staff satisfaction, well-being, commitment, and engagement. Thus, Dr. Brimhall’s work focuses on creating tools for leaders and managers designed to foster positive and inclusive work environments.