Inclusive leadership involves intentionally creating environments that are supportive, appreciative, and representative of the various identities within a shared community or workplace. While ensuring diversity is an important factor in fostering inclusivity in bringing people together, it is not the only ingredient to spark creativity, innovation, and community. Inclusive leaders take actions to ensure that every person in an organization can thrive and belong — meaning they are understood, acknowledged, and empowered at work. 

The Center for Health Care Strategies recently connected with Gary Smith, Medicaid director of the U.S. Virgin Islands Department of Human Services Office of Medicaid and Medicaid Leadership Institute alumnus, to learn how his approach to fostering inclusivity has impacted the organizational culture at U.S. Virgin Islands (USVI) Medicaid. During this conversation, Gary shared the value that differences can bring and how inclusive leadership has taken root within the USVI Medicaid agency.

While Gary’s perspective is particularly unique as a Medicaid leader in the Caribbean, the lessons he shares are applicable to leaders across the nation. Regardless of where a Medicaid agency sits in the U.S., there is a wealth of cultures, lived experiences, and other identities beating within the heart of them. Being an inclusive leader allows those differences to thrive — and in so doing, creates a deeper connection to the communities and members served by the program.

Q. How do you approach leadership development in the context of your Caribbean culture in the USVI?

A. We have a very personable culture in the USVI, so my approach to leadership development is person-centered. I like to have face-to-face interactions with staff and request meetings in their office space instead of mine, which can be viewed as reporting to a principal’s office. This can help them show up as themselves in their own environment.

I also like to involve staff in projects I lead, which creates opportunities to participate on projects sometimes outside of their experience and expertise. This means including them in as many spaces as I can — meetings with the federal government, strategic planning and operations meetings, and meetings with vendors. The more they are exposed, the more they can step up and achieve success.

Q. What does inclusive leadership look like in your agency?

A. Our program is separated by water because we have three islands. I encourage staff and managers to travel among the islands to spend time together. I want them to take the time to connect because it is important for collaboration and building camaraderie. This year our focus is on continuity of services for our members. We want there to be no differences in services whether someone goes to a St. Thomas Medicaid office or a St. Croix office. The process, procedures, and experience for members should all be the same. This requires staff to travel to each island and get to know their colleagues on a deeper level so that those programmatic changes for continuity are easier to implement.

Q. How have differences among staff in your agency enhanced the organization?

A. The USVI is very diverse because we have people who migrated — recently and generations ago — from many different islands in the region. With that migration, they brought in cultural norms from places like Saint Kitts/Nevis, Dominica, St. Lucia, Dominican Republic, Haiti, Trinidad and Tobago, and Jamaica, among others. These origin island countries are either independent, or were colonized by the British or the French, which means that their work styles or work ethics may be very different from each other. Similarly, approaches to problem solving and navigating relationships may be different, which creates a unique type of diversity in the workplace. I encourage folks to work things out on their own so they can build camaraderie and cohesiveness amongst the team. Ultimately, each person brings a different style and perspective that helps us better connect to members, who are also very diverse.

Q. Cultural context is an important part of inclusive leadership — how does the Caribbean culture of the USVI affect your inclusive leadership style?

A. We fly the U.S. flag now, but before the USVI became American it was Danish, and we are also situated in the Caribbean. Because of these backgrounds, our culture here is different from U.S. mainland culture and that means leadership styles are different. For example, I’ve observed that some of the islands that were previously governed by European countries tend to be more stoic in their leadership qualities. They call people by their last name, whereas I like to call people by their first name. It’s a difference in style.

We acknowledge and celebrate our differences but also recognize that we are here to ensure that people have access to Medicaid. I emphasize on a regular basis that we are here to ensure quality health care and healthy lives — that is our priority. Sometimes I think we could bring in more professional American culture because we are much more relaxed, but that also means we have very positive and personable relationships with everyone, including our vendors. The diversity among staff also means that many share lived experience of our Medicaid members. This representation offers opportunities for a deeper connection to those we serve.

Q. How have inclusive leadership principles helped you facilitate a meaningful change in USVI Medicaid?

A. One way I see the effects of inclusive leadership is when staff demonstrate leadership and initiate creative solutions without me. We are navigating the public health unwinding, which means increased calls on top of a backlog of cases. Staff created a system where they dedicate time to work on backlogs and new eligibility and enrollment calls are redirected to another person in the agency who has qualified experience, so that eligibility and enrollment inquiries are not missed. It may seem small but seeing that initiative and decision making where I did not need to be involved was huge. I appreciated the empowerment and confidence in their own leadership.

Q. Do you see other creative opportunities to continue to practice inclusive leadership in USVI Medicaid?

A. One thing we do that is unique — because we are a very small agency and have the capacity to do this — is allow members to come to our office for walk-ins. We started this in April 2023 with the hope of improving our interactions with members. Prior to that, we were facing public perception that our program was unhelpful, so we had to think of creative ways to improve our engagement with our members. We’d like to build on this and create more opportunities for staff to be out in the community. I want our members to know that they can approach us — we are a small community. My hope is that strengthening the relationships with our members means members will value our agency and the resources we provide.

Q. What advice would you give to other Medicaid leaders looking to strengthen their inclusive leadership skills?

A. It is important to know and engage with your staff on a deep level. Create opportunities for them to join the spaces that you are most involved in as the Medicaid director. The more participation and inclusion they get to benefit from, the more they can create and cultivate new relationships.