This study aimed to identify whether the recruitment of more culturally diverse employees to a central London based NHS Trust (STAR – acronym used to anonymise this Trust as agreed), has had an impact on workforce performance.
This study adopts a case-study approach to explore the impact of cultural diversity on a NHS workforce, by identifying whether the increase in employee cultural diversity at STAR has rendered the workforce more heterogeneous than it was five years ago (2011), whether this increase in cultural diversity has had an impact on workforce performance.
Evidence to date suggests that this change in employee might had an impact on the performance of the workforce. However, although the indication is that this might be negative, this study aims to investigate whether this is indeed the case and if so, to identify what the ensuing implications might be for STAR in the short and long term.
A mixed method research was adopted, of both qualitative and quantitative methods of primary data collection. Questionnaires were administered to collect the views of the target audience. In addition, some amount of observation was used to analyse change in behaviours amongst employees. Further, secondary data collection of current literature that contained findings on the subject matter were mostly used to provide a review and guideline for the course of study.
Keywords: Cultural Diversity, Group Outcomes, Organisational Effectiveness
ABBREVIATIONS
CIPD – Chartered Institute of Personnel and Development
ISTCs – Independent-sector treatment centres
NHS – National Health Trust
STAR – Acronym used to identify NHS London-based hospital confidentially
UK – United Kingdom
VUCA – Volatile, Uncertain, Complex and Ambiguous
This study is significant and timely because if the effectiveness and performance of this organisation is negatively affected, this could result in an inability to meeting the quality of care of patients in terms national quality standards and deadlines which could prove detrimental to many sick children locally, nationally and internationally. In addition, this will impact the image of the hospital and funding it receives as a result of that image, resulting in grave financial difficulty to keep up with its specialist care it provides.
The aim of this study is to explore the impact of the cross-cultural diversity that has rendered the workforce within STAR, more heterogeneous than it once was in the past and; its effect on the workforce and the ultimate effectiveness of the organisation.
This study aims to explore whether this is indeed the case in addition to the ensuing implications for the hospital. Further, the goal of this dissertation is to identify areas of improvement in research, to build on existing literature regarding the discussion of cross-cultural diversity in order to improve its impact on the organizational behaviour.
The objectives of this dissertation are to –
Questions posed regarding the focus of the study includes –
At a national level, globalisation, immigration and the freedom of movement among new members of the European Union has resulted in people of various cultures and countries into the UK in search of better job opportunities resulting in an increase of diversity in the UK and a more cross-cultural labour market (The Guardian, 2014). England is now more than ever a multi-racial and multi-cultural society and this has had an impact on not only the country’s economy and regulations; but also at the organisational level. In addition, the UK has witnessed a significant change in the gender mix of the labour force with women now making up nearly half accompanied by an increase in part-time working and a general ageing of the working population (Taylor, 2004).
As a result, the UK has adjusted and updated its legal compliance to accommodate the social and equality case of diversity. This is in keeping with the social justice argument which is based on the belief that everyone should have a right to equal access to employment and when employed should have equal pay and equal access to training and development, as well as being free of any direct or indirect discrimination and harassment or bullying (CIPD, 2015). The UK Government have had to incorporate policies and law which take into consideration equal rights and diversity for its citizens and migrant workers which include the Equality Act, Human Rights Act, Sex Discrimination Act, Disability Discrimination Act and the Race Relations Act.
Consequently, the UK’s modern workforce is far more diverse in its composition than it had been in the past. In addition, the structure of the United Kingdom (UK) labour market is rapidly changing as the population is aging, more women are working in organisations and members of different racial and ethnic minorities are moving from country to country (Taylor, R., 2000). Also, the UK has one of the most globally competitive markets, and as such it attracts various people to work in its country. According to the Oxford University Migration Observatory 2015, the share of foreign-born people in total employment in the UK increased from 7.2% in 1993 to 16.7% in 2014.
At the organisational level, the influx of various cultures into the labour market and change of demographics of employees has led to a cross-cultural of employees working together. Consequently, employers have had to adjust policies to allow for equality and diversity in the workplace. This meant that organisations have had to ensure that their policies and practices reflect that all workers be treated equally and given the same set of opportunities regardless of their race, age, gender, sexuality, disability, culture or anything else that might be discriminated against.
In addition to the legal compliance to accommodate the social and equality case of diversity, changes in economics have affected organisations and resulted in changes to its structures, making them more decentralized entities. Therefore, more and more groups of people are placed together, increasing workforce demographic, to work on common goals and objectives within teams of an organisation forming multicultural teams.
These legal and economic changes are still quite a progressing area of management for organisations to comply with as cultural diversity is ever evolving which poses challenges. Therefore, attracting and; retaining and effectively using people with the right cultural skills are increasingly challenging as top priorities of organisations and this continues to pose a challenge when there is a shift in work identity due to changes in demographics such as ethnicity and gender (Cox, T JR. (2001). According to NHS England (2013), the available data show that there are inequalities in both health outcomes and service experience, that have endured over time, despite substantial investment in healthcare. Inequalities are in evident between groups of people with different characteristics, and across geographies.
In keeping with changes at the national and organisational level, over the last two decades (since mid-1990s), there has been a significant growth in the cultural diversity of staff employed in a London based tertiary specialist hospital that reflects the diverse community that it serves (www.goshnhs.co.uk, 2016). This growth is due to factors mentioned above, including globalisation, immigration and the freedom of movement among new members of the European Union.
In turn, this organisation has seen a high rate of turnover during which time highly diverse temporary staff have filled the gap but equally do not remain long term impacting the effectiveness of the workforce performance in this organisation.
In addition, key Personnel have expressed their concerns regarding employees’ ability to work harmoniously with those of cultural difference, which they suggest could make it difficult for them to perform well particularly in today’s VUCA (Volatile, Uncertain, Complex and Ambiguous) environment beset with austerity measures (CIPD, 2014).
STAR identified in its annual report 2015/2016 that one of its top three risks to its operational or strategic plans was the recruitment and retention of sufficient highly skilled staff with specific experience. In which it pointed out that the inability to recruit and retain enough skilled staff could lead to a reduction in services that can be safely provided. In addition, that this risk has the potential reduction which could lead to STAR being unable to accommodate all referrals to the Trust and/or result in longer waiting times.
In response to this, STAR proposed mitigation plan included the use temporary staff to fill vacancies and to monitor the workforce performance indicators accordingly. This brings the research to the issue at hand, in that even though temporary staff is not reflective in STAR’s diversity statistics. There has been a high influx of cross-cultural staff who are being used to fill the gap of the insufficiency of skilled permanent staff which are provided by agencies.
Since one of STAR’s performance objectives is provide the best patient experience and outcome for its patients, it is imperative that staff turnover is kept to a minimum and all areas are fully staffed in order to meet the needs of patient care and deadlines. Therefore, it would be important that cross-cultural interactions between staff are understood and managed to achieve these performance objectives.
STAR is located in the London Borough of Camden which is one of the most diverse places in the country, both housing some the poorest and wealthiest neighbourhoods in London. Camden has a resident population of 225, 140 people as of 2013 of which 17% of its residents are below are between the ages of 0-17 years (39,300 children). In addition, Camden is home to a diverse variety of ethnicities and cultures; nearly 35% of Camden’s overall population are estimated to be from a black minority ethnic group (BME) background. This figure excludes the White Irish community and other non-British white residents. 22% of Camden’s residents are from the non-British, white community (Camden.gov.uk, (2016).
The hospital in question is a tertiary level hospital for children which means that they largely provide third-level specialist care. Primary care generally consists of frontline services such as GPs and dentists, while secondary care is offered by local hospitals. However, tertiary level care is done at specialist hospitals. Therefore, this hospital provides a range of specialist paediatric services to local, national and international patients. Around half of their patients come from outside of London and some are transferred from within Europe and other international destinations for second opinions and treatment. Therefore, it is important to note that at this stage the patients seen are really sick and more than often the parents dealing with their appointments are fragile.
The department within this hospital which is being interviewed is crucial to the administration of the hospital as it is the first point of contact for service users and it sets the service tone as to the level of service one is to expect when using the services of the hospital. It is also central department within the hospital which means that all other departments constantly communicate with and utilise their service to facilitate the smooth running of clinics, making it crucial to the performance of the organisation.
This administrative arm is composed of the hospital also has set service standard goals in the turnaround time in which patients are to be communicated with and therefore the cohesiveness of the group which work together on common goals is crucial to the performance of the hospital. Views and perceptions of the impact of cultural diversity of staff cohesiveness is important to monitor as it may have a direct effect on variables such as staff morale which can lead to absenteeism. If cultural diversity has an effect on the homogeneity of the group it is important to know to what level and if negative or positive, so that measures could be put in place to manage team diversity better as this may affect the patient-care experience.
According to Allen, P and Jones, L (2011), before the introduction of the National Health Service (NHS) in 1948, there was a patchwork of public, private and voluntary provision. Since the establishment of the NHS, when hospitals were nationalised, most of the organisations providing health care to NHS patients have been state-owned. NHS hospitals and commissioners have used spot contracting (i.e., ad hoc arrangements negotiated locally) with the private sector in order to reduce NHS waiting times and the number waiting.
Over the past two decades, there has been a marked shift in government policy to introduce a wider diversity in the organisations providing services to NHS patients. This was formally recognised in 2000, when the government entered into a so-called concordat with private providers. This allowed NHS commissioners to negotiate locally with private providers for a range of services, including elective surgery and primary care.
From about 2002, a more systematic approach was taken to introducing more competition into the NHS. As part of this move, there was an explicit decision to increase the diversity of types of providers offering services to NHS patients, including organisations from the independent sector for-profit and not-for-profit, and third-sector organisations. Most prominent in this policy was the nationally led process of procurement of a number of independent-sector treatment centres (ISTCs) to provide high-volume, low-risk elective surgery to NHS patients.
The government also encouraged for-profit providers to supply primary care services, with the intention of increasing capacity in areas with an insufficient number of GPs, a process that saw for-profit firms and social enterprises gain NHS GP contracts.
NHS foundation trusts were set up in 2004. They were conceived as a new kind of public organisation, still part of the NHS but modelled on co-operative and mutual traditions. They are different from other NHS trusts in two distinct ways:
Foundation trust policy thus contains two mechanisms intended to improve performance:
The NHS England is now the public health service of England and Wales is the UK largest employer; employing over 1.3 million staff (NHS Jobs (2016). Therefore, its staff serves people from all genders, cultures, faith, nationalities and other backgrounds. In addition, in specialist hospitals such as STAR, there is even the transfer of patients from other countries for urgent care and second opinions.
According to statistics provided by STAR in the tables attached (Appendix II) there has been high level of increase in growth in the diversity of its staff. In addition, it is evident based on STAR’s strategic objectives/priorities, there are issues around attracting and retaining staff with the right skills.
According to STAR’s annual report 2015/216 the key outcomes which they aim to deliver from their business model are –
• Clinical outcomes – world-class clinical outcomes for our specialised services.
• Patient and family satisfaction – high levels of patient satisfaction with our services.
• Research translated into clinical practice – new and innovative specialist treatments for children with complex or rare diseases.
• Education – the largest programme of specialist paediatric training and education in Europe.
• Financial – financially sustainable activities with the contribution from our private patient business supporting investment in developing our services.
• Reputation – a hospital for the NHS to be proud of with a worldwide reputation for excellence in providing specialist healthcare for children.
In keeping with the Equality Act 2010, STAR states that it has due regard for the following of strands of public sector equality duty and have reviewed their policies and practices to reflect this –
In addition, STAR states that equality data helps the organisation to better understand the impact of their policies and practices may have on their patients, families and staff and as a review tool to improve as well as examples of good practice.
As a corporate strategy STAR has set itself specific and measurable equality objectives which are publicly published and uses the NHS Equality Delivery System (EDS) to ensure they are meeting the requirements of the Equality Act 2000. Further, STAR utilises the Family Equality and Diversity group and the Staff Equality and Diversity group as a means of monitoring progress towards our specific equality objectives and taking forward the Trust’s equality agenda.
STAR reflects an ethos of togetherness by reflecting on its values as ‘always be one team’(www.gosh.nhs.uk, 2016).
The National Health Sector, England is always under scrutiny to ensure that their services offered are of the best quality. This is due to the fact that government funding needs to be justified and also because the nature of the service, people’s lives are at risk which incurs service quality regulations. In 2014, the NHS net expenditure has increased to £113.300bn in 2014/15 from £64.173 billion in 2003/04 (NHS Confederation, 2016). This means that accountability of financial expenditures will be highly scrutinised. The homogeneity of the groups is essential to ensuring the quality of the service is on par with quality standards set. The benefits of cultural diversity to the service standards is that it allows for a wider service range in terms of the collection of skills and experience such as languages and cultural understandings. However, the negative side of this is if there are cultural barriers which affect performance areas such as communication resulting in in ability to meet key objectives and lack of teamwork or low staff morale.
In addition, the management of cross-cultural diversity amongst staff at STAR is crucial to the level of service or patient experience received who access their services. This is in keeping with NHS’ mandate to deliver a person-centred, safe and effective care health services. The impact of cross-cultural diversity in the health sector has a direct effect on the staff who care for patients, or relate to patients in one way or the other. In other words, any impact that may affect the cohesiveness of a group of professionals will have a direct or indirect effect on the public’s care. On a positive note cultural diversity can increase adaptability to cultural difference in patients seen however, negatively it can equally cause a breakdown in the quality of care received.
As well as the quality of care, there is the issue of reputability and image. According to CIPD (2015), Healthy businesses flourish in healthy societies where the needs of people, communities and businesses are interrelated. For this reason, in keeping with the principles of equality and inclusion, NHS has a mandate to reflect the communities they serve (NHS Leadership Academy, (2015). Therefore, it is important that the diversity of the workforce within NHS represents the diversity of the patients and as such, groups of people are placed to work together on common goals in NHS sites. However, over the years, the dynamics of these settings have dramatically increased in complexity affecting the integration of people with different social or cultural identities who must be integrated into the teams.
In organisations, intercultural dimensions cannot be avoided and cultural differences influence the team members’ behaviour in cross-cultural groups. People with different cultural backgrounds, working together, may bring creativity, new ideas in the projects collaboration and new approaches to problem solving. However, equally, unmanaged diversity in the workplace might become an obstacle for achieving organizational goals. If there is a negative correlation between cross-cultural diversity and performance, such as low staff morale and absenteeism, which can result in HR issues and even ethical issues if service time frames are not met.
The second chapter of this dissertation draws on relevant theoretical concepts regarding culture, staff performance and organisational learning. To gain greater understanding of the implication of employees of diverse cultural background in an NHS London based Trust. Chapter three provides insight into the research approach adopted for this study, the data collection methods, target audience, duration of the study and the research limitations. Chapter four presents the research findings and an analysis of these findings as a means for identifying whether a culturally diverse workforce is a performance driver or resister. This is followed by conclusions to explore the implications of the study, prior to concluding the recommendations chapter.
In order to examine the subject matter of how cultural diversity can potentially affect workforce effectiveness and ultimately their organisational effectiveness, this research will now move on to examine existing literature of past findings of cultural diversity and its impact on organisational efficiency and performance. In so doing, this literature review chapter draws on relevant diversity and cultural theories and concepts of diversity and culture as a means to give a theoretical underpinning of this study.
The intention is to draw on Insights provided from the literature to gain greater understanding of the significance of diversity in the workplace, the implications of culture on cultural teams and its relevance to team-working relationships and business performance.
To follow in the subsections will firstly be an exploration of the theoretical underpinnings of cultural diversity and its relevance to this research. Secondly, the definition of key terms such as diversity and culture will be examined and its effect on workforce and organisational effectiveness and performance. thirdly, the concept of inclusivity in diversity will be touched on. This section will conclude a review of another study of diversity in the NHS and any gaps in the literature.
As a result of the flood of interest in teamwork in modern organisations, a surge of theories and models investigating the effect of cross-cultural teamwork have submerged. However, dominant studies conducted in the field include Hosfstede(1980 & 1983), Hall and Reed Hall (1990) and Hamden-Turner and Trompenaars (2000). (See Table I overleaf)
Geert Hofstede and Fons Trompenaars have conducted two leading studies of cross-cultural management which both proposes a set of cultural dimensions. The two sets of dimensions reflect basic problems that any society has to cope with but for which solutions differ (Anbari, F. T Et al. (2003).
Geert Hofstede described four ways that can help in analysing and understanding other cultures as follows: –
TABLE I: Summary of theorists who have analysed Cultures
| Hofstede (1983), Hofstede, (1980) | |
| Power Distance | Acceptance of differences in hierarchical status. Differences in perceptions and acceptance of individuals concerning their supervisor’s leadership style (autocratic vs. consultative). |
| Uncertainty Avoidance | An individual’s motivation to keep away from uncertainties and changes. Degree of anxiousness during work, tendency to obey rules and tendency not to quit employment. |
| Individualism (Collectivism) | Importance of leisure time, independency from one’s company, and own activity. |
| Masculinity/ femininity | Importance of income, recognition, and advancement vs. importance of cooperation and safety. In masculine societies differences between masculine and feminine values differ more strongly between males and females. |
| Hall and Reed Hall (1990) | |
| Context | Implicit (high context) or explicit (low context) use of language. Direct vs. indirect transfer of information. |
| Space | Amount of space needed by individuals to feel comfortable in interactions with others. |
| Time (monochronic vs. polychronic) | Sequential (monochronic) execution of tasks vs. simultaneous (polychronic) execution of tasks. |
| Hamden-Turner and Trompenaars (2000) | |
| Universalism/ Particularism | Whether rules apply to everybody in a society in the same way (universalism), or whether the application of rules depends on one’s status, friendships or loyalty (particularism). |
| Individualism/ Collectivism | Tendency of people to align their actions only with their own interest (individualism) or with the goals of their group (collectivism). |
| Affectivity/ Neutrality | Degree to which it is accepted to express emotions. Tendency to control emotions (neutrality vs. tendency to express emotions (affectivity). |
| Diffuse/ Specific | Degree to which private life is separated from work life. |
| Achieved Status/ Ascribed Status | Whether the status of an individual derives from his/ her performance (achieved status) or whether it derives from his/ her heritage (ascribed status). |
| Relationship with time | Sequential use of time vs. synchronic use of time. Also, orientation of a society towards it’s future, past, or present. |
| Relationship of humans towards nature | Whether individuals believe to control nature or whether they feel controlled by nature is mirrored in their goal orientation. People who control their environment will meet deadlines and define specific goals in contrast to people who consider their actions influenced strongly by the environment. |
Source: INTERNATIONAL JOURNAL OF BUSINESS STRATEGY, Volume 8, Number 2, 2008
Alderfer’s (1987) theory of intergroup relations posits that the distribution of power among cultural identity groups, both inside the organization and in the larger society, is key to how people think, feel, and behave at work.
Horwitz & Horwitz (2007) posits that in keeping with the similarity–attraction perspective given the opportunity to select another member to interact within a group, individuals have a tendency to select persons who are similar to themselves as homogeneous teams work well together because of their shared characteristics, thereby increasing team cohesion and performance.
Proponents of status characteristics theory argue that much of what we think of as the effects of membership in particular identity groups, such as race or sex, are in fact produced by the status value our society ascribes to those groups.
Culture is multifaceted concept in that it is manifested both in individual members’ attitude and behaviour and also in macro-social or institutional level. Culture is also a dynamic concept as it’s developmental and continual in nature. Therefore, there is no single all-encompassing definition of culture due to its complexity. Although culture operates at multiple levels of analysis, this research is concerned primarily with how cultural diversity relates to organizational behaviour of the workforce.
Hofstede, (1984) posits that culture is the collective programming of the mind which distinguishes the members of one human group to another. This definition implies that the group is programmed to perceive the world in certain way and has a shared meaning which holds them together. Also, this definition implies that culture is learned and the basis for socialisation which allows for norms and behaviour to be learned. Further, Hofstede’s definition implies that culture is relative, therefore no one group is superior to another (Browaeys, M-J & Price, R, 2015)
Shein (1990) developed the definition of culture and defined organisational culture as –
a pattern of basic assumptions, invented, discovered, or developed by a given group as it learns to cope with its problems of external adaptation and internal integration; that has worked well enough to be considered valid and, therefore is taught to new members as the correct way to perceive, think, and feel; in relation to chosen problems.
Whatkins, M (2013) posits that culture us multi-faceted in nature and can be known to be –
consistent, observable patterns of behaviour in organizations.
powerfully shaped by incentives.
a process of “sense-making” in organizations. Sense-making has been defined as “a collaborative process of creating shared awareness and understanding out of different individuals’ perspectives and varied interests.”
a carrier of meaning. Cultures provide not only a shared view of “what is” but also of “why is.” In this view, culture is about “the story” in which people in the organization are embedded, and the values and rituals that reinforce that narrative.
a social control system. in this definition of culture is the idea of behavioural “norms” that must be upheld, and associated social sanctions that are imposed on those who don’t “stay within the lines.”
a form of protection that has evolved from situational pressures. In other words, it rejects misfits of its culture. However, the problem here is it attacks change agents and with implications for the integration of people.
is dynamic. They shift, incrementally and constantly, in response to external and internal changes. Culture change can be managed as a continuous process rather than through big shifts therefore, culture of the organization should always be learning and developing.
Gelfand, M. J. et.al (2007) defines cross-cultural organizational behaviour as the study of cross-cultural similarities and differences in processes and behaviour at work and the dynamics of cross-cultural interfaces in multicultural domestic and international contexts. It encompasses how culture is related to micro organizational phenomena (e.g., motives, cognitions, emotions), meso organizational phenomena (e.g., teams, leadership, negotiation), macro organizational phenomena (e.g., organizational culture, structure), and the interrelationships among these levels.
The term cultural competence, also known as cross-cultural or intercultural competence, has come into increased use in recent years, particularly in the health industry, where it has been defined as:
A set of congruent behaviours, attitudes and policies that come together in a system, agency, or amongst professionals and enables that system, agency or those professionals to work effectively in cross-cultural situations … A culturally competent system of care acknowledges and incorporates—at all levels—the importance of culture, the assessment of cross-cultural relations, vigilance towards the dynamics that result from cultural differences, the expansion of cultural knowledge, and the adaptation of services to meet culturally-unique needs (Cross et al. 1989).
Cross (1989) posited from the definition above that cultural competence is a process which a system can measure its progress according to the agency’s achievement and specific developmental tasks. Therefore, guided towards progressively more culturally competent services.
Cross (1989) goes on to state that a system of care is strengthened when it values diversity. Appreciating differences are just as important as similarities. in the system of care, awareness and acceptance of differences in communication, life, view, and definition of health and family are critical to the successful delivery of services.
In addition, cultural competence refers to an ability to successfully negotiate cross-cultural differences in order to accomplish practical goals and has four major components: Awareness, attitude, knowledge, and skills. (Diversity Offer Magazine)
Browaeys, M-J & Price, R, (2015) posits that the key dimensions of culture can be ascertained from the work of anthropologists Kluckholn and Strodtbeck who developed a comparative model with six cultural dimensions (see table III). These are –
In addition, Hofsted and Trompenaars posited that there a set of cultural dimensions which affect human thinking, feeling and acting, and the behaviour of organisation in predictable ways (Anbari, F. T. et al (2003). The dimensions can be grouped into the following categories –
Subsequently, Aycan et. Al proposed two additional dimensions which were called socio-cultural –
As the dimensions of diversity may intertwine to produce unique synthesis of human profiles, made up of both differences and similarities. They interact with and influence one another, and emerge differently in different contexts, environments and circumstances, making analysis and management complex. The position and dominance of each dimension are not static, but dynamic, making the concept of diversity and diversity management more complex (Rijamampianina, R & Carmichael, T, (2005).
Graph I: The key dimensions of culture
Source: Browaeys, M-J & Price, R, (2015)
Taylor Cox, JR (2001) defines diversity as the variation of social and cultural identities among people existing together in a defined employment or market setting. This definition implies that social and cultural identity refers to the personal affiliations with groups which influence on people’s major life experiences, whilst employment and market settings would include work teams, churches and schools. In addition, Stevens, F et al., 2008 defines diversity as the degree to which a workgroup or an organization is heterogeneous with respect to personal and functional attributes.
van Knippenberg & Schippers, (2007) goes on to define Workgroup Diversity as the degree to which the differences between group members may affect group process and performance positively as well as negatively. Therefore, even though the results of diversity add value to organisational performance, the effects within teams & groups indicate that diversity can have both positive and negative effects. Mazur, B & Białostocka, P (2010) posits that these effects of diversity can be perceived as a “double-edged sword”.
According to Mazur, B & Białostocka, P (2010)the multiplicity of dimensions of diversity are inexhaustible however, three main dimensions emerges: primary, secondary and tertiary dimensions (see Table II overleaf). Primary dimensions have the most impact on groups in the workplace and society by exerting primary influences on our identities and include gender, ethnicity, race, sexual orientation, age and mental or physical abilities; and characteristics. Secondary dimensions diversity is less visible and apply a more variable influence on personal identity and impact our self-esteem and self-definition and include educational background, geographic location, religion, first language, family status, work style, work experience, organizational role and level, income and communication style. Tertiary dimensions are often the core of individual identity and lie deeper below the surface. It is the vast array of qualities that lie beneath the surface that provides the real essence of diversity to be tapped into, and these have not until recently been acknowledged. Tertiary dimensions include beliefs, assumptions, perceptions and attitudes.
TABLE II: Dimensions of Diversity
Source: Mazur, B & Białostocka, P (2010)
Taylor Cox, JR (1994) defines cultural diversity as the representation in one social system, of people with distinctly different group affiliations of cultural significance. In addition, O’Reilly & Williams (1998) states that a group is diverse if it is composed of individuals who differ on a characteristic on which they base their own social identity. Therefore, cultural diversity in the workforce can be regarded as dissimilar values and behavioural norms in a group resulting from the individual’s social or cultural identity.
Amadeo, K (2015), posits that cultural diversity is when differences in race, ethnicity, language, nationality, religion, and sexual orientation are represented within a community.
Further, Cultural diversity refers to the differentials of cultural classifications/ dimensions such as by Hofstede, e. g. low vs. high individualism, low vs. high power distance and low vs. high uncertainty avoidance.
Organisations are realising that workforce diversity is a fact and the reality of which has the ability to enhance their products and services, as well as negatively affect group processes and performances; and unmanaged diversity in the workplace might become an obstacle for achieving organizational goals. Therefore, diversity can be perceived as a “double-edged sword”.
However, there has been a limited research examining the impact of diversity on the interactions within and performance of workgroups or teams and within that limited evidence it shows that different types of diversity have different effects (CIPD, 2004).
Graph II: the effects of diversity on group processes and outcomes.
Source: Kochan, T. et. al. (2003)
Previous research on workplace diversity suggests that diversity can be either harmful or beneficial for employee performance (Williams and O’Reilly, 1998). Taylor Cox, JR (2001) examined theimpact of diversity on identity group memberships, such as race and sex and posited that the increase in workforce diversity enhances work group effectiveness.
Hofstede’s posited that every person has but cultures which causes the complexity of the term. In addition, culture is dynamic in nature and may change over time and this change may also lead to conflict. Conflict may occur in any kind of social interaction and among cultures might face problems of intercultural miscommunication and misunderstanding. In addition, culture may work as a link between what we call “an individual identity” to “collective ones” (Kawar, T. I. (2012).
In addition, Team members’ attitude towards diversity will influence innovation and performance. In this line Harrison et al. (2002) posits that the actual perceptions of diversity have an effect on diversity-related outcomes. However, there is still lack of insightful empirical studies about experiences of perceptions of diversity and its impact on workforce of cross-cultural teams. As a part of cultural diversity, one must consider cultural sensitivity as the choice of right team members in terms of personalities and experiences is crucial as is the team members’ intercultural training, which is regarded to increase performance.
According to Horwitz & Horwitz (2007), there are two competing perspectives often cited in the team literature, namely, the cognitive diversity hypothesis and the similarity–attraction paradigm, as they provide the most insights into team diversity variables and their potential effects on team outcomes. Several researchers using the theoretical arguments of the cognitive diversity hypothesis, have argued that team diversity has a positive impact on performance because of unique cognitive attributes that members bring to the team. Ultimately, cognitive diversity among heterogeneous members promotes creativity, innovation, and problem solving, and thus results in superior performance relative to cognitively homogeneous teams.
On the other hand, researchers taking either the similarity–attraction paradigm or the social identity theory in examining teamwork often conclude that member heterogeneity has an adverse impact on team outcomes. In light of this, researchers argue that varying member characteristics such as age, ethnicity, and expertise can be easily categorized by individual members and are negatively associated with team outcomes, particularly, the similarity–attraction perspective has argued that given the opportunity to select another member to interact within a group, individuals have a proclivity to select persons who are similar to themselves. Furthermore, homogeneous teams work well together because of their shared characteristics, thereby increasing team cohesion and performance (Horwitz & Horwitz (2007).
Further, Mazur, B & Białostocka, P (2010) stated that diversity can affect an organization’s functioning through four types of mediating variables – affective, cognitive, symbolic and communication. The affective effects refer to involvement, satisfaction, identification, role conflict, role ambiguity, perception of discrimination and social integration. The cognitive effect, or the ability of a group to put together information, process it, react to it and then reach conclusions. the symbolic effects – A heterogeneous staff can be a symbol of a socially just organisation for interested parties both inside and outside the organisation. Communicative effects. Communication patterns within a heterogeneous group tend to be more formal and less frequent.
Furthermore, Martin, G. C (2014) and CIPD (2004) posited that cultural diversity can affect the workplace in numerous ways, both positive and negative. Negative effects of diversity in the work place include –
Positive effects if diversity in the workplace include –
Graph III: An interactional model of the impact of diversity on individual career outcomes and organizational effectiveness
Source: Davidson, M.J & Fielden, S.L (2003)
Horwitz & Horwitz (2007) states that team performance is a multidimensional construct that encompasses several outcome measures such as quantitative production, qualitative team outcomes, and team cohesion. However, Horwitz & Horwitz (2007), alluded to three strategic domains of team outcomes associated with diversity: quality, quantity, and social integration –
Horwitz & Horwitz (2007) posits that in keeping with the similarity–attraction perspective given the opportunity to select another member to interact within a group, individuals have a tendency to select persons who are similar to themselves as homogeneous teams work well together because of their shared characteristics, thereby increasing team cohesion and performance.
Mazur, B & Białostocka, P (2010) posits that organisations need tofocus on diversity and look for ways to become totally inclusive organizations because diversity has the potential of yielding greater productivity and competitive advantages.
There are key gaps in knowledge of the business effects of the types of diversity in relations to customer relations, costs and organisational performance (CIPD, 2004). There is a lack of research of the impact of diversity upon customer relations and its implications for sales and communication. Similarly, there is limited evidence of costs relating to certain types of informational diversity such as the costs of managing social category diversity.
In addition, at the workgroup level, even though the impact of diversity on organisational performance has been explored it was done only in relation to top management composition. Therefore, the impact of work diversity upon overall business performance is still unexplored (CIPD, 2004).
According to research carried out by Roger Kline, Research Fellow, Middlesex University Business School, there is increasingly robust evidence that a diverse workforce in which all staff members’ contributions are valued is linked to good patient care.
This report was considered the extent of the gap between the diversity apparent in the workforce and the local population, and that visible among Trust leaderships and senior management within NHS Trusts in London. This research stemmed from the growing evidence about the impact of staff diversity on the effectiveness of healthcare provision and patient experience. Focus of the research was ethnicity around the absence of the black and minority ethnic (BME) staff for senior roles; and the under-representation of woman in the NHS.
Findings concluded that there was a continuing pattern of underrepresentation of BME executive appointment compared to both the workforce and the local population. Whilst the white staff in London are three time more likely to get hired in an executive post. In addition, findings show that the proportion of women are still underrepresented on NHS boards (Kline, R (2014).
This research evidence suggests that there may well be an adversely impact on the provision of services across the capital and denies the NHS the potential contribution a diverse leadership could make (Kline, R (2014).
The main objective of this research is to analyse the effect of cultural diversity on the workforce effectiveness. In order to explain the approach of this research, the purpose of this chapter is to lays out the research design and techniques, the data analysis strategy and method employed. Finally, the, this chapter examines the ethical considerations but also the validity, reliability and limitations of the research method chosen.
This research employed a mixed method approach which combined a mixture of primary and secondary research methods.
The research was quantitative and was carried out in the form of a structured online questionnaire of managerial and non-managerial teams. This approach was chosen as it allows for large number of completed questionnaires with less time away from busy work schedules. As staff have access to their emails away from the office, this allowed for completion even on the go from smart devices. Also, it allows for verbal feedback which some may find difficult giving in writing. Further, answering questions in person allows for a better feeling of anonymity as there are no physical evidence of filling forms themselves.
The Literature review was used to draw on existing research carried out in this field of organisational behaviour. Academic and business journals were mostly accessed online through various databases. Online books available through the university library was also used to gather information regarding cross-cultural diversity in the workplace.
There were a few informal interviews with staff to gather views and perceptions on the group and organisational culture; and cultural diversity of the team. This also allowed for a few areas to be polled in the questionnaire.
Informal observations were made around staff attitude and awareness of diversity within the workplace over a six months’ period. This was not officially documented but influenced the choice of questions in online questionnaire to be more relevant to this staff group.
The targeted industry was the health sector within the London borough of Camden. The target population for this research were employees within the central administrative arm of a tertiary hospital. The target population was chosen as a complete department of staff and primary research was carried out over a 4 weeks’ period.
The main areas of research are demographics of staff, perception of organisational culture, perception of the impact of cultural diversity on performance, views of organisational diversity; and perception of cultural diversity in the workplace. A comparative analysis was carried out on the non-managerial staff and managerial staff as well as other demographic variables such as gender, age and tenure of a team, working towards mutual goals of the department.
Overall 98 employees were approached through electronic link to the survey however 50 surveys were completed.
This research was carried out in the form of structured surveys which were all multiple choice answers. This approach was taken because it is easily replicable, and possible to compare the results with surveys that have been previously undertaken. Respondents were not in physical proximity of the researcher and this allowed for anonymity and answers of a more honest nature. CIPD (2009) posited that when both structure and detachment are achieved, data generated can be analysed to identify relationships between different variables.
In addition, this design of questionnaire was chosen as suitable since it allows for completion at respondents own time and in their own format. The link allowed for completion at any location to internet access and there was also the option of printing in hard copy. Further, the results from this can be analysed in a quantitative manner. This was done using a survey website which allowed for the easy collection and storage of responses from multiple respondents at once.
Finally, given the sensitive nature of the industry in which these employees work and the global reputation of the organisation, answering questions through an anonymous electronic questionnaire allows for a better feeling of anonymity as there are no physical evidence or paper trail of filling forms themselves.
There will be some amount of limitation in using structured questionnaires as feedback as this did not allow for in depth answers. Also, some interviewees may be better at expressing themselves in verbally.
In addition, as the questionnaire was completed online, this allowed for a more delayed approach to completing questionnaires within suitable timeframes. Some employees took the approach that there was no paper waiting to be completed and that they can do it whenever they felt like. This resulted in the researcher’s time in following up with everyone as due to its anonymity there was no way of tracking who had completed it so far.
Further, even though structured questionnaires save time and is easy to compare data, some of the multiple choice answers fail to allow for feelings, meanings and interpretations attributed to employees in relation to their organisation when seeking out perceptions.
The following is an analysis of the key findings in relation to my objectives set for this research. Collected data was analysed using SSPS software and data represented in graphs, charts and tables for better understanding and interpretation.
Table I: STAR’s staffing March 2014 – March 2016 (figures include Bank and Agency staff)
Source: STAR’s Operational Plan Document for 2014-16
| Total Workforce | Non-clinical staff | Administrative & Clerical Staff | Total number of respondents |
| 3765.3 | 909.7 | 98 | 50 |
| 100% | 24.16% | 2.60% | 1.33% |
Of the total non-clinical staff, 98 are clerical and administrative. Therefore, the survey sample represents 51% of the total staff in the administrative and clerical arm of STAR’s workforce under research.
Table II: Gender of respondents
| 1.1 Gender | |||||||||
| Answer Choice | Response Percent | Response Total | |||||||
| 1 | Male | 20.0% | 10 | ||||||
| 2 | Female | 80.0% | 40 | ||||||
| 50 | |||||||||
| Mean: | 1.8 | Std. Deviation: | 0.4 | Satisfaction Rate: | 80 | ||||
| Variance: | 0.16 | Std. Error: | 0.06 | ||||||
Table II shows the gender distribution of the respondents. Female respondents constituted 80% of the total respondents, while 20% were male respondents.
Table III: Age of respondents
| 1.2 What is your age? | |||
| Answer Choice | Response Percent | Response Total | |
| 1 | 18 to 24 | 6.0% | 3 |
| 2 | 25 to 34 | 34.0% | 17 |
| 3 | 35 to 44 | 36.0% | 18 |
| 4 | 45 to 54 | 22.0% | 11 |
| 5 | 55 to 64 | 2.0% | 1 |
| 6 | over 64 | 0.0% | 0 |
| 50 | |||
| Mean: | 2.8 | Std. Deviation: | 0.92 | Satisfaction Rate: | 36 |
| Variance: | 0.84 | Std. Error: | 0.13 | ||
Table III shows the age characteristics of the respondents. 36% are within the 25 to 34 age group, whilst cumulatively, 70% are between 25-44 age group. The data shows that a relatively high proportion of the respondents are in their active productive years.
Table IV: Ethnic compositions of respondents
| 1.3 What is your ethnicity? | ||||||||||
| Answer Choice | Response Percent | Response Total | ||||||||
| 1 | White | 0.0% | 0 | |||||||
| 2 | British | 4.0% | 2 | |||||||
| 3 | Irish | 0.0% | 0 | |||||||
| 4 | Any other White Background | 8.0% | 4 | |||||||
| 5 | Asian or Asian British | 0.0% | 0 | |||||||
| 6 | Indian | 4.0% | 2 | |||||||
| 7 | Pakistani | 2.0% | 1 | |||||||
| 8 | Bangladeshi | 2.0% | 1 | |||||||
| 9 | Any other Asian background | 8.0% | 4 | |||||||
| 10 | Mixed | 0.0% | 0 | |||||||
| 11 | White and Black Caribbean | 0.0% | 0 | |||||||
| 12 | White and black African | 0.0% | 0 | |||||||
| 13 | White and Asian | 0.0% | 0 | |||||||
| 14 | Any other mixed background | 18.0% | 9 | |||||||
| 15 | Black or Black British | 0.0% | 0 | |||||||
| 16 | Caribbean | 24.0% | 12 | |||||||
| 17 | African | 18.0% | 9 | |||||||
| 18 | Any other black background | 12.0% | 6 | |||||||
| 19 | Other Ethnic Group | 0.0% | 0 | |||||||
| 20 | Chinese | 0.0% | 0 | |||||||
| 21 | Any other Ethnic Group | 0.0% | 0 | |||||||
| 50 | ||||||||||
| Mean: | 13.24 | Std. Deviation: | 4.89 | Satisfaction Rate: | 61.2 | |||||
| Variance: | 23.94 | Std. Error: | 0.69 | |||||||
Table IV shows the ethnic composition of respondents. Cumulatively, the majority of respondents were from the Black background totalling 54% between Caribbean, African and any other black background. Whilst, the least amount of respondents was from the White background totalling 12% between British White and any other white Background.
Table V: Highest level of education qualification completed by respondents
| 1.4 What is the highest level of Educational Qualification you have completed? | |||
| Answer Choice | Response Percent | Response Total | |
| 1 | GCSE or equivalent | 10.0% | 5 |
| 2 | As Level or equivalent | 2.0% | 1 |
| 3 | A’ Level or equivalent | 28.0% | 14 |
| 4 | Undergraduate degree or equivalent e.g BA or BSC | 38.0% | 19 |
| 5 | Master’s Degree or equivalent e.g. MA or MSC | 22.0% | 11 |
| 6 | Doctorate or Research Degree e.g. PHD | 0.0% | 0 |
| 50 | |||
| Mean: | 3.6 | Std. Deviation: | 1.15 | Satisfaction Rate: | 52 |
| Variance: | 1.32 | Std. Error: | 0.16 | ||
Table V shows the highest level of education qualification completed by respondents. Commutatively, 60% have attained an Undergraduate or Master’s degree, whilst 12% have attained GCSE or equivalent; and As Level or equivalent.
Table VI: Tenure of respondents
| 1.5 How long have you been employed at STAR? | |||
| Answer Choice | Response Percent | Response Total | |
| 1 | 0 – 2yrs | 54.0% | 27 |
| 2 | 2 – 5yrs | 22.0% | 11 |
| 3 | 5 – 10 yrs | 14.0% | 7 |
| 4 | more than 10 yrs | 10.0% | 5 |
| 50 | |||
| Mean: | 1.8 | Std. Deviation: | 1.02 | Satisfaction Rate: | 26.67 |
| Variance: | 1.04 | Std. Error: | 0.14 | ||
Table VI shows that accumulatively, 76% of the respondents have worked with the STAR for 0-5years, while 10% have worked with STAR for more than 10years.
Table VII: Respondent’s length of time in current job role
| 1.6 How long have you been employed in your current job role? | |||
| Answer Choice | Response Percent | Response Total | |
| 1 | 0 – 2yrs | 60.0% | 30 |
| 2 | 2 – 5yrs | 26.0% | 13 |
| 3 | 5 – 10 yrs | 6.0% | 3 |
| 4 | more than 10 yrs | 8.0% | 4 |
| 50 | |||
| Mean: | 1.62 | Std. Deviation: | 0.91 | Satisfaction Rate: | 20.67 |
| Variance: | 0.84 | Std. Error: | 0.13 | ||
Table VIII shows the respondent’s length of time in current job role. The findings indicate that the majority of staff have been in their post for 2 years or less. In addition, a minimal amount of staff has been in their post for 2 to 5 years. Further, the least amount of respondents has been in their posts for more than 10 years.
Table VIII: Roles held whilst in employment at STAR
| 1.7 Have you been employed in another role within STAR? | |||
| Answer Choice | Response Percent | Response Total | |
| 1 | Yes | 20.0% | 10 |
| 2 | No | 80.0% | 40 |
| 50 | |||
| Mean: | 1.8 | Std. Deviation: | 0.4 | Satisfaction Rate: | 80 |
| Variance: | 0.16 | Std. Error: | 0.06 |
Table VIII indicates whether respondents had additional role to the one they now occupied whilst in employment at STAR. 20% of respondents were in a different role prior to their current role.
Table IX: How many Staff do you manage within your organisation
| 1.8 How many Staff do you manage within STAR? | |||
| Answer Choice | Response Percent | Response Total | |
| 1 | 1 – 5 | 6.0% | 3 |
| 2 | 6 – 10 | 2.0% | 1 |
| 3 | more than 10 | 2.0% | 1 |
| 4 | none | 90.0% | 45 |
| 50 | |||
Table IX indicates how many managerial and non-managerial staff were respondents and how many staff they manage. The findings indicate that the majority of respondents were non-managerial staff which compiled of 90% of the respondents. In addition, the least amount of staff was managerial staff which was reflective in 10% of the total respondents.
| 2.1 Tick as many of the following categories to describe your perception of STAR’s organisational culture – | ||||||||||
| Answer Choice | Response Percent | Response Total | ||||||||
| 1 | Restrictive | 50.0% | 25 | |||||||
| 2 | Tense | 60.0% | 30 | |||||||
| 3 | Corporate | 40.0% | 20 | |||||||
| 4 | Hierarchical | 78.0% | 39 | |||||||
| 5 | Supportive | 30.0% | 15 | |||||||
| 6 | Collective | 24.0% | 12 | |||||||
| 7 | Team-orientated | 56.0% | 28 | |||||||
| 8 | Diverse | 72.0% | 36 | |||||||
| 9 | Multicultural | 84.0% | 42 | |||||||
| 10 | Management led | 76.0% | 38 | |||||||
| 11 | Paternalistic | 22.0% | 11 | |||||||
| 50 | ||||||||||
| Mean: | 36.22 | Std. Deviation: | 73.63 | Satisfaction Rate: | 303 | |||||
| Variance: | 5421.9 | Std. Error: | 10.41 | |||||||
Based on the findings, the majority of staff perceived the STAR’s organisational culture to be Multicultural and Diverse; and Hierarchical and Management led. In addition, an average amount of participant found STAR’s organisational culture to be Tense and Restrictive; and team oriented. Further, to a minimal, staff perceived the STAR’s organisational culture to be Paternalistic, Collective and Supportive.
| Please answer each of the following statements, in relation to cultural diversity in your department, as to whether you Strongly Agree, Agree, Disagree or Strongly Disagree. | |||||||||||||
| Answer Choice | Strongly Agree | Agree | Disagree | Strongly Disagree | Response Total | ||||||||
| 1 | I can engage with persons from various cultural backgrounds within my department | 9 | 32 | 7 | 2 | 50 | |||||||
| 2 | I can be creative and innovative within the culture of my department. | 4 | 26 | 15 | 5 | 50 | |||||||
| 3 | I can communicate effectively with persons from various cultural backgrounds within my department. | 11 | 38 | 1 | 0 | 50 | |||||||
| 4 | I can share information with persons form various cultural backgrounds within my department. | 10 | 38 | 2 | 0 | 50 | |||||||
| 5 | I feel as part of a team amongst my work colleagues from various cultural backgrounds. | 4 | 14 | 24 | 8 | 50 | |||||||
| Mean: | 2.04 | Std. Deviation: | 0.69 | Satisfaction Rate: | 34.67 | ||||||||
| Variance: | 0.48 | Std. Error: | 0.1 | ||||||||||
The Majority of respondents in response to the questions on the impact of cultural diversity on performance agreed that they can engage, be creative and innovative, communicate effectively and share information with persons from various cultural backgrounds within their department. However, the majority disagreed that they felt part of a team amongst work colleagues of various cultural backgrounds.
Most respondents disagreed that diversity and inclusion are the heart of STAR’s organisational strategies; and that the management of STAR projects a strong image of a diverse workforce. On the other hand, most respondents agreed that the management of STAR creates a working environment that provides equal working opportunities and access to information; and the management of STAR ensures that diversity managed to have successful outcomes.
| Mean: | 18.54 | Std. Deviation: | 28.56 | Satisfaction Rate: | 206.86 |
| Variance: | 815.75 | Std. Error: | 4.04 | ||
The majority of the respondents are of the perception that the impact of cultural diversity in the workplace leads to better communication with diverse groups of potential and existing patients; and that it allows for a sound knowledge base with in-house talent. However, that it equally creates barriers of resistance to change; and results in lost in production and development of negative emotions. On the other hand, the least amount of respondents’ perception of the impact of cultural diversity in the work place was that cultural diversity helps to overcome culture shock.
Most respondents agreed that having a culturally diverse workforce leads to a wider service range provided to the patients; and inspires employee productivity. In addition, most respondents strongly agree that having a cultural diverse workforce leads to improvement of a national and global image of an organisation. On the other hand, most respondents disagreed that having a cultural diverse workforce leads to increased adaptability, a variety of employees’ viewpoints of ides and experiences; and organisational productivity.
With regard to the benefits of cultural diversity, the majority of respondents agreed that an organisation that promotes a management style that accepts and appreciates the unique differences in people will ensure organisational success; an organisation that encourages diversity, employee involvement and creates a sense of responsibility is important for management of a successful, diverse, and happy workplace; an organisation that promotes and believes in changing recruitment policies to reflect the multicultural workforce leads to an increased talent and employee efficiency and an organisation that has a work environment that is free from discrimination has a positive effect on employee performance. In addition, the majority of respondents strongly agreed that an organisation that promotes a diverse workforce improves company image.
Innate skills that result from being multicultural may help solve central problems in multicultural teams, including managing conflicts and boundary spanning across cultures however cultural diversity often prevents such potential from being realised due to issues such as conflicts across cultural boundaries, dealing with coordination, control issues, maintaining communication richness and developing and maintaining team cohesiveness.
Human resource programmes suggested by the employees to improve the effectiveness of workforce diversity have been considered in the recommendations.
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