A DIVERSITY AUDIT IN A HOSPITAL SETTING

John P. Gaze, Ph.D., FACHE

Assistant Professor, Colleges of Business Administration and Health Sciences Touro University International

EXECUTIVE SUMMARY

 The purpose of this study was to determine the extent to which employee receptivity of diversity and diversity management strategies varied by gender, and ethnicity in a sample of government and military employees from an overseas U.S. Navy Medical Treatment Facility (MTF).  Employee attitudes toward diversity and diversity management were measured using previously established receptivity to diversity scales.  The major findings of this study are: (1) In general, employees were receptive to diversity and diversity management; (2) Ethnic groups were found to differ on the measures given with: (2a) Male Asian Americans reporting significantly more receptivity to both diversity and diversity management than Caucasians, and (2b) Hispanics reporting more receptivity to diversity management than Caucasians.  Possible explanations for this are discussed. Managerial implications stemming from this study are: (1) Leaders who recognize and understand employee preferences based on ethnicity and gender will be better prepared to encourage a diverse workforce to work together towards a common goal; (2) Diversity management can be a benefit to employees and organizations; (3) Receptivity to diversity is thought to be a prerequisite of diversity management; (4) Hiring the right staff, focusing on team skills, diversity training, conducting audits and leadership support are important elements of a diversity management strategy.  Similar studies should be conducted to confirm the results of this study, and to find ways to improve diversity management approaches and methods in both military and civilian healthcare organizations.

INTRODUCTION

 There has been a movement by many U.S. organizations (for example, Ford, 3M and American Express) over the last two decades to place more emphasis on valuing employee differences, and developing diversity management initiatives (policies and programs that benefit all employees regardless of differences for a common goal).  The benefits of a diverse workforce are the topic of discussion in many organizations in a variety of industries.  At the same time, organizations are faced with understanding the importance of valuing differences and instituting effective diversity management initiatives as counter-measures to protect themselves from such negative consequences as lawsuits, loss of competitive advantage and diminished legitimacy in the eyes of the customers they serve. 

The increase in females and racial minority entrants in the work force, along with employers’ concerns about motivating and obtaining satisfactory levels of performance from a diverse group of employees, has created an urgency to understand and recognize the value of differences (Soni, 2000).  Although literature on diversity has increased, few healthcare management articles have published original research on the subject of racial and ethnic diversity (Dreachslin, Jimpson, Sprainer & Evans, 2001).     

The extant literature suggests mixed corporate attitudes toward the philosophy of valuing differences.  Historically, several companies have implemented a variety of initiatives for effectively utilizing and managing the current and projected diverse work force, but there are still some that have shown less interest in diversity issues.  For example, the Avon Corporation implemented awareness training at all levels of the organization.  It formed a multicultural participation council, which included the Chief Executive Officer (CEO), other high-ranking officials of Avon as well as minority employees.  On the other hand, a survey of 1,406 U.S. companies by the Hay Group (1992) found that more than 60 percent of the respondents reported that they felt diversity was either not very important or not a high priority for the next two years.  Nonetheless, several researchers (Gentile, 1994; Loden & Rosener, 1991; Thomas, 1991) have reported that gender and ethnic differences continue to have a significant effect on the treatment and experiences of people in the work place.

The basic problem is that diversity management strategies call for attention to differences; attention that previous initiatives such as affirmative action and equal employment opportunity practices have tended to regard as illegitimate and possibly discriminatory.  Present diversity management strategies require people to recognize, respect and celebrate a culture’s unique identity, customs and traditions, yet avoid over-emphasizing these differences (negative stereotypes) or offering disparate treatment based on them.  As such, diversity management initiatives require a distinction that can prove more subtle and potentially controversial in practice than in theory. 

LITERATURE REVIEW

The Diversity Management Movement

Shaped by changes in workforce demographics and legislation (Civil Rights Act, 1964 & Equal Employment Opportunity Act, 1972), U.S. Employment practices have evolved in response to numerous factors.  While these initially involved legal requirements, moral responsibilities, and responses to internal and external group pressures (Williams & Bauer, 1994), consultants, scholars, and top executives have increasingly advocated the “valuing differences” approach to enhance organizational effectiveness (Cox & Blake, 1991).  Valuing differences refers to an appreciation of differences and the creation of an environment in which everyone feels valued and accepted (Svehla, 1994). 

The motive for diversity management now stems more from the fact that in a global economy, workforce diversity is a reality requiring proper management to achieve organizational effectiveness (Williams & Bauer, 1994).  Diversity management is concerned with planning and implementing organizational systems and practices to manage people so that the potential advantages are maximized (Cox, 1993).  Despite the acclaim such management strategies have received by scholars and managers, whether employees value differences and support diversity management initiatives remains unclear.     

There has been very little research on the development of diversity programs (Kelly & Dobbin, 1998). What is known is that diversity management has been considered by mainstream business organizations like the Society for Human Resource Management to be a legitimate sub-field of human resources management (Kelly & Dobbin, 1998).  This paradigm (Giraldo, 1991,) moves beyond a human resource model based solely on legal compliance to one that suggests there is an inherent value in diversity.  By the early 1990s, diversity management initiatives were adopted by 70 percent of Fortune 50 companies (Wheeler, 1994).  However, the prevalence appeared to be lower among smaller companies (Kelly & Dobbin, 1998).  This management trend has continued in recent years (Gathers, 2003), and organizations have had ample guidance in transforming their Equal Employment Opportunity (EEO) and/or Affirmative Action (AA) activities into diversity programs in the form of articles, books, videos, conferences, newsletters and a growing cadre of organizational consultants (Kelly & Dobbin, 1998).  Characteristics of diversity management initiatives were similar to those of EEO/AA practices. 

Practices included mission statements, diversity action plans, accountability for meeting diversity goals, employee involvement, career development and planning, diversity education and training, and long-term initiatives directed at cultural change within the workplace (Wheeler, 1994).  The link between diversity and EEO/AA measures is confirmed by one of the new diversity practices, diversity training.  In the narrow sense, diversity training is about compliance, (e.g., EEO, AA and sexual harassment).  Although there is strong sentiment that diversity moves far beyond compliance, at this point, practices demonstrate a strong link between the two (Wheeler, 1994).

Councils and advocacy groups have become popular in organizations promoting diversity management initiatives as well.  For example, The IBM Company constituted a global workforce council to foster and promote diversity management.  The council identified five issues to address, which are cultural awareness and acceptance, multilingualism, diversity of the management team, the advancement of women and workplace flexibility and balance.  In addition, eight task forces were established to optimize satisfaction, productivity and creativity.  These task forces were made up of various gender and ethnic groups.  Some hospitals have developed similar initiatives (Mott, 2003).   

Training has been one of the more popular diversity management tools for organizations over the last several years.  Diversity training includes a wide range of training sessions both in type and frequency.  For example, Johns Hopkins Hospital conducted training on anti-discrimination law and a more personal cross-cultural communication class.  The frequency of these classes ranges from one to two times each year.   

The most significant diversity tool in practice today is the audit.  The audit utilizes surveys, interviews and focus groups (Thomas, 1991) to measure employee attitudes.  Obtaining employee feedback on top diversity issues remains an important tool in healthcare organizations today (Gathers, 2003).  However, attempts to change culture are costly long-term projects, and therefore, are much less common than repackaged EEO/AA measures that comprise the core of diversity management (Kelly & Dobbin, 1998).  One reason for this may be too many institutions are overwhelmed by too many healthcare challenges (Ruthledge & Wesley, 2001).        

The intent of diversity management is to create greater inclusion of all individuals into informal social networks and formal company programs (Sessa, 1992). Moreover, organizations want to ensure that an increasingly diverse group of employees will work together to achieve common goals (Eubanks, 1990).  At present, diversity training and EEO/AA practices are performed on a less frequent basis than has been recommended by government polices.     

Benefits of Managing Diversity

Muller and Haase (1994) describe managing diversity in terms of a manager being aware of the values and biases of his/her conventional management approaches, their ability and willingness to use employee focused strategies that affirm peoples’ differences while maintaining a high quality of productivity.  This approach is a strategically driven process whose emphasis is on building specific skills and creating policies that bring out the best in everyone.  Its goal is to create a level playing field through the assessment, identification and modeling of behaviors and policies that are seen as contributing to organizational goals (Svehla, 1994). 

Various benefits have been identified in the diversity literature and include:  group performance, organizational performance, profitability, and employee awareness.  More specifically, diversity has been linked to an increase in the quality of group performance, creativity of ideas, cooperation and the number of perspectives and alternatives considered (Cox, Lobel & McLeod, 1991; Watson, Kumar & Michalesen, 1993).   

The synergy model of managing diversity assumes that diverse groups will create new ways of working together effectively in a pluralistic environment.  However, resistance due to denial of demographic changes and recognition of the need for and the benefits of a program can quickly derail any efforts to implement and sustain managing diversity efforts  (Svehla, 1994).  

Progress Towards Managing Diversity

Diversity has been said to improve tolerance and understanding of differences, supposedly resulting in positive outcomes including heightened group commitment and individual employee satisfaction (Wise & Tschirhart, 2000).  However, despite changing demographics of the work force and potential benefits of diversity management, U.S. organizations have made minimal progress toward promoting friendly, productive working relationships across cultural differences (Ivanevich & Gilbert, 2000). 

It should be noted that despite the increase in diversity literature in the 1990s, there are still too few empirical research studies in the healthcare management field  (Dreachslin, et al., 2001).  Moreover, only a limited number of studies have focused on the area of receptivity to diversity (employee attitudes toward diversity) and receptivity to diversity management initiatives (employee support for diversity management initiatives implemented by the employer) (Soni, 2000).   

Among the few studies in this area the focus has primarily been on gender and ethnicity differences in attitudes toward EEO/AA measures (Aguirre, Martinez & Hernandez, 1993; Bobo & Kluegel, 1993) rather than diversity management strategies.  In one study, the emphasis on diversity within the organization and the role of AA programs was found to be a point of considerable disagreement between minority and majority samples (Triandis, Kurowski, Tecktiel & Chan, 1993).  Women and minorities favored AA programs and favored stronger pro-affirmative action policies than did Caucasian males (Triandis et al., 1993). According to Weech-Maldonado, Dreachslin and Dansky (2002), research on diversity management strategies in healthcare organizations is scarce.  Literature is also scare in the military, especially in military medicine.  Although the Defense Equal Opportunity Management Institute (DEOMI) conducts research and assists the military with climate surveys, their focus is limited to equal opportunity and equal employment opportunity.   

RESEARCH QUESTIONS

Analysis of the above literature suggests that the available research should be extended, and the common body of knowledge on diversity and diversity management be enhanced.  In testing a new theoretical model of receptivity to diversity, Soni (2000) did indeed find significant and meaningful differences in how Caucasian males and females, and minority males and females view diversity and diversity management initiatives.  However, very little empirical evidence exists about whether or not organizational members within specific racial groups in fact subscribe to the value of diversity and employer supported diversity management initiatives. 

This study provides an opportunity to better understand Soni’s (2000) findings and their potential to be generalized in a new setting, by determining the extent to which employee receptivity to diversity and receptivity to diversity management initiatives varied by gender and ethnicity.  Unlike the Soni (2000) study that collapsed the racial groups into majority (Caucasian) and minority (African American, Hispanic, etc.), this study enhanced these categories by treating each racial group as a separate category for analysis.   

Consequently, the research questions at the heart of this study were defined as follows:

1. To what extent does employee receptivity to diversity vary by gender and ethnicity?  
2. To what extent does employee receptivity to diversity management initiatives vary by gender and ethnicity?

METHODS

Selection of Subjects 

The U.S. Navy Medical Treatment Facility’s (MTF) personnel breakdown is comparable to the population percentages of males, females, Whites, Blacks, Asians and Hispanics in the United States Air Force, Army and Navy, and therefore all 100 percent of the MTF population (894 government civilian employees and military service members) were chosen as study subjects,  Demographically divided to: 510 males (57%), 384 females (43%);  393 Caucasians (44%), 244 Asian Americans (27%), 176 African American s (20%) and 80 Hispanics (9%). 

Research Instrumentation

The survey instrument used in this study was developed using the receptivity to diversity factor conclusions drawn from Soni’s (2000) study.  The items in each dimension were additively combined to create indexes reflecting the complex concepts.  Cronbach’s alpha coefficient for the indexes ranged from 0.8 to 0.9.  Content validity was used as the validity criterion for the instrument.  The questions relating to receptivity to diversity and receptivity to diversity management initiatives were rated in the study using a 1-5 Likert scale format, ranging from “strongly disagree” to “strongly agree”. 

Data Collection Procedures

 An introductory cover letter containing the purpose of the study, a request for cooperation and promise of anonymity was mailed to each member of the organization. All surveys were sent to the mailbox of each member of the organization with a request to return the survey in 20 days.  Measures taken to increase the survey response rate included two email reminders and a pledge by the researcher to donate $1.00 U.S. dollar to a local orphanage for every completed survey received. All responses were returned on a voluntary basis, so subjects were not influenced or coerced in any way.

Data Analysis

Univariate Analysis of Variance (ANOVA) was used to examine the relationships between:

• Receptivity to diversity and gender/ethnicity, (i.e., whether receptivity scores varied significantly by gender/ethnicity)
• Receptivity to diversity management and gender/ethnicity, (i.e., whether receptivity scores varied significantly by gender/ethnicity)

RESULTS

Demographic Data

A sound questionnaire response rate of 57% for males and 43% for females provided for a sample of 328 (224 male and 104 female) subjects broken down into the following ethnic groups: Caucasian: 140 (42.7%); Asian American: 86 (26.2%); African American: 67 (20.4%); Hispanic: 35 (10.7%)

Statistical Analysis

Tables 1 and 2 show the descriptive statistics and between-subjects effects for the dependent variable receptivity to diversity.  As can be seen in Table 2 there was no main effect for gender, [F(1,320) = 2.862 (p = .092)] however, the result approached significance with males scoring slightly higher than females on receptivity to diversity (M_Females=3.55; M_Males = 3.68).

Table 1

Descriptive Statistics, Dependent Variable: Diversity

Table 2

Univariate Analysis of Variance, Tests of Between-Subjects Effects; Dependent Variable: Receptivity to Diversity

As seen in Table 2, the 4 ethnic groups were found to differ significantly in receptivity to diversity [F(3, 320) = 5.317, P=.001].  A Bonferroni multiple comparisons procedure was conducted to determine which means were significantly different across ethnicity.  As indicated in Table 3, Asian American employees were found to be significantly more receptive to diversity than Caucasian employees.  The significant main effect for ethnicity was qualified by an interaction effect between gender and ethnicity whereby as a group male Asian American employees reported greater receptivity to diversity than Caucasian employees while female Asian American employees did not (see Figure 1). 

Table 3

Post Hoc (Bonferroni) Comparisons of Receptivity to Diversity by Racial Group

*** = Significant at p<.001

Figure 1

Estimated Marginal Means for Receptivity to Diversity by Ethnicity

Tables 4 and 5 show the descriptive statistics and between-subjects effects for the dependent variable receptivity to diversity management.  As the F-Test and significance levels presented in Table 5 indicate, there was no significant difference between female and male employees’ receptivity to diversity management scores (M_Females=3.50; M_Males = 3.52), F(1, 320) = .173, P=.678.

Table 4

Descriptive Statistics, Dependent Variable: diversity management