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Realising the Business Case for Diversity: A Realist Perspective on the British National Health Service

Published online by Cambridge University Press:  19 February 2014

Martin Powell
Health Services Management Centre, University of Birmingham E-mail:
Nick Johns
School of Social Science, Cardiff University E-mail:


This article takes a novel approach to exploring the business case for diversity (BCD) as it has been adopted in the British National Health Service (NHS), principally in terms of ‘race’ and ethnicity for the sake of clarity and manageability. It draws on realist perspectives that consider issues of context, mechanism and outcome. It concludes that transferring policies from other countries and sectors is problematic, and consequently that the application of the BCD to the NHS must be treated with extreme caution.

Copyright © Cambridge University Press 2014 

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Anderson, T. and Metcalf, H. (2003) Diversity: Stacking up the Evidence – a Review of Knowledge, Executive Briefing, London: CIPD.Google Scholar
Andrews, R., Boyne, G. A., Meier, K. J., O'Toole, L. J. Jr. and Walker, R. M. (2005) ‘Representative bureaucracy, organizational strategy, and public service performance: an empirical analysis of English local government’, Journal of Public Administration Research and Theory, 15, 4, 489504.Google Scholar
Ashley, L. (2010) ‘Making a difference? The use (and abuse) of diversity management at the UK's elite law firms’, Work, Employment and Society, 24, 4, 711–27.CrossRefGoogle Scholar
Awbrey, S. M. (2007) ‘The dynamics of vertical and horizontal diversity in organization and society’, Human Resource Development Review, 6, 1, 732.Google Scholar
Bach, S. and Kessler, I. (2012) The Modernisation of the Public Services and Employee Relations, Basingstoke: Palgrave.CrossRefGoogle Scholar
Bagilhole, B. (2009) Understanding Equal Opportunities and Diversity, Bristol: The Policy Press.CrossRefGoogle Scholar
Bleijenbergh, I., Peters, P. and Poutsma, E. (2010) ‘Diversity management beyond the business case’, Equality, Diversity and Inclusion: An International Journal, 29, 5, 413–21.Google Scholar
Butt, J. (2006) Are We There Yet? Identifying the Characteristics of Social Care Organisations that Successfully Promote Diversity, Race Equality Discussion Paper 01, London: Social Care Institute for Excellence.Google Scholar
Cabinet Office (2008) Together We Can Make Government Work Better: Creating a Diverse Cabinet Office – an Action Plan, London: Human Resources Directorate.Google Scholar
Carvel, J. (2003) ‘NHS is race biased says Phillips’, The Guardian (Society), 30 April.Google Scholar
Cashmore, E. (2002) ‘Behind the window dressing: ethnic minority police perspectives on cultural diversity’, Journal of Ethnic and Migration Studies, 28, 2, 327–41.Google Scholar
Catalyst (2004) The Bottom Line: Connecting Corporate Performance and Gender Diversity, New York: Catalyst.Google Scholar
Centre for Strategy and Evaluation Services (CSES) (2003) Methods and Indicators to Measure the Cost-Effectiveness of Diversity Policies in Enterprises, Final Report, Otford, Kent: CSES.Google Scholar
Chartered Institute for Personnel Development (CIPD), (2005) Managing Diversity: Linking Theory and Practice to Business Performance, London: CIPD.Google Scholar
Cohen, C. and Sterba, J. P. (2003) Affirmative Action and Racial Preference: A Debate, Oxford: Oxford University Press.Google Scholar
Commission for Racial Equality (CRE) (1995) Racial Equality Means Quality: A Standard for Racial Equality for Local Government in England and Wales, London: CRE.Google Scholar
Cox, T. H. (1991) ‘The multicultural organization’, Academy of Management Executive, 5, 2, 3447.Google Scholar
Cox, T. H. and Blake, S. (1991) ‘Managing cultural diversity: implications for organizational competitiveness’, Academy of Management Executive, 5, 3, 4556.Google Scholar
Craig, G., Atkin, K., Chattoo, S. and Flynn, R. (eds.) (2012) Understanding ‘Race’ and Ethnicity, Bristol: The Policy Press.Google Scholar
Crisp, N. (2010) 24 Hours to Save the NHS: The Chief Executive's Account of Reform 2000–2006, Oxford: Oxford University Press.Google Scholar
Curtis, E. and Dreachslin, J. (2008) ‘Integrative literature review: diversity management interventions and organizational performance – a synthesis of current literature’, Human Resource Development Review, 7, 1, 107–34.CrossRefGoogle Scholar
Dandeker, C. and Mason, D. (2001) ‘The British armed services and the participation of minority ethnic communities: from equal opportunities to diversity?’, Sociological Review, 49, 2, 219–35.Google Scholar
Davies, Lord of Abersoch (2011) Women on Boards, London: Equality and Human Rights Commission.Google Scholar
Department of Health (DoH) (2000a) Positively Diverse: Report 2000, London: DoH.Google Scholar
Department of Health (DoH) (2000b) Improving Working Lives Standard, London: DoH.Google Scholar
Department of Health (2009) Inspiring Leaders: Leadership for Quality, London: DoH.Google Scholar
Department of Trade and Industry (DTI) (2003) Achieving Best Practice in Your Business: Maximising Potential – High Performance Workplaces, London: DTI.Google Scholar
Dickens, L. (1999) ‘Beyond the business case: a three-pronged approach to equality action’, Human Resource Management Journal, 9, 1, 919.Google Scholar
Dreachslin, J. L., Weech-Maldonado, R., Kathryn, K. H. and Dansky, H. (2004) ‘Racial and ethnic diversity and organizational behaviour: a focused research agenda for health services management’, Social Science and Medicine, 59, 5, 961–71.Google Scholar
Dudau, A. L. and McAllister, L. (2010) ‘Developing collaborative capabilities by fostering diversity in organizations’, Public Management Review, 12, 3, 385402.Google Scholar
Equality and Human Rights Commission (EHRC)/Trades Union Congress (TUC)/Confederation of British Industry (CBI) (2008) Talent not Tokenism: The Business Benefits of Workforce Diversity, London: HMSO.Google Scholar
Esmail, A., Kaira, V. and Abel, P. (2005) A Critical Review of Leadership Interventions Aimed at People from Black and Minority Ethnic Groups, Manchester: University of Manchester.Google Scholar
Finkelstein, S. and Hambrick, D. C. (1996) Strategic Leadership: Top Executives and Their Effects on Organizations, St. Paul, MN: West.Google Scholar
Gauss, J. W. and Jessamy, H. T. (2007) ‘Back to basics: the boards role in developing a diverse leadership team’, Trustee, September, Scholar
Government Equalities Office (GEO) (2009) Public Appointments: Opening Doors Increasing Diversity – A Cross-Government Action Plan, London: Government Equalities Office.Google Scholar
Haas, H. (2010) ‘How can we explain mixed effects of diversity on team performance? A review with emphasis on context’, Equality, Diversity and Inclusion: An International Journal, 29, 5, 458–90.Google Scholar
Heres, L. and Benschop, Y. (2010) ‘Taming diversity: an exploratory study on the travel of a management fashion’, Equality, Diversity and Inclusion: An International Journal, 29, 5, 436–57.Google Scholar
Herring, C. (2009) ‘Does diversity pay?: race, gender, and the business case for diversity’, American Sociological Review, 74, 2, 208–24.Google Scholar
Jayne, M. E. A. and Dipboye, R. L. (2004) ‘Leveraging diversity to improve business performance: research findings and recommendations for organizations’, Human Resource Management, 43, 4, 409–24.CrossRefGoogle Scholar
Johns, N. R. (2006) How the British National Health Service Deals with Ethnic Diversity: Professional Problems, Patient Problems, New York: Edwin Mellen.Google Scholar
Johns, N., Green, A. and Powell, M. (2013) ‘Diversity in the British NHS: the business versus the “moral” case’, Equality, Diversity and Inclusion, 31, 8, 768–83.Google Scholar
Jones, A. (2006) Rising to the Challenge of Diversity, London: The Work Foundation.Google Scholar
Kalev, A. (2009) ‘Cracking the glass cages? Restructuring and ascriptive inequality at work’, American Journal of Sociology, 114, 6, 1591–643.Google Scholar
Kalev, A., Dobbin, F. and Kelly, E. (2006) ‘Best practices or best guesses? Assessing the efficacy of corporate affirmative action and diversity policies’, American Sociological Review, 71, 4, 589617.Google Scholar
Kalra, V. S., Abel, P. and Esmail, A. (2009) ‘Developing leadership interventions for black and minority ethnic staff: a case study of the National Health Service (NHS) in the UK’, Journal of Health Organization and Management, 23, 1, 103–18.Google Scholar
Kandola, R. and Fullerton, J. (1998) Diversity in Action: Managing the Mosaic, 2nd edn., London: Institute of Personnel and Development.Google Scholar
Kirton, G. and Greene, A. M. (2007) The Dynamics of Managing Diversity, 2nd edn., Oxford: Butterworth-Heinemann.Google Scholar
Kochan, T., Bezrukova, K., Ely, R., Jackson, S., Joshi, A., Jehn, K., Leonard, J., Levine, D. and Thomas, D. (2003) ‘The effects of diversity on business performance: report of the diversity research network’, Human Resource Management, 42, 1, 321.Google Scholar
Krishnan, G. and Parsons, L. (2008) ‘Getting to the bottom line: an exploration of gender and earnings quality’, Journal of Business Ethics, 78, 1/2, 6576.Google Scholar
Law, I. (1996) Racism, Ethnicity and Social Policy, London: Harvester Wheatsheaf.Google Scholar
Liff, S. (1996) ‘Two routes to managing diversity: individual differences or social group characteristics?’, Employee Relations, 19, 1, 1126.CrossRefGoogle Scholar
SirMacpherson, W. (1999) The Stephen Lawrence Inquiry Report, Sir William Macpherson of Cluny, London: HMSO.Google Scholar
Milliken, F. and Martins, L. (1996) ‘Searching for common threads: understanding the multiple effects of diversity in organizational groups’, Academy of Management Review, 21, 2, 402–33.Google Scholar
Naff, K. C. and Kellough, J. E. (2003) ‘Ensuring employment equity: are federal diversity programs making a difference?’, International Journal of Public Administration, 26, 12, 1307–36.Google Scholar
National Audit Office (NAO) (2004) Delivering Public Services to a Diverse Society, London: National Audit Office.Google Scholar
National Health Service Executive (NHSE) (2000) The Vital Connection – an Equalities Framework for the NHS, London: Department of Health.Google Scholar
NHS Employers (2009) Managing Diversity: Making It Core Business, Briefing Paper 60, London: NHS Employers.Google Scholar
NHS Institute for Innovation and Improvement (NHS III) (2009) Access of BME Staff to Senior Positions in the NHS, Coventry: NHS Institute.Google Scholar
Noon, M. (2007) ‘The fatal flaws of diversity and the business case for ethnic minorities’, Work, Employment and Society, 21, 4, 773–84.Google Scholar
Oikelome, F. (2007) The Recruitment and Retention of Black and Ethnic Minority Staff in the National Health Service, London: Race Equality Foundation.Google Scholar
Page, S. (2007) The Difference: How the Power of Diversity Creates Better Groups, Firms, Schools and Societies, Princeton, NJ: Princeton University Press.Google Scholar
Pawson, R. and Tilley, N. (1997) Realistic Evaluation, London: Sage.Google Scholar
Perriton, L. (2009) ‘”We don't want complaining women!” A critical analysis of the business case for diversity’, Management Communication Quarterly, 23, 2, 218–43.Google Scholar
Pitts, D. W. (2006) ‘Modelling the impact of diversity management’, Review of Public Personnel Administration, 26, 3, 245–68.Google Scholar
Pitts, D. W. (2009) ‘Diversity management, job satisfaction, and performance: evidence from US federal agencies’, Public Administration Review, 69, 2, 328–38.Google Scholar
Powell, M., Johns, N. and Green, A. (2013) ‘Equal opportunities and diversity: exploring the relevance of Le Grand's models of service provision’, Social Policy and Society, 12, 4, 495505.Google Scholar
Ram, M., Theodorakopoulos, N. and Worthington, I. (2007) ‘Policy transfer in practice: implementing supplier diversity in the UK’, Public Administration, 85, 3, 779803.Google Scholar
Richard, O. C. (2000) ‘Racial diversity, business strategy and firm performance: a resource-based view’, Academy of Management Journal, 43, 2, 164–77.Google Scholar
Richard, O. C. and Johnson, N. B. (2001) ‘Understanding the impact of human resource diversity practices on firm performance’, Journal of Managerial Issues, 13, 2, 177–95.Google Scholar
Richard, O. C., Barnett, T., Dwyer, S., and Chadwick, K. (2004) ‘Cultural diversity in management, firm performance and the moderating role of entrepreneurial orientation dimensions’, Academy of Management Journal, 47, 2, 255–66.CrossRefGoogle Scholar
Riley, R., Metcalf, H. and Forth, J. (2008) The Business Case for Equal Opportunities: An Econometric Investigation, Department for Work and Pensions Research Report No. 483, London: DWP.Google Scholar
Robinson, G. and Dechant, K. (1997) ‘Building a business case for diversity’, Academy of Management Executive, 11, 3, 2131.Google Scholar
Roberson, Q. M. and Park, H. J. (2007) ‘Examining the link between diversity and firm performance: the effects of diversity reputation and leader racial diversity’, Group and Organization Management, 32, 5, 548–68.Google Scholar
Rutherford, S. and Ollerearnshaw, S. (2002) The Business of Diversity – How Organizations in the Public and Private Sectors are Integrating Equality and Diversity to Enhance Business Performance, London: Schneider-Ross.Google Scholar
Ryan, J., Hawdon, J. and Branick, A. (2002) ‘The political economy of diversity: diversity programs in fortune 500 companies’, Sociological Review Online, 7, 1, Scholar
Saunders, P. (2011) The Rise of the Equalities Industry, London: Civitas.Google Scholar
Schneider, R. and Ross, R. (1992) From Equality to Diversity: The Business Case for Equal Opportunities, New York: Trans-Atlantic Publications.Google Scholar
Shah, A. (2009) Diversity: Boardroom Diversity – The Opportunity, London: NHS Leadership Academy.Google Scholar
Shapiro, G. and Allison, M. (2007) Reframing Diversity, Diversity Professionals’ Forum, Scholar
Shore, L., Chung-Herrera, B. G., Dean, M. A., Holcombe Ehrhart, K., Jung, D. I., Randel, A. E. and Singh, G. (2009) ‘Diversity in organizations: where are we now and where are we going?’, Human Resource Management Review, 19, 2, 117–33.Google Scholar
Straw, J. (1999) ‘Ethnic minority targets set for the police’, Equal Opportunities Review, 85, 21–4.Google Scholar
Thomas, D. A., and Ely, R. J. (1996) ‘Making differences matter: a new paradigm for managing diversity’, Harvard Business Review, 74, 5, 7990.Google Scholar
Weech-Manaldo, R., Dreachslin, J. L., Dansky, K. H., De Souza, G. and Gatto, M. (2002) ‘Racial/ethnic diversity management and culture competency: the case of Pennsylvania hospitals/practitioner application’, Journal of Healthcare Management, 47, 2, 111–24.Google Scholar
Wise, L. R. and Tschirhart, M. (2000) ‘Examining empirical evidence on diversity effects: how useful is diversity research for public-sector managers?’, Public Administration Review, 60, 5, 386–94.Google Scholar
Wrench, J. (2005) ‘Diversity management can be bad for you’, Race and Class, 46, 3, 7384.Google Scholar