City Research Online

"They created a team of almost entirely the people who work and are like them": A qualitative study of organisational culture and racialised inequalities among healthcare staff

Woodhead, C., Stoll, N., Harwood, H. , Alexis, O., Hatch, S. L., Bora-White, M., Chui, Z., Clifford, N., Connor, L., Ehsan, A., Ensum, L., Gunasinghe, C., MacCrimmon, S., Meriez, P., Morgan, A., Jones Nielsen, J. D. ORCID: 0000-0001-6874-1268, Onwumere, J., Rhead, R., Stanley, N., Stoll, N., Chandola, T., Coghill, Y., Creary, N., Cross, S., Dyer, J., Irwin, W., Khunti, K., Mir, G., Morriss, R., Marie Rafferty, A., Saddler, J., Stevelink, S., Valmaggia, L. & Team TIDES Study, (2022). "They created a team of almost entirely the people who work and are like them": A qualitative study of organisational culture and racialised inequalities among healthcare staff. Sociology of Health & Illness, 44(2), pp. 267-289. doi: 10.1111/1467-9566.13414


Racially and ethnically minoritised healthcare staff groups disproportionately experience and witness workplace discrimination from patients, colleagues and managers. This is visible in their under-representation at senior levels and over-representation in disciplinary proceedings and is associated with adversities such as greater depression, anxiety, somatic symptoms, low job satisfaction and sickness absence. In the UK, little progress has been made despite the implementation of measures to tackle racialised inequities in the health services. So, what is it about the health service organisational context which shapes and maintains such inequities, and what role does discrimination, bullying and harassment play? Drawing on qualitative interviews with 48 healthcare staff in London (UK), we identify how micro-level bullying, prejudice, discrimination and harassment behaviours, independently and in combination, exploit and maintain meso-level racialised hierarchies. Within teams, the high diversity–low inclusion dynamic shaped and was perpetuated by in- and outgroup inclusion and exclusion processes (including “insidious dismissal”) often employing bullying or microaggressions. These were linked to intersecting factors, such as race, ethnicity, migration, language and religion, and could increase segregation. For racially and ethnically minoritised groups, ingroup maintenance, moving teams or leaving were also ways of coping with organisational inequities. We discuss implications for tackling racialised workplace inequities.

Publication Type: Article
Additional Information: © 2021 The Authors. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL (SHIL). This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Publisher Keywords: bullying, discrimination, ethnicity, Healthcare staff, qualitative, race
Subjects: H Social Sciences > HT Communities. Classes. Races
R Medicine > RA Public aspects of medicine
Departments: School of Health & Psychological Sciences > Psychology
Text - Published Version
Available under License Creative Commons Attribution.

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