HIN CEO Rishi Das-Gupta writes about the importance of diversity in the workplace and the challenges it can present.

The NHS recently dropped its diversity targets (they are not part of planning guidance for 2023-24) and some MPs and media are waging war to remove the posts which were added to make the workplace fairer and more diverse. While this is understandable in the current cost-constrained environment, diversity within the NHS is essential for providing high-quality, patient-centred care.

A diverse workforce brings a wide range of perspectives, ideas, and skills that can lead to better outcomes for patients and their families. However, it is important to acknowledge that there can also be challenges associated with having a more diverse workforce. One such challenge is that there are usually more opinions to take into account (which is the point!) and so it can take longer to reach decisions - at a time of crisis this can be frustrating. However, I think that now is a time of change. Including diverse perspectives is essential and we all must get more comfortable fostering disagreement within our teams.

It is possible to argue that the NHS has one of the most diverse workforces in the world. In London, where I work, providers have people with backgrounds from almost every country in the world and speaking scores of languages. In addition, across the service as a whole we have near equal gender balance (NHSemployers). We bring individual perspectives based on professional background, patient interactions, and personal circumstances. Despite this, some groups are still systematically over/under represented in senior decision making. As the makeup of decision-making groups changes, the conversations can be less comfortable.

Most NHS discussions start with common values and so if you disagree, you might not be ‘NHS’ enough. I temporarily left the NHS to get experience in other industries before returning, so often feel I should speak up when I have a different view. I’ve always been surprised by how uncomfortable this feels in the NHS and call on all our leaders to understand and foster constructive conflict to get to better answers for our patients and staff.

When a group of individuals with different backgrounds, experiences and perspectives come together, it can often lead to a wider range of opinions and ideas being put forth. This can be a positive thing as it leads to more thorough discussions and considerations of different options. However, it can also lead to a longer decision-making process as the group works to come to a consensus. Without good discussion facilitation or chairing, this conflict can feel uncomfortable.

Benjamin Laker and Vijay Pereira explored the reasons for team conflicts in an article in Harvard Business Review published on 31 May 2022 (that was not focused on diversity). However, they highlighted four common causes of conflict from a study of 1,000 managers across 76 companies – and I think that each of these can be exacerbated by diversity in backgrounds, professional experience and communication preferences:

These are all factors which are at play in our discussions in healthcare – and the risk of each of these factors coming into play increases as the diversity of the team increases and as we work across organisations as part of ICS working. It’s even more important as we work under time pressure and there is a need for swift and efficient decision-making.

It is important to remember that this added time and effort is necessary to make well-informed and inclusive decisions that take into account the needs of all patients and staff. Which brings us to what we can do about it… In my opinion we should:

• Spend time to outline what our values are (or have them pinned to the wall) and highlight whether a conflict is a result of us having different values or applying our values differently.
• Spend time being clear about what problems we are trying to solve – my experience is that we always want to solve the problem without clarifying exactly what we understand by it. In a diverse group the chances of having different interpretations of the issues is high. Personally, I value using a problem statement worksheet to tease out the issues.
• Recognise communication differences – in organisations I’ve worked with this has been done using Myers-Briggs or the Insights Discovery tool. These can be the start of a discussion but other factors are important too.
• Spend time agreeing actions – and make these clear. Laker and Pereira suggest being clear about what is satisfactory delivery and what is good/above the required level which sounds like a great way to go… but I must admit I’m not always good at doing this!
• Negotiate the time constraints if you feel this is what is causing frustration – I find the best questions to ask as a manager are “Is that a realistic timeline?” and “What will need to be delayed to get this done on time?”
• Getting performance standards right in the NHS is harder… In general I think we are nicer than in other industries where I’ve worked. I think it’s important to highlight when performance is below the expected level and have seen this done sensitively with questions to understand why this was. Often, I’ve found it’s because the required outcome was unclear for instance, I might have a different understanding of what a “high-level financial model” is to a management accountant. Less frequently, the person didn’t have the skills and support needed, or there were personal issues that prevented delivery – it’s rare that people’s heart wasn’t in the right place (which I think of as a values issue).