Does Religious Diversity in Health Team Composition Affect Efficiency? Evidence from Dubai
| Date | 01 October 2016 |
| Published date | 01 October 2016 |
| DOI | http://doi.org/10.1111/1467-8551.12184 |
British Journal of Management, Vol. 27, 740–759 (2016)
DOI: 10.1111/1467-8551.12184
Does Religious Diversity in Health Team
Composition Aect Eciency?
Evidence from Dubai
Alessandro Ancarani, Ali Ayach,1,2 Carmela Di Mauro, Simone Gitto3
and Paolo Mancuso3
Department of Civil and Environmental Engineering, University of Catania, Catania, Italy, 1Dubai Health
Authority, Dubai, United Arab Emirates, 2Department of Enterprise Engineering, University of Rome
‘Tor Vergata’, Italy, and 3Department of Industrial Engineering, University of Rome ‘Tor Vergata’, Italy
Corresponding author email: simone.gitto@uniroma2.it
Team cultural diversity, the degree to which working team members dier in culture-
related factors, may aect healthcare teams’ outcomes. This paper focuses on one par-
ticular source of cultural diversity, namely religion, and examines its relation to the
production eciency of hospital wards.Building on the categorization-elaboration model
of organizational diversity, the authors test an empirical model positing that team reli-
gious diversity has non-linear eects on eciency, and considering the role of moderating
variables of the relation diversity–eciency. Empirically, the authors adopt a two-step
approach, whereby the first step applies data envelopment analysis to estimate eciency
scores for each team, and the second investigatesthe eect of diversity and of moderating
variables. The model is tested on a sample of hospital wards from threelarge hospitals in
Dubai. The results suggest an inverse U-shaped relation between religious diversity and
the wards’ eciency. Evidence is provided that the relation is moderated by task com-
plexity,task conflict, team leader tenure and diversity in nationality. This studyadvances
research on the management of hospital team diversity by emphasizing the complexityof
diversity eects and the importance of contextual factors.
Introduction
Cultural diversity is the result of dierences be-
tween nationalities,ethnicities and religions, which
in turn reflect deeper underlying norms and values
(Stahl et al., 2010).
Because of rising labour-market mobility, an in-
creasing degree of cultural diversity characterizes
organizations’ workforces and the composition of
work groups. Healthcare is part of this trend: on
the one hand, the growing complexity of clinical
and surgical activities calls for the joint collabo-
ration of diverse medical specialties and medical
The authors are indebted to the anonymous reviewersfor
helpful criticism and suggestions.
roles; on the other, the shortage of medical profes-
sionals experienced by many countries leads to the
hiring of foreign medical sta, presenting a diverse
set of cultural characteristics.
Cultural diversity has been recognized as
potentially beneficial in terms of patient satis-
faction improvement (Ivancevich, 2007), more
equitable management of health organizations
(Weech-Maldonado et al., 2012), eective com-
munication (Dreachslin, Hunt and Sprainer,
2000), performance as perceived by patients
(Weech-Maldonado et al., 2003), strategic change
(Naranjo-Gil, Hartmann and Maas, 2008) and
innovation (Fay et al., 2006).
However, contrasting evidence exists on the ef-
fects of cultural diversity on performance in the
workplace. On the one hand, diversity allows the
© 2016 British Academy of Management. Published by John Wiley & Sons Ltd, 9600 Garsington Road, Oxford OX4
2DQ, UK and 350 Main Street, Malden, MA, 02148, USA.
Religious Diversity in Health Team Composition 741
expansion of the capabilities of teams, and in-
creases the capacity to change and innovate. On the
other hand, several perceptions and approaches
to work have to be integrated in teams composed
of people with dierent cultural backgrounds, re-
quiring time and eort to reach consensus on fea-
sible solutions, and increasing coordination costs
(Guillaume et al., 2013).
Among the various sources of cultural diversity,
scholarly research on the diversity–performance
relation has focusedmainly on nationality and eth-
nicity (Dahlin, Weingart and Hinds, 2005; Earley
and Mosakowski, 2000), because nationality rep-
resents a key determinant of a person’s self-identity
(Earley and Mosakowski, 2000). Religion remains
a relatively neglected issue (Pitts and Wise, 2010),
in spite of the fact that religious convictions may
be deeply held and involve attitudes and obliga-
tions that aect the way in which people behave
as employees (Hicks,2003), thereby influencing or-
ganizational performance (Rao, 2012). This paper
contributes to filling this research gap by empiri-
cally investigating the relation between workforce
religious diversity and performance in hospitals.
The organizational context that we study –
hospital care in Dubai – represents an exemplar
case of widespread multinational, multi-religious
teams in healthcare. The rising population, the
growth in income levels and the government’s
strategy to attract international medical tourism
has led healthcare organizations to hire qualified
foreign personnel to cope with the shortage in
local professionals. While the issues created by
multinationality cannot be denied, we believe that
it is of particular relevance to analyse the eects
created by multi-religious work teams, given that
the Emirates is a predominantly Muslim country,
and religion has an important influence on specific
health practices (Kronfol, 2012). Further, when
the health conceptions of healthcare professionals
dier substantially from the cultural groups they
serve,this may lead to confusion, conflicting health
promotion goals and low adherence to treatment
regimes (Hannawi and Al Salmi, 2014), thus
aecting the quality and eciency of healthcare.
Our measure of performance is the ward’s pro-
duction eciency. For several healthcare systems,
including Dubai’s, the challenge is to satisfy in-
creasing demand, while facing resource constraint
in terms of sta and equipment. Therefore, the
input–output relation is an important metric of
performance on which to gauge the impact of
workforce diversity. With respect to the organi-
zational diversity literature, production eciency
also oers the advantage of being an ‘objective
measure’. As such, unlike perceptual measures
of performance, it is not prone to biases in the
measurement of the diversity–performance rela-
tion (van Dijk, van Engen and van Knippenberg,
2012).
Analogous to most studies on workforce diver-
sity in healthcare, the team is considered the rele-
vant unit of analysis, since teamwork is crucial in
hospitals, where patient care is distinctively based
on joint actions (Shortell et al., 2001). The hos-
pital ward is a reasonable proxy of the hospital
team, especially for smaller wards. However, even
if larger wards may encompass multiple teams,
each of them cannot account for hospital output
defined as patient cases treated without the col-
laboration and coordination of other teams be-
longing to the same ward (e.g. in surgical wards,
cases treated result from the joint action of nurs-
ing and operating-room teams). Thus, in terms of
eciency,a hospital ward may be viewed as a team
in charge of providing the whole care necessary to
treat a patient.
The analysis is undertaken by adopting a two-
step approach (Bozec, Dia and Bozec, 2010),
whereby the first step measures production e-
ciency with bootstrapped data envelopmentanaly-
sis (DEA), whereas the second step applies regres-
sion models to estimate the impact of diversity on
eciency.
Our results may be of interest to scholars and
policy-makers alike. First, from a theoretical
standpoint, the research contributes to further
the understanding of the diversity–performance
relationship, by showing that religious diversity
has a curvilinear eect on eciency, and by study-
ing how relevant moderating variables shape this
relationship. In this direction, the study addresses
the call for research by Jackson, Joshi and Erhardt
(2003), who see religion as an underrepresented
but salient source of diversity. Next, the research
develops a refined model of how religious diversity
aects team eciency in healthcare, a context
increasingly called to address the issues raised by
a multicultural workforce, and to cope with the
demands of a multi-religious customer base. Al-
though many of the arguments used in hypothesis
development are specific to healthcare,the analysis
may add to the understanding of multi-religious
teams also in other industries that use teams
© 2016 British Academy of Management.
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