Skip to main content Accessibility help

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

  • Martin Powell (a1) and Nick Johns (a2)


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.



Hide All
Anderson, T. and Metcalf, H. (2003) Diversity: Stacking up the Evidence – a Review of Knowledge, Executive Briefing, London: CIPD.
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.
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.
Awbrey, S. M. (2007) ‘The dynamics of vertical and horizontal diversity in organization and society’, Human Resource Development Review, 6, 1, 732.
Bach, S. and Kessler, I. (2012) The Modernisation of the Public Services and Employee Relations, Basingstoke: Palgrave.
Bagilhole, B. (2009) Understanding Equal Opportunities and Diversity, Bristol: The Policy Press.
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.
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.
Cabinet Office (2008) Together We Can Make Government Work Better: Creating a Diverse Cabinet Office – an Action Plan, London: Human Resources Directorate.
Carvel, J. (2003) ‘NHS is race biased says Phillips’, The Guardian (Society), 30 April.
Cashmore, E. (2002) ‘Behind the window dressing: ethnic minority police perspectives on cultural diversity’, Journal of Ethnic and Migration Studies, 28, 2, 327–41.
Catalyst (2004) The Bottom Line: Connecting Corporate Performance and Gender Diversity, New York: Catalyst.
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.
Chartered Institute for Personnel Development (CIPD), (2005) Managing Diversity: Linking Theory and Practice to Business Performance, London: CIPD.
Cohen, C. and Sterba, J. P. (2003) Affirmative Action and Racial Preference: A Debate, Oxford: Oxford University Press.
Commission for Racial Equality (CRE) (1995) Racial Equality Means Quality: A Standard for Racial Equality for Local Government in England and Wales, London: CRE.
Cox, T. H. (1991) ‘The multicultural organization’, Academy of Management Executive, 5, 2, 3447.
Cox, T. H. and Blake, S. (1991) ‘Managing cultural diversity: implications for organizational competitiveness’, Academy of Management Executive, 5, 3, 4556.
Craig, G., Atkin, K., Chattoo, S. and Flynn, R. (eds.) (2012) Understanding ‘Race’ and Ethnicity, Bristol: The Policy Press.
Crisp, N. (2010) 24 Hours to Save the NHS: The Chief Executive's Account of Reform 2000–2006, Oxford: Oxford University Press.
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.
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.
Davies, Lord of Abersoch (2011) Women on Boards, London: Equality and Human Rights Commission.
Department of Health (DoH) (2000a) Positively Diverse: Report 2000, London: DoH.
Department of Health (DoH) (2000b) Improving Working Lives Standard, London: DoH.
Department of Health (2009) Inspiring Leaders: Leadership for Quality, London: DoH.
Department of Trade and Industry (DTI) (2003) Achieving Best Practice in Your Business: Maximising Potential – High Performance Workplaces, London: DTI.
Dickens, L. (1999) ‘Beyond the business case: a three-pronged approach to equality action’, Human Resource Management Journal, 9, 1, 919.
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.
Dudau, A. L. and McAllister, L. (2010) ‘Developing collaborative capabilities by fostering diversity in organizations’, Public Management Review, 12, 3, 385402.
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.
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.
Finkelstein, S. and Hambrick, D. C. (1996) Strategic Leadership: Top Executives and Their Effects on Organizations, St. Paul, MN: West.
Gauss, J. W. and Jessamy, H. T. (2007) ‘Back to basics: the boards role in developing a diverse leadership team’, Trustee, September,
Government Equalities Office (GEO) (2009) Public Appointments: Opening Doors Increasing Diversity – A Cross-Government Action Plan, London: Government Equalities Office.
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.
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.
Herring, C. (2009) ‘Does diversity pay?: race, gender, and the business case for diversity’, American Sociological Review, 74, 2, 208–24.
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.
Johns, N. R. (2006) How the British National Health Service Deals with Ethnic Diversity: Professional Problems, Patient Problems, New York: Edwin Mellen.
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.
Jones, A. (2006) Rising to the Challenge of Diversity, London: The Work Foundation.
Kalev, A. (2009) ‘Cracking the glass cages? Restructuring and ascriptive inequality at work’, American Journal of Sociology, 114, 6, 1591–643.
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.
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.
Kandola, R. and Fullerton, J. (1998) Diversity in Action: Managing the Mosaic, 2nd edn., London: Institute of Personnel and Development.
Kirton, G. and Greene, A. M. (2007) The Dynamics of Managing Diversity, 2nd edn., Oxford: Butterworth-Heinemann.
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.
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.
Law, I. (1996) Racism, Ethnicity and Social Policy, London: Harvester Wheatsheaf.
Liff, S. (1996) ‘Two routes to managing diversity: individual differences or social group characteristics?’, Employee Relations, 19, 1, 1126.
SirMacpherson, W. (1999) The Stephen Lawrence Inquiry Report, Sir William Macpherson of Cluny, London: HMSO.
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.
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.
National Audit Office (NAO) (2004) Delivering Public Services to a Diverse Society, London: National Audit Office.
National Health Service Executive (NHSE) (2000) The Vital Connection – an Equalities Framework for the NHS, London: Department of Health.
NHS Employers (2009) Managing Diversity: Making It Core Business, Briefing Paper 60, London: NHS Employers.
NHS Institute for Innovation and Improvement (NHS III) (2009) Access of BME Staff to Senior Positions in the NHS, Coventry: NHS Institute.
Noon, M. (2007) ‘The fatal flaws of diversity and the business case for ethnic minorities’, Work, Employment and Society, 21, 4, 773–84.
Oikelome, F. (2007) The Recruitment and Retention of Black and Ethnic Minority Staff in the National Health Service, London: Race Equality Foundation.
Page, S. (2007) The Difference: How the Power of Diversity Creates Better Groups, Firms, Schools and Societies, Princeton, NJ: Princeton University Press.
Pawson, R. and Tilley, N. (1997) Realistic Evaluation, London: Sage.
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.
Pitts, D. W. (2006) ‘Modelling the impact of diversity management’, Review of Public Personnel Administration, 26, 3, 245–68.
Pitts, D. W. (2009) ‘Diversity management, job satisfaction, and performance: evidence from US federal agencies’, Public Administration Review, 69, 2, 328–38.
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.
Ram, M., Theodorakopoulos, N. and Worthington, I. (2007) ‘Policy transfer in practice: implementing supplier diversity in the UK’, Public Administration, 85, 3, 779803.
Richard, O. C. (2000) ‘Racial diversity, business strategy and firm performance: a resource-based view’, Academy of Management Journal, 43, 2, 164–77.
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.
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.
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.
Robinson, G. and Dechant, K. (1997) ‘Building a business case for diversity’, Academy of Management Executive, 11, 3, 2131.
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.
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.
Ryan, J., Hawdon, J. and Branick, A. (2002) ‘The political economy of diversity: diversity programs in fortune 500 companies’, Sociological Review Online, 7, 1,
Saunders, P. (2011) The Rise of the Equalities Industry, London: Civitas.
Schneider, R. and Ross, R. (1992) From Equality to Diversity: The Business Case for Equal Opportunities, New York: Trans-Atlantic Publications.
Shah, A. (2009) Diversity: Boardroom Diversity – The Opportunity, London: NHS Leadership Academy.
Shapiro, G. and Allison, M. (2007) Reframing Diversity, Diversity Professionals’ Forum,
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.
Straw, J. (1999) ‘Ethnic minority targets set for the police’, Equal Opportunities Review, 85, 21–4.
Thomas, D. A., and Ely, R. J. (1996) ‘Making differences matter: a new paradigm for managing diversity’, Harvard Business Review, 74, 5, 7990.
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.
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.
Wrench, J. (2005) ‘Diversity management can be bad for you’, Race and Class, 46, 3, 7384.


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

  • Martin Powell (a1) and Nick Johns (a2)


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed