Healthy Diversity? The Politics of Managing Emotions in an Ethnically Diverse Hospital Workforce

ABSTRACT

Emotions are increasingly incorporated into organisational diversity management initiatives to address some of the challenges said to arise from workforce diversity. Yet few studies have looked at the impact that this emphasis on managing emotions has on minority group struggles for equality, inclusion and justice. We examine this issue in a hospital workplace within a District Health Board located in the bicultural, multi-ethnic and settler colonial context of Aotearoa / New Zealand. Through analysis of diversity training documents and interviews with senior-level managers, we found that the use of emotionality individualised responsibility for inclusive diversity to healthcare workers and maintained the privileged emotions of the white majority. This obscured the structural issues that (re)produce exclusion and inequities.

KEYWORDS:

• Emotions
• hospital
• Aotearoa / New Zealand
• privilege
• cultural and linguistic diversity
• healthcare workers

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Notes

1 District Health Boards are geographically-bounded organisational units of healthcare governance in New Zealand. Established in 2000, their responsibility is to ensure the provision of health care services within their jurisdiction. Currently, there are 20 DHBs across the country.

2 The ethics agreement for the research required that the hospital and DHB be anonymous therefore our references to documents are not directly named.

3 Cultural competence emerged in the 1970s from Transcultural Nursing in the US to ‘meet the health needs of a multicultural world’ (Leininger 1987: XX). The concept has a recognition-based politics with an emphasis on understanding different cultures to provide effective healthcare. The introduction of cultural competency in Aotearoa/New Zealand in the 1990s reflected recognition of ethnic diversification and its impacts in healthcare delivery. Cultural competency was formally legislated in 2003 in the Health Practitioners Competence Assurance Act 2003 (HPCAA), which applies to all health practitioners.

4 Accessing bi-lingual, ‘cultural clinicians’ or ‘cultural staff’ are other means of better engaging with patients encouraged in the documents (Document A).

5 Hofstede’s main cultural dichotomies are ‘Masculinity v. Femininity’, ‘Individualism v. Collectivism’, ‘High power v. Low power distance’ and ‘High v. Low uncertainty avoidance’

6 The continuum was adapted from Cross et al.’s (1989) that emphasises cultural competence as a continual learning process.

7 In contrast, system supports for Asian patients who use the hospital were well developed (including interpreters, booking and reminder systems, health education materials, patient satisfaction surveys and other health information systems).

8 Cultural safety is a concept developed in the 1980s by Māori nurse practitioners that takes a political, structural and social approach to address Māori health inequities (DeSouza 2008), recognising that such inequities result from institutional racism and the devaluing of Māori conceptions of health. Cultural safety was made a requirement for nursing and midwifery in 1992 by the New Zealand Nursing Council, defining the concept as: ‘The effective nursing of a person/family from another culture by a nurse who has undertaken a process of reflection on own cultural identity and recognises the impact of the nurses’ culture on own nursing practice’ (cited in Papps and Ramsden 1996: 491). Cultural safety faced significant criticism, particularly claims that it discriminated against Pakeha and was extremist, and that nursing practice and education is and should remain politically and culturally neutral (Ramsden and Sponnley 1994). In 2002, the nursing guidelines were revised and cultural safety was separated from its basis in Te Tiriti and emphasis on Māori health inequities (Mortensen 2010).

Additional information

Funding

This research was funded by a Faculty Development Research Fund in the Faculty of Science, The University of Auckland.

Notes on contributors

Sandy Lee

Sandy Lee has a PhD in human geography. Her research focuses on multiculturalism, diversity and inequalities in cities with a particular interest in labour and places of work.

Francis L. Collins

Francis L. Collins is Professor of Geography at the University of Waikato, New Zealand. His research focuses on international migration and cities with a particular emphasis on the experiences, mobility patterns, and government regulation of temporary migrants in urban contexts.

Rachel Simon-Kumar

Rachel Simon-Kumar is Associate Professor at the School of Population Health, the University of Auckland. Her research interests sit in the intersections of gender, ethnicity, diversity, health and policy.