Organizational diversity and inclusive boundary-work: the case of Israeli hospitals

• Pages: 447-462
• Published date: 21 April 2020
• Date: 21 April 2020
• DOI: https://doi.org/10.1108/EDI-08-2019-0231
• Author: Yael Keshet
• Subject Matter: HR & organizational behaviour,Employment law,Diversity,equality,inclusion

Organizational diversity and

inclusive boundary-work: the case

of Israeli hospitals

Yael Keshet

Department of Sociology, Western Galilee College, Akko, Israel

Abstract

Purpose –The theoretical conceptualization of boundaries is proposed as a useful approach to study diversity

in organizations.

Design/methodology/approach–Two types of diversity in health-care organizations –functional diversity

and social category diversity –are compared, drawing on two extensive studies of Israeli hospitals. One study

addresses the boundarybetween the medical professions and complementary medicine and the other examines

the boundary between Israel’s Jewish ethnic majority and the Arab minority.

Findings –With regard to functional diversity, boundary-work is used to draw, redraw, and maintain the

boundary between biomedicine professionals and complementary medicine practitioners. With respect to

social category diversity, boundary-work is employed to blur the boundary between Jewish and Arab

professionals working within the organization and the ideal of professionalism is used as a boundary object to

blur this ethno-national boundary.

Originality/value–This typology is offered in the hope of providing greater theoretical insight into the study

of organizational diversity in the context of power relations.

Keywords Diversity, Boundary-work, Ethnicity, Hospitals, Professionalism

Paper type Research paper

Introduction

In recent years, a broad range of empirical methods and approaches have been used by

scholars to study the widespread phenomenon of diversity and its management through

work and organization studies (Pullen et al., 2017). Diversity is used in this paper to indicate

differences between functional and social categories and as an analytical tool to help

understand and explain issues of inequity, discrimination and inclusion as organizational

resource in the workplace. Understanding how such categories are used, defined, and

constructed may help understand how the power structures and power relations within an

organization interact with other processes and practices, and affect the lives of people

working (and service recipients) in organizations (Risberg and Pilhofer, 2018). Diversity may

constitute beneficial resources but also pose a challenge, and organizations struggle to

embrace and manage them successfully (Harrison and Klein, 2007).

A framework commonly used to explain the ambiguity of diversity is the categorization–

elaboration model (Van Knippenberg et al., 2004), which proposes that the benefits and

disadvantages of diversity for teams are derived from two independent but interacting

processes. On the one hand, diversity may enhance the effectiveness of work groups because

the greater pool of available knowledge and experiences facilitates elaboration of

task-relevant information. On the other hand, individuals tend to organize their social

environment cognitively into groups on the basis of shared characteristics and to identify

with a social in-group (Hofhuis et al., 2018).

While diversity may refer to an almost infinite number of dimensions, in practice much

diversity research has focused on functionality and social categories. Functional diversity,

which focuses on job-related dimensions such as educational background and functional

Organizational

diversity and

boundary-

work

447

The Israel National Institute for Health Policy Research funded part of the research.

The current issue and full text archive of this journal is available on Emerald Insight at:

https://www.emerald.com/insight/2040-7149.htm

Received 27 August 2019

Revised 14 December 2019

10 February 2020

11 March 2020

Accepted 17 March 2020

Equality, Diversity and Inclusion:

An International Journal

Vol. 39 No. 4, 2020

pp. 447-462

© Emerald Publishing Limited

2040-7149

DOI 10.1108/EDI-08-2019-0231

differences, provides a necessary resource for organizations in a society that relies on

specialization. This type of diversity enables teams to perform better because they have a

larger pool of knowledge and experience from which to draw. Organizations have thus

increasingly relied on cross-functional teams (Lovelace et al., 2001), which include members

from different functional backgrounds (Keller, 2001).

Functional diversity in health-care teams in which members from different health-care

professions work together is often advocated as the key to enhancing patient outcomes. Thus,

introducing interprofessional collaboration has become a high priority for health and social

care professionals around the globe (WHO, 2010). Yet functional diversity tends to exacerbate

role conflict and this helps to explain why it does not always lead to effective team

performance (Johnson et al., 2018). As interprofessional collaboration becomes more

commonplace in health and social care, both scholars and practitioners are searching for

ways to optimize the performance of functionally diverse teams. While some scholarship has

shown that the presence of practitioners from functionally diverse backgrounds may lead

teams to perform better, other studies show that functional diversity generates

categorization, reduces team cohesion and complicates interpersonal communication,

thereby reducing performance (Hofhuis et al., 2018).

A second prevalent type of diversity is social category diversity. This is often called

“surface-level diversity”because individuals can make a fair estimate of the age, gender and

ethnic background of others, and thereby assess the level of their (dis)similarity to themselves

(Harrison et al., 2002). According to social categorization theory, individuals in a given

situation tend to employ any obviously visible characteristic (such as ethnicity) to place

themselves and others into opposing social classifications (“us”versus “them”)(Jaiswal and

Dyaram, 2018).

Ethnic diversity, which is a prevalent type of social diversity in health-care organizations,

was found to be essential to delivering culturally competent health care that helps to reduce

health inequities (Smedley et al., 2004;McGee and Fraher, 2012). Greater workforce diversity

in health organizations can foster the provision of more appropriate health care to diverse

ethnic minority groups and can enhance health professionals’knowledge of minority cultures

(Dreachslin et al., 2000;Pearson et al., 2007). However, ethnic diversity may also heighten

tension and conflict and lead to manifestations of prejudice and racism directed at minority

health-care practitioners (Keshet and Popper-Giveon, 2018).

More generally, diversity is in fact the consequence of classification and the creation of

categories, which is a ubiquitous human activity that serves to bring order to our lives.

“Classifications are powerful technologies. Embedded in working infrastructures they

become relatively invisible without losing any of that power ... classifications should be

recognized as the significant site of political and ethical work that they are”(Bowker and Star,

1999, p. 319). Classification schemes are produced by setting the boundaries of categories

(Bowker and Star, 1999). In their widely cited paper The study of boundaries in the social

sciences, Lamont and Moln

ar (2002) explain the value of the concept of boundaries, which has

become one of our most fertile conceptual tools because it allows us to capture fundamental

social processes at work across a wide range of social phenomena, institutions and locations.

Drawing on empirical studies of two types of diversity in hospitals, I propose to use the

theoretical conceptualization of boundaries to study diversity in hospitals, and more

generally in organizations.

The concept of boundary is used in this paper as a sociocultural, cognitive and discursive

analytical concept. As a social and cultural concept it rests on the construction of identities as

a continuous process of referring to different social systems of meaning with which we

identify or that we “de-identify”from (to create “alterity”)(Czarniawska, 2002). The concept of

boundary is used to study the rhetorical construction of differences and the consequences of

policy, such as the effect of jurisdictional challenge on the division of labor among

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