Middle Managers as Barriers or Enablers in Tackling Racial Discrimination in the NHS: A Qualitative Research Study

Objective

To explore the role of senior and mid-level managers as barriers or enablers to change in tackling the discriminatory challenges experienced by Black and Minority Ethnic (BME) employees working in the NHS.

Design

A multi-level, multi-sourced qualitative study of five NHS Trusts in England.

Setting and participants

26 qualitative interviews with senior leaders and BME network chairs (27 participants) and 5 focus groups (37 participants) with BME employees, across five NHS Trusts in England.

Results

Our findings revealed that discrimination, racial harassment, incivilities, lack of progression and exclusion experienced by BME employees, appear to be deeply ingrained in the culture of the NHS. Despite numerous national and local initiatives aimed to promote inclusivity and address discriminatory behaviours, our findings also revealed a notable disparity between what senior leaders thought was effective in addressing discriminatory behaviours and the actual lived experiences of BME employees. Finally, a key finding was the pivotal role middle managers played in setting the tone for whether discriminatory behaviours are challenged or allowed to persist, which directly impacts on the overall experiences of BME employees within the NHS.

Conclusions

Our results provide evidence that not only does racial discrimination continue to be experienced by NHS BME employees, but that middle managers are key to addressing and improving this situation. Despite there being national policies and initiatives addressing racial discrimination, our study found that positive change, whether at an individual or organisational level, is dependent on the actions and commitment of middle managers.

STRENGTHS & LIMITATIONS

• Multi-sourced data from both senior leaders and BME staff

• BME staff in a variety of roles and grades

• Mixed qualitative method using interviews and focus groups

• Self-selected focus group participants may not be representative

• Participating Trusts actively motivated to address issues re: inequality – again less representative