Tesi etd-09292025-131115
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Tipo di tesi
Corso di Dottorato (D.M.226/2021)
Autore
TRINCHESE, DAVIDE
URN
etd-09292025-131115
Titolo
Workforce Diversity and Performance in the Public Healthcare Sector: Challenges and Perspectives
Settore scientifico disciplinare
SECS-P/07
Corso di studi
Ph.D. in Health Science, Technology and Management - Ph.D. in Health Science, Technology and Management
Commissione
Relatore Prof.ssa VAINIERI, MILENA
Membro Prof. MANNION, RUSSELL
Presidente Prof. TRULLEN, JORDI
Membro Prof.ssa CANTARELLI, PAOLA
Membro Prof. MANNION, RUSSELL
Presidente Prof. TRULLEN, JORDI
Membro Prof.ssa CANTARELLI, PAOLA
Parole chiave
- Nessuna parola chiave trovata
Data inizio appello
12/02/2026;
Disponibilità
parziale
Riassunto analitico
This PhD dissertation investigates the dual nature, both constructive and problematic, of diversity in the public healthcare sector. While diversity is widely advocated as a lever for improving organizational effectiveness, innovation, and responsiveness, it also presents complex challenges in terms of coordination, cohesion, and governance. Through a four-article structure, this dissertation critically examines how workforce diversity interacts with organizational dynamics and performance outcomes in public healthcare settings.
To ground the research in existing knowledge, the first study presents a systematic review of the empirical literature on workforce diversity and its impact on healthcare performance. By analyzing 58 peer-reviewed articles, the review highlights that workforce diversity is generally associated with positive effects on organizational outcomes at the organizational level. However, at the team level, the evidence is more mixed, especially when considering relational performance, where diversity can lead to fragmentation, miscommunication, and reduced cohesion. The study also emphasizes the role of demographic and professional faultlines in shaping these outcomes, calling for a more context-sensitive understanding of diversity management in healthcare. Finally, at the board level, most studies have focused on gender, suggesting a positive relationship between board gender diversity and performance, unless the setting is not just balanced, as in the UK, where the results are more mixed or not significant.
The second study deepens the analysis through a qualitative exploration of team diversity dynamics within Italian public healthcare organizations. Drawing on in-depth interviews with healthcare professionals, this study identifies both enabling and hindering factors that influence whether team diversity becomes a strategic asset or a source of dysfunction on the basis of the social cognitive theory. The findings stress the importance of shared goals, supervisory leadership, time dynamics, and relational trust. Practical strategies such as functional turnover, job rotation, and targeted training are proposed to mitigate risks and foster inclusive, high-performing teams.
The third and fourth studies provide a quantitative exploration. In this sense, the third study examines the relationship between gender diversity and healthcare performance in the Italian healthcare setting, using an econometric analysis. It reveals that greater female representation in executive positions is significantly associated with improved clinical outcomes, such as shorter average lengths of stay. Conversely, gender imbalances at non-executive levels may contribute to organizational inefficiencies. These findings suggest that gender diversity at leadership levels can act as a driver of better healthcare performance, while also highlighting the need for gender rebalancing throughout the organizational hierarchy. In this sense, we found evidence of the positive impact of diversity.
Finally, the fourth study focuses on the dark side of diversity, investigating how board-level demographic and task-related faultlines influence employee turnover in public hospitals. Based on a five-year dataset from NHS trusts, the study shows that strong internal divisions within boards are linked to higher turnover rates. However, the presence of relational and functional alignment between the CEO and the board can attenuate these negative effects. The results underscore the need for strategic leadership practices that can manage diversity-related tensions and avoid the unintended consequences of diversity.
In conclusion, this dissertation contributes to the literature on public management and healthcare by assessing the complex picture of workforce diversity in the healthcare context. The healthcare sector was deliberately chosen as the field of investigation because it represents a highly complex and interdependent environment, where diversity is not only prevalent but also crucial for addressing challenges. Rather than viewing it as inherently positive or negative, diversity is conceptualized here as a context-dependent force, whose effects are shaped by leadership, structure, communication, and institutional design. The studies presented aim to contribute to the literature underlining how to leverage the bright side of diversity while anticipating and mitigating its dark side in pursuit of more resilient, equitable, and high-performing public healthcare systems.
To ground the research in existing knowledge, the first study presents a systematic review of the empirical literature on workforce diversity and its impact on healthcare performance. By analyzing 58 peer-reviewed articles, the review highlights that workforce diversity is generally associated with positive effects on organizational outcomes at the organizational level. However, at the team level, the evidence is more mixed, especially when considering relational performance, where diversity can lead to fragmentation, miscommunication, and reduced cohesion. The study also emphasizes the role of demographic and professional faultlines in shaping these outcomes, calling for a more context-sensitive understanding of diversity management in healthcare. Finally, at the board level, most studies have focused on gender, suggesting a positive relationship between board gender diversity and performance, unless the setting is not just balanced, as in the UK, where the results are more mixed or not significant.
The second study deepens the analysis through a qualitative exploration of team diversity dynamics within Italian public healthcare organizations. Drawing on in-depth interviews with healthcare professionals, this study identifies both enabling and hindering factors that influence whether team diversity becomes a strategic asset or a source of dysfunction on the basis of the social cognitive theory. The findings stress the importance of shared goals, supervisory leadership, time dynamics, and relational trust. Practical strategies such as functional turnover, job rotation, and targeted training are proposed to mitigate risks and foster inclusive, high-performing teams.
The third and fourth studies provide a quantitative exploration. In this sense, the third study examines the relationship between gender diversity and healthcare performance in the Italian healthcare setting, using an econometric analysis. It reveals that greater female representation in executive positions is significantly associated with improved clinical outcomes, such as shorter average lengths of stay. Conversely, gender imbalances at non-executive levels may contribute to organizational inefficiencies. These findings suggest that gender diversity at leadership levels can act as a driver of better healthcare performance, while also highlighting the need for gender rebalancing throughout the organizational hierarchy. In this sense, we found evidence of the positive impact of diversity.
Finally, the fourth study focuses on the dark side of diversity, investigating how board-level demographic and task-related faultlines influence employee turnover in public hospitals. Based on a five-year dataset from NHS trusts, the study shows that strong internal divisions within boards are linked to higher turnover rates. However, the presence of relational and functional alignment between the CEO and the board can attenuate these negative effects. The results underscore the need for strategic leadership practices that can manage diversity-related tensions and avoid the unintended consequences of diversity.
In conclusion, this dissertation contributes to the literature on public management and healthcare by assessing the complex picture of workforce diversity in the healthcare context. The healthcare sector was deliberately chosen as the field of investigation because it represents a highly complex and interdependent environment, where diversity is not only prevalent but also crucial for addressing challenges. Rather than viewing it as inherently positive or negative, diversity is conceptualized here as a context-dependent force, whose effects are shaped by leadership, structure, communication, and institutional design. The studies presented aim to contribute to the literature underlining how to leverage the bright side of diversity while anticipating and mitigating its dark side in pursuit of more resilient, equitable, and high-performing public healthcare systems.
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