Team religious diversity, the degree to which working team members differ in their religious beliefs, is a relevant factor that affects healthcare teams’ outcomes. Because of globalisation and rising labour market mobility, an increasing degree of religious diversity characterises the workforce of many organisations and the composition of work groups.

There are at least three layers through which religion can represent a source of diversity in the workplace. These include core values and beliefs (e.g. the role of work in life, work ethics), attitudes (e.g. attitude towards women in the workplace or towards work itself), and behaviour and symbols (e.g. festivities, clothing).

What is the effect of this diversity on team outcomes, is it beneficial or detrimental? By investigating the relation between the degree of religious diversity and the efficiency of 66 hospital teams, our research shows that there is no simple answer to the above question, since the direction of the impact depends on “how much” diversity a team exhibits.

Religious diversity within health care teams in countries is increasing for several reasons, including growing multiculturalism, the shortage of medical professionals that leads to hiring foreign medical staff, and the need to cater for patients of different religions.

Contrasting arguments exist on the effects of cultural (e.g. in nationality, ethnicity, religion) diversity within workplace teams on their performance. On the one hand, diversity allows expanding the capabilities of teams, and increases the ability of the team to change and innovate. Diversity enriches the teams by bringing in new mind-sets, experiences, and viewpoints. On the other, several beliefs and approaches to work have to be integrated in teams composed of people with different cultural backgrounds, requiring time and efforts to reach consensus on solutions, and making communication and coordination more difficult. While the former effect will drive higher team performance, the latter will make working life more difficult and worsen outcomes.

The organisational context we study is hospital care in Dubai, an interesting case of widespread multi-national, multi-religious teams in healthcare. Given the relevance of the Muslim religion in Dubai, we posit that the proportion of Muslims (the official religion of Dubai) vs. non-Muslim within a work team identifies the relevant measure of religious diversity.

Moderate diversity accrues when within a work team there is a dominant religious group and a smaller sub-group, whereas maximum diversity corresponds to the presence of two equally sized religious subgroups within the hospital team. Our results show that both positive and negative effects can stem from religious diversity in terms of efficiency, with a curvilinear fashion (Exhibit 1). The inverse U-shaped relation suggests that a moderate degree of diversity is beneficial to the performance of healthcare teams, adding new capabilities and allowing serving patients better.

Conversely, when diversity is high, i.e. equally sized and homogeneous religious subgroups form in the workplace, subgroups will tend to express internally cohesive views and positions and may become confrontational. Communication and coordination processes become difficult and relational conflicts may develop, leading to lower performance.

Figure 1. Relationship between efficiency and diversity in religion


As a second step of the analysis, we searched for factors that may influence the inverse-U relation between diversity and team performance. Building on a theory known as CEM, we expect complexity of tasks performed by the team (in terms of informational and decision requirements of the work activities) to enhance the positive effects of diversity. To test for this effect, we mapped the relation between religious diversity and performance separately for surgical and clinical teams. The former are expected to carry out on average more complex work than clinical teams, involving a higher degree of interdependence.

Indeed, we find that surgical teams benefit more than clinical teams from a moderate degree of religious diversity. We also expect the beneficial effects of diversity to be enhanced by effective conflict management practises by the team leader. In the hospital context, task conflict among care-givers reduces efficiency by making information exchange and processing more difficult in activities that require patient-tailored and timely solutions. Our analysis shows the impact of conflict management is especially beneficial when religious diversity is high.

The positive effects of diversity on performance will bog down when diversity is associated with social categorisation, i.e. when members of a team perceive a threat to the identity of their subgroup. Our hypothesis was that the co-presence in the team of another source of diversity (such as nationality) could trigger social categorisation. Results suggest that this is true only when diversity in nationality is coupled with high religious diversity. Social categorisation could be damped by an experienced team leader who could guide the team in developing a common identity, However, our results indicate that the tenure of the team leader makes little difference when religious diversity is high. Therefore, managers’ experience may be no panacea when the composition of the team is very diverse, and conflict management practices become necessary.

The gist of our story is that hospital managers should encourage the creation of multicultural teams, especially in surgical units. However, managers should also be aware that there is a “right mix” of religious diversity. The creation of teams composed of two equally large subgroups diverse for some cultural aspects should be avoided, since they may become antagonistic.



alessandro_ancaraniAlessandro Ancarani is Associate Professor in Managerial Engineering, University of Catania (Italy). He is co-editor in chief of the Journal of Purchasing and Supply Management and member of the Board of the Journal of Public Procurement. He was President of the International Purchasing and Supply Education and Research Association (IPSERA) in the period 2009-2012 and founding member of the European Decision Sciences Institute (EDSI). His research interests are in the analysis of intangibles in public service organisations, public procurement, suppliers’ performances evaluation, and behavioural operations. He has published in leading academic journals.

ali-ayachAli A. Ayach has completed his Ph.D. in Management and Enterprise Engineering, for which he graduated with distinction. He is a Research Fellow at the Faculty of Management Engineering at the University of Rome “Tor Vergata”, and serves the Health Department under the Dubai Government administration. His main research interests include: health care efficiency, productivity and strategy. He won the Executive Award for Enterprise Engineering in Business Internationalization, by the University of Rome “Tor Vergata”, in collaboration with the Italian CNR (National Centre of Research).

carmela-di-mauroCarmela Di Mauro is Associate Professor in Managerial Engineering, University of Catania, Italy. Her research focuses on health care organisation and management, organisational behaviour, behavioural operations and public procurement. Her most recent research has been published in leading international referred journals. She is president-elect of EDSI.


simone_gittoSimone Gitto is Assistant Professor at the University of Rome “Tor Vergata”. He obtained a Ph.D. in Managerial Engineering in 2008. His main research interests include: air transport regulation, forecasting methods, health efficiency and productivity and economic growth. His works have been published in leading international refereed journals.


paolo-mancusoPaolo Mancuso is Associate Professor in Industrial Organization at the University of Rome “Tor Vergata”. He teaches applied economics and industrial organisation. His main research interests include industrial economics, health efficiency and forecasting methods. His research has appeared in several academic refereed journals.