Diversity and performance in healthcare: A systematic review of the evidence base

Background: Diversity in the healthcare sector has been put forward as a key factor for improving organizational performance; however, the evidence based on this assumed positive impact is still fragmented. Purpose: Adopting a narrative and critical approach, this systematic review investigated the relationship between surface and deep-level diversity and performance in the healthcare sector. Performance is categorized into two main dimensions: relational performance, arising from interactions between groups of individuals within organizations, and organizational performance, which refers to outcomes related to the overall organizational activity. Methods: This systematic review focused on scientific papers published in English in international peer-reviewed journals, retrieved from the ISI Web of Science citation and search database. Additionally, citation snowballing was employed to identify further relevant studies. A total of 58 papers were identified as meeting the research criteria. Results: The analysis of the 58 selected studies indicates that at the organizational level, diversity has a generally positive effect on performance. At the team level, however, diversity is frequently linked with mixed or negative relational performance outcomes. Undesired consequences of diversity specifically relate to the emergence of homogeneous subgroups, so-called faultlines, in groups of individuals, ultimately leading to a negative impact on relational and organizational performance. At the board level, where the extant literature has mainly focused on gender diversity, increasing female representation appears to yield positive effects, except when it is already comparatively high. Practice Implications: Policymakers and practitioners should recognize both the benefits and challenges of diversity in healthcare. While diversity is essential in such a complex sector, it may produce unintended negative consequences, particularly when diversity is at high levels or faultlines emerge. This highlights the importance of effective management strategies and human resource policies to optimize its impact.