Perceptions of diversity in the largest overseas US Navy hospital

The aim of this study was to assess the extent to which employees’ receptivity to diversity and diversity management varied by gender and ethnicity in the largest overseas hospital in the US Navy. A survey of 328 participants, of whom 68.3% were male and 42.7% were white, showed no significant difference between female and male employees in their receptivity to diversity. Asian males reported significantly greater receptivity to diversity than whites. Asian females were not as receptive to diversity as the Asian males. When it came to endorsing diversity initiatives in the workplace, Hispanic and Asian Americans were significantly more receptive to these than their white counterparts. A similar though statistically insignificant pattern was seen for African Americans compared to Whites. The theoretical and practical implications of the results are discussed, limitations of the study are noted, along with suggestions for future research, and lastly, managerial implications are presented.


Introduction
The size, distribution and composition of the American military population 'continues to reflect demographic trends that are altering the entire American population', a population that continues to become more diverse each year (Segal and Wechsler-Segal, 2004, p. 37). A Defense Equal Opportunity Management Institute (DEOMI) report from 2004 to 2010 found a decrease in white male active duty forces and an increase in minority male active duty forces (Sudduth, 2011). Although African American female active duty forces decreased by 6%, white, Hispanic and American Indian/Alaska Native female active duty forces increased by 4%, 21% and 12% respectively. In line with this trend, the US Navy workforce has become increasingly diverse in terms of gender and race (Velarde, 2008) and has invested substantial resources to develop and implement policies that promote opportunity (Paige, 2011;Metzer, 2013) and a culture of diverse backgrounds and perspectives as outlined in the Navy's Total Force Vision for the 21st Century (US Navy, 2010). Hence a considerable amount of time is spent measuring diversity-related factors in the military such as inclusion, benefits, justice, mentoring, work group effectiveness, work group cohesion, personal accountability, training and development, and leadership (Sudduth, 2011). What is not clear is whether organisational members subscribe to the value of diversity and to diversity management initiatives in the Navy. What is known, from a limited number of studies conducted in the public sector in the US federal government, is that an employee's receptivity to diversity and diversity management varies between gender and race groups (Soni, 2000;Choi and Rainey, 2010;O'Brien et al, 2010). Burress et al (2008) found a total of 274 journal articles and research reports about aspects of race and gender diversity in the Navy and the other US military services, citing published research conducted since the advent of an all-volunteer force in 1973. Of this number, only 49 articles were directly related to diversity and an even smaller number, 17, were related to diversity management. None of these studies focused on how a culturally diverse workplace and the support and actions of top management to effectively manage diversity are perceived by US Navy Hospital employees. Little research has been published in this area to date. This is surprising given that behaviour is in part based on perceptions; therefore, it is important to understand how employees perceive others and the actions of top management (Mor Barak, 2005;Holtz and Harold, 2013). This paper reports on a study that addressed gaps in the literature by examining the extent to which receptivity to diversity and receptivity to diversity management vary among US Navy employee groups.

Receptivity to diversity, gender and race
Most studies have focused on gender and race differences in attitudes toward Equal Employment Opportunity/Affirmative Action (EEO/AA) rather than diversity (Aguirre et al, 1993;Bobo and Kluegel, 1993;Zdaniuk and Bobocel, 2011). The emphasis on diversity within the organisation and the role of AA programmes was found to be a point of considerable disagreement between minority and majority employees (Triandis, et al, 1993;Mangum, 2008;Ortega et al, 2012). Attitudes toward AA policies tend to be more positive among minorities as compared to whites (Bobo, 2000;Kravitz and Klineberg, 2000;Klineberg and Kravitz, 2003;Harrison et al, 2006). The promotion of multicultural work environments is based on the premise that such diversity will create better decision-making in the organisation, greater creativity, increased competitiveness (Bassett- Jones, 2005;Kravitz et al, 2008;Thomas, 1990) and improved performance (Knouse, 2003;Cummings, 2004) and outcomes (Riche, 2005).
Women and minorities are more likely to be recipients of benefits within the organisation from policies and procedures that encourage and promote a more diverse workforce. Conversely, white males may see themselves as not benefiting from the same policies that affect the power structure and resource allocation within the organisation (Kossek and Zonia, 1994;Hansken and Tippins, 2012). This can lead to resentment, disruption in the workplace (Parvis, 2005), resistance and stereotypes, which damage intergroup relations.

Receptivity to diversity management, gender and race
Previous research points to the existence of gender and race differences in perceptions of discrimination in organisations which can affect how employees view and support diversity management programmes. For example, many Blacks assume that most Whites are prejudiced (Triandis, 1976;Appiah, 2011;Irizarry, 2013), and consequently, people of colour perceive their race as a barrier in their advancement (Jones, 1986;Worsley and Stone, 2011). Vinson and Holloway (1977) found that Blacks see less discrimination in organisations that have formal rules for hiring and firing as opposed to none at all. They assume that if the supervisor has discretion, they will be subjected to discrimination. This perception or their reality may still be viewed as an issue by members of some minorities (Crosby and Clayton, 2004;Evans and Chun, 2007;Bendick and Nunes, 2012). Alderfer et al (1980) and Khosrovani and Ward (2011) suggest that women and minorities receive fewer opportunities for training and development to prepare them for additional responsibilities. Black employees may believe that they receive less important career information than do their White counter-parts (Zajac, 2011;Trueland, 2012). Triandis et al (1993) found that members of minority groups often perceive ambiguous behaviours as prejudice. It is also thought that women tend to have less access to a variety of important resources in organisations than do men.
Potential advancement is limited in scope and frequency for women and minorities. EEO/AA polices are not designed, or at least not perceived to be designed, for all employees. It may be expected that members of different groups, particularly white males, will have different reactions to EEO/AA policies in an organisation (Bobo and Kluegel, 1993;Graves and Powell, 1994;Harrison et al, 2006). Members of minority groups perceive themselves to benefit from identity group programmes, white men may not and may even regard diversity management initiatives as harmful (Kidder et al, 2004). In testing a new theoretical model of receptivity to diversity, Soni (2000) identified significant and meaningful differences in how white males and females, as opposed to minority males and females, view diversity and diversity management initiatives. However there is very little empirical evidence about whether or not organisational members within specific race groups in fact subscribe to the value of diversity and employer-supported diversity management initiatives.
This study provided an opportunity to better understand the Soni (2000) findings and their potential to be replicated in a new setting, by determining the extent to which employees' receptivity to diversity and receptivity to diversity management initiatives varied by gender and ethnicity. Unlike the Soni study that amalgamated race groups into majority (White) and minority (such as African American, Hispanic), this study treated each race group as a separate category for analysis.

Research aims
To ascertain the extent to which employees' receptivity to diversity and diversity management initiatives varies by gender and race.

Procedure
The study was conducted in the largest overseas hospital in the US Navy. The chair of the Institutional Review Board confirmed that the study did not require ethical review. Permission for this research was approved in an effort to support academic research, provide access to a relevant study population, and use the results for process improvement initiatives to strengthen the effectiveness of work teams, diversity policies and diversity programmes.
The intention was to replicate Soni's (2000) study using her survey tool developed to test a theoretical model of receptivity to diversity (Table 1). She constructed the survey tool using two different dimensions, receptivity to diversity, and receptivity to diversity management initiatives. The survey tool was slightly modified for difference in organisational terms (from Agency Top Administrators to Organisation Directors and Senior Leadership). The content of the questions remained the same. Soni (2000) developed these indices based on her understanding of the theory underlying receptivity to diversity and diversity management. Soni (2000) reported adequate reliability (Cronbach's alpha coefficient for the indexes ranged from 0.8 to 0.9). This range demonstrated a moderate to high level of internal consistency. Content validity was used in the study as the validity criterion for the instrument. This provides a reasonable foundation on which to build a methodological assessment of the survey instrument's validity (Litwin, 1995).
The 20 questions captured the variables of interest, receptivity to diversity and receptivity to diversity management using a five-point Likert scale (Table 1). The first 10 questions were used to obtain a receptivity to diversity score. The second 10 questions were used to obtain a receptivity to diversity management score. The survey was administered by mail with an introductory cover letter containing the purpose of the study, a request for cooperation and a promise of anonymity mailed to each member of the organisation with a request for returns within 30 days.
The address and (free to employees) Military Postal Service name was provided with each survey. All surveys were sent to the mailbox of each member of the organisation with a request to return the survey. An email was sent to all hospital staff to let them know a survey was sent to them, the purpose of the study and the importance of their response. Staff members were told that for each survey received, one US dollar would be donated to a local orphanage. The US military and civilian population maintains close ties with the local community. The rationale was that people would be The responsibility for creating diversity rests with senior leadership Increased diversity will require the organisation to invest more resources in teaching staff how to deal with cultural differences All staff can benefit from effective diversity management Diversity management is necessary for tapping the contributions of all employees The organisation does enough to address various diversity issues This organisation is spending enough time and money on diversity issues Diversity management is the current terminology used to describe affirmative action Attention to diversity management is necessary due to the perceptions of discrimination by women and minorities The organisation's directors and senior leadership practice what they preach about diversity management Most leaders in the organisation set a positive example of how to effectively manage diversity willing to complete the survey if they were earning money for a charity initiative.
Ten days after the original mailing a follow-up message was sent via email to all staff members. Two more follow-up emails were sent at 10-day intervals. The surveys were received and screened by a neutral third party who removed any information that might personally identify a respondent. Once anonymity was safeguarded, the neutral party forwarded the survey information to the researcher for data processing. Demographics were divided into eight categories: gender (male and female), race (White, Asian, African American and Hispanic).
The data were analysed using descriptive statistics. Univariate Analysis of Variance (ANOVA) was used to examine the relationships between: . Receptivity to diversity and gender/race (whether receptivity scores varied significantly by gender/ race) . Receptivity to diversity management and gender/ race (whether receptivity scores varied significantly by gender/race).

Sample
All 894 employees, both Navy and civilian personnel, were invited to participate in the study, with assurances that this was completely voluntary and anonymous. A total of 328 responded, yielding a 37% response rate. This was considered to be an acceptable return rate.
Of the 328 participants, male employees composed the largest group by gender at 68.3%. Most respondents (42.7%) were white, while 26.2% were Asian, 20.4% were African American, and the remaining 10.7% Hispanic. No other race groups were represented within the organisation at the time of the study such as Pacific Islander, American Indians, Alaska Natives or other. These percentages were proportionate to those in the whole employee population.

Findings
Receptivity to diversity Table 2 shows means and standard deviations of the receptivity to diversity score for gender and ethnic groups. Table 3 shows the ANOVA of the receptivity to diversity score with ethnic group and gender as independent variables. The race group were found to differ significantly in receptivity to diversity [F(3, 320) = 5.317, P=0.001]. A Bonferroni multiple comparisons procedure was conducted to determine which means were significantly different across race. Asian employees were found to be significantly more receptive to diversity than white employees. The significant main effect for race was qualified by an interaction effect between gender and race whereby, as a group, male Asian employees reported greater receptivity to diversity than white employees when compared with female Asian employees (Table 4). Receptivity to diversity management Table 5 shows means and standard deviations of the receptivity to diversity management score with ethnic group and gender as independent variables. The ANOVA results indicate that receptivity to diversity management differed significantly across race F(3, 320) = 6.480, P<0.001 (Table 6). A Bonferroni multiple comparisons procedure was conducted to determine which means were significantly different from one another ( Table 7). The results show significant differences between white and Asian and between white and Hispanic ethnic groups. The difference between white and African American just failed to reach significance. No differences among the minority groups reached significance.  (2000). More specifically, this study was of staff in an overseas US Navy hospital. Diversity research was found to be lacking between gender and race groups with respect to receptivity to diversity and receptivity to diversity management. Contrary to the Soni (2000) findings, no significant difference was found between female and male employees in their receptivity to diversity. There was an interaction effect between ethnicity and gender with regard to receptivity to diversity in that male Asian employees reported greater receptivity to diversity than Whites. Female Asian employees were less receptive to diversity than male Asian employees. The lack of a significant main effect for gender on either dependent variable may represent a selection effect due to the military environment studied. Females that work in a male-dominated environment, such as the military, may be those that have less traditionally feminine identities and thus, do not perceive the personal benefit of treating gender as a target for diversity management interventions. This lack of differences could also reflect the success of Navy medicine in promoting the work and value of female personnel. The absence of a statistically significant gender finding could also be the levelling result of a rule-oriented and compliance-driven environment where mandated equal employment opportunity training and regular command climate evaluations are the norm.
It is also arguable that the training of recruits and subsequent operational experiences provided by the US Navy offer some of the most effective approaches to managing diversity seen in large organisations. The US Navy builds cohesive units out of diverse groups of individuals during training, emphasising the importance of teamwork in overcoming obstacles. Strong bonds are often forged through overcoming shared adversity. Moreover, early on in the induction to Navy life, personnel are taught a set of unified values more commonly referred to as core values: honour, courage and commitment. These core values may moderate attitudinal differences based on gender and race. Such a team-oriented society may engender respect and appreciation for the unique skills and perspectives brought to bear on shared problems by team members from diverse backgrounds. As such, there may be a general level of acceptance and appreciation for diversity that mitigates most between-group differences.
However, the benefits of these experiences may be limited as differences between race groups became stronger when receptivity to diversity management was examined. In other words, the hypothesised respect for diversity inherent in the military culture may only go as far as leveling people's openness to diversity but not to diversity management. When it came to endorsing diversity initiatives in the workplace, Hispanic and Asian American employees were significantly more receptive to these than white employees. A similar, though statistically insignificant pattern, was seen for African Americans compared to Whites.
There is still one question that needs to be reconciled. Why was the difference in receptivity to diversity more pronounced between white and Asian American employees as opposed to the other race groups? This is an interesting finding since the literature (Kravitz and Platania, 1993;Bell et al, 1997;Bobo, 1998;Kravitz and Klineberg, 2000) suggests that Asian American employees are generally less receptive to diversity than Hispanic and African American employees, but more receptive to diversity than white employees. No evidence of differences among minority ethnic groups was found.
Most of the Asian employees in the study were born in the Philippines. As a subpopulation within the category of Asian Americans, they are likely to have unique characteristics, which warrant further study as a separate group. Additionally, a post-survey interview of some of the Asian American employees revealed that some had past experiences with discrimination and valued different cultures and heterogeneous teams. The location of the institutional setting in Okinawa, Japan, also deserves mention. The embedding of a Western-based institution in an Eastern culture may have highlighted cultural differences that were more salient to Asian Americans than to other minorities. Lastly, qualitative data collected in the form of post survey interviews underscored the differences in the receptivity to diversity management means between white employees and Asian and Hispanic employees. Many Asian and Hispanic employees reported that they thought diversity management policies and programmes were necessary in the workplace. Some commented that programmes 'let people know they need to treat others fairly' and that '[the organisation is] simply open to diversity.' In fact, some respondents believed that diversity policies and programmes assisted them with their advancement.

Limitations and directions for future research
The Hispanic population in this study was small, comprising 8-9% of the hospital population, which may limit generalisation to other settings. There is some evidence to suggest that individuals can differ in the extent to which their group membership is central and salient to their self-concept. The study confined itself to surveying civilian and military employees of an overseas US Navy hospital and while the authors believe this sample to be reasonably representative of other employee populations in US military hospitals, caution is recommended in generalising these findings to other settings.
The findings of the current study shed some light on important questions for future research studies to address. First, as the current study is the first in a US Navy hospital, future studies can be extended to other, similar organisations to validate the findings. Secondly, findings may have been affected by limited demographic questions. Future research could be extended to include other dimensions of diversity such as position level (supervisor or non-supervisor), age, organisational tenure, employment classification (military or civilian), and education level. Finally, it is suggested that future studies utilise larger and more balanced samples within gender and race groups to examine the differences between these groups.

Implications for managers
As styled earlier, it is estimated that the population of the US will increase to 438 million in 2050 from 296 million in 2005, and 82% of this increase will be due to immigrants arriving from 2005 to 2050 and their USborn descendants (Passel and D'Vera Cohn, 2008). These figures challenge organisational leaders to influence everyone to want to work together as an effective and efficient team. As workplace diversity increases in organisations, so will the possibility of problems between members of different cultures. Leaders who understand this upfront can help temper adverse effects on the staff and on the organisation as a whole. Hiring staff, especially leaders, who value differences, focusing on team building, offering diversity training, developing policies and programmes that recognise differences but share a common goal towards unity, conducting periodic culture audits and sharing results with staff are all ways to improve receptivity to diversity and to achieve and maintain diversity management.

Conclusion
In total, the US Navy Hospital is comprised of a diverse workforce that largely embraces the concept of diversity and diversity management. The findings of this study found no significant difference between female and male employees in their receptivity to diversity. Further study regarding affirmative action policies is needed to further understand the perceptions of more specific ethnic groups.

CONFLICTS OF INTEREST
None.