Diversity challenges in German nursing teams: a participatory organizational development approach

Abstract Background Migration of health care professionals, demographic change and the transformation of the health care system result in highly diverse nursing teams in German hospitals and nursing homes. Different orientations (regarding qualification, generation or migration background) collide in a working environment characterized by staff shortage, time pressure and decisions about life and death. But team cooperation not only has a strong impact on patient safety, but on job satisfaction and therefore retention management. Little is known on how teams cope with diversity challenges and how this is linked with organizational structures. Methods Based on qualitative content analysis of 197,5 hours of participatory observation, 8 group discussions and 25 interviews in 6 nursing teams in 2 hospitals and 2 nursing homes situated in a major German city, we developed workshops on the topic of team diversity and cooperation. 10 workshops (4-16 participants each) were in held in 2023/24 both on team- and management-level. Results All teams are struggling with diversity-related problems, but in their specific ways, depending on the particular neighbourhood of the facility and team composition among other things. Due to the strong team spirit and identity, the teams have a fundamental tendency to integrate diverse perspectives and orientations. But they need time capacities and supportive organizational structures. The workshops created a space to discuss the team specific problems. Starting points for structural changes could be identified and further discussed in the workshops at the next higher hierarchical level. Conclusions Organisational structures provide the framework conditions that enable teams to integrate different perspectives resulting from diversity in a productive way. One-fits all solutions are not suitable to address those problems and improve teamwork. A participatory bottom-up process seems to be the most appropriate approach. Key messages • Institutions need to provide structures in which diversity is not perceived as an additional burden. • The best way to initiate improvements is through a participatory bottom-up approach.