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Peppler L, Molzberger K, Beck P, Matusiewicz D, Schenk L. Dealing with staff diversity in German hospitals: A comparative analysis of doctors and nurses. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Germany is increasingly recruiting foreign healthcare staff due to the shortage of skilled workers. This diversity of professional and cultural backgrounds poses a challenge to everyday life in inpatient care. Previous studies have focused on the renegotiation of professional identities and competencies in nursing or medicine. In contrast, this study sheds light on group-specific mechanisms through a comparative analysis: How do doctors and nurses deal with diversity in the workplace? Where do profession-specific differences emerge and what does this mean for future interventions?
Methods
Eight group discussions (June 2019 to October 2020) were conducted with groups of doctors and nurses with and without a migration background in four hospitals in two federal states in Germany; including 22 nurses and 10 doctors (n = 32). The data were analysed using the documentary method to examine professional meaning-making processes. The results were validated intersubjectively.
Results
The respective handling of diversity in the workplace is influenced by different professional group identities. The situation is precarious for nurses with a migration background - especially for those with an academic degree, as nursing is still an apprenticeship profession in Germany. In the medical profession, on the other hand, diversity does not lead to significant controversies, even if cultural differences are discussed.
Conclusions
Dealing with diversity is negotiated within professional groups. As nursing or medical ‘communities of practice’ (E. Wenger), these have a mediating role through which they can mitigate institutional and individual barriers to the integration of migrants in the workplace.
Key messages
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Affiliation(s)
- L Peppler
- Institute of Medical Sociology and Rehabilitation Science, Charité University Medicine , Berlin, Germany
| | - K Molzberger
- Center for Diversity Research in Teaching, Universität Bonn , Bonn, Germany
- Institute of Medical Sociology and Rehabilitation Science, Charité University Medicine , Berlin, Germany
| | - P Beck
- Institute for Health & Social Sciences, FOM University of Applied Sciences gGmbH , Essen, Germany
| | - D Matusiewicz
- Institute for Health & Social Sciences, FOM University of Applied Sciences gGmbH , Essen, Germany
| | - L Schenk
- Institute of Medical Sociology and Rehabilitation Science, Charité University Medicine , Berlin, Germany
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Peppler L, Molzberger K, Beck P, Matusiewicz D, Schenk L. Diversität im Krankenhaus: Unterschiedliche Ansichten in
Medizin und Pflege. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- L Peppler
- Charité – Universitätsmedizin Berlin, Institut
für Medizinische Soziologie, Berlin, Deutschland
| | - K Molzberger
- Universität Bonn, Zentrum für
Diversitätsforschung in der Lehre, Bonn, Deutschland
- Charité – Universitätsmedizin Berlin, Institut
für Medizinische Soziologie, Berlin, Deutschland
| | - P Beck
- FOM Hochschule für Oekonomie und Management, Institut
für Gesundheit & Soziales, Essen, Deutschland
| | - D Matusiewicz
- FOM Hochschule für Oekonomie und Management, Institut
für Gesundheit & Soziales, Essen, Deutschland
| | - L Schenk
- Charité – Universitätsmedizin Berlin, Institut
für Medizinische Soziologie, Berlin, Deutschland
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Peppler L, Schenk L. Teilhabe von Gesundheitspersonal mit Migrationshintergrund in Krankenhäusern. Erfordernisse und Handlungsoptionen aus Sicht von Expert*innen in medizinischen und pflegerischen Leitungsfunktione. Das Gesundheitswesen 2021. [DOI: 10.1055/s-0041-1732741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- L Peppler
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Charité Universitätsmedizin Berlin
| | - L Schenk
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Charité Universitätsmedizin Berlin
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Peppler L, Schenk L. Integration of migrant healthcare workforce from the perspective of leading hospital staff in Germany. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The German healthcare system is facing a serious shortage of healthcare professionals and is therefore dependent of foreign staff to ensure adequate healthcare. 14 % of the physicians and 17 % of the nurses working in Germany have foreign citizenship. The variety of cultural backgrounds and language skills raises the question for advantages and challenges when it comes to human resource policies in hospitals and outpatient care services.
Methods
The findings are based on 16 expert interviews with physicians, nurses, and managers in leading positions of two hospitals and two outpatient care services. These institutions differ in the extent to which they treat migrant patients and hire foreign healthcare workers.
Results
From the experts' perspective, the biggest advantage in foreign health workers are their language skills. Foreign language skills are a huge advantage provided that their knowledge matches the patients' languages and their German skills are adequate as well. Additionally, their knowledge about other medical cultures are very much appreciated. The experts see challenges in different qualifications that the professionals have gained in their home countries as well as diverse working cultures, which often leads to frustration among the teams. Therefore, too much ethnic diversity is difficult for everyday working life. Ethnic discrimination is the case in hospitals with less migrant staff and patients.
Conclusions
To ensure adequate healthcare, healthcare professionals should get a special training, which enables them to work in diverse teams with colleagues from other countries. Meanwhile, foreign staff need time to get used to new hospital structures and should feel strengthened to bring their skills in. This is a process, which the institutions must moderate and accompany constructively.
Key messages
Immigration of foreign healthcare professionals leads to multicultural teams in healthcare, which are characterized by differences in cultures and qualifications. Therefore, leading professionals should support and encourage multicultural teams to learn how to deal with this diversity in everyday working life.
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Affiliation(s)
- L Peppler
- Charité University Medicine, Berlin, Germany
| | - L Schenk
- Charité University Medicine, Berlin, Germany
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Peppler L, Sonntag PT, Schenk L. Intercultural opening: participant observation in two hospitals and two outpatient care services. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The German healthcare system is facing intercultural diversity, since numerous migrant patients, nurses, and doctors are involved. This raises the question as to what extent everyday processes, working cultures and institutional framework conditions change because of this and how intercultural healthcare can be improved.
Methods
The participant observation took place on 22 days during summer 2018 in two outpatient care services and two hospitals, which show different degrees of intercultural opening (e.g. more or less migrant employees and patients). The aim was to reconstruct the daily work routine of health staff as well as the patients’ daily routine. The anonymized records include meetings, care tours, handovers and visits. The observation protocols were analyzed by documentary method and compared on two levels: degree of intercultural opening and sector affiliation.
Results
The results show that intercultural opening has a sector-specific impact on organization and daily work processes. The health staff of the hospital with high intercultural opening showed routine handling and relaxed reactions to communication difficulties due to the regular care of migrant patients, whereas that of the hospital with low intercultural opening showed stress-related defensive stance due to rare cases. The situation in the outpatient sector is different: The care of migrant patients was perceived to be more costly in the institution with high intercultural opening, because the migrant employees repeatedly perform additional socio-educational work that is not covered by insurance.
Conclusions
The migration-specific knowledge of employees has a positive effect on patient care in both inpatient and outpatient sector. However, this may be financially disadvantageous for nursing services under the conditions of outpatient care.
Key messages
Synergy effects arise from the involvement of migrant health workers and the care of migrant patients. Framework conditions must support these synergy effects in order to improve cultural sensitive healthcare.
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Affiliation(s)
- L Peppler
- Institute for Medical Sociology and Rehabilitation Science, Charité University Medicine, Berlin, Germany
| | - P T Sonntag
- Institute for Medical Sociology and Rehabilitation Science, Charité University Medicine, Berlin, Germany
| | - L Schenk
- Institute for Medical Sociology and Rehabilitation Science, Charité University Medicine, Berlin, Germany
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Peppler L. Workshop Mantelabstract: Migration und Mundgesundheit. Gemeinsamer Workshop der AGs „Dental Public Health“ und „Migration und Gesundheit“ der DGSMP. Das Gesundheitswesen 2018. [DOI: 10.1055/s-0038-1667764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- L Peppler
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Berlin, Deutschland
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Peppler L. 3.5-O3Opportunities and challenges of an ethnic doctor-patient-relationship by the example of physicians and patients of Turkish origin in Germany. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- L Peppler
- Institute for Medical Sociology and Rehabilitation Sciences, Berlin, Germany
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Peppler L. Die Ärzteschaft türkischer Herkunft als Mittler zwischen ‚ausländischer‘ Klientel und ‚deutscher‘ Medizinerschaft. Gesundheitswesen 2016. [DOI: 10.1055/s-0036-1586662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Peppler L. Ärzt/innen und Patient/innen türkischer Herkunft: Zur Generierung ethnischen Expertenwissens und präventiver Praxis am Beispiel von Hepatitis B. Gesundheitswesen 2015. [DOI: 10.1055/s-0035-1562971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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