Middle managers as barriers or enablers in tackling racial discrimination in the NHS: a qualitative research study

Long, J ORCID: 0000-0002-6889-6195, Buchan, S ORCID: 0000-0002-4157-8760, Sampson, FC ORCID: 0000-0003-2321-0302, Otaye-Ebede, L ORCID: 0000-0001-5158-290X and Dawson, J ORCID: 0000-0002-9365-8586 (2026) Middle managers as barriers or enablers in tackling racial discrimination in the NHS: a qualitative research study BMJ Open, 16 (1). e100910-. ISSN 2044-6055, 2044-6055

Access the full-text of this item by clicking on the Open Access link.

Abstract

Objective To explore the role of senior and mid-level managers as barriers or enablers to change in tackling the discriminatory challenges experienced by Black and Minority Ethnic (BME) employees working in the National Health Service (NHS). Design A multi-level, multi-sourced qualitative study of five NHS Trusts in England. Setting and participants 26 qualitative interviews with senior leaders and BME network chairs (27 participants) and five focus groups (37 participants) with BME employees, across five NHS Trusts in England. Results Our findings revealed that discrimination, racial harassment, incivilities, lack of progression and exclusion experienced by BME employees appear to be deeply ingrained in the culture of the NHS. Despite numerous national and local initiatives aimed at promoting inclusivity and addressing discriminatory behaviours, our findings also revealed a notable disparity between what senior leaders thought was effective in addressing discriminatory behaviours and the actual lived experiences of BME employees. Finally, a key finding was the pivotal role middle managers played in setting the tone for whether discriminatory behaviours are challenged or allowed to persist, which directly impacts on the overall experiences of BME employees within the NHS. Conclusions Our results provide evidence that not only does racial discrimination continue to be experienced by NHS BME employees, but that middle managers are key to addressing and improving this situation. Despite there being national policies and initiatives addressing racial discrimination, our study found that positive change, whether at an individual or organisational level, is dependent on the actions and commitment of middle managers.

Item Type:	Article
Uncontrolled Keywords:	Health Workforce, Human resource management, Work Satisfaction, QUALITATIVE RESEARCH
Divisions:	Faculty of Humanities & Social Sciences Faculty of Humanities & Social Sciences > School of Management Faculty of Humanities & Social Sciences > Faculty of Humanities & Social Sci (All T&R Staff) Faculty of Humanities & Social Sciences > School of Management > Work, Organisation and Management (WOM) Faculty of Humanities & Social Sciences > School of Management > School of Management (T&R Staff)
Depositing User:	Symplectic Admin
Date Deposited:	29 Jan 2026 09:20
Last Modified:	28 Feb 2026 15:47
DOI:	10.1136/bmjopen-2025-100910
Open Access URL:	https://bmjopen.bmj.com/content/16/1/e100910
Related Websites:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3196805
Disclaimer:	The University of Liverpool is not responsible for content contained on other websites from links within repository metadata. Please contact us if you notice anything that appears incorrect or inappropriate.