Mak­ing progress

Sus­tained ef­forts to in­crease mi­nor­ity rep­re­sen­ta­tion in health­care ex­ec­u­tive ranks are de­liv­er­ing re­sults, but bar­ri­ers still re­main

Modern Healthcare - - SPECIAL REPORT - Ashok Sel­vam

Just as grow­ing di­ver­sity is shak­ing up the na­tion’s pol­i­tics, the in­creas­ingly mul­ti­cul­tural pop­u­la­tions served by U.S. health­care providers are also driv­ing changes in the or­ga­ni­za­tions’ C-suites and board­rooms. But the trans­for­ma­tion is still a work in progress. Based on 2012 data from the In­sti­tute for Di­ver­sity in Health Man­age­ment, an af­fil­i­ate of the Amer­i­can Hos­pi­tal As­so­ci­a­tion, mi­nori­ties now make up 14% of hos­pi­tal C-suite po­si­tions. That’s up sig­nif­i­cantly from 9% in the pre­vi­ous year and only 2% in the or­ga­ni­za­tion’s first bench­mark sur­vey in 1994.

Sev­eral fac­tors ac­count for the re­cent gains, says Fred Hobby, the in­sti­tute’s pres­i­dent and CEO. He cred­its or­ga­ni­za­tions in­dus­try­wide that have stepped up ef­forts to fo­cus on di­ver­sity, while also not­ing that more se­nior-level ex­ec­u­tives have an­nounced their re­tire­ments, cre­at­ing ad­di­tional op­por­tu­ni­ties.

But the num­bers still don’t re­flect the na­tion’s racial and eth­nic pro­file, in which nearly 22% of the U.S. pop­u­la­tion is non­white, ac­cord­ing to the Cen­sus Bureau.

There’s still plenty of work to do, says John Blu­ford, pres­i­dent and CEO of two-hos­pi­tal Tru­man Med­i­cal Cen­ters in Kansas City, Mo., and a pre­vi­ous AHA board chair­man. He’s also one of this year’s win­ners of Mod­ern Health­care’s CEO IT Achieve­ment Awards. “Di­verse per­spec­tives yield bet­ter de­ci­sions, and bet­ter de­ci­sions yield bet­ter out­comes,” he says. “Those who are in a di­verse en­vi­ron­ment are go­ing to be more suc­cess­ful com­pet­i­tively.”

Providers have cre­ated di­ver­sity com­mit­tees and ex­ec­u­tive ti­tles fo­cus­ing on strate­gies to re­cruit more mi­nori­ties, women and mem­bers of the gay-les­bian com­mu­ni­ties to lead­er­ship roles. While progress has been made in hir­ing and pro­mot­ing mi­nori­ties, bar­ri­ers still ex­ist. “Part of it is just the his­tory and main­tain­ing the sta­tus quo while be­ing com­fort­able in that sta­tus quo,” Blu­ford says. “If you don’t stretch your­self and take a risk, you are in ef­fect tak­ing a risk.”

Blu­ford, who is African-Amer­i­can, cred­its dili­gence and his com­mit­ment to the mis­sion of health­care for his suc­cess, but ac­knowl­edges that some or­ga­ni­za­tions need a primer in di­ver­sity strate­gies. An or­ga­ni­za­tion can’t pin the trans­for­ma­tion of its cul­ture on a com­mit­tee or the chief di­ver­sity of­fi­cer. It needs to be a sys­tem -wide ef­fort start­ing at the top, he says.

David El­garico, board chair­man of the Asian Health Care Lead­ers As­so­ci­a­tion and ex­ec­u­tive di­rec­tor of an­cil­lary ser­vices-ad­min­is­tra­tion at 363-bed Univer­sity of Cal­i­for­nia at Irvine Med­i­cal Cen­ter, echoes Blu­ford’s re­marks on the need for greater di­ver­sity. “Per­son­ally, I’d like to see more mi­nori­ties as CEOs; that’s the main met­ric used to mea­sure suc­cess,” says El­garico, who is of Filipino de­scent.

Only 9% of CEO po­si­tions at hos­pi­tals and health sys­tems are held by mi­nor­ity pop­u­la­tions, the sec­ond-low­est per­cent­age of all C-suite po­si­tions, ac­cord­ing to the di­ver­sity in­sti­tute. Chief fi­nan­cial of­fi­cers scored lower, at 7%. Mi­nori­ties hold 16% of chief med­i­cal of­fi­cer po­si­tions and 14% of chief op­er­at­ing of­fi­cer jobs. Not sur­pris­ingly, the top role for mi­nor­ity ex­ec­u­tives was chief di­ver­sity of­fi­cer, at 60%.

Es­tab­lish­ing pro­grams that pro­vide train­ing op­por­tu­ni­ties and the sup­port of strong men­tors are two keys to in­creased rep­re­sen­ta­tion in the C-suite and on gov­ern­ing boards, El­garico says. Par­tic­i­pat­ing in or­ga­ni­za­tions such as the AHCLA, the Amer­i­can Col­lege of Health­care Ex­ec­u­tives and the National As­so­ci­a­tion of Health Ser­vices Ex­ec­u­tives are also im­por­tant for ca­reer de­vel­op­ment and net­work­ing.

El­garico dis­agrees with the fre­quently heard no­tion that there’s still a short­age of highly qual­i­fied mi­nor­ity can­di­dates to fill many of the top jobs in health­care. He says the big­ger prob­lem is of­ten with the hir­ing process. “The chal­lenge is some peo­ple will pick only peo­ple who re­mind them of them­selves or some­one you know,” he says. “They’re not con­sciously aware that this is go­ing on. It’s only hu­man na­ture.”

For the top ex­ec­u­tive ranks in health­care to bet­ter re­flect the racial and eth­nic makeup of Amer­ica, gov­ern­ing boards at hos­pi­tals and health sys­tems—the peo­ple who make most of the hir­ing de­ci­sions at the top lev­els—also need

to be­come more di­verse.

African-Amer­i­cans hold key lead­er­ship posts at 55-hos­pi­tal Catholic Health Ini­tia­tives, based in En­gle­wood, Colo. Those in­clude the top two C-suite po­si­tions, Pres­i­dent and CEO Kevin Lofton and Ex­ec­u­tive Vice Pres­i­dent and COO Michael Rowan. But CHI still faces chal­lenges in its board re­cruit­ing.

“There’s a real short­age of per­sons, not so much women any­more, but per­sons from dif­fer­ent eth­nic and racial back­grounds,” says Sis­ter Phyl­lis Hughes, chair of CHI’s 17-mem­ber board of stew­ard­ship trus­tees. She says that while there’s high de­mand for peo­ple to serve on national boards, the sup­ply re­mains low.

Hir­ing Lofton in 2003 was in­te­gral to at­tract­ing mi­nor­ity staff at all lev­els of the health sys­tem, Hughes says. It showed that CHI wasn’t con­tent with just mak­ing di­ver­sity part of its mis­sion state­ment, she says. Hughes also touted the sys­tem’s di­ver­sity com­mit­tee, which helps to ef­fec­tively com­mu­ni­cate pol­icy and ex­pec­ta­tions to staff while serv­ing as a fa­cil­i­ta­tor when de­vel­op­ing the health sys­tem’s di­ver­sity strate­gies.

Judg­ing by en­roll­ment in health­care man­age­ment pro­grams, gov­ern­ing boards should be see­ing a sharp in­crease in qual­i­fied mi­nor­ity can­di­dates for top man­age­ment po­si­tions. About 42% of grad­u­ate stu­dents in health­care man­age­ment pro­grams na­tion­ally were mi­nori­ties in the 2009-10 aca­demic year, ac­cord­ing to the As­so­ci­a­tion of Univer­sity Pro­grams in Health Ad­min­is­tra­tion. The per­cent­ages have steadily in­creased from the 14% in the 1990-91 aca­demic year and 30% in 2000-01. Time will tell if the grow­ing en­roll­ments trans­late into more op­por­tu­ni­ties for the grad­u­ates.

At many sys­tems, tal­ent de­vel­op­ment is home-grown. Of­fi­cials at Kaiser Per­ma­nente, Oakland, Calif., say they are for­tu­nate they had the chance to pro­mote Bernard Tyson, who has spent 29 years with the com­pany, most re­cently as pres­i­dent and COO. Tyson, who is AfricanAmer­i­can, will as­sume the top job at the end of the year, re­plac­ing long­time Chair­man and CEO Ge­orge Halvor­son.

Kaiser’s com­mit­ment to di­ver­sity drew Jenny Ming to the or­ga­ni­za­tion as a board mem­ber in 2006. She’s now pres­i­dent and CEO of Char­lotte Russe Hold­ings, a cloth­ing re­tailer for young women. Ming says she’s ex­cited about her on­go­ing role in help­ing to make Kaiser lead­er­ship re­flect the com­mu­ni­ties the or­ga­ni­za­tion serves.

Ming, who was born in China, re­it­er­ated that any changes to a com­pany’s cul­ture stem from will­ing se­nior lead­er­ship. She also echoes El­garico re­gard­ing the im­pact that sub­con­scious bias can have on the hir­ing process, which she says hin­ders ad­vance­ment of mi­nori­ties in­side and out­side of health­care.

“There are some gen­er­al­iza­tions into what I look like,” Ming says. “I cer­tainly don’t look like a typ­i­cal CEO in many com­pa­nies.”

Reach­ing out to stu­dents is also es­sen­tial, and Tyson’s pro­mo­tion shows how im­por­tant it is to rec­og­nize tal­ent early on, says Dr. Ron­ald Copeland, Kaiser’s se­nior vice pres­i­dent of national di­ver­sity strat­egy and pol­icy and chief di­ver­sity of­fi­cer. Nur­tur­ing that tal­ent and re­tain­ing mi­nor­ity staff mem­bers re­main on­go­ing chal­lenges, Copeland says.

The ACHE, long a cham­pion of in­creas­ing di­ver­sity at all lev­els of health­care man­age­ment, spelled out a num­ber of sug­ges­tions in a pol­icy pa­per for in­creas­ing and sus­tain­ing racial and eth­nic di­ver­sity, last re­vised in 2010. Com­pa­nies need to of­fer mi­nori­ties op­por­tu­ni­ties to shadow se­nior ex­ec­u­tives and should re­cruit at schools with di­verse eth­nic en­roll­ments. The or­ga­ni­za­tion also rec­om­mends a bat­tery of in­tern­ships, res­i­den­cies and fel­low­ships for mi­nori­ties to pro­vide the req­ui­site ex­pe­ri­ence highly val­ued by health­care em­ploy­ers.

Train­ing and ed­u­ca­tional pro­grams at all lev­els in health­care or­ga­ni­za­tions are help­ing to pro­mote di­ver­sity. Asha Ro­driguez is the first ex­ec­u­tive fel­low at 17-hos­pi­tal Christus Health in Irv­ing, Texas. It’s a two-year pro­gram, not ex­clu­sively for mi­nori­ties, de­signed to pre­pare stu­dents for ca­reers at the C-suite level. Much of Ro­driguez’s work is con­ducted at 778-bed Christus Santa Rosa Health Care in San An­to­nio. She spends about 60% of her time there and the rest trav­el­ing around the re­gion to learn at other Christus fa­cil­i­ties. She says she par­tic­i­pates in staff train­ing pro­grams, which pro­vide ex­po­sure to pa­tient-care is­sues and also of­fer a glimpse into a hos­pi­tal’s strate­gic-plan­ning process.

Ro­driguez was born on the Vir­gin Is­lands, and says her fam­ily has roots in Trinidad and In­dia. She de­scribes her­self as Afro-Caribbean, and came from a hu­man re­sources back­ground be­fore ap­ply­ing for the fel­low­ship. The pro­gram is all about pro­vid­ing an op­por­tu­nity to change the tra­jec­tory of her ca­reer, Ro­driguez says.

“It put me squarely into op­er­a­tions where I didn’t have any op­por­tu­nity be­fore,” she says. “It’s easy to get pi­geon­holed in a par­tic­u­lar area. With this fel­low­ship, I have a chance to be an ac­tive par­tic­i­pant as a mem­ber of the hos­pi­tal lead­er­ship that I’m as­signed to.”

VeLois Bow­ers, vice pres­i­dent of di­ver­sity and in­clu­sion at Christus, serves as a guide and men­tor for Ro­driguez. She calls the fel­low­ship pro­gram a key part of the health sys­tem’s mis­sion to bet­ter re­flect the com­mu­ni­ties it serves. Bow­ers also cites a some­times un­con­scious bias by board mem­bers and man­age­ment in the hir­ing process, and one way to ad­dress that is to in­crease the pool of highly qual­i­fied mi­nor­ity job can­di­dates. Fel­low­ship pro­grams help de­velop that pipe­line by match­ing fel­lows with a di­verse group of men­tors.

“Peo­ple can work up the ranks, both for­mally and in­for­mally, but I think the idea that is so crit­i­cal is that you have to em­pha­size the avail­able op­por­tu­ni­ties and you re­ally need peo­ple of all back­grounds to step up and con­tinue to men­tor,” Bow­ers says.

In­creas­ing aware­ness among board mem­bers, ad­min­is­tra­tors and oth­ers in­volved in re­cruit­ing and hir­ing is the pri­mary path to ad­dress­ing on­go­ing chal­lenges of lead­er­ship di­ver­sity, says Hobby of the di­ver­sity in­sti­tute. Hos­pi­tals that tend to have more suc­cess at­tract­ing mi­nor­ity ex­ec­u­tives have a cul­ture that’s ready to ac­cept change, he says. Hobby, an African-Amer­i­can, also says he wants health­care ex­ec­u­tives to un­der­stand that broad di­ver­sity in top man­age­ment is a sign of a provider that of­fers cul­tur­ally com­pe­tent care.

“This is a health and safety is­sue,” he says. “This is a qual­ity is­sue.”

TAKE­AWAY: Ed­u­ca­tional ef­forts and men­tor­ing pro­grams help boost the ranks of mi­nor­ity ex­ecs, but num­bers show there’s still a long way to go.

MOD­ERN HEALTH­CARE GRAPHIC

Source: In­sti­tute for Di­ver­sity in Health Man­age­ment Health Re­search & Ed­u­ca­tional Trust, June 2012

MOD­ERN HEALTH­CARE GRAPHIC

Source: In­sti­tute for Di­ver­sity in Health Man­age­ment Health Re­search & Ed­u­ca­tional Trust, June 2012

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