Getting To The C Suite
By Laurie Larson
What Will It Take To See Diversity Across Health Care Leadership?
Diversity in health care leadership has improved greatly over the past 40 years, but minorities still frequently encounter a “glass ceiling” between director-level positions and the “C suite”—that is, health care’s “chief-titled” executive leadership jobs.
According to the latest data from the American College of Healthcare Executives (ACHE), even though ethnically diverse employees represent a growing percentage of the health care profession, they still hold a marginal percentage of executive level positions. This disparity persists despite the fact that more minorities are attaining graduate degrees in health administration. From 1992 to 2001, the number of minority health care master’s degree graduates nearly doubled, and by 2004, the proportion of ethnically diverse graduates from health care master’s programs amounted to nearly 30 percent of the total. But joint studies conducted by ACHE, the Institute for Diversity in Health Management (IFD), the National Association of Health Services Executives (NAHSE) and others show that there are still relatively few of those master’s-trained minorities attaining executive health care positions.
“The 30 percent increase in diverse graduate students is recent,” says ACHE President and CEO Tom Dolan. “It will be a few years before they are CEOs…. We’re making progress but we’re still overcoming 200 years of discrimination.”
IFD’s President and CEO Frederick Hobby says, “There has been an increase in the numbers of minorities in administrative and trustee positions, however, statistically, that increase is not significant over the past five years.” That’s because the total number of hospital administrators has grown as well, so growth remains disproportionate, he explains. White women have improved their numbers in health care leadership more than minorities, and Hobby says he believes that’s because it is a comparatively less dramatic culture shift.
“Some executives are not willing to step outside their comfort level to put someone in authority who is ethnically different,” Hobby says. “And, if a [hiring executive] has a master’s degree, they will look to their own alma mater first when starting an executive search.” He adds, “The problem isn’t among entry-level jobs. The barrier comes for many at midcareer—those with 10 to 15 years experience and graduate degrees in health administration—they can’t get past the director level to the senior executive level, to the top four or five administrative positions.”
The ACHE states: “Studies suggest that diversity in health care management can enhance quality of care, quality of workplace life, community relations and the ability to affect community health status.” So what’s the holdup? Perhaps what it often is in health care—a deep attachment to the status quo and the unwillingness to really see the business case for diversity.
But it’s not for lack of demand. ACHE’s chair Samuel Odle says, “I get one to two calls a month from recruiters looking for minority candidates, but it’s not what it should be.”
Howard Jessamy, executive search consultant with Witt Kieffer in Bethesda, Md., says his health care clients have been requesting more diversity candidates over the past four to six years for all the “chief” positions, as well as for physician executives and large department administrators.
“Health care is catching up to the rest of corporate America in seeing diversity as a business imperative,” Jessamy says. “If you’re marketing to diverse populations as a provider of any [type of] services, it’s good business sense to have that diversity represented by the provider.” However, he says, “Just because a client asks for diversity doesn’t mean they will choose that way. [Administrators] are sometimes going through the motions, being ‘in compliance,’ but lately it’s been more than looking at [diversity candidates].”
In some institutions he has seen another strong influence. “Many senior executives’ annual performance is being evaluated on their [commitment to] ethnic and gender diversity—it’s a powerful motivator,” he says.
It Starts with the Board
“Boards have to become more diverse first and foremost,” Dolan says. “Once you have a diverse board, individuals of color will be comfortable to apply for management positions.” Jessamy adds, “If the board and top leadership are not interested in advocating principles of inclusion, it won’t happen—and it can’t be token inclusion. The diverse board member has to have connections back to the business sector and the community. You are looking for a person with broad reach.” In seeking diverse trustees, Jessamy suggests local clergy, as well as minority executives in the corporate sector. Hobby recommends speaking to ethnic fraternities and sororities, as well as querying universities that historically have had large minority graduate programs.
Patricia Webb, immediate past president of NAHSE, says the board also needs to be able to measure its success with diversity. At Boston Medical Center, where she is senior vice president of human resources, leadership uses scorecards with measurable goals to improve representation of minorities in managerial and technical areas. The goal is to have 33 percent of these positions filled with minority candidates, and for the past four to five years, Webb says, they have met that goal.
“As positions come open, the board must insist that the candidate pool is diverse and that recruitment goes beyond window dressing,” she says. This means looking beyond hospitals for diversity candidates. “Many positions [in businesses] are interchangeable,” she explains. “Look at health care from a broad perspective.”
Odle adds, “Boards need to demonstrate their commitment to diversity by demanding to see all the best available candidates. Boards should make sure that search firms bring back a diverse candidate pool—they need to make that clear to them. Absent that, recruiters will go to their traditional choices.”
“There are a lot of well-intentioned people who truly don’t understand, who don’t think diversity is an issue,” says Kevin Lofton, chair elect of the American Hospital Association. “And [there are] those who think it’s a numbers game, giving jobs to minorities for the sake of it … the key to advancing past where we are is to continue to educate people on why it matters … [giving] the business case for diversity.”
He adds, “Diversity starts at the top in both management and governance. For those organizations that make excuses that they ‘can’t find anyone,’ governance has to hold management and themselves accountable. If the board makes diversity a priority … they’ll be surprised at what they can accomplish.”
Odle also advises making sure that diversity is a component of succession planning—thinking ahead to the community the hospital will be serving in the future.
Jessamy says “pushback” is still common within organizations whose leaders are not ready to choose a minority candidate for a top executive position. “Lots of organizations won’t take the next step—I’ve seen this a lot, and it’s very, very disappointing,” he says. “They’ll use seniority to trump the diversity [job candidate] or say they fear [being accused of] reverse discrimination; they choke.” The counter argument, he believes, comes when the minority candidate for an executive position is at least as qualified as other candidates, but is “equal plus” because of his or her ethnicity. But there are success stories. Jessamy remembers a senior level search he was asked to conduct for Catholic Healthcare Partners in Cincinnati. Witt Kieffer’s pool of candidates so impressed the system that they hired three of them for various positions—and all three were minority candidates. “The ground moved … it was a defining moment,” Jessamy says.
Still, many midlevel minority executives have not been able to wait for such breakthroughs. “Minorities numbers are still low at the executive level because many have left the field because they haven’t seen anyone [who is a minority] in front of them … midlevel is where they stopped,” Jessamy says.
That same discouraging horizon is still there for many considering the health care field, Webb says. “If there aren’t improvements [in health care leadership diversity] in a reasonable period of time, students will stop pursuing health care,” she says. “Young people aren’t patient about health care executive careers. They don’t want to wait 15 years to see themselves move ahead.”
Jessamy adds, “More students need to be told early in their careers that advancement is possible in health care—the biggest deterrent is feeling like they cannot.” They should also be told that “the executives you see [in health care] are not the exception,” he says. Lofton concurs, “My whole message is that ‘You can do this, too.’ I try to give young people encouragement.”
Mentoring is a Must
Such encouragement is needed early to avoid midcareer setbacks, Odle says. “You need a significant mentoring relationship within your first five years in the field,” he says. “That relationship will give you the opportunity to take risks. As time goes by, there is less opportunity for that … after five years, you’re competing with other nonminority candidates, and generally [resumes of] nonminorities tend to look better [in terms of] a wide experience. It’s hard to make that up; you stay behind your whole career because your resume is not as strong.” However, mentors and mentees don’t need to be the same ethnicity.
“Every speech I give, I encourage executives to make a commitment to mentor someone not like themselves,” Odle says. “If people are really leaders in health care, they should understand the importance of diverse leadership teams. If we are ever going to say that we are meeting the needs of the community, leadership has to represent that community.”
NAHSE’s current president, Christopher Mosley, had Lofton as a mentor and says he was “pivotal in my professional journey.” Mosley is currently president and CEO of Chesapeake (Va.) General Hospital. Lofton first hired him in 1996 as a director of strategic planning at the University of Alabama Hospital at Birmingham, coaching and mentoring him—and serving as a role model.
“Kevin encourages the pursuit of excellence,” Mosley says. “He’s a man of high integrity with a passion for his work. He helped bring out my qualities like that and practice them.”
Although Webb agrees that, once successful, minority executives “should reach back and help people come up,” ethnically diverse health care professional mentees should take the initiative for themselves as well. “You should have several mentors in many areas to learn more, to prepare to be an executive,” she says.
Hobby adds, “You have to step out of your comfort zone to broaden your network. Minorities often don’t feel comfortable where they’re not invited, but sometimes you just have to go.” An example might be a conference where diversity is slim, but where opportunities to meet the right people will be most promising. “Find an executive who will introduce you [to others in the field],” Hobby advises. “The more executives realize the similarities you have to them—the barriers dissipate.”
Webb advises, “Always [give] yourself opportunities to learn more and don’t shy away from helping people see what value you bring to the table.” She says it comes down to relationship skills. “Social skills are just as important as job skills after a certain point…. You must be able to excel even if you are the only [minority] or one of the few. On the other hand, don’t become so comfortable [with your own success] that you don’t help others.”
Some areas of health care offer more career advancement than others. Lofton cites an ACHE/NAHSE study that showed that the career track of an administrator in a clinical department advanced more quickly, regardless of race. He says that’s because such positions present the opportunity to interact directly with physicians and patients, as well as to be a part of a revenue-producing department—all experience a chief executive needs. The first of these is particularly important. “The long-term success or failure of health care executives is tied to their ability to work with physicians,” Lofton says. “Also, your work is more readily seen, being where the action is relative to patient care.”
Private, not-for-profit and faith-based institutions also offer more opportunity for minority advancement than government or state hospitals, Lofton says, because the employee base in those settings is more diverse.
In the final analysis, diversity may become as powerful a change driver for health care as information technology. Mosley says 25 percent of the current U.S. population are minorities, and “other industries see that as an opportunity ... the buying power of minorities is increasing, their economic vitality is on the upswing.” But he adds, “I see diversity as a means to an end. The ultimate goal is to provide services to patients that are high quality and culturally competent.”
“In the workplace, we have an obligation to reflect the community we serve,” Hobby says. “If you have minority patients accessing your hospital, their comfort level and trust in the care they receive will be heightened with people who look like them working there … particularly if those people are wearing a suit and tie.”
Lofton describes one of CHI’s ultimate diversity goals as being “diversity of thought,” explaining that “better outcomes result from a high-functioning management team [that includes individuals] from different backgrounds … our ability to serve the community … is better with different points of view brought to the table—it’s a common sense approach.”
Finally, Lofton says, “The board has to make diversity a goal that will be prioritized like any other aspect of the strategic plan—it can only come from the board.”
Laurie Larson is Trustee’s senior editor.
This article 1st appeared in the December 2099 issue of Trustee Magazine.
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