Healthcare Business News

Sustainable diversity

This year’s Top 25 Minority Executives in Healthcare highlights leadership diversity, but some question the true level of inclusion

By Barbara Kirchheimer
Posted: April 7, 2008 - 12:01 am ET

As the nation becomes ever more diverse, many healthcare leaders say they are succeeding in attracting a greater number of minority candidates to top healthcare positions.

There are some data to back up that contention. Although it’s still relatively small, the percentage of members of the American College of Healthcare Executives who are minorities has risen over the past decade, as have the number of hospitals and systems with formal diversity strategies and a commitment to the recruitment of minorities.

However, there is a difference between “programmatic” diversity and sustainable diversity, suggests Andrés Tapia, chief diversity officer and leader of emerging workforce solutions at benefits-consulting firm Hewitt Associates. Many organizations have established programs—such as diversity fairs and minority mentoring programs—to bring people of different ethnic and racial backgrounds through the door. Fewer organizations, however, have the leadership training, succession planning and overall business strategies firmly entrenched to make their workplaces truly welcoming to minorities, and to help them ascend to the highest executive levels. Put another way, many organizations focus on surface diversity without addressing true inclusion.

  • View a slideshow of this year's honorees

  • View related chart: Who are the minority groups?

  • View related chart: Enrollment in administration programs

  • View related chart: Growing representation at the ACHE

  • Honoring diversity

  • How we selected the winners

  • “Diversity is the mix,” Tapia says. “Inclusion is making the mix work.” In addition to simply getting more minority candidates into healthcare leadership positions, it is this deeper level of integration that healthcare as an industry faces today. Whether the industry rises to the challenge may determine whether it is able to lessen healthcare disparities among different racial and ethnic groups, and adequately market itself to a national population projected by the U.S. Census Bureau to be half-minority by 2050.

    “At the end of the day, it’s all about patients getting the best quality care they can get,” says Georges Benjamin, a physician and executive director of the American Public Health Association in Washington who’s one of Modern Healthcare’s Top 25 Minority Executives in Healthcare. This year’s program was co-sponsored by Russell Reynolds Associates, an international executive search firm.

    The son of a physical education teacher and a social worker, Benjamin went to medical school on a U.S. Army scholarship because he had an interest in molecular genetic research and ended up falling in love with clinical medicine instead. Although he says he feels comfortable and secure in his career attainments, he still says that race is “the big elephant in the room, no matter what.” His career has included stints as the secretary of Maryland’s Department of Health and Mental Hygiene and the acting commissioner for public health for the District of Columbia.

    The Institute for Diversity in Health Management is working to bring healthcare organizations to a deeper level of diversity and a stronger sense of cultural inclusion, says President and Chief Executive Officer Fred Hobby. When Hobby became head of the institute in 2005, it had about 240 hospital members, he says. Now there are more than 600 members, most of which have a designated person in charge of diversity strategy within their organizations.

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    New efforts

    In recent months, the institute has helped jump-start other diversity-promoting organizations. One of them, the Asian Health Care Leaders Association, had its first official board meeting in October 2007 and is now putting together a leadership team. The association’s chairman, Anthony Armada, who is also one of this year’s Top 25 Minority Executives in Healthcare, is president and CEO of Henry Ford Hospital and Health Network in Detroit.

    Meanwhile, the National Forum for Latino Healthcare Executives, created to increase the ranks of Latinos among hospital CEOs, last month named its first executive director, Angela Anderson. Both groups are affiliated with the American College of Healthcare Executives and the diversity institute.

    About a year ago, the institute also formed the American Leadership Council on Diversity in Healthcare, a group of about 20 healthcare diversity professionals who gather twice a year to share information and discuss best practices in setting up and improving hospital diversity programs.

    The council’s latest project, which members expect to come to fruition in the fall, is the development of the nation’s first certificate program for diversity management in healthcare.

    Up until now, many hospitals have by necessity sought leaders for their diversity programs from outside healthcare. “But if you don’t understand the culture and the idiosyncrasies of a hospital environment, you may not be all that successful,” Hobby says. “This curriculum was developed by diversity practitioners in healthcare for diversity practitioners in healthcare.”

    One of the people helping to develop the certificate program is Wayne Boatwright, vice president of cultural diversity for Meridian Health, Wall Township, N.J., who, like Tapia, says that diversity has to be deeply embedded in an organization’s mission and values to be successful. “Otherwise,” he says, “it’ll be programmatic—Martin Luther King (Jr.) and Cinco de Mayo—and then back on the shelf.” Diversity is about more than just “coloring up the organization,” he says. It is about improving the outcomes of patients from diverse communities and recognizing that their backgrounds and cultures may affect their interaction with the healthcare system. In this way, it is about aligning the hospital’s diversity strategy with the broader strategic plan of the organization. That means it has to be a priority of top executives and reflected in both the hospital’s board composition and its agenda.

    The new certificate program, which the institute is developing with Simmons College’s School for Health Studies in Boston, will take students four to five months to complete, with 70% of the education Web-based, Hobby says. The curriculum is still being developed, but it is expected to include some 12 modules, such as historical perspectives on diversity; legal and regulatory issues pertaining to diversity in the healthcare setting; organization and structure of the healthcare system; diversity communications; and mentoring.

    Also of interest to hospitals is a diversity report card that Hobby says should be available in the fall. The institute plans to send out a “state of diversity in healthcare survey” to about 8,000 hospital professionals in its database that will ask about the racial and ethnic makeup of their communities, minority representation on their boards, leadership composition, business dealings with minority-owned vendors and other diversity-related questions.

    The institute is working with survey firm HR Solutions International, Chicago, to crunch the numbers and provide feedback to hospitals on how they measure up against their peers on diversity issues. Those that are at the top of the heap will be recognized, and those that do not fare as well can learn from those that have been more successful, Hobby says.

    An early start

    Despite these promising efforts, some argue that it will be difficult to improve diversity at the top echelons of healthcare without addressing the basic challenge of attracting minority students to healthcare careers in the first place. Some of this year’s Top 25 had to overcome long odds simply to get a foothold in healthcare.

    One of them, Michael Butler, a physician who’s the acting CEO of Louisiana State University’s Health Care Services Division and formerly the chief medical officer of its seven hospitals, credits the no-nonsense attitude at the primary school he attended growing up in a small town in northern Louisiana. “They did not tolerate any types of excuses,” he says.

    Butler was admitted to prestigious Amherst College in Massachusetts and had an opportunity to attend a summer program between high school and college that helped disadvantaged minority students catch up on college-level math and science courses. The experience gave him a firsthand appreciation that a person’s future contributions should be put in the broader context of life experience. Not all of the students who participated in that summer program had had strong math and science training when they entered, but many went on to become successful physicians, he says. Had they not been given that extra help, they might not have made it through college pre-med classes.

    In hospital administration, a diverse team is valuable, he says, but the value may be difficult to quantify for those who have not experienced it and who may just be looking at a list of accomplishments on a resume or the bottom line of their organization.

    “We all make better decisions when we all participate,” Butler says. “I don’t need people around me who think exactly like I do. I need people who bring their own ideas.”

    Another of this year’s Top 25 Minority Executives in Healthcare is Joxel García, a certified obstetrician/gynecologist who just last month became an assistant secretary of HHS and medical director of the Public Health Service. Most recently he was a senior vice president and senior medical director for Maximus Federal Services, a company that reviews Medicare managed-care appeals. He also sits on the board of the National Forum for Latino Healthcare Executives. He was deputy director of the Pan American Health Organization, a regional office of the World Health Organization, and before that served as Connecticut’s public health commissioner.

    García says he sometimes wears boots to remind himself of his background as a farm boy in northern Puerto Rico. He started dreaming of becoming a physician when he was in sixth grade and met an African-American neurosurgeon. He says today’s students need to be given encouragement, mentoring and strong math and science training before they even get to high school, and that will require healthcare organizations to get more involved in their communities.

    “We need to educate them and their parents and their community leaders that the best way to change things is to have good representation of all people,” García says.

    The importance of “cultural competence”—the ability to recognize and navigate different cultural backgrounds—hit home for García when he had his own medical practice and was trying to attract Latino patients. Nothing was working, and finally García realized that the nearest bus stop was several miles away, and that most of the patients he was targeting did not own a car and simply could not get to his office. “That’s essentially what made me realize the problem was bigger than just my practice,” he says.

    ‘We need to go further’

    Fifteen years ago, 4.8% of the members of the ACHE were minorities, while this year, 12.9% are (See chart, p. 24). “I think we are seeing more diversity in senior management and boards of trustees, but we need to go further,” says ACHE President and CEO Thomas Dolan.

    Some of the barriers are cultural, while others are economic. Henry Ford’s Armada notes, for example, that his parents were stunned when he told them he wanted to give up a career in medical technology to pursue healthcare administration. Armada, who emigrated from the Philippines in 1969, comes from a family of healthcare providers; his father was a physician, his mother a pharmacist, and his siblings include a medical research scientist, an OB/GYN, a family practitioner and two nurses.

    “From their standpoint and their upbringing and how we were brought up, if you weren’t a doctor in healthcare, then what else is there?” he says. “I’m sure in a lot of cultures … there are those certain thought processes and upbringings that in some respects will limit somebody’s (options) if they’re not getting support in the front end in early childhood.”

    Recent trends are mixed. According to the Association of University Programs in Health Administration, or AUPHA, the percentage of minorities enrolled in both undergraduate and graduate programs in health administration dropped slightly in 2007 compared with the previous year. While minorities in undergraduate health administration programs represent nearly half of enrollment, their representation slid slightly to 48% in 2007 from 52% in 2006, according to AUPHA data. In graduate programs, minority enrollment dropped to 37% in 2007 from 39% in 2006. Still, minority representation at the graduate level has jumped from 14% in 1991 (See chart, p. 28).

    At medical schools, as of 2006, black, Hispanic and Native American groups accounted for only 14.6% of medical school graduates, while they made up 28.8% of the U.S. population, according to data from the Association of American Medical Colleges. Still, in 2007, the number of black and Hispanic male applicants to medical schools increased by 9.2%, higher than the growth rate of the total applicant pool, according to the AAMC.

    AUPHA President and CEO Lydia Reed says that the academic world has made progress, but there is still room for improvement, and one challenge is improving diversity at the faculty level to provide more mentoring opportunities for minority students. Toward that end, the AUPHA is developing brochures about careers in healthcare administration targeted at high school guidance counselors.

    “Healthcare management in general is not the kind of profession that most kids grow up thinking they want to do,” Reed says. Her organization is trying to give healthcare administration greater visibility as a not-for-profit career path as well as highlight the variety of jobs available to someone with a master’s degree in healthcare administration. The AUPHA is also partnering with for-profit hospital chain HCA, Nashville, to finance two scholarships each year for healthcare master’s programs for minority students.

    Enter the mentor

    Many successful minority healthcare leaders note the importance of having—and becoming—mentors. Andrea Price, one of this year’s Top 25, credits several mentors with allowing her to explore and rise within the profession. Price, executive vice president and chief operating officer of Sparrow Health System in Lansing, Mich., says her door is always open to students who have questions about healthcare careers. “My mentors have been invaluable,” she says.

    She believes there are enough minority candidates within the healthcare field to draw upon, but they have a hard time rising to top positions.

    “I believe what needs to happen is the industry needs to understand that everyone doesn’t start off on the same playing field,” she says. “Just because they don’t doesn’t mean they don’t have the capability to perform in a job.”

    Doug Smith, president and CEO of B.E. Smith, an international healthcare executive search firm, says that it’s getting harder for hospitals to judge people based on their potential rather than their accomplishments, as Price and Butler suggest they should.

    “We’re getting candidates in the pool,” he says, “but it’s awfully hard to get them in senior administrative jobs when the pressure from day one requires them to know these things very, very thoroughly.”

    The National Association of Health Services Executives, or NAHSE, an organization of black healthcare executives, is targeting that middle-management area, says Rodney Miller, the organization’s president. Miller, administrator of 690-bed Memorial Regional Hospital in Hollywood, Fla., is also one of this year’s Top 25. “The biggest area of importance from a leadership development standpoint is that middle-management area,” he says. “We struggle as African-Americans and minorities, moving from midmanagement levels into the C-suite.”

    NAHSE is developing an institute aimed at helping individuals at the vice president level to be able to make the jump to the C-suite, Miller says.

    Other organizations are targeting this area as well.

    Some large hospital systems, such as Catholic Healthcare West, require that a certain percentage of top management positions be filled by minority candidates. San Francisco-based CHW is headed by Lloyd Dean, one of this year’s Top 25. At Catholic Health Initiatives in Denver, President and CEO Kevin Lofton, another of this year’s Top 25, says he is trying to expand his system’s executive diversity fellowship program. The program targets individuals with five to 10 years of experience and trains them with the goal of hiring them.

    “We’re trying to take it to another level,” Lofton says. That means bringing in minority candidates at lower and entry levels to feed the pipeline for the top jobs. If the organization doesn’t focus its energies on all levels, then its goals of promoting diversity and promoting from within the organization work at cross-purposes, he says.

    Nashville-based HCA has a development program in place to train middle managers to become hospital COOs. The program, in place since 2001, has so far promoted 50 participants to COO roles, 44% of whom have been women or minorities, according to an HCA spokesman. Currently, the program has 38 participants, 61% of whom are women or minorities. And the percentage of HCA hospital leaders—COOs, CEOs, chief financial officers and chief nursing officers—that are minorities has tripled since 2002 to 15%.

    Kim Sharp, HCA’s vice president of diversity, inclusion and cultural competence, says she is working to embed diversity into HCA’s “DNA.” While raw numbers of minority employees tell part of the story, other successes are equally important, she says. For example, employees at one Miami-based HCA hospital that has a large Hispanic community realized their waiting rooms were not large enough to accommodate the many relatives who would visit when a loved one was in the hospital, so they brought in picnic tables and umbrellas to provide a place for families to sit outside.

    “It was a huge, huge demonstration of respect,” Sharp says.

    At another HCA hospital in Florida that had a large Jewish community, one elevator was designated a “Shabbat” elevator that made stops on each floor on Saturdays, the Jewish Sabbath, so observant Jews would not have to violate their religious beliefs and work the elevator buttons.

    It is this type of cultural awareness that Hewitt’s Tapia references when he talks about sustainable diversity. To get to that point throughout the healthcare industry, he says, hospitals need strategies, programs and processes at all levels to empower minority employees and patients, and that kind of commitment has to come from the CEO and be fostered throughout the organization. It also involves equipping employees to manage and navigate diversity.

    “Tolerance and sensitivity aren’t enough,” he says.

    Barbara Kirchheimer, a former reporter and news editor at Modern Healthcare, is a freelance writer in Highland Park, Ill. Reach her at

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