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More than a year into President Barack Obama's first term in office, it's worth reflecting on the gains made in diversity at the top.
The nation's first black president has selected a diverse Cabinet, with Hilda Solis, a Latina, as labor secretary; Eric Holder, who's black, as attorney general; and two Asian-Americans, Steven Chu and Gary Locke, serving as secretaries of energy and commerce, respectively.
Click here to view a slideshow of this year's honoreesThe country sees diversity on the White House staff, and representing U.S. interests abroad, with Susan Rice, an African-American, for instance, serving as U.S. ambassador to the United Nations.
So where is healthcare at when it comes to diversity in leadership?
A recent survey suggests the industry still has a ways to go.
White men continue to dominate the top healthcare management positions, according to a 2008 survey of 1,500 members of the American College of Healthcare Executives and the National Association of Health Services Executives.
Some 56% of white men surveyed held top jobs of CEO, chief operating officer or senior vice president. Meanwhile, 37% of Hispanic women and 31% of white women held these top posts. And 39% of black men surveyed held positions in the highest levels of management, according to the report.
White men earned more. In 2007, white male healthcare executives earned on average 30% more than black male executives. The white men surveyed earned a median of $168,200 that year, while black men earned $117,500. Hispanic men earned 21% less than white men, or a median of $132,300. Asian men earned $111,300, or 34% less than their white male counterparts.
Women also lagged behind in earnings. White women earned 25% less than white men, or a median of $126,700 in 2007. Black women earned 23% less than white women, or $97,700. Hispanic women earned slightly more, at a median of $101,200, and Asian women earned 22% less than white women, or $98,900, according to the survey.
Controlling for education and years of healthcare management experience, white men still earned the most compared with their peers.
Minority healthcare executives reported lower job satisfaction, too. Black women expressed the lowest level of satisfaction in their careers, while white respondents were the most satisfied on the job. Black women also were most likely to say they experienced discrimination because of their race, including failure to get promoted or receive fair compensation, according to the survey.
All this comes as no surprise to Denise Brooks-Williams, president and CEO of Battle Creek (Mich.) Health System.
Brooks-Williams is one of Modern Healthcare's Top 25 Minority Executives in Healthcare for 2010. She is also the president of NAHSE, which collaborated on the executive survey (The complete list of the Top 25 begins on page 26).
“It's not that people (of many races and ethnicities) aren't being trained and developed,” Brooks-Williams says. “It's that they are not getting into leadership positions. And when they get there, they don't stay.”
Brooks-Williams, a native of Detroit, credits her employer, Trinity Health, for making diversity a priority across the organization.
For instance, all of the hospital CEOs working in the Trinity Health system also hold the title of chief diversity officer. That means each is responsible for a diversity action plan, including training and mentoring, Brooks-Williams says. Every element of the system's diversity initiative is overseen by the CEOs, who collaborate across facilities.
Starting this year, all Trinity Health facilities adopted a program called Equity in Care, which trains staff to ask patients about their religion and ethnicity. The idea is to provide culturally competent care, reduce health disparities and improve outcomes. “It's being received favorably,” Brooks-Williams says.
Truth be told, diversity in the C-suite isn't a priority for many health organizations, says Bob Clarke, CEO of Furst Group, a Rockford, Ill.-based healthcare executive search firm and sponsor of Modern Healthcare's biennial list of the Top 25 Minority Executives in Healthcare.
“A lot of organizations don't recognize on a number of fronts the value of diversity in leadership,” Clarke says. “There are still not a lot of opportunities for people to excel.”
Too often, diversity in healthcare leadership is still measured in quotas, or head count, Clarke says. “That's the wrong reason to fill a position,” he says. “That's where I'm not sure we've made significant progress.” Filling an executive job with a certain candidate “just because you need another color in the board room … is an affront to me personally,” Clarke says.
Also problematic is that some health systems remain fixed on a certain type of education and number of years logged in executive healthcare positions as top priorities for hiring. These requirements can eliminate some minority candidates right away, Clarke says.
“If you can open up to a broader set of expectations, there is a very, very broad segment of very talented leadership candidates,” he says. “There isn't a shortage of candidates, it's more of a shortage of perception.”
John Bluford agrees. Also among this year's Top 25 Minority Executives in Healthcare, Bluford says healthcare organizations should better reflect the population they serve. For the past decade, Bluford has served as president and CEO of Truman Medical Centers in Kansas City, Mo., a two-hospital system.
“We talk about patient-centered care, but we need leadership to reflect the patients we serve,” Bluford says.
In the mid-1940s, two patients with similar illnesses were admitted to a hospital in Oakland, Calif. One patient was white, the other black. Attending medical staff asked Henry Kaiser, the founder of the hospital, whether the two patients should be segregated.
As the story is told today, Kaiser asked his staff whether there was any medical reason—any reason at all besides race—why the patients should be cared for in separate rooms. The staff replied no. And it was then that the decision was made that Kaiser Foundation Hospitals would not segregate patients based on race.
Bernard Tyson, another of this year's Top 25, tells this story as an example of Kaiser Permanente's commitment to diversity, a commitment that started long ago and is ingrained in the organization.
Tyson would know. He started working at Kaiser Permanente in 1981 as an administrative analyst. Today, he's executive vice president of health plan and hospital operations for the managed-care giant, where he oversees all eight regions, a budget of $30 billion, 35 hospitals and 150,000 employees. Tyson reports directly to the CEO and has led the $27 billion capital improvement plan for the organization. He's also board chairman of health plans for the Mid-Atlantic States and Georgia regions.
As an industry, Tyson says healthcare has made “significant progress” in terms of diversity.
Tyson has stuck with Kaiser Permanente throughout the years because he says he's an advocate for “the Kaiser way.”
“I believe in what we are trying to do,” Tyson says. “I've worked in all parts of the organization—in programs, in different regions. I see an organization that is genuinely committed to doing the right thing.”
Like other top executives interviewed for this article, Tyson says his focus now is on improving the quality of care.
At Kaiser Permanente, Tyson is working on a three-year plan to deliver superior quality of care. This includes full implementation of KP HealthConnect, the system's electronic health-record system, along with bar-coding, cross-checking medications and physician orders and rapid-response teams.
“I want to demonstrate that walking into a hospital is as or more safe than getting on an airplane,” Tyson says.
This initiative includes transparency about “near misses”—medical errors that almost happened but didn't. The plan is to foster a more open and transparent culture where people aren't afraid to report these almost-mistakes to their supervisors, he says. Near misses can create opportunities for learning that in turn will help build better quality, Tyson says.
“It's a work in progress,” he says. “It's a balance between holding people accountable but at the same time creating an environment of an open atmosphere where people can speak the truth.”
Quality, and a deep desire to help people achieve better outcomes, is what drew many of this year's winners into healthcare in the first place.
Paula Autry, another Top 25 executive, grew up watching her older sister struggle with neurofibromatosis, a serious genetic disorder of the nervous system. “Hospitals and the healthcare setting was a second home,” she says.
As a young girl in Baton Rouge, La., Autry witnessed many of the problems in the healthcare system. When her sister was 12, she had spinal surgery to help correct her condition. The surgery left her paralyzed from the waist down. Autry was 10 years old at the time. Her sister died at age 39 from a complication brought on by a medical error.
“From a young age, I saw the disconnect,” Autry says. “I really saw a lot of inefficiencies in patient care.”
She also watched her mother, a physics teacher, stick close to her sister during her hospital stays and doctor visits because of prevalent medical errors. It was a lesson in the importance of having a patient advocate.
“I understand that it is so important for nurses to be an advocate for their patients,” Autry says.
Today, as president of Mount Carmel East Hospital in Columbus, Ohio, a Trinity Health facility, Autry has made quality a priority for the organization, focused on improving the patient-care experience and identifying areas for improvement, such as eliminating hospital-acquired infections.
Bluford of Truman Medical Centers agrees that quality can drive an organization's success. “We've changed our mindset from cash being king to quality being king,” he says. “That gives you some different values.”
Today, Bluford kicks off all his board meetings with a discussion about quality initiatives. He learned how to run efficient and effective board meetings from his mentors at Cook County Hospital in Chicago, where he worked as a night and weekend administrator in the 1970s.
What he observed was “a participatory process with a very firm decision made from the top,” Bluford says. He adopted that leadership style as his own, and it's the one he stays true to today.
Early experience with the healthcare system also can influence views on the uninsured crisis.
Ruth Brinkley, president and CEO of Carondelet Health Network in Tucson, Ariz., also a member of the Top 25 this year, says growing up in rural Georgia without health insurance or a primary-care physician helped formulate her view of the healthcare system.
“If you have always had healthcare, you have a different perspective,” Brinkley says.
Brinkley witnessed people in her rural community—black and white—die early or become disabled because of untreated chronic medical conditions, such as hypertension. This helped propel her to the field of nursing and, later, into healthcare management.
Brinkley says her grandmother wanted her to choose a career in nursing, and her grandparents, who raised her, emphasized the importance of education as a path to success.
Everyone needs mentors, and the Top 25 Minority Executives in Healthcare are no exceptions. Like Bluford, many credit one or more mentors for helping them pursue healthcare administration as a career and hone their management styles.
Growing up in San Antonio, George Hernandez Jr. spent five years in a Catholic seminary studying for the priesthood. He credits his success partly to a popular parish priest in his neighborhood who helped kids develop their self-esteem and aspire to great things. Many of these kids, he says, went onto prosperous careers, including a childhood friend who became a district judge.
Hernandez earned his law degree from George Washington University and then returned to San Antonio, where he worked in the city attorney's office. He later went on to represent the Bexar County (Texas) Hospital District, which is now University Health System. He served as general counsel for the district and is now president and CEO of University Health, a 377-bed academic medical center in partnership with the University of Texas Health Science Center at San Antonio.
He credits continuing legal education courses required for all attorneys as helping him learn about the business of healthcare. “When you learn the client's business, you become a competitor for the job,” he says.
The challenge is providing educational opportunities for everyone, Hernandez says. Although his parents didn't obtain high school degrees, he and his siblings all completed college and went onto successful careers thanks to the robust educational system of the 1950s and hard work. One brother is a physician, another is an engineer, and his sister is getting a doctorate degree.
Diversity in our country is here, Hernandez says. “The real thing we can affect is whether we will develop the next generation to take the place of the baby boomer generation.”
A fan of the management book Good to Great by Jim Collins, Hernandez says managing a large, complex organization requires hiring the best people. “They are experts in their area; they know what to do,” he says. “There is so much talent here, and it's important to hire and promote the right people.”
Fostering that talent requires giving an ear or an opportunity to the next generation, executives interviewed for this article say.
George Brown, president and CEO of Legacy Health System in Portland, Ore., also one of this year's Top 25, recalls being a young gastroenterologist on a fellowship at Walter Reed Army Medical Center in Washington in the late 1970s.
“I saw many things going on I didn't like that I felt we could do better,” Brown says.
Never one to hesitate to speak his mind, Brown approached the leadership at Walter Reed about his concerns. They suggested that he talk to the surgeon general of the Army at the time, Gen. Charles Pixley. So he did.
“I was a major, and he was a three-star general,” Brown says. Pixley spent more than an hour talking with Brown about his ideas. Pixley told the young man, “You have a choice in healthcare. You can be a clinician or you can be an administrator. My suggestion is that you try everything and move back and forth,” Brown recalls.
“I was very impressed by that,” Brown says. “Here's the No. 1 doctor in the Army who took one or one and a half hours out of his day to spend some time with a young major who had a mustache and a haircut that didn't meet specifications.”
Brown went on to have a stellar career in the Army and returned to Walter Reed in the mid-1990s as commander.
Despite the continued disparities in the top ranks of the healthcare industry, many interviewed for this story say a black president in office helps break down barriers across professions.
Brinkley of Carondelet Health Network is among them.
“I hope we can become one society at some point,” she says. “Having an African-American president takes us one step closer to that.”
