Minority executives and their peers tout the benefits of broader representation in the C-suite, boardrooms
Properly treating a patient population means adhering to their unique needs, and healthcare executives are increasingly turning their attention toward understanding how diversity meshes with the goal of improved quality of care.
“If you don't understand that and deal with that, then the outcomes won't be good,” says Dr. Ram Raju, CEO of the Cook County Health & Hospitals System based in Chicago.
Raju, who joined Cook County last November, is the former executive vice president for the New York City Health and Hospitals Corp. He makes his first appearance this year on Modern Healthcare's biennial list of the Top 25 Minority Executives in Healthcare. His chief undertaking in his new position at Cook County is turning around the financially strapped government-run system. While the Cook County system is smaller than New York's, it's not exactly compact, ranking as the third-largest system in the U.S. The staff at Cook County also speaks 53 languages.
“Cook County is very diverse … and the workers are very diverse,” Raju says.
Minority executives often draw on the experiences of their childhood or those of their parents, which motivate them to help underserved populations. Raju, while speaking last month in Chicago at the American College of Healthcare Executives' annual Congress on Healthcare Leadership, drew a parallel with his native India and America, comparing how the subcontinent's caste system prevents the poor from receiving healthcare. He talked about how he was stunned to learn that the same problem plagues America, despite the difference in per-capita incomes.
“Even today, in the greatest country of the world, people—mostly people of diversity—go without adequate healthcare,” Raju told his ACHE audience. “Even when they get healthcare, the outcomes are not as good as the majority.”
Raju and other minority administrators say their perspectives allow them to better focus on the needs of these communities. Raju's new job includes overseeing Chicago's only safety net hospitals.
He says he's determined to succeed at Cook County: “I won't fail.”
That same determination helped Raju along the way as he faced the same challenges most administrators coming from a variety of backgrounds encounter as their careers progress. But Raju, trained as a surgeon, says there was a little added pressure because there were few other Indians embarking on a similar career track at the time.
“The career path was tough, but you have to learn a lot of good things, to think globally,” he says. “Because physicians are taught just to fight for your patient, at the exclusion of anybody else, that's what makes you a good doctor. But now, as an administrator, you have to make decisions regarding the overall betterment of the hospital, patients and the communities you serve.”
Raju worries about healthcare providers who assume multicultural patients will simply forget traditions and rapidly integrate into America. He says that's dismissing the importance of their patients' backgrounds and beliefs.
“That's stupid, it's not the way it works,” he says. “The beliefs are brought back with them; you need to understand that and cater the treatment toward that.”
Saad Ehtisham shares a similar perspective, and also makes Modern Healthcare's Top 25 Minority Executives list for the first time. He's CEO at 245-bed University Medical Center in Lebanon, Tenn. Ehtisham grew up in Pakistan, coming to the U.S. to study in 1988 as a freshman at Baylor University in Waco, Texas. On occasion he talks with his older brother, Dr. As'ad Ehtisham, about the lack of Pakistanis in administrative roles. His brother is associate professor of neurology and neurosurgery at the University of Mississippi Medical Center in Jackson.
“I think a lot of students go toward the medical side of being a physician, or perhaps being a dentist and that sector of the healthcare field instead of going the administrative route,” Saad Ehtisham says. “Though, I have recently seen a lot of students who are born to Pakistani immigrants—first-generation Americans—who are in MHA and MBA programs and want to go into the healthcare sector.”
One way to attract more minorities to administration is persuading them to leave medicine for careers as physician-executives, Ehtisham says, since there seems to be more diversity on the practicing-physician side. Ehtisham considered medical school while in Pakistan before altering his career path.
“I wanted to be a physician but decided to go the administrative route early on,” he says.
Raju, who made the transition from surgeon into administration, reflected on his experiences and says that more doctors need to step in and lead the charge for change instead of “sitting on the sideline and complaining.”
“This is our healthcare system, our home, our industry,” he says. “We have to make this better for ourselves and our patients.”
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The need for better representation extends outside of executive offices. Dr. John Combes, president and chief operating officer of the American Hospital Association's Center for Healthcare Governance, pushes the conversation toward the boardroom.
“We've known for a long time that minorities and people of color are underrepresented on boards,” Combes says.
Combes, like Raju, also attended the ACHE Congress and made a presentation where he shared results of the latest AHA Governance Survey. Those results show that about 90% of hospital governing boards are Caucasian.
“What's striking is that number really hasn't changed since our last survey in 2005; that number was 91%,” Combes told his ACHE audience.
The survey's findings show who's on an average board and which ethnicities are represented. According to the survey, a typical board has 12 members, and of that group, about 10.83 board members are Caucasian. African-Americans and Hispanics/Latinos average less than one member on the board. African-Americans average 0.6 of a board member, with Hispanics/Latinos averaging 0.36. The numbers are lower for Asian/Pacific Islanders, who averaged 0.12. American Indians averaged less than one-tenth of a member, as did those described as “other.”
Contrast those numbers with the demographics of the communities hospitals serve, and there appears to be a problem, Combes says.
“I've got to tell you, I go around the country all the time and I walk into boardrooms and I drive through neighborhoods to get to those hospitals … and the boardroom does not represent the community of most hospitals that I go into,” he added.
The demographics of the board don't necessarily need to fully represent that community, Combes clarifies: “But what I'm saying is you've got to have the perspective at the table if you're really going to serve that community, and our numbers this time are a little bit disheartening because they show very little progress.”
Though recognizing that boards need better representation, there are more board seats versus hospital executive positions, meaning there's a better chance for boards to achieve diversity faster than positions in the C-Suite.
The survey did show improvement in opportunities for women, Combes says. Some wonder if greater representation for women in executive posts comes at a cost to improvements in ethnic diversity.
That's a question that was posed to Alyson Pitman Giles, the former president and CEO of 233-bed Catholic Medical Center in Manchester, N.H., when she spoke to a roomful of female executives at the ACHE Congress. An audience member wondered how a mentor could address that potential conflict. Giles answered that it depends on the goals of those being mentored.
“If I'm not the right person to mentor them, then I'd introduce them to some people in the organization with whom they would identify more strongly,” Giles says. “So it's really about the relationship and what it is you want to get out of it and what the mentor is able to give. And if it's not the right fit, then you work within the organization to get the right fit.”
But Giles was quick to point out that a mentor does not have to be from the same background—women should be encouraged to seek out male mentors as well.
“The fact that we even can ask that kind of a question now, that we're available, both men and women are thinking more about mentoring. … There was a day when a woman made it in to the CEO suite and shut the door behind her; they didn't want anyone else to come in,” Giles says. “Now that was 25 years ago, 20 years ago, and now it's our job to put our hand back in and pull other people up and help them.”
Michael Ugwueke, another newcomer to this year's list, is a CEO at Methodist Le Bonheur Healthcare, in charge of Methodist North and South Hospitals in Memphis, Tenn. He came to America in 1980 from Nigeria. He credits guidance from mentors including Michael Covert, president and CEO at two-hospital Palomar Health in San Diego. The two knew each other while Covert was president and CEO at Washington (D.C.) Hospital Center, where Ugwueke served as vice president of support services and strategic planning.
Ugwueke would still like minorities to have better opportunities at significant positions with greater roles and responsibilities. But he acknowledges those are “very, very hard to come by these days” for everyone, given the economy and overall competition.
“Diversity is not just a skin color, it's a diversity of opinion, ideas, input,” he says. “The degree that organizations place a priority on diversity is the thing I think really broadens the scope of what they can accomplish.”
When asked about where he saw much progress when it came to diversity, Ugwueke praised Roman Catholic health systems, saying they have a strong record of offering minorities opportunities with significant responsibilities.
Kevin Lofton, president and CEO of Englewood, Colo.-based Catholic Health Initiatives, certainly holds one of those posts. Lofton makes the Modern Healthcare Top 25 Minority Executive list once more, having appeared in all three previous rosters. He says a large portion of his job is reaching into his network and matching people with the right job openings.
“A big part of how things get done, as you well know, is through networking,” Lofton says. “Individuals will contact me conversely knowing minorities in the field, knowing I can be a good conduit, and I constantly try to match people up with people.”
Lofton, an African-American who has led 55-hospital CHI since 2003, also has appeared eight times on Modern Healthcare's 100 Most Influential People in Healthcare rankings.
One tool at CHI's disposal to match employees with the right opportunity is a Web-based portal called GPS—an acronym for goals, performance and success. Implemented in the fall of 2011, the program is designed so CHI administrators have a database to better understand the career goals of its 2,000 administrators systemwide.
The program also gives those executives a platform to share those goals, making it easier to pair an opportunity with an interested person. The portal continues what Lofton calls an “ongoing dialogue” with executives, in an effort to make sure staffers are happier in their jobs.
Attracting minority candidates is one thing, but retaining them is another, as “one organization's talent today is the next person's recruit,” Lofton says. “The culture has to be inviting, and the culture has to be willing to support it.”
One of Lofton's hires this year was Ruth Brinkley, now CEO of KentuckyOne Health, CHI's $320 million venture merging Jewish Hospital & St. Mary's HealthCare in Louisville and St. Joseph Health System in Lexington (Jan. 9, p. 10).
Brinkley, who had been the longtime CEO of Ascension Health's Carondelet Health Network in Tucson, Ariz., is a well-known leader in Catholic healthcare. While she's not on this year's list of the Top 25 Minority Executives, she was included in the 2010 roster. Brinkley says she sees it as her responsibility to help mentor other minorities and ensure they have the opportunities.
Brinkley, who is African-American, also says recruiters can't rest on their laurels. “They need to be aggressive and go into communities to seek candidates,” she says. “They need to actively seek out minorities at places of worship and other settings.”
She says she believes in a special type of mentor, which she calls a sponsor, “that person who paves the way for you, and when you fail—everyone is going to fail or nearly fail—who helps you have perspective. When you fail at something, you believe it's the end of the world and you can't recover, and it helps to have someone more mature to advocate and help pull yourself together.”
CHI is familiar with Brinkley, who previously worked as president and CEO of CHI-owned 405-bed Memorial Health Care System in Chattanooga, Tenn.
Sometimes leadership faces the pressure of two positive, yet sometimes conflicting, values, Lofton says. Promoting from within can prevent the recruitment of minority candidates from outside the organization.
“A lot of times you have two well-intentioned but sometimes competing objectives,” he says. “Everyone wants to promote from within, that's one of the objectives, and at the same time, if you want to expand diversity, and you don't have good people in terms of diverse candidates in your organizations, then you have to bring some people in.”
The recruiting process continues to spotlight the challenges involved in the shortage of young and prepared candidates ready to assume executive positions, says James Gauss, chairman of board services at executive search firm Witt/Kieffer.
“There's a shortage of diversity, not just African-Americans, but there's a shortage of candidates for the senior positions in our hospitals and health systems,” he says. “It's my opinion that the pipeline is growing, but it's not growing fast enough for the demand that many of the organizations need to fill the positions.”
One younger candidate primed for more responsibility is 37-year-old Jackie DeSouza, CEO of 64-bed Lee's Summit (Mo.) Medical Center. Officials from the Kansas City, Mo.-based HCA Midwest Health System in November tapped DeSouza to lead their affiliate. DeSouza's mother is from Guatemala and her father from Kenya and is of Indian descent. This is also DeSouza's first appearance on Modern Healthcare's Top 25 Minority Executives roster.
“For me it's an incredible honor to be recognized that way,” she says. “I think it's a part of my upbringing, with me being a first-
generation American and with my family coming here with pretty much nothing.”
Citing her family's humble beginnings, she says she's most proud of her work with the Kansas City Free Health Clinic, which helps underserved patients in Jackson County. She's currently a board member for the organization, and DeSouza says she's inspired by her father, who worked at a free clinic in Arlington, Va.
Even at this early stage of her career, DeSouza says she's already served as a mentor for five or six budding executives.
“I'm a firm believer in giving back and paying it forward,” DeSouza says. “I feel very blessed to be born in the family that I was born in.”
DeSouza recognizes the need for better appreciation of culture among the administrative ranks, and says healthcare reform will increase the need.
“I think, if anything, ACOs are going to allow several different entities to work together to take care of different patient populations more efficiently and cost effectively,” she says, referring to the growth in accountable care organizations that are promoted under the Patient Protection and Affordable Care Act. “I think with this focus of different entities partnering together, it's going to benefit all different patient populations.”
The change has to come from within, as leadership needs to have patience and commitment, Raju says.
Implementing a new plan and corporate culture can take three to five years to see results, Gauss says. That's backed by ACHE numbers, which show a 12% increase in minority ACHE affiliates from 2011 to 1990, compared to the 0.5% change from 2010 to 2011.
“A change in the culture just takes time to work, to do the training, to bring new people in,” Gauss says. “I would say starting pretty much from scratch, I think the change in perspective could take place fairly quickly, but it's going to take several years to achieve results.”
Listening to the patient population and building trust can't be overlooked, Raju says. “Everything you do has a big impact on it. We need to understand the cultural barriers, the economic barriers and the ethnic barriers when seeking care inside of a system.”