Articulate, poised, well-educated and ambitious, Derek Rowell is the very model of the business leader of the future. At 23, he wants "to give back instead of always take, to do a moral thing and make a living." That's why he wants to become a hospital administrator.
He's also a rare commodity in healthcare administration. He's black.
Minority hospital leaders are almost as scarce as hen's teeth. Nobody knows exactly how many there are, but everyone agrees there are too few. Industry leaders have sporadically tried to increase the numbers, without noticeable success.
Healthcare, especially the hospital industry, is viewed as lagging other industries in recruiting and promoting minority executives.
In Southern California, for example, "we have a population that speaks 103 different languages and dialects," says Jim Lott, executive vice president of the Healthcare Association of Southern California. "If you look at the managerial ranks in our hospitals, you don't see that diversity reflected anywhere on a parity level." Of the 220 hospitals in Southern California, four are led by minorities-and those are county institutions.
It's not just that minorities lack the opportunity, Lott says, but also that they lack the preparation to assume the top roles in healthcare organizations.
It's the same across the country. Increasingly, hospitals and other providers are looking for qualified minority candidates. But suitable applicants are scarce.
The pipeline is largely dry, and some fear it may get drier before a new generation of minority healthcare executives matures.
Turning it around. There are indications, however, that this situation can be turned around. Some initiatives undertaken in the past few years are beginning to show signs of success:
* Executive search firms are seeking qualified minority candidates.
* Senior hospital executives are mentoring younger minority employees.
* Summer programs are attracting young people and showing them that healthcare can be a rewarding profession.
* A new job bank is informing minority junior managers about promotion opportunities.
* A healthcare leadership conference sponsored by the American College of Healthcare Executives is providing a setting for minority candidates and potential employers to meet.
These specific interventions are designed to replenish the dwindling pool of qualified minority managers. If they work, and if the healthcare industry shows interest in young minority management candidates and sustains them in their early careers, the disappointing scenario of the past few years might reverse in time to lead the industry through the seismic demographic shifts that the 21st century portends.
"I'm optimistic," reports Thomas Dolan, ACHE president. "I think we're making progress. I have no hard data to quote, and can only give my perceptions."
Minorities, and women, still face significant challenges. Yet the field has become more sensitive to these issues in the past few years, Dolan says.
Grass-roots initiatives are occurring everywhere. But the revival of the slumbering Institute for Diversity in Health Management surely counts as one of the most promising signs. The institute "has made a world of difference in attracting bright minority students to health services administration," Dolan says, and others concur.
When MODERN HEALTHCARE last surveyed the industry's progress on minority hiring, the IDHM was foundering (Dec. 15, 1997, p. 30).
The ACHE, the American Hospital Association and the National Association of Health Services Executives (NAHSE), a professional organization for African-Americans, launched the institute in 1994. The Association of Hispanic Healthcare Executives later joined as a sponsor.
Since 1997, the sponsors have given
the institute a financial shot in the arm and shaken up its board and management. It also has received a boost from substantial foundation funding. In March, Rupert Evans, a career military man and healthcare administrator, was installed as the institute's president and chief executive officer.
"I've always had a passion for (minority development)," Evans says. When he was commissioned by the U.S. Air Force Medical Service Corps in 1975, he noted there were only 100 black health services administrators of 1,100 worldwide. By the time he retired, as a major, in 1995, there were just 75 of 1,300.
Evans networked widely with military and civilian minorities and became involved with the NAHSE. He noticed that most of the minorities who were promoted to leadership positions worked in the government sector. "In the voluntary sector, the number was very small. People thought this was not a viable opportunity," he recalls.
Evans says he believes healthcare is lagging most other industries in its attention to employment diversity. "If the healthcare industry doesn't start to really make some changes in its organizations, to try to get people in leadership and governance positions who try to understand the communities they serve, we're going to have big problems," he says. "We've got to get busy."
A three-pronged attack. The institute has created a three-pronged approach to supply the pipeline with talented young healthcare hopefuls. It sponsors a summer enrichment program for students, an annual leadership conference and a new World Wide Web site.
The 12-week Summer Enrichment Program, which combines classroom courses with on-the-job training, is for college seniors and other young people who want to move into healthcare administration. More than 600 have completed the program. Last year 85 hospitals offered positions, and 13 universities collaborated on classroom education.
"The hope is (that) the organization they work in becomes interested in them and they get interested in those organizations and come back to work for them," Evans says. However, he adds, it hasn't worked out that way as often as he'd like.
Like this year's leadership conference, next year's conference will be held in June in Chicago. The conference includes a job fair and ample exposure to executive recruitment firms.
The most recent conference drew more than 200 CEOs, chief operating officers, human resources executives, diversity experts and students. The target is 300 attendees next year.
The IDHM's most promising innovation, though, is its World Wide Web site, www.diversityconnection.com, which came online last June. The site includes a job bank for minorities, an employer bank, a mentoring exchange, a discussion group and other tools to allow minority managers to network with other minority managers. The site also helps prospective employers to recruit minority managers (See story, p. 35).
The W.K. Kellogg Foundation has provided $1.6 million to lay down a long-term infrastructure for the institute. Other supporters include Abbott Laboratories, the ACHE, the AHA, Northwestern Memorial Hospital and the Robert Wood Johnson Foundation. Now organizations such as Korn/Ferry International, a search firm, are seriously thinking about donating funds to help sustain it, says Ed Mullen, national practice leader for healthcare at Korn/Ferry.
No firm numbers. The lack of firm numbers makes it difficult to measure how minorities in healthcare are faring on the career ladder. Statistics are not available from the ACHE, the AHA or the NAHSE.
"Nobody knows what percentage of hospital CEOs are minorities," Dolan says. The most relevant information he has is from a form ACHE sends to its members asking them their race. Some members don't fill in that line, but the extrapolated numbers suggest that of ACHE's 21,037 practitioner members, 1,536, or 7.3%, are black, Hispanic, Asian or American Indian.
About 35% of the members are female, Dolan says, about double their representation in 1987.
It would be easier to track and count the minorities if healthcare administrators were licensed, like dentists, nurses, pharmacists and physicians, says Nathaniel Wesley Jr., who teaches health administration in the pharmacy school at Florida A&M University, a historically black institution
"We could have an outstanding young administrator working for Blue Cross in Charlotte, N.C., but we don't know her. We don't have a good way of keeping up with people," he says.
In 1992 and again in 1997, the association sponsors of the IDHM surveyed minorities and documented disturbing gaps in pay, achievement and attitudes among different groups (April 20, 1998, p. 3). Those surveys, however, did not calculate how many minorities hold positions of authority.
To get a better handle on why more minorities and women aren't in leadership positions, the executive search firm Witt/Kieffer, Ford, Hadelman & Lloyd surveyed 650 healthcare executives in 1998. Of the 121 respondents, 76% were white, 19% black and 4% Hispanic.
Respondents said they thought diversity was important but that not much progress had been made on that front. Some 43% of respondents had not hired or promoted any minorities to executive positions in the past five years.
Howard Jessamy, Witt/Kieffer's first African-American partner, says the anecdotal responses gleaned from telephone interviews shed more light on the dilemma. "White males tended to say they didn't have easy access to networks of African-American candidates. Black respondents say they don't know where to look."
Witt/Kieffer has made identifying more minority candidates a priority. Company representatives say that since 1993 Witt/Kieffer has placed 180 ethnic minorities in leadership positions, including five CEOs in the past two years.
Witt/Kieffer officials say search firms have a clear role in augmenting the ranks of minority executives. They can encourage clients to consider, recruit and promote minorities.
When the 1997 survey was published, Jessamy says, it was clear that a lot of African-American candidates didn't want to participate in the search process. "They felt they were only being seen so the client could say they had looked at minority candidates. I said, that becomes a self-fulfilling prophecy. If they don't put themselves forward, the client won't find any."
Fortunately, clients are much more open to looking at diversity candidates than they were just a few years ago, Jessamy says.
Korn/Ferry's Mullen says he sees the same trend. "More clients of ours are interested in minority candidates," he says. "Many of the mission-driven hospital corporations, such as Catholic hospitals, and other large companies like Kaiser Foundation, make a point in each search of ensuring that diversity candidates are part of the mix."
Mullen says minority candidates often don't have the same level of experience as white candidates, but they do have a strong educational background and a history of sound decisionmaking. In those cases, clients may need to be reminded that minority candidates are qualified to do the job even if they haven't done it before. "Clients are becoming more receptive to that," he says.
Reaching out. People who worry about minority representation in the executive suite say the industry should reach out to younger people.
John Bluford, executive director and CEO of Truman Medical Center in Kansas City, Mo., has hired summer interns as full-time employees after graduation. "The only thing I'm really looking for is someone who can communicate and has a lot of energy," Bluford says." Everything else, we're going to teach them."
Bluford makes sure that the young African-Americans under his charge are exposed to different aspects of healthcare management. They deal with upper management and attend board meetings and important legal meetings. "They get a clue of where they can be in 10 years," he says.
The benefits run both ways. "You get energized by younger kids," Bluford says. "They come to you technologically astute. They are fluent on the Web and do a lot of research for you."
Bluford's career was aided by strong mentors: Bill Silverman and Bob Shacknoe at Cook County Hospital in Chicago and Robert Taylor at Hennepin County Medical Center in Minneapolis.
Those men were white, because as Bluford recollects, "there weren't a lot of African-Americans to be associated with." He's taken it as his personal mandate to increase the number of qualified African-American young people in health administration.
Derek Rowell was the first of Bluford's proteges. As a sophomore at Morehouse College in Atlanta, a historically black college, he was seriously interested in healthcare administration.
Through a family friend, he approached Bluford, then chief operating officer at Hennepin, and persuaded him to give Rowell a summer job in 1996.
Rowell drafted contracts, analyzed reimbursements and looked at cost-accounting systems. Bluford liked him so much he brought him back for a second summer. "John Bluford made sure I rotated from finance to internal auditing to accounting, getting to know the hospital," Rowell says. "Taking that experience, looking at how everything is connected, I was able to apply that leverage to get the position I have now."
Today Rowell works as a pharmaceutical representative at SmithKline Beecham in Chicago.
Next he'd like to do strategic consulting for a healthcare firm. But eventually he wants to become a hospital administrator.
A summer after Rowell's internship, Bluford brought in another undergraduate from Morehouse, Terrance Goldston, who now works for him as an administrative assistant at Truman. In the meantime, Hennepin has institutionalized the administrative internship program with Morehouse.
If healthcare doesn't encourage minorities to choose healthcare careers, minorities won't become candidates for executive positions, Florida A&M's Wesley says. The present dearth of qualified candidates results from the failure to create opportunities for them in the early 1990s, he believes. Florida A&M is planning to initiate a master's degree program in health administration in 2000.
Wesley says organizations need to plan for succession and groom minorities to move up to those positions. "That's what Ford does, what Boeing does, what General Electric does. Don't wait around until there is a crisis."
Lott says companies should get to young people in high school. "You really do have to plant that seed before the kid goes to college," he says. "It's an arduous educational regimen to go through to get into this business."
Lott teaches a graduate-level healthcare administration course in Los Angeles. "Of the 10 or so students in my seminars, maybe one is an ethnic minority." He says clinical programs in medicine and nursing may be the best resource from which to draw minority executives. But even those individuals must be made aware that careers in healthcare administration are open to them.
That's one reason the ACHE is pushing to open up more summer programs and internships to young minorities. Dolan is sending a letter to ACHE leaders and board members, asking them to consider employing a minority intern next summer. For last summer's program, he sent the letter in March. For next summer's, he's sending it now. "Like any other big initiative, it takes a while to get organized," Dolan says, "but I think we're making real progress."