As healthcare organizations across the country work to find new or better ways to serve a more racially and ethnically diverse patient base, the question is, are they making adjustments to the diversity of their own staffs and leadership as well?
Most organizations would say yes, but some, like San Francisco-based Catholic Healthcare West, have the policies to prove it. CHW's recruitment policy calls for a minimum of 10% of all senior management vacancies to be filled with minority candidates -- and it starts at the top: Lloyd Dean, CHW's president and chief executive officer, is included in Modern Healthcare's inaugural roster of the Top 25 Minority Executives in Healthcare.For profiles of the Top 25 Minority Executives in Healthcare, click here.
In an organization with 44,000 employees and 40 hospitals, more than 50% of executives with systemwide responsibilities are women or minorities. Dean and the other members of Modern Healthcare's list represent a group of executives who are already leading the way in diversifying healthcare management.
"I think diversity in large organizations often doesn't just happen because people wish it. You do have to take some structural action to make sure your goals and objectives become a reality," Dean says.
"So the 10% is only one element of getting from where you are to where you want to be. The real emphasis is on our leadership and making sure that our executives reflect the demographics of the community they're serving," he says.
CHW isn't alone in such efforts. In 1999, St. Louis-based SSM Health Care created a similar program to advance minorities into executive-level positions (Aug. 11, 2003, p. 14), and a number of regional, systemwide minority acceleration programs have been established (See chart, p. 25).
Those efforts come as estimates from the Census Bureau predict minority populations will total half of all U.S. residents by 2050.
Despite increasing efforts on several fronts -- and results to show for them -- it's clear that minorities continue to face numerous obstacles to reaching the upper echelons of healthcare management.
In a March 2006 study by healthcare executive search firm Witt/Kieffer, in conjunction with the Ohio State University School of Public Health, on leadership issues and succession planning, the majority of respondents reported no formal organizational programs available for the development of current and future executives. In the same study, targeting minorities for leadership development ranked as the lowest organizational priority, on average (See chart, p. 28). Of the 844 hospital and health system CEOs who participated in the survey, 84% were male and 96% were white.
And before minorities can be considered for senior management, they also face what Thomas Dolan, CEO of the American College of Healthcare Executives, calls a two-pronged challenge -- getting into the field young and having enough midcareer guidance and high-level continuing education to get to the executive-level positions.
Minority enrollment in healthcare administration programs is rising, climbing 10% from 2003 to 2004, according to surveys conducted by the Association of University Programs in Health Administration.
"Approximately 35% of students obtaining health or hospital administration degrees are people of color," says Fred Hobby, president and CEO of the Institute for Diversity in Health Management. "And when they come out of these programs, finding their first job isn't that difficult, assuming that they have good grades and have done some networking."
With the help of programs and events sponsored by the institute, such as fellowship and summer enrichment programs, and those sponsored by colleges and universities, students gain advanced knowledge of future opportunities.
Joan Reede, dean for diversity and community partnership at Harvard Medical School in Boston -- and also a member of Modern Healthcare's Top 25 roster -- has helped establish such programs at Harvard.
More than 700 students have been through the visiting clerkship program, a four-week clinical program open to qualified third- and fourth-year students that offers elective courses, as well as networking opportunities with medical school faculty, staff and students.
"One of the issues we had -- if you think about diversity on our faculty and in our institutions -- is with our residents. How do you make more minority students aware of the kind of opportunities that might be available at Harvard? Last year, 25% of those (visiting clerkship program) students matched for Harvard residencies," she says.
Some would argue, however, that many minorities cannot attend medical schools or graduate programs without financial assistance from federally funded scholarships, grants and fellowships.
"The issue around minorities going into the practice of medicine -- the No. 1 issue -- is the availability of scholarship funding," says John Maupin, president and CEO of Meharry Medical College, one of the nation's two independent, historically black medical colleges. "When we talk about diversity, we need to understand that it's going to take federal support.
"The most significant challenge is the current budget focus of eliminating funding. It is the most dangerous decision ... and could close up schools like Meharry and Morehouse" School of Medicine, Maupin says.
Past budget cuts and those proposed for federal fiscal 2007, which begins Oct. 1, hit funding for the Health Careers Opportunity Program, a "pipeline program for minority students," says Dale Dirks, a lobbyist for the Association of Minority Health Professions Schools.
"They reach down to high school and junior high to identify promising individuals from disadvantaged or minority backgrounds, and nurture them for a slot at a health professions school," he says, noting that the program's budget dropped to $4 million in 2006 from $35 million in 2005.
The Bush administration's budget also has proposed funding cuts to the Centers of Excellence; its grants provide health profession schools with funding for blacks, Hispanics and American Indians. Its budget was cut from $33 million in 2005 to $12 million in 2006.
"Congress was not able to fully restore funding in fiscal 2006," Dirks says. "The administration (proposed to) completely cut the only two programs in the entire federal (2007) budget that are dedicated to training minorities for the health professions."
For some minorities, it's more than just financial aid that keeps them from advancing further in healthcare administration. "The problem is at the midcareer level," Hobby says. "These minorities with seven to 12 years of experience haven't been able to get past the director level; they have not penetrated the top four to five positions of the hospital level so they change careers, drop completely out of healthcare -- not willing to wait for that opportunity to come up. They end up selling hospital- and health-related products; they work for a pharmaceutical company, a supplier; and abandon their goals of hospital administration. We can't afford to let that continue to happen."
George Zeppenfeldt-Cestero, president of the Association of Hispanic Healthcare Executives, agrees. "We find most Latinos caught in this midcareer segment trying to break through this Teflon ceiling unsuccessfully. And the result is a greater deal of frustration on their part as to why they're unable to go to that next step."
Although he is seeing long-term initiatives being put into place -- both nationally, by groups like the Institute for Diversity in Health Management, and regionally, by organizations such as the Greater New York Hospital Association -- he doesn't see "hospitals biting the bullet and saying, `OK, there are qualified Latinos in the marketplace ... why don't we have a program to fast-track them?' "
One crucial aspect to preventing a stalled career is to invest in mentoring, says A. David Jimenez, chief operating officer of Catholic Healthcare Partners, Cincinnati, and one of Modern Healthcare's Top 25.
The next level
"During the course of my career, there's nothing that has really been as rewarding" as helping midcareer managers, he says. "Some of them have stalled out or have developed habits that are keeping them from moving to the next level."
Sam Odle, president and CEO of Methodist Hospital and Indiana University Hospital, Indianapolis, also on Modern Healthcare's list of Top 25 minority executives, believes it's important to find a mentor early.
"In the first five years of your career, you need to have a very positive, beneficial mentoring relationship to help you get a good start, so you can take risks ... I think those years are the most competitive," Odle says. "If you're behind at the five-year mark, you're going to be behind at the 10-year and 15-year marks. I always tell them (minority students) when they come out of school: `You've got to find a way or else you're going to be disadvantaged. If you know the hill's a little steeper, you can't complain about it, you've got to run a little faster.' "
Christopher Mosley, another of Modern Healthcare's Top 25 minority executives, says he learned to find value in every relationship.
"When I got in healthcare, there were a number of minority executives who clearly took a vested interest in my growth," Mosley says. "I've also benefited from people who were not as forthcoming and who may have not had my best interests at heart, because even in those circumstances I've learned to navigate within a system and work with people for the greater good ... all of that has helped me reach this point," says Mosley, president and CEO of Chesapeake (Va.) Health and Chesapeake General Hospital.
"I'm here not only because of my skills, but I'm standing on the shoulders of people like Haynes Rice (past president of the National Association of Health Services Executives -- a not-for-profit association of black healthcare executives -- and former CEO of Howard University Hospital, Washington), people who gave back, people who understood legacy. I see value in that and I try to go out of my way to continue that."
Though the members of Modern Healthcare's inaugural list of minority executives seem to defy the norm, many believe that the "old boys' network" still applies at many levels in healthcare, especially boardrooms. In a 2002 ACHE study, minority participants ranked such cliques, along with the composition of the board of directors, as reasons for inequities in healthcare management.
"We have to focus on helping boards become more diverse," the ACHE's Dolan says.
"When people look at an organization, they look at the leadership to see what kind of message they're sending ... and unfortunately, the further up you go, the less representative they are of the community," he says. "The least representative are boards of trustees. Leadership from the top continues to be important."
A 2004 report conducted by the Puerto Rican Legal Defense & Education Fund titled Condition Critical surveyed 13 New York City voluntary hospitals and found that, in a city with a 27% Hispanic population, six had no Latinos on their boards. Of the same hospitals, 12 of the 13 had no Latinos in senior management positions.
"There is a direct correlation between the success in diversity and the profile of the board of trustees," Zeppenfeldt-Cestero says. "If you find one or less Latinos on the board of trustees, you're likely to find very few Latinos at the senior executive healthcare level."
Hobby also recognizes the importance of having a variety of racial and ethnic members on an organization's board. "The minorities (on the board) will raise expectations for the executive leadership group to also diversify itself. If you have diverse board members who understand the social and economic importance of diversity, the rest of the organization will get it."
Apart from the personal and professional growth opportunities available for mentors and their proteges, the business case for developing strong minority candidates for senior management and embracing diversity in healthcare is hard to ignore.
"Organizations that adopt inclusion are creating a competitive business advantage for themselves and they're going to continue to increase their population, their market share and their revenue," Hobby says. "Those that are hesitant, reluctant or not sure are going to have some serious problems going forward."
He believes it pays for hospitals to step up and lead the diversity initiatives in their communities because the competition will inevitably follow.
Sending the right signals
"Minorities are the new market and you must understand them socially and culturally to effectively attract them. We're leading into a time of highly educated patients -- they can go on the computer and do research on what hospitals offer services that specifically address their needs. If you're a minority, you have an increased comfort level doing business where you know that diversity is valued. Hospitals have to send that signal."
And it seems as though hospitals are receiving that signal as well. The Institute for Diversity in Health Management has attracted 92 hospitals as members during the first quarter of 2006. Its expansion this year has already doubled its membership growth for all of 2005 -- in part because of the addition of several tools and resources, such as bimonthly teleconferences called Diversity Dialogues and two new affinity groups -- the Asian-American Healthcare Leaders Association and the National Forum for Latino Healthcare Executives. "We're seeing growing interest, growing support for this philosophical concept of inclusion," Hobby says.
The institute isn't the only organization to see a greater interest in diversification. Organizations such as the ACHE also are reporting increased minority membership.
"In 1990, 5% of our members were people of color. Today, 11% of our members are people of color," Dolan says. "Since this is the organization of healthcare executives, it would suggest some progress in that area."
Though most observers agree progress is being made, nearly all are quick to add that it isn't happening fast enough.
Hobby says that while diversifying an executive leadership team isn't easy because of perceptions that there are not enough resources or qualified minority candidates in the pipeline, it's also not always a welcome philosophy to those who reside in the C-suite -- as the results of the Witt/Kieffer survey seem to show. "A certain number of executives don't really believe that it's the right thing to do -- some are threatened by the concept and some just plain don't agree with it due to their prejudices."
Reede -- who at Harvard has created 16 programs aimed at addressing the pipeline and leadership issues for minorities and women -- agrees with that assessment.
"As a nation that's becoming more diverse, we must take the best and brightest from everywhere, from all groups,"she says. "Dinosaurs did die out, and those who are not able to embrace the change will not always be in charge and the people who are coming in to replace them need to be aware of those issues and embrace them. Not everybody has to embrace it -- others will come along and others will retire."
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1st Lt. Charles Allen
Allen, 25, is currently the healthcare administrator at the 92nd Medical Group for the U.S. Air Force in Spokane, Wash. Previously he was the medical plans and operations officer for the Air Force's Office of Security Cooperation-Afghanistan, where he was responsible for developing the national healthcare system for the Afghan National Army, or ANA, and integrating the country's three independent healthcare networks.
As president and chief executive officer of the New York City Health and Hospitals Corp., or HHC, Aviles, 55, is responsible for management of the largest municipal healthcare system in the nation. Under his leadership, HHC has implemented a $1.3 billion program to rebuild and modernize New York's public hospitals. Before his tenure as a healthcare administrator, Aviles was a practicing lawyer and served as an assistant attorney general in the civil rights bureau of New York.
Bluford, 56, has led Truman Medical Centers in Kansas City, Mo., as president and chief executive officer since 1999. He spearheaded the creation of the TMC Corporate Academy to create educational and personal growth opportunities for employees and their families. Since its launch in September 2001, the academy has seen more than 20,000 class registrations with a 99% course completion rate.
Clark, 57, president and chief operating officer of Horizon NJ Health, West Trenton, N.J., oversees New Jersey's largest managed healthcare company serving the publicly insured. Throughout her 39 years in the industry, Clark has been recognized for her advocacy and outreach on behalf of women, children and families. She also led her company's participation in the Lead Screening Pilot Program, which helped screen children.
Collins, 53, is an associate professor in the departments of health services management and leadership, and health policy at George Washington University, Washington. Previously she served in the health policy practice at Powell, Goldstein, Frazer & Murphy in Washington, primarily advising health systems and related associations on federal funding strategies, regulations, corporate governance and strategic issues. Among other recognition, Collins received the Nelson Mandela Award for Health and Human Rights in 1995.
Cordova, 56, is president and chief executive officer at Childrens Hospital Los Angeles. Cordova previously served as president of the Southern California region of Kaiser Permanente Health Plan and Hospitals. There he co-sponsored an initiative to develop a business plan for an $800 million project to implement an integrated hospital information system and inpatient electronic medical records. Cordova also is chairman-elect of the Institute for Diversity in Health Management.
Coronado, 73, has served as director for the South Texas Veterans Health Care System in San Antonio since its formation in 1995. He also serves as chairman of the Veterans Affairs' Graduate Healthcare Administration Training Program, which oversees the VA's fellowship and residency programs. As a member of the federal government's Senior Executive Service, a corps of senior public service executives, he was recognized by three previous presidents.
Daniel, 51, is president and chief executive officer of the Washington, D.C., region for Doctors Community Healthcare Corp., Scottsdale, Ariz. Daniel has more than 25 years of experience in the healthcare industry. She serves on the credentials committee and is a fellow of the American College of Healthcare Executives, as well as scholarship chairwoman for the National Association of Health Services Executives.
Dean, 55, is president and chief executive officer of San Francisco-based Catholic Healthcare West. Since Dean's appointment in 2000, the not-for-profit system has seen rising patient satisfaction scores, higher employee confidence ratings and an operating profit after several years of steep annual losses. His dedication to promoting minority healthcare professionals has affected both management and policy.
After joining Evanston (Ill.) Hospital in 1979, Grady was named president of the hospitals and clinics division of Evanston (Ill.) Northwestern Healthcare in 1995 and president and chief executive officer of Evanston Hospital in 1999. Grady, 55, is on the board of directors for the American Hospital Association and is a past chairman of the Institute for Diversity in Health Management.
Hood, 60, is chief executive officer and managing partner of CareView Medical Group in San Diego. He also is president and CEO of the San Diego Multicultural Foundation Health Disparities Institute; president and co-founder of the MultiCultural Primary Care Physicians, Independent Physicians Association; and a member of the University of California at San Diego School of Medicine Diversity Task Force.
A. David Jimenez
As chief operating officer of Cincinnati-based Catholic Healthcare Partners, Jimenez, 53, oversees several top officers, and seven regional chief executive officers. In line with his belief that it's necessary and responsible to build a diverse leadership team, he encouraged the establishment of CHP's Diversity Health Fellowship program and helped create and implement the CHP Strategic Plan for Diversity and Inclusion in 2002, which will be carried out through 2008.
Killingsworth, 53, is president and chief executive officer of the Boston-based Blue Cross and Blue Shield of Massachusetts, where he leads the company's efforts to serve its 2.9 million members. In addition to his more than 30 years in the healthcare industry, he is a founding member of the Executive Leadership Council, an independent corporation established to provide black executives with a leadership advisory forum on business issues.
As executive vice president and chief operating officer at Lawrence Hospital Center, Bronxville, N.Y., Lee, 50, oversees the 182-bed hospital, a part of Stellaris Health Network. He brings his 25 years of healthcare management experience to his oversight of a technology implementation program, which has included nursing documentation, computerized physician order entry, cost accounting, enterprise scheduling and more.
Lee, 60, is the Oahu regional chief executive officer of Hawaii Health Systems Corp. With more than 25 years as a senior healthcare administrator, Lee spent 20 of those years as vice president of St. Francis Medical Center, Honolulu, where he developed and implemented three medical clinics to serve Oahu populations, with a special focus on serving homeless, low-income and medically uninsured patients and immigrant workers. His current undertaking has included standardizing the 12-hospital system's accounting practices.
Lofton, president and chief executive officer of Catholic Health Initiatives, Denver, is responsible for overall leadership of the nation's second-largest Roman Catholic healthcare system's 70 hospitals and 44 long-term-care facilities. He has charged CHI employees with the responsibility to "move the American health system beyond a focus on 'sick care' to a reality of 'well care.' " Lofton, 51, will be only the second African-American to chair the American Hospital Association.
With more than 28 years of administrative healthcare experience, Lopez, 53, is president and chief executive officer of Harris County Hospital District, a three-hospital system in Houston. Lopez's previous work as chief operating officer led to strategic partnerships with business, industry and community leaders to ensure that the hospital district received all state and federal funds needed to improve patient access to primary and specialty care.
In less than four years, Miller, 33, president and chief executive officer of Schneider Regional Medical Center in St. Thomas, U.S. Virgin Islands, has increased net revenue by $12 million, led construction of an $18 million, 34,000-square-foot cancer institute and increased overall inpatient and outpatient satisfaction scores by 12%. He was the first participant in the Institute for Diversity in Health Management's summer enrichment program to reach the rank of CEO.
In just over a year, Mosley, president and chief executive officer of Chesapeake (Va.) Health and Chesapeake General Hospital, led a turnaround -- registering a profitable operating margin and net income margin after two consecutive years of operating losses. Under his lead, Chesapeake Health also improved its cash position by $13.7 million in 2005. Mosley, 42, is president of the National Association of Health Services Executives.
With more than 20 years of healthcare leadership experience, Munroe is currently serving as president of Advocate Trinity Hospital in Chicago, owned by Advocate Health Care, Oak Brook, Ill. In addition to his day-to-day leadership responsibilities, Munroe, 41, has presented seminars on cultural competency and proficiency; executive healthcare leadership; and HIV/AIDS-related causes.
Nichols is chief executive officer of Amerigroup Corp. for the District of Columbia and Virginia. Her focus has been on improving preventive primary-care services. Before assuming her current positions, Nichols, 48, was selected as state director of the Arkansas Health Department by then-Gov. Bill Clinton. She also was chosen as an honoree by the National Congress of Black Women in 2005.
Odle is president and chief executive officer of Methodist Hospital and Indiana University Hospital and executive vice president of Clarian Health System, Indianapolis -- the largest healthcare employer in Indiana. With more than 35 years of experience in the healthcare industry, Odle, 56, is also the immediate past chairman of the American College of Healthcare Executives.
Reede, 52, is the dean for diversity and community partnership and director of the minority faculty development program at Harvard Medical School in Boston. After arriving at Harvard in 1990, she created the Biomedical Science Careers Program for students from middle school to college. Reede founded the Commonwealth Fund-Harvard University Fellowship in Minority Health, and is a commissioner of the Sullivan Commission on Diversity in the Healthcare Workforce.
Williams, 56, is president and chief executive officer of Aetna, the nation's third-largest health insurer. He served as executive vice president, chief of health operations and president of the Hartford, Conn.-based company before taking over as CEO. Under Williams' supervision, Aetna was the first national health insurer to launch health reimbursement arrangement and health savings account plans.
Woods is president and chief executive officer of Lexington, Ky.-based St. Joseph Healthcare, a three-hospital system within Catholic Health Initiatives.
St. Joseph began an $85 million expansion and renovation project at St. Joseph Hospital, the system's flagship, in 2005. Woods, 41, previously worked for the Washington (D.C.) Hospital System, a 907-bed teaching hospital, where he played a central role in helping to turn a $14 million loss into a $14 million surplus.