Making progress

Just as growing diversity is shaking up the nation's politics, the increasingly multicultural populations served by U.S. healthcare providers are also driving changes in the organizations' C-suites and boardrooms. But the transformation is still a work in progress.

Based on 2012 data from the Institute for Diversity in Health Management, an affiliate of the American Hospital Association, minorities now make up 14% of hospital C-suite positions. That's up significantly from 9% in the previous year and only 2% in the organization's first benchmark survey in 1994.

Several factors account for the recent gains, says Fred Hobby, the institute's president and CEO. He credits organizations industrywide that have stepped up efforts to focus on diversity, while also noting that more senior-level executives have announced their retirements, creating additional opportunities.

But the numbers still don't reflect the nation's racial and ethnic profile, in which nearly 22% of the U.S. population is nonwhite, according to the Census Bureau.

There's still plenty of work to do, says John Bluford, president and CEO of two-hospital Truman Medical Centers in Kansas City, Mo., and a previous AHA board chairman. He's also one of this year's winners of Modern Healthcare's CEO IT Achievement Awards. “Diverse perspectives yield better decisions, and better decisions yield better outcomes,” he says. “Those who are in a diverse environment are going to be more successful competitively.”

Providers have created diversity committees and executive titles focusing on strategies to recruit more minorities, women and members of the gay-lesbian communities to leadership roles. While progress has been made in hiring and promoting minorities, barriers still exist. “Part of it is just the history and maintaining the status quo while being comfortable in that status quo,” Bluford says. “If you don't stretch yourself and take a risk, you are in effect taking a risk.”

Bluford, who is African-American, credits diligence and his commitment to the mission of healthcare for his success, but acknowledges that some organizations need a primer in diversity strategies. An organization can't pin the transformation of its culture on a committee or the chief diversity officer. It needs to be a systemwide effort starting at the top, he says.

David Elgarico, board chairman of the Asian Health Care Leaders Association and executive director of ancillary services-administration at 363-bed University of California at Irvine Medical Center, echoes Bluford's remarks on the need for greater diversity. “Personally, I'd like to see more minorities as CEOs; that's the main metric used to measure success,” says Elgarico, who is of Filipino descent.

Only 9% of CEO positions at hospitals and health systems are held by minority populations, the second-lowest percentage of all C-suite positions, according to the diversity institute. Chief financial officers scored lower, at 7%. Minorities hold 16% of chief medical officer positions and 14% of chief operating officer jobs. Not surprisingly, the top role for minority executives was chief diversity officer, at 60%.

Establishing programs that provide training opportunities and the support of strong mentors are two keys to increased representation in the C-suite and on governing boards, Elgarico says. Participating in organizations such as the AHCLA, the American College of Healthcare Executives and the National Association of Health Services Executives are also important for career development and networking.

Elgarico disagrees with the frequently heard notion that there's still a shortage of highly qualified minority candidates to fill many of the top jobs in healthcare. He says the bigger problem is often with the hiring process. “The challenge is some people will pick only people who remind them of themselves or someone you know,” he says. “They're not consciously aware that this is going on. It's only human nature.”

For the top executive ranks in healthcare to better reflect the racial and ethnic makeup of America, governing boards at hospitals and health systems—the people who make most of the hiring decisions at the top levels—also need to become more diverse.

African-Americans hold key leadership posts at 55-hospital Catholic Health Initiatives, based in Englewood, Colo. Those include the top two C-suite positions, President and CEO Kevin Lofton and Executive Vice President and COO Michael Rowan. But CHI still faces challenges in its board recruiting.

“There's a real shortage of persons, not so much women anymore, but persons from different ethnic and racial backgrounds,” says Sister Phyllis Hughes, chair of CHI's 17-member board of stewardship trustees. She says that while there's high demand for people to serve on national boards, the supply remains low.

Hiring Lofton in 2003 was integral to attracting minority staff at all levels of the health system, Hughes says. It showed that CHI wasn't content with just making diversity part of its mission statement, she says. Hughes also touted the system's diversity committee, which helps to effectively communicate policy and expectations to staff while serving as a facilitator when developing the health system's diversity strategies.

Judging by enrollment in healthcare management programs, governing boards should be seeing a sharp increase in qualified minority candidates for top management positions. About 42% of graduate students in healthcare management programs nationally were minorities in the 2009-10 academic year, according to the Association of University Programs in Health Administration. The percentages have steadily increased from the 14% in the 1990-91 academic year and 30% in 2000-01. Time will tell if the growing enrollments translate into more opportunities for the graduates.

At many systems, talent development is home-grown. Officials at Kaiser Permanente, Oakland, Calif., say they are fortunate they had the chance to promote Bernard Tyson, who has spent 29 years with the company, most recently as president and COO. Tyson, who is African-American, will assume the top job at the end of the year, replacing longtime Chairman and CEO George Halvorson.

Kaiser's commitment to diversity drew Jenny Ming to the organization as a board member in 2006. She's now president and CEO of Charlotte Russe Holdings, a clothing retailer for young women. Ming says she's excited about her ongoing role in helping to make Kaiser leadership reflect the communities the organization serves.

Ming, who was born in China, reiterated that any changes to a company's culture stem from willing senior leadership. She also echoes Elgarico regarding the impact that subconscious bias can have on the hiring process, which she says hinders advancement of minorities inside and outside of healthcare

“There are some generalizations into what I look like,” Ming says. “I certainly don't look like a typical CEO in many companies.”

Reaching out to students is also essential, and Tyson's promotion shows how important it is to recognize talent early on, says Dr. Ronald Copeland, Kaiser's senior vice president of national diversity strategy and policy and chief diversity officer. Nurturing that talent and retaining minority staff members remain ongoing challenges, Copeland says.

The ACHE, long a champion of increasing diversity at all levels of healthcare management, spelled out a number of suggestions in a policy paper for increasing and sustaining racial and ethnic diversity, last revised in 2010. Companies need to offer minorities opportunities to shadow senior executives and should recruit at schools with diverse ethnic enrollments. The organization also recommends a battery of internships, residencies and fellowships for minorities to provide the requisite experience highly valued by healthcare employers.

Training and educational programs at all levels in healthcare organizations are helping to promote diversity. Asha Rodriguez is the first executive fellow at 17-hospital Christus Health in Irving, Texas. It's a two-year program, not exclusively for minorities, designed to prepare students for careers at the C-suite level. Much of Rodriguez's work is conducted at 778-bed Christus Santa Rosa Health Care in San Antonio. She spends about 60% of her time there and the rest traveling around the region to learn at other Christus facilities. She says she participates in staff training programs, which provide exposure to patient-care issues and also offer a glimpse into a hospital's strategic-planning process.

Rodriguez was born on the Virgin Islands, and says her family has roots in Trinidad and India. She describes herself as Afro-Caribbean, and came from a human resources background before applying for the fellowship. The program is all about providing an opportunity to change the trajectory of her career, Rodriguez says.

“It put me squarely into operations where I didn't have any opportunity before,” she says. “It's easy to get pigeonholed in a particular area. With this fellowship, I have a chance to be an active participant as a member of the hospital leadership that I'm assigned to.”

VeLois Bowers, vice president of diversity and inclusion at Christus, serves as a guide and mentor for Rodriguez. She calls the fellowship program a key part of the health system's mission to better reflect the communities it serves. Bowers also cites a sometimes unconscious bias by board members and management in the hiring process, and one way to address that is to increase the pool of highly qualified minority job candidates. Fellowship programs help develop that pipeline by matching fellows with a diverse group of mentors.

“People can work up the ranks, both formally and informally, but I think the idea that is so critical is that you have to emphasize the available opportunities and you really need people of all backgrounds to step up and continue to mentor,” Bowers says.

Increasing awareness among board members, administrators and others involved in recruiting and hiring is the primary path to addressing ongoing challenges of leadership diversity, says Hobby of the diversity institute. Hospitals that tend to have more success attracting minority executives have a culture that's ready to accept change, he says. Hobby, an African-American, also says he wants healthcare executives to understand that broad diversity in top management is a sign of a provider that offers culturally competent care.

“This is a health and safety issue,” he says. “This is a quality issue.”

TAKEAWAY: Educational efforts and mentoring programs help boost the ranks of minority execs, but numbers show there's still a long way to go.

Follow Ashok Selvam on Twitter: @MH_aselvam