Robert Wood Johnson University Hospital's leadership bench in 2011 looked much like most other U.S. healthcare systems' administrative teams—very white. Despite caring for a community of African-Americans, Hispanics and Asian-Americans, the New Brunswick, N.J.-based hospital lacked diversity in its ranks and had no real strategy to change that.
So, the hospital's board of directors—seeing that major companies outside of the hospital industry, like General Electric Co. and Johnson & Johnson, had formal diversity and inclusion programs—asked then-CEO Stephen Jones to build one.
The hospital created a three-year plan to inject a dose of diversity into the organization, in part by developing junior employees into future leaders who would better reflect its multicultural patients. It set up a mentoring program for employees who wanted to develop their leadership skills. And it created several “business resource groups” where workers with similar interests or cultural backgrounds could come together for support and work toward common goals.
The hospital collected data through its annual leadership and talent review to learn what ethnicities and genders were underrepresented across its management and pinpoint opportunities to promote them. It also analyzed its succession planning program. And it embedded diversity and inclusion in its operating strategy and tied executive compensation to meeting diversity goals.
Finally, to help cultivate the young and diverse up-and-comers identified during the talent reviews and succession planning, Jones invited 30 of them to spend the day with him to discuss the hospital's priority projects and exercise their business and design skills.
“It was great feedback for us and it was a really innovative way to cultivate and groom young leaders,” said Jones, who is now a professor of health administration at Rutgers University.
The strategy helped increase the percentage of minorities on Robert Wood Johnson University Hospital's leadership team to 32% in 2015 from 4% in 2012. Minority representation on its board grew to 22% in 2015 from 17% in 2011. It nabbed the American Hospital Association's Equity of Care Award in 2015 for its efforts.
Healthcare systems are keenly aware that diversity among staff, leadership and board members is important to improving patient medical outcomes and reducing health disparities. Diversity also improves the bottom line. Companies with the most ethnically diverse executive teams are 33% more likely to outperform peers on profitability, according to McKinsey & Co.
Now, some organizations are grooming junior employees from minority backgrounds to become the next generation of leaders to better reflect the growing diversity of the patient and human populations. They are also working with minority-focused executive search firms and professional associations to fill open positions.
“This is not affirmative action. It's not about the numbers. It's about really representing the communities you serve and making people feel welcome because there's someone who looks like you working in the organization,” said Yolanda Robles, CEO of consultancy CulturaLink, which helped Robert Wood Johnson University Hospital increase its diversity.
Diversity among hospital leadership teams is lacking and in some cases worsening. While minorities make up 32% of patients, they hold 11% of executive leadership positions at hospitals, down from 12% in 2013, according to the AHA Institute for Diversity and Health Equity's latest benchmark study from 2015. Minority representation in every C-suite position has either decreased or remained flat since 2013. That is, except for the chief diversity officer position, with minorities representing 77% of those with that title, up from 58% in 2013.
“It appears we are going in the wrong direction,” said Fred Hobby, who served as president of the Institute for Diversity from 2005 to 2015, adding that the chief diversity officer, while important, may also be a way for hospitals to bolster their leadership diversity statistics.
In the cases where minority representation is slipping or stagnant, Hobby suggested that hospitals in some cases may be reducing the size of their leadership teams. But unconscious bias is also a factor. People prefer to be around people who look and talk and act like them, he explained.
Earlier this year, black professionals and those of other minority backgrounds studying for advanced health administration degrees told Modern Healthcare of their frustration at the racial bias they felt was holding them back from reaching the highest hospital positions and their reluctance to speak out about the lack of diversity and other issues lest they be labeled difficult or angry. Many readers shared similar experiences; others wrote to deny that racism or bias is present in the healthcare industry.
A growing body of research indicates that diversity among healthcare leaders and physicians is good for the industry and can help reduce the disparities that plague minority patients. Minorities, for example, generally have a harder time accessing care and use less healthcare than white patients.
“I'm not suggesting that nonminorities can't reduce disparities. What I am suggesting is that without minorities, it's going to take longer to reduce disparities,” said Hobby, who now serves as chief diversity strategist at CulturaLink.
According to the Institute of Diversity's benchmark study, 79% of hospitals require employees to undergo cultural competency training to gain a better understanding of other cultures, but Hobby argued that intimate knowledge of a culture cannot be taught. Having diverse leadership and staff is a better way to reduce disparities, he said.
Macon, Ga.-based Navicent Health has promoted many minorities because of a program CEO Ninfa Saunders implemented several years ago that requires employees to be evaluated by managers of different departments across the organization, rather than only the direct supervisor.
The program helps reinforce objective evaluations based on how well an employee achieved goals outlined at the beginning of the year, whereas an evaluation by a single direct supervisor could end up being more subjective, Saunders said.
“We've been on an intentional journey because we believe there is a strong relationship between diversity and inclusion and equity in healthcare,” said Saunders, who is the former chair of the Institute for Diversity.
Navicent, which won the AHA's Equity of Care Award this year, also offers a mentorship program and an internal leadership coaching program to develop top talent. And when it looks for candidates to fill open roles, Saunders said it ensures minorities are in the group by asking its search firm to partner with a minority-focused one.
The search firm Desir Group, for example, focuses on readying and elevating professionals from minority backgrounds to healthcare system leadership roles. Founder Etheline Desir often gets calls from hospitals who wish to diversify their teams but have trouble doing so because traditional search firms seem to recycle the same candidates.
Still, firms that are committed to diversity and improving patient outcomes and safety will do what it takes to find the right talent, she said.
And the talent is out there. According to the Association of University Programs in Health Administration, 47% of the applicants to health administration programs at 43 universities in 2017 identified as Asian, African-American or black, or Hispanic. Among the others, 45% were white and the rest did not report their ethnicity or selected two or more races.
“Nobody applied is not an acceptable answer,” Rutgers' Jones said, adding that he has rejected plenty of pools of job candidates that lacked diversity.
Other healthcare systems offer minority fellowships and internships to find talent from backgrounds traditionally underrepresented in healthcare. Mount Sinai Health System, for example, offers a summer development program in which 40 high school students from minority backgrounds intern at its seven hospitals, said Pamela Abner, vice president and chief administrative officer in the New York system's office of diversity and inclusion.
Mount Sinai's two-year administrative fellowship program readies minority students who already have master's degrees for management positions. Its first cohort of four fellows graduated this year and all assumed managerial and administrative positions at Mount Sinai. Next year, the hospital system's nontraditional healthcare departments will begin offering fellowships.
“It's about creating a pipeline,” Abner said. “People bring different things to the table because of their background.”
By some estimates, minorities will become the majority in the next 20 years.
“Diversity is inevitable,” Hobby said. But “if we don't solve this healthcare disparities issue while minorities are still minorities percentagewise, before they attain majority status, we are going to have some major financial and health issues in this country. You'd think hospitals would be doing everything they can to address these problems of disparities and lack of equity.”