INTRO COMMENTS: Hello and welcome to Next Up, Modern Healthcare’s podcast for emerging healthcare leaders. My name is Kadesha Smith, and I’m your host. I'm the founder and CEO of CareContent, a digital strategy agency based in Chicago.
In our last episode, I had one of the most amazing, candid conversations ever with Dr. Carladenise Edwards. She’s the incoming chief strategy officer for Henry Ford Health System. We talked about how leaders can navigate the two crises that have engulfed our country over the last few weeks: the COVID-19 pandemic, and the civil unrest that has led several brands and healthcare organizations to declare their commitment to ending racism.
That’s great and all, but now the conversation has shifted to what do we do? What action steps should healthcare organizations take? Aurora Aguilar, Modern Healthcare’s Editor-in-Chief, tackled this very question during a panel titled, “How Healthcare Can Heal Racism?”
We’ll talk to her in a bit about some of those ideas, but first, Dr. Edwards shares her thoughts on how healthcare leaders can affect populations' lives. Let’s listen to Dr. Edwards again.
MODERN HEALTHCARE: Here’s some very sobering information about the state of diversity in healthcare leadership. This data is from 2015, which is the most recent that’s available, from a June 6th Modern Healthcare story written by Steven Ross Johnson. And he reported that minority groups combined made up to approximately 37% percent of the US population, that they account for just 14% of hospital board members in 2015. And about 11% of executive leadership and most of those executive leaders are diversity officers. Now, we hope that, that has changed when new data comes out, hopefully soon. But, as you talk about how, you know, you’ve seen people take action steps to make those changes, what can healthcare organizations do to make good on these statements about diversity? Clearly, leadership is an important part of this. What should healthcare organizations do if they look around their board and their executive leadership, and say, “We don’t have people who reflect our community?”
EDWARDS: I have mixed feelings about this. I have witnessed organizations that have done a phenomenal job of hand-picking the rainbow and ensuring that they fill in the diversity grid. And you can do that, I think that’s one step. I think that’s necessary, is to be intentional about making sure that the individuals on the board and the executive team are representative of diverse opinions, viewpoints, and experiences. And they also represent the people in the communities that you serve — or want to serve — and should want to do that at a global level. Which means you need to be exceptionally diverse in how your leadership is represented. My concern is that some organizations think once they’ve filled in the grid, they’re done. So, that’s the diversity step.
The next step is actual inclusion, where now that you’ve brought the people into the organization or you’ve given them a seat at the table, are you taking the right steps for them to be included and to actually feel included? Because your perception as the Other of someone being included might be, “Well, we gave them a seat at the table.” The person at the table may not feel welcome or in a position where they can be their authentic self. Or can speak up for the issues that are important to drive the diverse dialogue that’s needed. Because they're afraid that if they say that, they may not be invited back. Yes, do the grid, and be very intentional in making sure that you have the representative voices at the board level and the executive level. But step two is making sure that now you’ve invited them, you’ve welcomed them, and they feel included.
And the way that works is by engaging, going back to my very first statement. Asking the question — knowing that something traumatic happened in the community, let’s say the night before — and not starting the board meeting or the executive meeting without acknowledging that traumatic event.
And then the equity piece, which is — you know what, organizations? Make sure your people are paid equitably. The women, the men, the folks from different backgrounds. I've had more times in my life, people say to me, “Well, we want you to grow into the job.” But you didn't hire me to grow into the job. You hired me to do the job on the day that I was hired.
MODERN HEALTHCARE: Right.
EDWARDS: So, shouldn't I get paid equitably on the day that I was hired? I've had all those types of statements as rationalization or justification for not paying equitably on day one. We are so desperate to get our foot in the door — I’m guilty — we take it. And guess what? You know what? Then I have a little attitude and people can't understand why I have an attitude. Because not only am I smarter, working harder and smarter, I'm getting paid less. And I'm watching, going, “Dang it, why’d I do that to myself?” So, not up to me to constantly advocate for myself. Somebody else needs to advocate for me. Somebody else needs to make a conscious decision, a person who has power and control, to give up some of that power and control to create equity. I can’t do that for you. You’re holding all the cards, right?
MODERN HEALTHCARE: Yeah, absolutely. That is such a good point because that — that sort of creates the empowerment to engage, right?
EDWARDS: Right.
MODERN HEALTHCARE: I think you kind of silence them a bit when you say, “Oh no, you’re not, you’re not really ready for the pay that comes with this role, but we want you to keep doing it and keep trying, and maybe one day.”
EDWARDS: Meanwhile, you’re knocking everything out of the park. Every metric they give you, every task they give you — you’re nailing it. And they just keep giving you more.
MODERN HEALTHCARE: And that’s a good point for the audience that’s listening to this, just the importance of advocating for yourself and making sure that you’re being compensated according to your worth.
EDWARDS: Yes. But I’m going to add a little nuance to that, which is — and again, you do have to advocate for yourself. I think I’ve been blessed, privileged, fortunate enough where I have had white male mentors and black male mentors, bosses, coaches, advocates, who have helped me. They have gone out of their way against the norm to ensure that I was in the right place at the right time, that I felt as if I was being compensated or rewarded accordingly. And to advise me on how to approach very difficult situations and circumstances. That wasn’t all Carladenise. That was the Jeb Bushes of the world, and the Arnold Schwarzeneggers of the world, and the Tommy Thompsons of the world. And the people who I worked for, who have gone out of their way to ensure that I was in the right place at the right time, that I felt confident when I walked in the room. And how do you make somebody feel confident? You make them feel equal!
MODERN HEALTHCARE: Yes.
EDWARDS: That’s how I got to this point, where it wasn’t just me advocating for myself and trying to scrape from the bottom of the barrel and crawl on top of people. It was because people who were in positions of power made a conscious decision to ensure that Carladenise was included.
MODERN HEALTHCARE: Did you initiate those mentorship relationships? Did they reach out, or was it sort of mutual?
EDWARDS: I can say I’m pretty aggressive and persistent. I don’t know, I hope none of them would say I was aggravating. For me, every real, valuable, incredible opportunity came to me because my reputation preceded me. I was called.
One of the things I tell young people is, “Do what you do, laser-focused, exceptionally well. Right now, when they ask you and how they ask you.” I think where people fail is, they’re so busy trying to get to the next ladder, they don’t actually finish the step that they’re on. And so I've never looked for the next ladder. I just don’t. And this is a little bit of my demise — I’d probably be a CEO right now, but that’s not my endgame. My endgame is, when I leave this planet, for people to say, “Doggone it, we asked her to do something and she nailed it. And the impact that she had lived beyond her existence there.” That’s what my tombstone should say. It wasn’t like, “Oh, she became CEO because she stepped on 50 people and moved them out of the way.” No. I just want it to say, “She said she was going to do something. She did it exceptionally well. And the positive impact lived well beyond her existence.”
MODERN HEALTHCARE: That’s great motivation and it’s a good reminder: Focus on the present, focus on what’s in front of you — keeping your endgame in mind — but do this right, first.
EDWARDS: Right! Because guess what? Everything else will come.
MODERN HEALTHCARE: Thanks again to Dr. Edwards for her wisdom on this topic. We’re now here with Aurora Aguilar, Editor-in-Chief of Modern Healthcare. How are you?
AGUILAR: I’m good Kadesha, how are you doing?
MODERN HEALTHCARE: I’m good, I’m good. Thank you for being here to share some final thoughts on this topic. Since you’re constantly in touch with healthcare executives, can you paint a picture of, sort of, what the ultimate goals are for addressing diversity, inclusion, and equity in healthcare leadership? Is there any kind of industry consensus about what the real goal is?
AGUILAR: Sadly, no. There is no consensus, which is kind of strange for a data-driven industry. We’ve seen that some goals and metrics and analysis work for other industries. For example, you know, if we have a company that says, “We will increase diversity within our employee base by x%, we will increase diversity in leadership by x%, people of color and gender diversity by x%, and then we have these goals tracked to this date,” we’ve seen success in that. Even better if you have your CEO be accountable for those metrics. So, if you tie their compensation directly to meeting those goals.
Now, we surveyed our audience last year and found that only 8% had formalized training or mentorship programs with established tracks for advancement. Only 11% of those organizations — most of them are some of the largest in the nation — had workshops or training on eliminating bias. And only 6% have salary equity studies. Only 10% had company-wide diversity goals and metrics for diverse representation. And only 11% had CEOs whose salaries were tied to meeting or surpassing these goals. So, you know, you might say, “Well, really, what’s the point if you’re not necessarily trying to hit certain metrics or trying to make sure that you are holding yourself and your employees accountable for meeting these metrics?”
So, when you’re looking at this group of people who are rising through the ranks and grew up in a generation that is heavily invested in diversity and inclusion, the goal of seeing more people in healthcare reflective of individual communities is less of a moral obligation and more of a business one. Especially when you take into account the results of COVID-19 recently. We saw huge disparities, right? And that in itself shows you what can happen if you have physicians and nurses and administrators that are in tune with the communities that might be most vulnerable, and are actually making decisions based on what those communities need.
MODERN HEALTHCARE: If you’re in leadership at an organization, and they’ve declared a commitment to addressing gaps in diversity, inclusion, or equity — even short-term — what are your next steps for the rest of 2020? Just going beyond releasing the statement and making the declaration and the commitment. What are your next steps?
AGUILAR: So, there are some really clear guidelines that I’ve actually borrowed from a lot of other organizations. IT is very heavily invested in diversity and inclusion, and has shown great results from that. I’m talking about the industry as a whole. So I kind of borrowed some best practices from a couple of different organizations outside of healthcare, and then also I’m thinking about some of the ones within healthcare that do this really well.
So, #1 would be moving towards an evidence-based selection screening process. So, that means that interviewers are using a set of interview questions that are standardized. So, no matter what your experience in life has been, you are not bringing that into your decision-making process when you are vetting candidates. You are going by a standard set of questions that everyone is going to be asking and that have specific reasons for why it is being asked. Skillsets, and any identifiers that would be helpful to both the responsibilities that you’re going to be responsible for in this position and also what might be able to work best within a certain culture that the organization’s looking for. So, that’s #1.
Removing barriers that overlook under-tapped candidate pools — nearly every labor market contains pools of talent that organizations are overlooking or accidentally have overlooked because they are being, sort of, labeled as disqualified. So, looking at economically depressed communities for talent, investing in those communities for scholarships and partnerships, will be able to expand that pool that you might be able to get new talent for.
In healthcare, one model has been really, really successful. And this is the grow-your-own model. So, this is the approach that calls for investing in a pipeline to increase the number of minority students who matriculate into school and training that would eventually give you the talent to be able to increase your workforce. Whether it’s physicians, whether it's nurses, whether it’s tech, whether it’s hospital administrators — these are all of the people that would be able to help you advance in your business. And you start at the high school level, maybe even at the elementary level, trying to train these minds to think this way. So, getting them interested in STEM, and you know, showing them what might be possible if they might be able to go after a career in healthcare.
Rush University in Chicago has been really successful. They are in a partnership with Malcolm X College which is one of the community colleges in Chicago that is strictly for healthcare careers. And they have actually been able to get a ton of new talent through this pipeline. Mt. Sinai in New York also formed an alliance with several local schools to provide free prep training to 150 New York City and New Jersey residents from underrepresented groups. On average, 85% of these kids end up studying STEM. So talk about having, like, a really solid pipeline there, right?
MODERN HEALTHCARE: Yes.
AGUILAR: So, other kinds of tips are to collect, count, and compare all of the data that have been able to provide you with any kind of feedback on what your patients think about whether or not they’re reflected in your staffing, what your employees think about the efforts that you make and whether or not those are enough. And then, just make sure that you are holding yourself accountable when you get those survey results.
Deploying alternative complaint systems is a really important one because this goes back to making sure that you’re listening and that you’re being respectful to the opinions and thoughts of the people that you’re working with. So, if you are in an organization, for example, that is very top-heavy and has a lot of input from the higher-ups, and not enough of information and ideas and solutions that are coming from the bottom-up, then you have a problem. Because those people are not necessarily feeling listened to, and you are potentially not getting some really, really great ideas from that diverse group that you’re hoping that you are increasing and are helping you in creating better business plans, so that you are better able to respond to your patients. So, if those people feel as if they can’t make a complaint about their colleague or their superior without repercussions, then they’re not going to speak up as much — both in a way that would be helpful to you by getting ideas and also to be able to address problems. So, having ways that are not punitive whenever people bring forth ideas or complaints is really, really important.
As we go into more of this AI world and technologically really heavy universe, we want to make sure that we’re testing for any biases within technology that often is used for applicants.
MODERN HEALTHCARE: Yep.
AGUILAR: For looking through candidate pools. With that technology also comes the possibility that there might be inherent bias in some of the questions that are asked and some of the technology that’s used. So, constantly testing for that bias is really important. And then lastly, just involving the managers from the start, right? If you don’t have any kind of investment from the top — and I’m not just talking about the CEOs, but also the board members — you’re not going to get anywhere. So, both an investment into all these programs, but then also just, you know, support for accountability and making sure that the metrics are met, the complaints are addressed, and the solutions are implemented. You have to have the top people in the room talking, and also very, very much invested in making sure that these changes are made.
MODERN HEALTHCARE: This is a huge culture shift for a lot of healthcare organizations, I can imagine. I mean, a top-down mindset shift being very deliberate about making sure that diversity, inclusion, and equity are part of your culture.
AGUILAR: Yeah.
MODERN HEALTHCARE: We have time for one more question. And this kind of comes from a personal thought that I had. When I’m presenting to a hospital executive team, I pause a little bit when I notice that every single person is a white male. I look around and I say, “This community looks very different. Why has that not translated over into who’s running this hospital?”
Is your sense that the COVID-19 pandemic, the civil unrest, sort of the reckoning that our country is having about racial bias — do you sense that this is going to change anything? Do you sense that the statements that have pretty much become very normal for a lot of brands and healthcare organizations, are they really going to lead to actionable change?
AGUILAR: I mean, I think it’s just like we’re seeing throughout the United States and around the globe, right? There is a lot of patience, and insistence, and a desire on accountability and change.
And so you mentioned that I had spoken to a group of very established leaders earlier this month, and they all talked about their employees turning to them and saying, “You know, if we’re not doing something, if we’re not part of the solution, then we’re just as complicit as the officers who did nothing to help George Floyd.” And so in ways that we’ve never seen before — nurses, doctors, lobbying groups — all of their leadership are speaking out and doing things that they’ve never done before. Include resolutions, for example, for the AMA (the American Medical Association) during their house of delegates meeting, that said, “Absolutely — this is a public health crisis. Racism is a public health crisis. And not having diversity for our leadership and for our physicians, and not having training for implicit bias, is a problem that we need to address.” And so they have absolutely included plans to be able to do so.
In Chicago, just before the weekend, we saw 36 healthcare organizations get together and again proclaim racism a public health crisis. And they added a promise to reexamine their institutional policies with an equity lens and make any policy changes that promote equity and opportunity. Granted, some of these were organizations like Rush, which were already making strides. But the fact that they were able to get all of these other organizations along with them, I think, is huge. It does come back to accountability, and again, it does come back to these difficult conversations that should be happening between directors speaking out for their workforces, which of course tend to be much more diverse than those leadership ranks that you and I are seeing when we’re sitting across the table from some of these, you know, very powerful and influential people.
And it requires those honest conversations between those emerging leaders. The ones that you’re speaking to, you know, in this podcast, and all of the ones that we’re seeing rise through the ranks, being very, very clear, deliberate, and having that voice, that supports their employees. And offer them sponsorship, right? So, one thing that we’ve seen as a problem over and over again in healthcare is that we need all leaders — whether you’re of color or whether you are white — acting as sponsors for people that do not have the strong voices under you. The support staff, the people that are working alongside you that might not necessarily have that seat at the table or feel the ability and the comfort in speaking on their own. So, this is where someone that is rising through the ranks that might not want to rock the boat too much needs to feel empowered, and needs to feel able to speak out for the needs and the desires of their workforce.
MODERN HEALTHCARE: Thank you so much for sharing that. That was excellent data on the current state of where healthcare is with diversity and inclusion, and honestly, how far we need to go.
AGUILAR: Thank you so much, Kadesha. Thanks for bringing it up.
OUTRO COMMENTS: Addressing diversity, inclusion, and equity will also be a focal point of Modern Healthcare’s upcoming Women Leaders in Healthcare Conference. This virtual event will be held on August 13 and 14. To register, visit modernhealthcare.com/womenleaders.
If you use the discount code NextUp, you’ll receive 25% off the fee.
Again, I’m your host Kadesha Smith, CEO of CareContent. We create digital strategies and content to help healthcare organizations reach their audiences online.
Check out past and future episodes of Next Up at modernhealthcare.com/podcasts. Or subscribe at Apple Podcasts, Google Podcasts, or your preferred podcatcher. Thank you so much for listening.
