Healthcare leadership lacks the racial diversity needed to reduce health disparities

Michellene Davis can recall as recently as a year ago seeing sudden looks of disbelief and shock that would come over the faces of some of her colleagues when she proposed addressing “structural” or “systemic” racism as a means of reducing racial health disparities.

“I would watch their necks snap back, I would see them blink several times with this look of shock at hearing the term,” said Davis, executive vice president and chief corporate affairs officer at New Jersey-based RWJBarnabas Health.

But the heightened attention to systemic racism in the wake of George Floyd’s killing—and the Black Lives Matter movement’s escalating activism—has shifted the kinds of discussions healthcare organizations are having about race, discrimination and health. Those talks have evolved from ignoring or minimizing the existence of systemic racism to searching for solutions to mitigate its effects on health.

“It seems that we are beyond the point of debating whether or not there is still racism in America,” Davis said. People call it structural racism because it is interwoven throughout systems and structures that originally created the platforms for why health disparities exist and those that permit it to continue.

Yet, many healthcare organizations struggle moving beyond talking points to action that can lead to substantive change.

“I believe there are a number of hospitals and healthcare organizations that are well-intentioned; they’ve talked about it and they’ve had groups in their organizations, but they haven’t laid out the concrete steps to actually get it done,” said Marvin O’Quinn, president and chief operating officer at CommonSpirit Health, one of the country’s largest health systems. “Until you take that next step you don’t get there.”

One obstacle to taking action is the lack of current data. The American Hospital Association’s Institute for Diversity and Health Equity hasn’t updated its benchmark report on diversity and disparities since 2015. At that time, racial and ethnic minorities made up just 11% of senior managers. An AHA spokesman says an updated snapshot of its benchmark report will come out in the fall. He declined to provide the minority representation within the AHA’s own senior management ranks.

Similarly, the most recent set of data on race and ethnic diversity offered on the American College of Healthcare Executives’ website dates back to 2015.

More recently, a Modern Healthcare survey of the 20 largest health systems found the median percentage of senior managers who were racial or ethnic minorities among the 15 systems that responded to be about 20%. So with roughly 80% of senior managers being white, that’s higher than the general population’s percentage of whites who are non-Hispanic and non-Latino, which is 60%.

“There are so few ethnic and racial minorities around the table when they’re making decisions on what type of healthcare services are we providing—who’s providing those services, what will enhance and inhibit utilization—that the policies that come from those decisions don’t necessarily reflect the needs of the community,” said Dawn Morton-Rias, CEO of the National Commission on Certification of Physician Assistants.

Organizations that do not have significant racial and ethnic minority representation in senior leadership are less likely to make racial health inequities a priority.

“Even with the best intentions, without having some sort of real understanding of the challenges individuals from minority communities go through, it’s very difficult to make meaningful change,” said Dr. Eric Rafla-Yuan, chief resident in the University of California at San Diego’s community psychiatry program. “If you did have a good understanding of this you would want to try to include these people in positions of leadership.”

Ascension, a Catholic healthcare system that’s one of the largest in the nation, has formalized its efforts to increase diversity. 

“Ethnic and gender diversity are critical to the long-term sustainability of our ministry and something we’re focused on as a national system,” Herb Vallier, executive vice president and chief human resources officer, said in an emailed statement.

“We’ve begun a diversity and inclusion initiative called ABIDE (Appreciation, Belongingness, Inclusivity, Diversity, Equity) with the goal of creating a more diverse and inclusive culture and workforce and a welcoming environment.”

Most of the barriers to progress are rooted in a lack of commitment by top management to recruit, cultivate and promote more people of color to leadership positions. The next level is going from saying that Black lives matter to showing that commitment, said Dr. Robert Winn, director of the Massey Cancer Center at Virginia Commonwealth University in Richmond. “If Black lives matter, then how does that impact your hiring practices?”

North Carolina-based Novant Health has worked to embed diversity, equity and inclusion within the organization for more than a decade. But in 2015, the health system stepped up its commitment when it became one of more than 700 hospitals that year to sign the American Hospital Association’s pledge to eliminate healthcare disparities.

Since then, Novant has approached diversity more holistically, aiming to change its culture rather than relying on a specially created diversity program to succeed, said Tanya Blackmon, executive vice president and chief diversity, inclusion and equity officer.

“We all know what happens to programs,” Blackmon said. “You have a program and you have money to fund it today but then if there’s no money tomorrow you stop the program.”

Novant’s strategy has involved tying its work toward improving racial diversity to the organization’s business imperatives. Since 2006, the health system has invested $1 billion in initiatives promoting economic development in underserved communities by purchasing goods and services from women- and minority-owned businesses.

But Novant’s commitment to diversity is also reflected in its executive leadership. In five years, Novant has gone from having one person of color and one woman on its executive leadership team to currently having 40% of the team represented by each category.

Experts say healthcare organizations that have had greater success increasing minority representation in their leadership ranks actively recruit for candidates from underrepresented backgrounds.

Effective strategies have included the use of pipeline programs to identify young individuals with a desire to pursue careers in healthcare, said Lisette Martinez, executive vice president and chief diversity officer at Philadelphia-based Jefferson Health. Program participants are provided with supports and mentorship aimed at recruiting them to become students and potential employees.

But VCU’s Winn felt the healthcare industry could do a better job in its outreach efforts if the goal is to truly increase representation of individuals from ethnic, racial and minority communities. Only 31% of hospitals surveyed in 2015 reported having a documented plan to increase the number of racial and ethnic minority executives in senior leadership roles, according to AHA’s benchmark report.

Recruitment challenges aside, racial and ethnic minority healthcare professionals can often face other unique challenges that can hinder opportunities for career advancement. There’s a burden, for instance, often placed on minority professionals to mentor other minorities. While most view mentoring as an important responsibility, some say the demands on time can keep minority professionals from making the types of contributions that would likely increase chances for their own advancement into leadership.

“You would recruit a minority faculty member and then put them on every committee you can think of because you’re thinking about minority representation, which on one level is a good impulse,” said California state Sen. Dr. Richard Pan, a practicing pediatrician and former University of California at Davis faculty member. “On another level that’s a career killer for that junior faculty member who doesn’t have time to actually do the things they need to do to get promoted.”

Pan said such situations are a common dilemma for Black and Brown professionals in academic medicine. Minority professionals feel pressure to volunteer on committees or mentor students only to be passed over for promotion because they haven’t authored as many research papers as their white colleagues who are not mentoring.

“You want to be helpful and you want to be involved, but at the same time people need to make sure they are also taking care of their careers,” said Dr. Wayne Frederick, president of Howard University in Washington, D.C. “Oftentimes they don’t have people above them who can advocate for them appropriately so they have to learn to become their own advocates.”

Overall, a healthcare organization’s success in improving diversity throughout its ranks comes down to a will to make meaningful change—from the top down. Suzet McKinney, CEO and executive director of the Illinois Medical District in Chicago, said the fact that progress has mostly stalled indicates increasing minority representation in leadership remains a lesser priority for many organizations.

“If healthcare organizations are not prioritizing bringing in people of color to their C-suites and also to their boards, then it makes it really impossible for people of color, particularly African Americans, to achieve those leadership levels,” McKinney said.

In another recent Modern Healthcare survey, less than 40% of nearly 200 respondents from the nation’s largest healthcare organizations said that their companies’ leaders were financially incentivized to reach diversity and inclusion goals.

CVS Health in July announced it is investing nearly $600 million over the next five years to address racial inequality. Part of that will go toward mentoring, developing and advancing employee diversity initiatives, as well as companywide training and corporate culture programs to promote inclusion. Dr. Garth Graham, vice president of community health and chief community health officer at CVS Health, said years of tracking data on racial health trends helped lay the foundation for the company’s diversity and inclusion efforts.

In 2019, 13% of CVS Health’s senior-level management—defined as having the title of vice president or above—had ethnicities that were described as “diverse,” according to the company’s 2019 Corporate Social Responsibility Report, a share that was relatively steady compared with the two previous years.

Some see healthcare’s current focus on addressing diversity and structural racism as a chance to lobby organizations to make big changes that promote greater racial health equity.

“The acknowledgment of there being racism in systems is a start, but it takes more than words,” said Dr. Xenia Johnson Bhembe, assistant professor of clinical psychiatry at Harvard Medical School and director of community minority affairs for the Cambridge Health Alliance. “It really does take chipping away at some of the innate practices and defaults that are built into how we operate as healthcare systems in order for us to move past (the) racism in them.”

If that doesn’t occur, closing the racial health gap could become even more difficult once public awareness of the problem turns into indifference.

“Moments like this are cyclical, and I think they’re really dependent upon the foundation that’s laid in between moments like this,” said Dr. Damon Francis, chief clinical officer at Health Leads, a national organization that partners with healthcare providers to help address the social needs of low-income patients. “I’m of course concerned that the moment of awareness will pass and that not much will change, because we have hundreds of years of history of that happening.”