Though minority groups combined made up approximately 37% of the U.S. population in 2015, they accounted for just 14% of hospital board members that year and 11% of executive leadership posts, according to a 2015 benchmark diversity survey from the American Hospital Association’s Institute for Diversity in Health Management, the group’s most recent available data.
“Health systems and hospitals themselves can commit to advancing diversity and including persons from historically marginalized populations in their leadership and governing bodies,” AHA CEO Rick Pollack said in an emailed statement. The study found that the percentage of executive leadership positions filled by minorities had remained flat since 2011, and that chief diversity officers represented 77% of those positions.
“People in my generation who have had the blessing of leadership positions, we just have not gotten the job done,” said Dr. David Skorton, CEO of the Association of American Medical Colleges. “We have not done enough to relieve the burden of structural racism—first, perhaps in our own hearts, in the organizations that we lead, and in our communities in general.”
Healthcare providers need the courage and will to assess if they’re actually improving diversity and inclusion in their organizations—in recruiting, professional development, procurement, community investment and beyond, Skorton said.
Such actions are part of what hospitals should be doing to forge stronger ties with their communities, he added. In light of current events, Skorton said one step hospitals could take is speaking out against the kind of policing tactics that led to Floyd’s death. Several organizations have issued such statements and posted on social media.
“Why can’t we as leaders in our communities get involved in discussions about policing tactics—it’s all part of being part of a community,” Skorton said.
In Minneapolis, Allina Health has taken a top-down approach to assessing policies regarding race, said Jackie Thomas-Hall, the system’s diversity director.
One of the health system’s main hospitals, Abbott Northwestern, is in the neighborhood where much of the unrest after Floyd’s death has occurred. Allina Health CEO Dr. Penny Wheeler said the health system decided in 2005 to move its headquarters to help revitalize one of the city’s most economically disadvantaged areas and better address its health needs.
Becoming more embedded within the community provided insights on forming effective partnerships with stakeholders, Wheeler said. The system works with a community wellness center that has developed action teams tasked with addressing specific health concerns of residents. “We have learned significant lessons,” Wheeler said. “The community told us, ‘Don’t tell (us) what (we) need,’ but rather they articulated (their) needs and had us support them.”
Thomas-Hall said Allina’s diversity and inclusion initiatives must pinpoint what needs improvement and determine what it means to deliver equitable care. “One of the first things that we’re focusing on is our whole understanding around bias and how bias really is the impetus behind how we make decisions and the impact of those decisions.”
Still, a lot of organizations don’t regularly update their policies, LeRoy said. AAFP reviews its policies to weed out potential bias every five years. Such assessments were necessary to ensure policies were keeping up with societal and cultural changes.
“You can’t just let your policies become stagnant,” LeRoy said. Organizations “just keep adding more policies, but they don’t go back and look at the old policies and refresh them.”
Clear policies and strong enforcement are crucial for creating a culture of zero tolerance for racial bias and discrimination against patients or staff, said Dr. Aisha Terry, associate professor of emergency medicine at George Washington University School of Medicine in Washington, D.C., and an American College of Emergency Physicians board member.
“It’s vital to create official policies that speak to the selective opinions of an organization,” she said. “But a policy or statement without subsequent action is a disservice to the topic and the organization’s capacity to ignite change.”
Organizations should factor health equity into all their decisions, much like the “health-in-all-policies” approach that public health advocates have lobbied governments to use in developing public policy, Terry and LeRoy said.
“For organizations, there must be a theme threaded throughout every aspect of its mission that addresses health equity,” Terry said. “Whether it be related to leadership, membership, quality initiatives, health information technology or even education … there should be some representation of health equity.”
Ensuring health equity is included in every policy discussion should be the chief diversity officer’s role. But organizations should expand the position’s scope so diversity officers participate in policy decisions that may not seem directly connected to diversity, Terry added.
Organizations often see diversity officers as devoted to recruiting and retaining a diverse workforce or addressing workers’ racial discrimination concerns.
“You cannot just hire someone brown to take care of brown problems,” LeRoy said. “You have to make certain that they have a voice and they have a choice of detailing racist policies and weighing in on the conversation—we need to be included in the conversation and not just talked about.”