Enhancing diversity

When Shafiq Rab agreed to become chief information officer and senior vice president of Rush University Medical Center late last year, the Chicago hospital snagged a leader in the use of mobile health care technology to engage patients.

Rab was recruited from a fast-growing health system in New Jersey, where his team developed an app that allows patients to schedule appointments and check test results from any device. He also created facial-recognition technology to match a patient with his or her data and a way for patients to connect a physician to their medical records, regardless of the system that the doctor uses.

Trustee talking points

  • The American Hospital Association joined other leading organizations in 2011 in a National Call to Action to end health care disparities and promote diversity.
  • The AHA also encourages hospitals to take the Equity of Care pledge  and to become involved in the programs offered by the Institute for Diversity to help address disparities of care.
  • Hospital and health system boards and C-suites that reflect the diversity in their communities are well-positioned to address disparities in care.
  • Some health systems are creating robust pipelines of diverse C-suite leaders.
  • Success requires a multifaceted strategy and commitment from top leaders.

In a news release announcing Rab's appointment, Michael Dandorph, the medical center’s president, called him “a perfect fit with our mission and vision.”

He was referring to Rab’s professional training and experience. But recruiting Rab, who completed an internal medicine residency in Pakistan, was another kind of success as well: In joining the inner circle of Rush leadership, Rab was the fourth to bring ethnic diversity to the group of 10 senior vice presidents.

Increasing diversity in the C-suite is just one tactic that Rush is using to address disparities in health care outcomes in the communities it serves. Larry Goodman, M.D., CEO of the medical center and president of Rush University, points to the difference in life expectancy of individuals living on Chicago’s affluent Near North Side and the West Side.

“That gap is as big as 16 years in survival,” he said. “While that gap is mainly around negative social determinants of health, like poverty and educational attainment, in this city, like so many other cities in the United States, it is explained, unfortunately, by racial lines more than anything else.”

In 2015, Rush partnered with DePaul University to co-found the Center for Community Health Equity to focus on eliminating health inequities in Chicago. That effort stems directly from a new way of thinking about diversity and inclusion that Rush adopted in 2007.

Related story: Henry Ford Health System's board is essential for diversity

Its first step was an initiative to ensure that minority- and women-owned businesses have an equal opportunity to sell goods and services to Rush. In the decade since, the value of diversity has been borne out through dozens of policies, practices, goals and metrics.

“We had, over the years, struggled with being successful in diversity in all the ways we were trying,” Goodman says. “What helped us was a more organized approach to diversity.”

From progress to good progress

John W. Bluford III was American Hospital Association chair in 2011 when the association joined four others — the Association of American Medical Colleges, the American College of Healthcare Executives, the Catholic Health Association of the United States and America’s Essential Hospitals — to issue a National Call to Action to end health care disparities and promote diversity.

The group determined that increasing “diversity in leadership and governance” had the potential to most effectively address the call to end care disparities. This summer — six years later — Bluford says hospitals and health systems are making progress.

In 2015, the AHA – through its #123forEquity pledge campaign – reiterated its commitment to the goals of the National Call to Action and is continuing to work with hospitals and health systems on efforts in key areas.

“But I emphasize there has been progress as opposed to good progress,” he says. “It’s been much slower than I think we all anticipated.”

Indeed, a 2015 survey commissioned by the AHA’s Institute for Diversity in Health Management found that, although minorities represent 32 percent of patients in hospitals responding to the survey, they comprise only 14 percent of hospital board members. Moreover, only 11 percent of executive leadership positions and just 19 percent of first-level and midlevel manager posts at those hospitals were filled by minorities.

The survey was conducted by the AHA's Health Research & Educational Trust. Data were collected through a national survey mailed to the CEOs of 6,338 U.S. hospitals; the response rate was 17.1 percent, and the sample was generally representative of all hospitals.

Bluford, who retired as president and CEO of Truman Medical Centers in Kansas City, Mo., in 2014, believes health system executives are increasingly aware of the need to increase diversity among health care leaders, and he sees some meaningful efforts to address the problem. But he stresses a need to get at the real issue.

“The end goal is not diversity per se but the reduction of disparities among vulnerable patient populations, which oftentimes includes minorities,” he says. And he emphasizes how important it is to address substantial differences in these disparities.

That’s why he started the Bluford Healthcare Leadership Institute five years ago to help spur change. The institute seeks to build a pipeline of young, diverse leaders who recognize the potential for great careers in health care.

Many students, Bluford says, think health care careers are limited to doctors and nurses and, unless those professions appeal to them, the larger field of opportunities never enters their minds. His mission is to persuade them otherwise. Each summer the institute brings an ethnically diverse group of 14 high-achieving students to Kansas City to meet a wide range of national and local health care leaders, to learn about executive presence and career pathways, and to persuade students to accept a job placement at a major health system the following summer.

Bluford hopes that he is influencing the careers of future health system CEOs, chief financial officers and chief operating officers.

“We need more diversity in positions of clout,” he says.  “Those are the positions that drive the organization.”

Building the pipeline

When the Catholic Health Association recognized Christus Health employee Asha Rodriguez with an elite honor — one of only 11 individuals in the CHA's Tomorrow’s Leaders class of 2017 — her colleague Lisa Turner was not surprised.

Turner, vice president of talent management at Irving, Texas-based Christus, runs the health system's Executive Fellowship program, designed to prepare ethnically diverse leaders to take on executive roles. Rodriguez was the first person chosen for the program when it started in 2012; last year, she was promoted to administrator of Christus Santa Rosa Hospital in San Antonio.

Before the fellowship, Rodriguez had worked in patient advocacy, organizational development and performance improvement — all posts that are far from the C-suite.

“She’s such a wonderful learner and a real star,” Turner says. “But to make that transition to operations, she needed different experience. Without the fellowship program, she would not have been ready.”

The Executive Fellowship program targets ethnically diverse individuals who have at least seven years of work experience, including at least three years in health care; a graduate degree; managerial experience; and a professional goal to be a health care executive. Hand-picked for their leadership potential, the individuals remain in their regular positions during the two-year fellowship period. But they take on extra responsibilities, attend executive meetings, spearhead a project at their own facility and participate in system-level projects.

While the Executive Fellowship program is small — three fellows in the health system’s U.S. service area and three in its Mexico service area in the current cohort — Christus’ Leadership and Ethics Academy is building diversity into the C-suite pipeline in a different way.

The academy is an 18-month program for middle managers who have been identified for their high potential to be senior leaders. Each cohort includes 25 to 30 individuals. Academy participants in each service area work together on a project, and they each are mentored by their CEO to learn something outside their current scope of responsibility. Each participant is assigned a career coach and receives a 360-degree assessment.

In the program’s early years, there was a requirement that 50 percent of academy participants would be diverse in terms of gender, race/ethnicity or sexual preference. Now in its 11th cohort, diversity has become embedded into the initiative.

“Now the diverse representation just naturally happens,” Turner says. “Everybody has that priority top of mind.”

Meanwhile, Christus has been working since 2011 to increase the diversity of its system board of trustees, as well as of the 12 regional boards that oversee its various markets. The value of diversity was written into board principles and translated to policy: Each board shall reflect the communities it serves.

“We have expressly told all of our regional governing boards that we expect them to change their makeup to better reflect the community,” says Linda McClung, Christus executive vice president and chief administrative officer.

The governance committee at the system level is responsible for monitoring the diversity of the system board and all the regional boards. Each year, it receives a report on the racial/ethnicity and gender demographics of each region and how the makeup of the respective board compares. That analysis is used to create specific recommendations for nominating committees. 

Christus staff coach board members to reach into their communities — churches, the hospital medical staff, their foundation boards — to find people they may not have met.

“Once we challenged our boards to not just sit around the room and think about people they knew, but to start looking for the leaders in different segments of their communities, it became a lot easier,” McClung says.

The boards are finding that diversity begets diversity.

“It’s hard to be the first woman on an all-male board, but once you start bringing females onto the board, they can help you find other good female candidates,” she says.

The C-suite and beyond

At Rush, diversity and inclusion have their own governance structure and their own multiyear plan, including systemwide goals and 16 strategic drivers to help meet the goals.

Many of those top leaders, including Goodman and Dandorph, sit on the Diversity Leadership Council, a group of 22 executives charged with executing the diversity and inclusion strategy. That gives the council power to make a difference throughout the organization, says council Chairman Terry Peterson, vice president of corporate and external affairs for the medical center.

“If an issue is brought to the council, we can make a decision right then and there about how to address it,” he says.

Rush’s board of trustees has been a driver of the organization’s focus on diversity and inclusion, including an assessment of the board itself. It was found to be “disproportionately male, disproportionately Caucasian, and mostly people over the age of 55,” Goodman says.           

Two strategies are working to change that makeup over time. The first is the creation of Rush Associates, a group of individuals in the general age range of 25-45 who are potential candidates for board openings. The group has grown to more than 100 members, many of whom are involved in fundraising and other volunteer work for the medical center.           

“Some members of the Rush Associates sit in on board meetings, so there's a networking opportunity for them,” Goodman says.

In addition, the board’s nominations committee was reorganized to include more women and underrepresented minorities currently on the board.

“Because of that, if you look at the numbers of people who have been asked to join the board over the last five years, a significant percentage are women and underrepresented minorities,” he says.

Beyond Rush's board and C-suite, the organization's Diversity Leadership Council oversees seven committees that report bimonthly on specific areas of focus. The women’s leadership committee, for example, is working on pay equity and increasing the number of women in positions of leadership, while the ADA Task Force creates programming and accommodations to support people with disabilities, whether they are students, employees or patients, and the LGBTQ Health team works to bring best practices around diversity to Rush.

“Those kind of efforts reflect being intentional about making sure that the organization is diverse and inclusive,” Peterson says.

Goodman says that intentionality — what he calls an “organized approach to diversity” — was a gift given by J. Robert Clapp Jr., a top Rush executive who died in 2012. Clapp pushed for the strategic planning and organizational resources that are given to any other top priority to also be devoted to diversity and inclusion..

“Being a diversity advocate is important, especially in senior leaders, because they're the ones that can have the greatest impact on the medical center,” Goodman says. He suggests looking at a leader’s track record on diversity when considering candidates for top positions.

A decade later, Rush has made a lot of progress — but there's more work to be done. A new, five-year diversity and inclusion strategic plan will work to push D&I initiatives deeper into the organization, Peterson says.

“Over the past 10 years, we’ve accomplished a lot,” he says. “But we keep looking at the things we can do differently and things that we can do better.” 

Lola Butcher is a contributing writer to Trustee.

Diversity has many faces

If 10 percent of your patient base is Chinese-American, then 10 percent of your board members, your executive team and your staff should be of Chinese descent, right?

“That’s silliness,” says John Bluford, retired president and CEO of Truman Medical Centers in Kansas City, Mo. Bluford, a former American Hospital Association chair, now runs the Bluford Healthcare Leadership Institute, a professional development program for underrepresented college students.

The way to measure the success of a health system’s diversity and inclusion efforts is to measure the health of the community it serves. Start by looking at the incidence rates of chronic diseases — hypertension, diabetes, obesity, asthma and others — in various segments of the population base.

“Do the mortality and morbidity rates of those conditions disproportionately impact minority patient populations?” Bluford says. “It is not merely about making a quota, it is about making a difference. And a diversity of racial/ethnic and gender makeup will get you there sooner [rather] than later with more sustainable results.”

Those disparities can be addressed by bringing a wider range of perspectives to decision-making to ensure that priorities change. Mike Supple, executive vice president at B.E. Smith, a health care executive search firm, identifies types of diversity that typically need attention:

  • Racial/ethnic: Many health systems struggle to improve the racial/ethnic makeup of their boards and senior executive teams and are looking for ways to make meaningful change. About one-third of hospitals surveyed by the AHA’s Institute for Diversity in Health Management have a documented plan to increase the ethnic, cultural and racial diversity of their senior leadership teams.
  • Gender: Nearly 80 percent of the health care workforce is female, but women are underrepresented in health system boardrooms and C-suites.
  • Generational: Millennials — the fastest-growing segment of the health care workforce — see diversity in terms of demographics and equal opportunity, according to the Deloitte University Leadership Center for Inclusion. Their older colleagues, by contrast, define diversity as a mix of experiences, identities and ideas.
  • Experiential: “Health care systems should really consider professionals with diverse backgrounds and skill sets, people from different areas of health care or from outside health care altogether,” Supple says. Information technology, finance, marketing and human resources offer logical opportunities to recruit talent from other industries to get fresh thinking into an organization.
  • Cognitive: “This is diversity of thought, bringing diverse points of view and different approaches to problem solving,” Supple says. The pace of change in the health care industry requires agility, innovation and collaboration, none of which are supported by entrenched thinking. 

Trustee takeaways

Most health care leaders want their organizations to be more diverse. So, where do they start?

Paul Bohne, managing partner and co-leader of Witt/Kieffer’s health care practice, and Mike Supple, executive vice president at B.E. Smith, share insights from their years of recruiting health care leaders.

  1. Make a strategic plan for increasing diversity throughout your organization with measurable goals. “There’s a difference between ‘hoping for’ more diversity and matching aspirations with intentionality,” Bohne says.
  2. Make a commitment. “This isn’t something you can turn on and off,” Supple says. “It requires the support and the financial resources necessary to monitor the program and make changes as needed to achieve results.”
  3. Start at the top of the organization, the bottom and everywhere else. Diversity in the C-suite is insufficient. The value of diversity must be embedded in all levels of an organization, in all programs and within the culture.
  4. Create a diverse selection committee. Members of a homogeneous group are likely to only consider people who look like themselves.
  5. Walk your talk. “So many times I see this: An organization will bring in a panel of diverse candidates, but when it comes to crunch time, they do not go with a diverse candidate,” Supple says. They choose what he calls a “safe” candidate, meaning one who looks like the individual he or she is replacing.
  6. Do not assume that progress will happen as the health care workforce becomes more diverse. Need proof? The vast majority of health care employees are female, but women do not dominate health system C-suites and boardrooms.
  7. Do not engage in window dressing. “As a recruiter, I can vouch for the fact that it is hard to retain and recruit diverse leaders if they sense that their ‘participation’ is only symbolic,” Bohne says. “They expect meaningful, rewarding roles and will take their talents elsewhere if need be to get them.”
  8. Mentor for success. “Women, minorities and other diverse individuals who move into board and executive roles need support and consultation from [people] who can show them the ropes,” Bohne says.
  9. Check yourself. Use employee engagement surveys to see whether your organization’s diverse workers are truly engaged with the health system, Supple says.