Posted: 16 Sep. 2021 8 min. read

Health execs are discussing DE&I…are we at a tipping point?

By Kim Griffin-Hunter, managing partner, Deloitte & Touche LLP

Nearly 30 years have passed since the American College of Healthcare Executives (ACHE) teamed up with the National Association of Health Services Executives (NAHSE) to examine diversity among health care leaders. While health care executives in the US aren’t much more diverse than they were three decades ago, the needle does appear to be moving, according to new research from NAHSE and the Deloitte Center for Health Solutions.

NAHSE is a non-profit association of Black health care executives that works to promote the advancement and development of Black health care leaders and elevate the quality of care provided to minority and underserved communities. Deloitte and NAHSE recently surveyed 105 NAHSE members and interviewed 10 executives at health care organizations who are leading diversity, equity, and inclusion (DE&I) initiatives in their workforces. 

The survey data, combined with findings from our interviews, revealed that many organizations are prioritizing DE&I initiatives. More than half of our survey respondents (56%) said gender, race, ethnicity, disability, sexual orientation, socioeconomic background, and other factors can influence whether someone has the opportunity for promotion.

8 Questions for NAHSE’s executive consultant

In 1992, minorities represented 20% of US hospital employees, yet minorities held less than 1% of top management positions, according to a report commissioned by ACHE and NAHSE. The report led to the creation of what is now the Institute for Diversity and Health Equity (the Institute), which includes the American Hospital Association and the Catholic Health Association. Research conducted by the Institute in 2017 revealed that Black and Brown patients often did not receive the same quality of care as white patients. That lower quality of care often translates to increased ER visits, poor health outcomes, and, in some instances, death.

I recently had a conversation with Cynthia Washington, executive consultant at NAHSE and former interim President and CEO of the Institute. We discussed health disparities, the importance of DE&I in health care, and the need to get young people interested in pursuing health care careers. Here is an excerpt from that conversation:

Kim: You received your Bachelor of Science degree from North Carolina Agricultural and Technical State University. Why did you pursue a career in health care?

Cynthia: I never intended to pursue a career in health care. When I was in high school, recruiters from the University of North Carolina at Chapel Hill invited me, along with some other honors students, to consider coming to the university to be part of a minorities-in-health-care program they were building. At the time, I wasn’t interested in health care. Instead, I pursued a career in marketing and business. I wound up in health care later, but it was not intentional.

Kim: Did attending an HBCU [Historically Black Colleges and Universities] shape your thoughts around diversity and health care, and your role at NAHSE?

Cynthia: I was certainly influenced by my teachers. But I was also influenced by my librarian, Bettye Davis McCain. Her husband, Franklin McCain, was one of the four North Carolina A&T students who [in 1960] refused to leave the Woolworth’s lunch counter when they were denied service. Attending an HBCU gave me an education as well as a rich cultural experience. Just being in that environment helped raise my social consciousness as a young Black lady from the South. It wasn’t even about diversity…it was more like understanding our overall Blackness.

Kim: Tell me a little about NAHSE’s mission. Has it changed over the years? 

Cynthia: Our mission hasn’t changed because the issues we face today are the same ones we faced in 1968, the year NAHSE was founded. The mission is, and has always been, to promote the advancement and development of Black health care leaders and elevate the quality of health care services rendered to minorities and underserved communities. We are being approached by various companies and organizations that want to partner with us to help expand our message and mission. I believe [hospital and health system leaders] want to do something, but they often don't know how to get started. We try to offer a path forward and some direction with meaningful outcomes.

Kim: You’re saying that the mission of NAHSE hasn’t changed in 30 years, but the way it approaches its mission is evolving.

Cynthia: That’s right. Once the pandemic hit, the topic of health disparities and inequities were leading stories in the local and national media. This has been a drumbeat for a very, very long time…but there does seem to be more of a sense of urgency now to address it. HBCUs, NAHSE, and other institutions are being recognized for the role they can play in improving vaccination rates. Given what is going on at the national level, we had no choice but to evolve. People were looking at us to help other organizations understand how to address health disparities. Through collaborations with Deloitte and other organizations, we developed a vaccine hesitancy toolkit, which we have shared with our 30+ chapters. The toolkit is a resource our chapter leaders can use to educate their communities about the COVID-19 vaccine and why people need to get it.

Kim: Do you feel that health care organizations have access to a diverse and qualified pool of talent who could become leaders?

Cynthia: There are already deep pools of qualified candidates. The challenge is in getting decision makers to move people out of those pools and into positions where they have the potential to advance their careers.

Kim: Our report suggests that effective mentoring programs can help hospitals and health systems develop and retain diverse talent. How important are those types of programs?

Cynthia: It's important to give students and recent graduates exposure to health systems and health care leaders. The Institute offers a summer enrichment program for graduate students. There is also a post-graduate enrichment program, which includes a 20-week internship in a hospital working alongside an executive. Through these programs, and others like them, we hope students and recent graduates begin to understand the operational side of health care management. One of the things we hear from health care executives is that they need people who have experience. These programs have created a nice pipeline of talent.

Kim: Our research determined that many health care organizations are prioritizing DE&I initiatives in their workforces. But more work needs to be done to engrain it in the culture. How do you change a culture that has never really focused on DE&I?

Cynthia: The culture is not going to change until health care executives start having conversations. Mandated DE&I training programs are a way to begin those conversations. Sometimes people are afraid to speak up. Creating a safe space to have those critical conversations is really important. These programs should be mandated, and they need to be on-going.

Kim: Three out of four of our survey respondents said they did not think leadership is held accountable for meeting the objectives and goals of the DE&I committees. Should they be?

Cynthia: Absolutely. Once an organization makes DE&I a strategic priority, metrics need to be established to measure the results. If you don’t measure it, nothing gets done. Those results should be tied to CEO compensation packages, for example. Research done by the Institute showed that the needle moves when [DE&I] results are tied to compensation. DE&I should also be a standing agenda item during board meetings. Boards represent the communities they serve, and this should be a learning opportunity for them as well. The light is beginning to shine, and I'm optimistic that within the next five years, we will see some changes. But nothing changes without resistance.

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