Increasing and Sustaining Racial/Ethnic Diversity in Healthcare Leadership

 

Approved by the Board of Governors Nov. 16, 2020.

Statement of the Issue

One of the hallmarks of a democratic society is providing equal opportunity for all citizens, regardless of race or ethnicity. In the healthcare sector, racially/ethnically diverse employees represent a growing percentage of all healthcare employees, but they hold only a modest percentage of top healthcare leadership positions. For example, according to estimates based on data from the American Hospital Association and ACHE, in 2019, 89 percent of all hospital CEOs were white (non-Hispanic or Latino) while, according to the most recent U.S. Census Bureau data, 60 percent of the population is white (non-Hispanic or Latino) [1] .

This disparity persists despite two decades of success in attracting racially/ethnically diverse students to graduate studies in health administration. According to the Association of University Programs in Health Administration, racial or ethnic minority students made up 43.7% of AUPHA graduate programs in the 2018–19 academic year.1 In addition, undergraduate programs were composed of an estimated 44.8% racial or ethnic minority students in the same year [2].2  More recent data collected by the Commission on the Accreditation of Healthcare Management Education CAHME suggests that 41 percent of the CAHME graduate student population in the 2017–2018 academic year was nonwhite [3].

In addition to these trends, the results of the 2014 study A Racial/Ethnic Comparison of Career Attainments in Healthcare Management, a survey of association members conducted by ACHE, the Asian Health Care Leaders Association (now known as the Asian Healthcare Leaders Forum), Institute for Diversity in Health Management (now the Institute for Diversity and Health Equity), the National Association of Health Services Executives and the National Association of Latino Healthcare Executives, showed that the proportion of minority men holding CEO positions was closer to that of white men than it was six years earlier. Further, controlling for education and experience, Asian men in the study earned approximately the same median salary as white men. The Asian and Hispanic women that were studied earned about the same median salary as white women, when education and years of experience was taken into account [4].

However, the same study showed white men were still more likely to hold senior-level positions in healthcare than minority men, white women were more likely to hold senior-level positions than minority women, and the gap between the proportions of white and minority women holding those senior positions has widened over the last six years. Controlling for education and years of experience, black men continued to earn median salaries that were 17 percent less than white men. Hispanic men earned 8 percent less and black women have moved from earning almost the same median salary as white women in 2007 to earning 13 percent less.

Our country's increasingly diverse communities will result in a more diverse patient populations moving toward a majority-minority balance by 2045, according to projections from the U.S. Census Bureau [5]. Currently, those changing demographics are reflected in hospital patient populations. And yet, this increasing diversity is not reflected in healthcare administration leadership.

Studies suggest diversity in healthcare leadership can enhance quality of care, quality of life in the workplace, community relations and the ability to affect community health status. Achieving diversity in leadership requires a commitment at all professional levels (including early careerists, middle managers and senior executives) within the organization through the awareness of diversity, equity and inclusion issues and conversations about practices to address them; hiring practices that attract diverse staff; organizational climate and culture that support diversity; inclusive leadership development (in educational programs and organizations); mentoring and sponsorship of diverse staff for challenging leadership assignments that enhance career trajectory; equitable advancement practices; and organizationwide diversity and cultural competency training with accountability systems throughout the organization.

Policy Position

ACHE embraces diversity, equity and inclusion within the healthcare leadership field and recognizes them as both ethical and business imperatives. ACHE urges all healthcare executives, board members, educators and policymakers to actively strive to increase diversity within healthcare leadership ranks, especially with regards to race and ethnic background. ACHE actively strives to increase representation of racially/ethnically diverse individuals in healthcare leadership and works to create a supportive, collegial environment that encourages their membership and advancement within ACHE itself. As a founding member, ACHE also is committed to collaborating with the Institute for Diversity and Health Equity and other affiliated groups focused on these shared issues and with the American Hospital Association and others on the Equity of Care Initiative. ACHE believes fostering inclusive environments will help reduce disparities in care and improve quality care for all.

Further, all stakeholders should renew and strengthen their commitment to redressing any imbalance in representation of racially/ethnically diverse individuals in leadership and governance to enhance our profession now and in the future.

ACHE encourages all healthcare executives to play a significant role in addressing this issue by actively pursuing the following:

Recruitment

  • Promote healthcare careers to diverse populations via school programs and community organizations. Encourage students to shadow healthcare executives and explore careers in healthcare.
  • Develop strong outreach mechanisms to attract promising racially/ethnically diverse candidates to healthcare leadership careers with special emphasis on increasing recruitment efforts at colleges and universities with predominately racially/ethnically diverse student enrollments.
  • Offer internships, residencies and fellowships to racially/ethnically diverse students and provide mentoring to help prepare them for success in the job market.
  • Advocate for racial/ethnic diversity in the appointment of job search committee members and promote the provision of a diverse slate of candidates for senior leadership positions.
  • Recruit racially/ethnically diverse individuals at every level, being transparent about hiring criteria, so as to increase current representation in leadership but also to develop a pool of qualified candidates for the future.
  • Recruit candidates external to the healthcare field to broaden the pool of racially/ethnically diverse candidates.
  • Direct executive recruiters to identify and present racially/ethnically diverse candidates for leadership positions. Have them share criteria they use to recommend candidates for senior-level positions.

Promotion

  • At every opportunity advocate for achieving full representation of racially/ethnically diverse individuals at entry, mid and senior levels in healthcare leadership.
  • Institute policies that (1) prevent discrimination on the basis of race/ethnicity, (2) increase diversity in the recruitment and hiring of candidates and (3) create an environment that encourages retention, development and promotion of qualified racially/ethnically diverse employees. Ensure that policies are well known and understood, and measure and reward changes resulting from these policies.
  • Consider implementing practices to build an inclusive environment and reduce social isolation such as the following: create a position responsible for diversity and inclusion; appoint a diversity committee; adopt a diversity action plan; conduct diversity, equity and inclusion training for leaders; evaluate leaders based on their effectiveness in achieving diversity-related objectives; and promote inclusive social gatherings, resource groups and mentoring programs.
  • Publicize career advancement opportunities, such as continuing education, professional development organizations, networking events and vacancies inside the organization, in a manner that appeals to everyone, especially racially/ethnically diverse individuals.
  • Encourage retention, development and advancement of racially/ethnically diverse individuals. Identify potential candidates to support and create clear pathways for advancement from entry- to mid-level positions and from mid- to senior-level positions.
  • Develop and disseminate specific criteria for advancement in leadership that would allow all individuals to have an equitable opportunity for senior-level positions. Such criteria could be useful to racially/ethnically diverse individuals who wish to prepare themselves for senior-level positions.
  • Conduct regular reviews of organizational compensation programs to ensure salaries are equitable and nondiscriminatory.

Support

  • Work with organizations representing racially/ethnically diverse individuals within their communities to create sources for scholarships and fellowships.
  • Advocate for governmental and private philanthropic programs that increase funding to underwrite advanced education, information dissemination and employment opportunities for racially/ethnically diverse individuals.
  • Support organizations—such as the Institute for Diversity and Health Equity, the National Association of Health Services Executives, and the National Association of Latino Healthcare Executives—that champion diverse executives through internships and other programming. Enable employed diverse executives to participate in the programs and be part of the volunteer leadership of such organizations.
  • Support and assist the development of mentoring programs within healthcare organizations specifically focused on developing long-term relationships between senior healthcare leaders and racially/ethnically diverse professionals.
  • Provide scholarship support for employed diverse executives to participate in leadership development programs.
  • Urge racially/ethnically diverse healthcare executives who are not ACHE members to join and become active at both the local (via chapters) and national levels. Extend invitations to hosted events such as executive breakfasts, chapter networking events and educational programs.

In addition, ACHE encourages racially/ethnically diverse healthcare executives to actively pursue the following:

  • Earn an advanced degree in healthcare administration or business.
  • Seek internships, fellowships and administrative development opportunities that lead to permanent positions and form a foundation for building their careers.
  • Seek positions in organizations that have a demonstrated commitment to diversity, equity and inclusion in order to build their careers.
  • Choose positions that offer new experiences and expand their skill sets and leadership abilities.
  • Interact with colleagues and actively pursue professional development by becoming involved in professional associations.
  • Seek out mentors and sponsors and serve as mentors and sponsors to other professionals.

Improving the representation and equitable treatment of racial and ethnic diversity in healthcare leadership requires significant social change, and ACHE advocates adopting a wide variety of approaches to accomplish it.

Policy created: July 1990
Last revised: November 2015

 

References

  1. U.S. Census Bureau, "USA People Quick Facts" Accessed May 13, 2020.
    https://www.census.gov/quickfacts/fact/table/US/PST045218
  2. Association of University Programs in Health Administration 2019 Annual Report.
  3. Annual Report of Graduates of CAHME Programs: Diversity Data, 2018-2019.
  4. American College of Healthcare Executives, "2014 Racial/Ethnic Comparison of Career Attainments in Healthcare Management."
  5. U.S. Census Bureau, Demographic Turning Points for the United States: Population Projections for 2020 to 2060. Accessed May 13, 2020. https://www.census.gov/content/dam/Census/library/publications/2020/demo/p25-1144.pdf

Related Resources

American College of Healthcare Executives Diversity Resources

Institute for Diversity and Health Equity:

www.ifdhe.aha.org

National Association of Health Services Executives:
www.nahse.org

National Association of Latino Healthcare Executives:
www.nalhe.org

1 Based on data from 72 AUPHA graduate members, just over 50 percent of the graduate membership.
2 Based on data from 23 AUPHA undergraduate members, about 25 percent of the undergraduate membership.