It's not easy to define diversity. It's a fluid concept, one that evolves alongside society and changing ideologies. However, diversity itself is a solid pillar of good governance and leadership. And in healthcare, a diverse leadership — or lack thereof — has lasting effects on care delivery.
Traditionally, diversity referred to people of different racial and ethnic backgrounds, a term linked to phenotypic characteristics. Gender, too, has historically been included in the diversity umbrella. But now, diversity encompasses a much larger spectrum including life experiences, lifestyle choices and ideas, such as socioeconomic status and sexual orientation. It even takes into consideration the social determinants of health.
This newer, all-inclusive definition of diversity is perpetuated by the millennial generation. According to a 2015 study by Deloitte and the Billie Jean King Leadership Initiative, millennials tend to define diversity in the context of experiences, opinions and thoughts, while older generations focus on religion, demographics and representation.
Considering this emerging definition and the fact that millennials are the most diverse generation in the U.S. population (By the traditional definition, at least. A 2014 White House fact sheet says 42 percent of millennials identify with a race or ethnicity other than non-Hispanic white), current healthcare leadership isn't on par with reflecting those they serve.
Diversity in leadership
In 2013, a survey from the American Hospital Association's Institute for Diversity found minorities represent 31 percent of patients nationally, but minorities constitute just 14 percent of hospital board members, 12 percent of executive leadership positions and 17 percent of first- and mid-level management positions.
Healthcare executives aren't blind to this gap. A 2015 survey from healthcare executive search firm Witt/Kieffer found 26 percent of Caucasian respondents and 10 percent of racially and ethnically diverse respondents believe minority executives are well-represented in healthcare management teams today.
Catholic Health Initiatives is trying to change that. At the Englewood, Colo.-based system, diversity is embodied throughout the organization, says Rosalyn Carpenter, CHI's chief diversity officer and vice president of diversity and inclusion. "CHI is very unique in the healthcare industry in that three of our senior-most leaders are diverse," she says. "So how do we embody it? We are actively living it."
Ms. Carpenter mentions Kevin Lofton, CEO of CHI; Michael Rowan, COO and president for health systems delivery; and Patricia Webb, executive vice president, chief administrative officer and chief human resources officer; all of whom are black, as evidence of the system's commitment to diversity.
At CHI, embodying diversity means incorporating it into the recruitment process, but it's not a matter of seeking out diversity for diversity's sake; rather, it's a business strategy. "In addition to ensuring the candidate has the skills for the position and is a good fit for the organization, we must consider diversity because a diverse workforce is about the diversity of perspective, thoughts and ideas necessary for an organization to be competitive," Ms. Carpenter says.
This sentiment is reflected in Witt/Kieffer's study, in which 66 percent of respondents said diversity recruiting enables an organization to reach its strategic goals. What's more, the Deloitte survey found, "millennials frame diversity as a means to a business outcome, which is in stark contrast to older generations that view diversity through the lens of morality (the right thing to do), compliance and equality."
With millennials now the largest generation in the workforce with the diversity mindset they have, hospital boards and executive leadership teams will likely look a lot different just a few years down the road.
The intersection of diversity and population health
While diversity is critical for strategy and business, it also has a positive effect on patient care, especially as healthcare turns its focus to population health.
This idea is manifested at Great Neck, N.Y.-based Northwell Health. Within Northwell Health's Office of Community & Public Health resides the Diversity, Inclusion and Health Literacy division, led by Jennifer Mieres, MD, senior vice president and chief diversity and inclusion officer.
Dr. Mieres' definition of diversity reflects the newer millennial mindset, which includes cultures, lifestyles and different ideas. She says Northwell seeks to create a diverse environment that places patients' needs at the center of their care. One pillar of Northwell's inclusion strategy is a commitment to diverse culture, which includes having a leadership team, board of trustees and frontline workers that reflect the community served.
"Having a workforce that reflects the diverse cultures and ethnicities and the diverse lifestyles of the community has helped us formalize strategies to be a much more inclusive health system," Dr. Mieres says.
To achieve this, Northwell calls upon its frontline workers to advocate for patients through the system's business employee resource groups. Employees voluntarily join the groups to advise leaders on how to bridge gaps in care for different patient populations, including veterans, multicultural patients and the LGBT community.
For example, the VALOR group — Veterans and Allies: Liaisons of Reintegration — has been around for three years, and it prompted the hospital to change protocol for treating veterans who present in the ER. Clinicians ask veterans questions that are sensitive to PTSD symptoms and note if behavioral services may be required. In addition to better serving the veteran population, Dr. Mieres says such changes also make the hospital a more attractive workplace for veterans.
Diversity for diversity's sake?
People tend to feel more comfortable around similar individuals, or those who share certain traits, demographic or otherwise. But having a workforce that mirrors the patient population may, in some areas, result in a homogenous organization.
Look at Los Angeles and Burlington, Vt. These two cities were among the highest and lowest, respectively, for diversity in Brown University's 2010 American Communities Project, which makes available sociological data on metropolitan areas. Los Angeles scored 79.6 on the diversity scale, while Burlington, Vt., scored 23.5.
Given the demands of population health and the theory that people trust those that look, live and believe like them, is it beneficial for a hospital in a relatively homogenous area like Burlington, Vt., to prioritize diversified leadership?
Oliver Tomlin says yes. Mr. Tomlin is a senior partner at Witt/Kieffer and an author of the firm's study.
"In the old days, I would have said, 'Maybe not. Maybe [diversifying leadership teams in homogenous areas] wouldn't have value,'" he says. "The reality is that healthcare is no longer local or regional. It's becoming more national."
Mr. Tomlin points to organizations like Rochester, Minn.-based Mayo Clinic, which has sites of care in smaller markets throughout the country and overseas.
Dr. Mieres has a different approach. She says a population that serves a homogenous population may not have as urgent of a need to formalize diversity and cultural competency strategies and policies. She emphasizes placing the patient at the center of the care matrix and being culturally competent to the patient's needs.
Building the diverse workforce of the future
The divide between diversity in healthcare leadership and the populations they serve persists.
Even at CHI, whose 15-member board includes seven women and three racially diverse members, Ms. Carpenter says attracting and retaining leadership that reflects the system's communities is an ongoing effort.
Northwell Health's Dr. Mieres, too, says her health system has progress to make. She estimates about 60 to 70 percent of staff and leaders accurately represent the patients they serve.
But one silver lining is that the healthcare workforce is already more diverse than many other professional industries. Analyzing data from the Census Bureau and the Bureau of Labor Statistics, a 2015 report from The Atlantic found 72.3 percent of healthcare employees are white, less than the legal profession (80.9 percent are white), education (78.2 percent), and business and finance (74.3 percent).
What's more, healthcare appears to be making a concerted effort to embody diversity, as the chief diversity officer role is becoming more commonplace. Witt/Kieffer's Mr. Tomlin says many medical schools and academic medical centers are starting to search for CDOs, oftentimes as an inaugural position. Yale School of Medicine in New Haven, Conn., is seeking its first CDO, and Boston-based Partners HealthCare named Dani Monroe its first chief diversity and inclusion officer in January.
Dr. Mieres is Northwell Health's first CDIO, a position she assumed five years ago. She is also a professor of cardiology and population health at Hofstra Northwell School of Medicine and is still actively involved in clinical research about gender disparities in heart disease.
Speaking about her CDIO duties, Dr. Mieres says, "It's a harder job than being a cardiologist, but it's going from touching one life at a time to impacting policies and procedures that will really foster a patient-centered partnership with the diverse communities served by Northwell Health."
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