In 2018, just 13 percent of all voting hospital board members were non-white, according to the American Hospital Association's 2019 governance survey.
In 1994, Craig Becker, retiring president and CEO of the Tennessee Hospital Association, remembers that percentage being close to zero.
"I came [to Tennessee] 25 years ago and when I walked into my first board meeting, basically 21 old, white men were in there," he told Becker's Hospital Review. "Then I looked around at the rest of my CEOs and people in senior C-suite positions, and there were very, very few people of color at the time."
While diversity in hospital governance is incrementally improving — the AHA found 58 percent of hospital boards had at least one non-white member in 2018 compared to 53 percent in 2014 — disparities persist, especially in the C-suite.
The Agenda 21 Internship Program, launched by Mr. Becker and its first director, G. Rumay Alexander, EdD, RN — who is now president of the National League for Nursing — around the turn of the 21st century, is intentionally addressing these racial disparities. The program matches 10-12 minority graduate students with hospital executives for a 12-week paid summer internship. Under the program, students work as fellows, with many earning an opportunity to become an associate administrator and, eventually, COO or higher. Some students have even become CEOs themselves.
Yolanda James, director of public relations and strategy for THA, said she saw a 56 percent increase in applications for the program this year compared to last. Nine students are in this summer's cohort and will receive paychecks from THA, funded by hospitals participating in the program.
Tom Ozburn, president and CEO of Parkridge Health System in Chattanooga, Tenn., part of Nashville, Tenn.-based HCA Healthcare, told Becker's about two Agenda 21 interns he hosted — both of whom went on to take a higher role within healthcare administration.
Before Mr. Ozburn joined Parkridge Health as CEO in 2017, he was CEO of HCA-affiliate TriStar Southern Hills Medical Center in Nashville. There, he worked with interns Samuel Boadi and John Baldwin. During their summer internships — Mr. Boadi summer 2017, and Mr. Baldwin summers 2015-17 — they joined most of Mr. Ozburn's leadership meetings on strategy, operations and finances, and stayed in constant connection with him, the COO and other market CEOs.
Mr. Boadi, now an administrative fellow for Parkridge Health System, is currently overseeing a half-million dollar facility refresh project. He told Becker's the internship "changed my administrative fellowship goals as I looked to organizations that could provide a robust project-based fellowship centered on hospital operations."
For Mr. Baldwin, who is now market associate administrator and co-ethics and compliance officer for Parkridge Health System, Agenda 21 was the deciding factor between a career in healthcare administration or medicine.
"I was making a decision whether I wanted to pursue medical school or pursue a career in healthcare administration," he said. "And just the exposure that [Mr. Ozburn] provided, he gave me a very robust opportunity. I was treated as a member of the senior leadership team." Mr. Baldwin went on to complete his master's in health administration degree from the University of Memphis in Tennessee after finishing his Agenda 21 internship.
To Mr. Ozburn and Mr. Becker, these results reflect a "conscious and deliberate effort" to diversify the C-suite, something Mr. Ozburn said is "not going to happen by chance."
Audrey Gregory, PhD, CEO of Saint Francis Healthcare in Memphis, part of Dallas-based Tenet Healthcare, agrees with Mr. Ozburn. She has led her own Agenda 21 interns who have gone on to take directing positions in healthcare. A minority leader herself, Dr. Gregory said the question of diversifying the C-suite is a sensitive one, especially as a woman of color. She was recently honored for her own efforts to increase diversity in healthcare, which included recruiting more than 50 registered nurses from the Caribbean to work in the Memphis market via a visa.
"There are still some obstacles in convincing diversified candidates to work toward transitioning to the C-suite," Dr. Gregory, a nurse by background, told Becker's. "One, in particular, is finding mentors and sponsors who will help them map their path and follow through with them on their journey. It takes dedication and intentionality, and that is not always present."
Today, THA's board is not just "21 old, white men." Four people of color and four women are represented. But for Mr. Becker, that's still not enough.
"Most boards [aren't diversified], and certainly not the C-suites," he said. "The hope is that we've come a long way. But we've got a long way to go."
Agenda 21 is also working to ensure applicants from all marginalized communities are represented, including LGBTQ and Latinx communities. And the talent pool is only growing: Data by the Commission on the Accreditation of Healthcare Management Education found 31 percent of CAHME graduate students were non-white in 2014.
Dipping into this talent pool will change how healthcare administration looks, and allow students like Mr. Baldwin to become leaders that promote "a diverse and inclusive environment where people feel they can be their authentic selves," he told Becker's.
"As a leader, you have to be focused on growth throughout the organization, but also to invest and grow your team. To do that, you have to invest in your people."
Editor's note: This article was updated August 20, 2019, to reflect that Dr. Alexander was involved in the development of Agenda 21.