9
Overcoming Barriers to Developing and Retaining Diverse Talent in Health-Care Professions
LAURA MORGAN ROBERTS, STACY BLAKE-BEARD, STEPHANIE CREARY, BEVERLY EDGEHILL, and SAKSHI GHAI
Health-care organizations face a number of challenges with respect to the effective development and retention of diverse talent. In the United States, they continue to face rising labor shortages and increased cost of operations, and in response, these organizations seek innovative ways to develop competitive advantage. Yet few organizations have developed practices for successfully attracting and advancing underrepresented minorities in health care.
In this chapter, we present the findings of an empirical study of Black and Hispanic American health-care professionals’ perceptions of personal and organizational factors that enable and constrain their career advancement and leadership development. We first highlight the findings of previous research on the recruitment and retention of diverse health-care professionals. Second, we outline the goals, participants, and procedures of our focus-group study of health-care professionals of color. Third, we reveal the comprehensive insights gleaned from the eight focus groups regarding facilitators of and challenges to participants’ career advancement and leadership development. We then offer several recommendations for both senior-level executives in decision-making roles and minorities who seek to advance to senior levels in health care. Our recommendations are based on focus-group participants’ comments, our interpretation of underlying patterns in the data, and empirically based best practices for diversity, leadership development, and talent management.
Background Research on Diversity and Health-Care Professionals
Though much has been written about challenges to career advancement and methods for attracting and advancing underrepresented minorities, diverse talent continues to be underdeveloped and underrepresented in leadership positions in the health-care industry. To begin, much of the research to date that focuses on the careers of minority health-care professionals is concerned with the challenges that health-care organizations face in recruiting these professionals into patient care roles (Bleich, MacWilliams, & Schmidt, 2015; Brooks-Carthon, Nguyen, Chittams, Park, & Guevara, 2014; Colville, Cottom, Robinette, Wald, & Waters, 2015; Murray, Pole, Ciarlo, & Holmes, 2016; Phillips and Malone, 2014; Villarruel, Washington, Lecher, & Carver, 2015) and the challenges these professionals experience in these roles once recruited (Black, 2016; Carter, Powell, Derouin, & Cusatis, 2015; Gates, 2018; Hubber, 2018; Jeffreys, 2016). The limited insights we currently have on their leadership suggest that they struggle to advance beyond middle management and experience a “middle-management plateau” (Larson, 2006; Silver, 2017; Voges, 2006)—that is, in spite of having considerable experience in middle-management roles, they tend to lack mentoring and visibility in the organization, become frustrated with their lack of career progress, and decide to leave health care altogether (Voges, 2006).
This middle-management plateau highlights the importance of mentoring for diverse health-care professionals. Mentoring, which is described as the provision of career and psychosocial functions, has received considerable attention in discussions of diversity and talent management, particularly in health-care organizations (see Ambrose, 2003; Barney, 2002; Bowen, 1994; Chyna, 2001; Dolan, 1993; Dreachslin, Jimpson, Sprainer, & Evans, 2001; Dufault, 2007; Gathers, 2003; Henault, 2004; Jessamy, 1997; Kahn, 1994; King, 2005; Larson, 2006; Moore, 1999; Romano, 2005a, 2005b; Sloane, 2006; Voges, 2006). For example, Dolan (1993) suggested several benefits to establishing a “climate for mentoring” among senior-level executives and minorities, in light of the many pressures that senior-level executives experience with respect to cost containment and time management. Dolan argued that mentoring would provide protégés with critical guidance and direction from senior-level mentors and allow protégés to usher innovative ideas into organizations, draw on more recent interactions with academic institutions, and present perspectives from their diverse set of experiences. Dolan further proposed that cross-gender, cross-cultural, and cross-generational mentoring was pivotal in creating value for diversity within health-care organizations. As a result of effective mentoring, Dolan proposed that organizations may realize increased satisfaction and retention of underrepresented minorities.
Lack of access to mentoring is only one factor that may be affecting the careers of diverse professionals. Other research suggests that the diversity climate of health-care organizations (with the undercurrent of implicit and explicit racism) may also play a role in the limited advancement of minority health-care professionals (Dotson, Bonam, & Jagers, 2017; Selvam, 2012; Valantine and Collins, 2015). Further, the lack of commitment from top management and health-care boards may also explain the lack of diversity in health-care leadership (Witt/Kieffer, 2015). While some majority group members argue that health-care organizations lack access to diverse candidates to promote from within, minority group members (i.e., African American, Hispanic, and Asian respondents) argue that there is a lack of commitment among senior leadership to increasing the representation of underrepresented minorities in health-care leadership positions.
From the standpoint of practice, it is clear that some health-care organizations are beginning to design and implement interventions focused on advancing underrepresented minority midcareer professionals to leadership roles (Day et al., 2016; Dolan, 2013; Winkfield et al., 2017). For example, executive leadership initiatives such as the Thomas C. Dolan Executive Diversity Program (2013) focus on preparing midcareer minorities to advance to more-senior management roles. Professional medical organizations such as the American Society of Clinical Oncology and the American Society for Gastrointestinal Endoscopy have also launched strategic plans to increase the diversity of health-care leadership (Day et al., 2016; Winkfield et al., 2017). Less understood is how minority professionals access developmental opportunities such as these given the obstacles just outlined.
The Current Study
We sought to broaden our understanding of the engagement, retention, and advancement of underrepresented minorities in health-care organizations. In particular, we sought to more fully characterize obstacles to career advancement for underrepresented minorities in health-care and identify methods of increasing maximal engagement of both minority and majority group members in health-care leadership positions. Our research questions were as follows:
1) What are the challenges that professionals of color face in advancing to more-senior leadership within health care?
2) What recommendations can be offered to underrepresented minorities and senior executives for increasing diversity among senior health-care leadership?
Methods
To answer these questions, we conducted eight focus-group discussions in Boston, Massachusetts. We chose to conduct focus groups rather than individual in-depth interviews or surveys because we believed participants would have some shared experiences and that unexpected themes would arise from the group discussion, allowing for further deliberation (Odom, Roberts, Johnson, & Cooper, 2007). Additionally, focus groups, as a method of conducting qualitative research, capitalize on the group process, which can stimulate conversation and help participants to clarify their views (Kitzinger, 1995). We elected to conduct this study in the Boston area due to the dense concentration of top-ranked academic teaching hospitals there. Focus-group sessions were held at the headquarters of the Partnership.1 Four of the focus groups were formed with members of the same professions (two groups of physicians and two groups of administrators); the other groups were randomized by profession. All groups were randomized by ethnicity and gender. Three of the authors facilitated the groups; the fourth author was the CEO of the Partnership at the time of data collection, and helped to design the study, but did not attend or facilitate any focus groups, nor did she have access to any identifying information of the participants.
Participants
Twenty-five Boston-area health-care professionals self-identifying as members of underrepresented minority groups participated in the eight focus groups. Eight participants were male and seventeen were female. The vast majority self-identified as African American (n = 18), three identified as African American and White, one identified as African American and Hispanic, and three identified as Hispanic. Participants represented the following range of professional experience: eleven nonphysician administrators, eight physicians with some administrative or faculty responsibility, three psychologists, two registered nurses, and one pharmacist. Notably, all of the participants held college degrees and graduate degrees, several from elite academic institutions in the Boston area.
Procedure
Each focus group discussion lasted ninety minutes and was facilitated by two researchers. Participants were informed that the purpose of the focus group was to (1) gain insight into the most relevant questions and topics that should be pursued for future research and (2) offer preliminary advice to health-care executives about how to maximally engage and develop underrepresented minorities within their organizations. Participants provided written consent for participating in the confidential sessions and having them audiotaped. Refreshments were provided to participants in exchange for their time, but no other form of compensation was given. The facilitators asked participants several open-ended questions about their experiences as health-care professionals, definitions of success, enablers and obstacles to success, and recommendations for increasing diversity among senior health-care leadership. At the end of the discussion, participants were told that they could contact the facilitator should any questions or comments about the study arise.2
Data Analysis
Audiotapes of the focus-group discussions were transcribed verbatim. Each researcher individually reviewed the transcripts and their notes in their entirety, qualitatively compiling themes derived from the sessions. The researchers then discussed the themes as a group and found that the deduced themes were consistently strong in each of the focus groups and across reviewers. The researchers represented expertise in health-care, qualitative research, health and social behavior, diversity management, and organizational behavior.
Findings: Facilitators of Success
In this section, we summarize the major themes that emerged from participants’ discussions of the factors that facilitated and inhibited their success as health-care professionals. Table 9-1 details each theme and provides illustrative quotes of facilitators and inhibitors. It is important to mention that participants’ personal definitions of success framed the conversation about facilitators and inhibitors. In this study, participants viewed success as having recognizable and progressive achievements at different levels and stages within one’s career. Success additionally involved having a certain degree of control over one’s career path and the ability to balance personal and professional goals. Yet nearly all health-care professionals of color believed that there were significant inhibitors to their career success; some were related to organizational-level practices, while many others were related to individual and group-level practices.
Three facilitators of success were mentioned frequently: supportive relationships, training and education, and personal characteristics. The most prominent theme in this discussion of facilitators was supportive relationships. Many participants recounted how role models and mentors inspired, motivated, and developed them. Role models were generally noted as family or community members who held prominent professional positions and inspired participants to achieve but were not necessarily guides in the participants’ careers. Mentors, also holding distinguished appointments within their organizations, were those individuals who proffered both psychosocial and career support. Participants reported that mentors were generally responsible for introducing them to health care, encouraged them to seek out opportunities, wrote recommendation letters, or taught them how to politically navigate the health-care organization. Additionally, mentors empowered participants to not get discouraged by obstacles and to balance personal and professional commitments.
One participant described how her college mentor enabled her success: “Someone … was encouraging me to just take your biggest dream and do it. And I’d said, well I don’t want to go to medical school unless I go to School X, and she said, well, apply. And it was the only school I applied to, and I luckily got in. It was one of those situations where if she hadn’t told me that, I probably would have never gone. So, it was a huge enabler” (group 8).
|
Themes and illustrative quotes |
||||||
|
Theme |
Facilitator |
Obstacle |
Personal strategy |
|||
|
Supportive relationships Inspire and motivate |
Role models, mentors, social networks “I think that I’ve been very lucky to have formal networks of support, whether it’s mentors or peers. And typically [my support comes from] women of color and typically African American women, who have really supported me in having my vision and being very determined and seeking out opportunities that will help me fulfill that.” (Group 3) |
Inaccessibility and active discouragement “I always hear, like ‘you’re so articulate,’ but I don’t hear anybody else being told that. So, I almost find that a little bit patronizing. ‘Don’t worry about moving forward. You’re still very young. You’re too ambitious.’ Yeah, those are the same traits I see in my [white] colleagues, but they’re never called ambition.” (Group 8) “Stop using the big words. You don’t have to use the big words around us to show that you’re smart.” (Group 8) |
Proactivity “You have to resist the urge to stay at the computer from nine o’clock to five o’clock and just do your work.… You have to build alliances with people throughout the organization and outside the organization. I think it’s definitely helpful to have a variety of people to give you feedback, and also bounce ideas off of.” (Group 5) |
|||
|
Training and education Knowledge of business and management |
Administrative graduate degrees, administrative fellowship programs, leadership development programs “The Partnership has opened the doors for many different avenues of my career personally and professionally. I’ve built a lot of relationships with a lot of people that I probably wouldn’t have been able to meet outside of the Partnership.” (Group 5) |
Lack of “pedigree” or exposure “I felt like there definitely was this kind of [Ivy League] undergrad group that was recognized differently than those who came from state schools or historically black colleges and universities.” (Group 8) “We can come up with a million ideas that are probably well connected to the needs of the patient, but have no sense of how to assess it, measure it, follow it, create a scope, create a budget. Not because we can’t think that way, because we never thought about it and because in medicine you are not trained to think about it.” (Group 1) |
Persistence “There were no people of color in regards to management at all. There was no one to mentor me. So it would have to be resiliency on my behalf that pushed me to try to attain higher education [MBA].” (Group 8) “You’re making yourself a marketable asset, and you want to continue to increase your value. And how do you increase your value? Well, you don’t just sit there and depreciate by saying, ‘OK, I’ve done all my schooling, now I’m done, I’m just here.’ No, you continually learn new skills. You find out what’s needed, not just in your organization, but in other organizations, so you have more options in front of you.” (Group 5) |
|||
|
Organizational diversity |
Strategic, comprehensive approaches “I think that when the institution, in some important ways, lets the employees know that this is a key initiative (‘We’re going to make a cultural change in this direction’), that creates buy-in. [When the institution] rolls out a whole program, the way they would for anything else (you know, like patient safety or quality improvement), then, I think it becomes a part of the fabric of the institution.… Unfortunately, what happens when we have a seminar here and a consultant there (‘This department had a crisis, so we’re going to have somebody go to that department’), it’s just not holistic.” (Group 5) “Acknowledge that racism exists … [a]nd that it’s morphed into a very covert, culturally embedded, make nice, ignoring the systemic oppression and racism. I honestly feel like if institutions could even acknowledge that, that would be a tremendous first step.” (Group 3) |
Stereotyping and unwelcoming climate “Institutions have history, they have their own identities, and they have a strong sense of pride in being very, very selective.… So there’s an assumption that the people who come in are going to be so glad to be there. And so then you come in, and you start making suggestions about how things might be different, and it’s hard to do that in an organization that feels they’re great, and the world tells them that they’re great.” (Group 5) Pigeonholing “I’m interested in minority health, and I’m interested in disparities in health … and I hate to say this in the wrong way, but it’s almost like they’ve pigeonholed me into being the minority that’s going to do the minority stuff, and thus I can’t do work on anything else or talk about all the other things intelligently.” (Group 8) |
Strategic self-presentation “Because I was a woman of color, [I] recognize[d] that I was probably pegged with a certain reputation or type of image if I came off in a certain way. And I think it just made me much more strategic about how I present myself initially, so that I could develop relationships with people. So that later on I could say whatever the hell I wanted to say, but have it be attributed to me rather than women of color.… Rarely am I angry or heated in public with other professionals because of certain stereotypes.” (Group 3) Prioritizing “I think that race, if anything, is a challenge because of all the things that come with it.… I am the only black female physician. I am the only black researcher.… There have been a lot of calls or requests that my contemporaries who are white males don’t have to deal with, so they can just focus on research. And it’s something I’ve enjoyed doing, but I have to tell you, I came to a point where I realized that since I’m primarily a researcher, if I’m not hitting those goals as a researcher, then it doesn’t matter.” (Group 3). |
|||
The vice president of human resources facilitated another person’s career placement: “Early on, when I said, ‘I know what I want to do, [but] I don’t know if the job is here at the hospital for me,’ he said, ‘We’ll create the job.’ And it’s been like carte blanche, and incredibly supportive” (group 5).
Other participants described how their social networks provided an extra boost for their career opportunities in health care. Many benefited from their status as alumni of elite educational institutions and noted that alumni networks were significant in their career advancement by “opening doors” and providing connections to people in key decision-making roles. One participant indicated that every employment position she had held involved a connection with her undergraduate institution.
Training and Education
The majority of participants commented on how their higher education and developmental experiences facilitated their success. Some participants who held administrative graduate degrees stated that their knowledge of business and management in organizations enabled them to advance their health-care careers. Those who participated in administrative fellowship programs following graduate degree programs in health administration believed these fellowships were critical to their success, because they provided greater access to management, career advancement planning, and a structured learning environment.
One participant spoke highly of her fellowship experience: “The fellowship really helped me to get an institutional perspective that I don’t think the vast majority of the people get.… At a fairly young age, [I] jumped into a job that I don’t think I probably would have gotten had I not had the history at the organization, and had they not known me as a somewhat proven entity” (group 2).
Other participants reported that the opportunity to engage in leadership training programs external to the work setting assisted their career advancement. For example, alumni of the Partnership’s leadership development programs indicated that these programs provided a forum for important career discussion, facilitated social interaction, and enhanced their social networks among professionals of color with shared experiences.
Personal Characteristics
Several participants ascribed their success in part to personal attributes by acknowledging the importance of internal motivation and drive. Participants indicated that in the presence or absence of a support system, the ability to take initiative, actively earn trust, and persevere despite adversity was key to minorities’ career advancement in health care.
Findings: Inhibitors of Success
On balance, discussion of inhibitors to success far outweighed dialogue regarding facilitators of success in both breadth and depth. Inhibitors to success were categorized according to the following three themes: lack of leadership development training and industry-specific expertise, lack of support for career advancement, and organizational diversity climate and stereotyping. Several inhibitors reflected a lack of access to the aforementioned facilitators—namely, formal training or education and career support. Further, while participants attributed their success to personal attributes (e.g., internal drive and persistence), they identified structural and systemic factors (e.g., organizational diversity climate and stereotyping) as inhibitors of success.
Lack of Leadership Development Training and Industry-Specific Expertise
Many participants proposed that minorities were not readily advancing within health care on account of insufficient business training and health-care experience. Among those participants with administrative graduate degrees, one implied that an inadequate supply of administrative fellowships prohibited many minority candidates from effectively bridging theoretical and practical knowledge, making them less competitive for administrative roles. In addition, some participants without health-care experience believed that they were recruited because of their transferable skills; yet, once in health care, their lack of industry experience inhibited them from being recognized as knowledgeable.
Participants also voiced concerns about the lack of transparency, objectivity, or accessibility of systems for selection and promotion in their organizations and perceived that their organizations were only providing resources to “check the box” on diversity management. Participants reported that while some opportunities were available, they did not support a path to senior administrative leadership. Many opportunities were bound to clinical leadership and middle-management positions. Consequently, our participants experienced the pathways to leadership as hidden from their purview. Many participants argued that providing minority professionals with leadership and management training would benefit health-care organizations. But they also reported that most health-care organizations have restricted financial scholarships to those employees seeking clinical roles.
Lack of Support for Career Advancement
Lack of opportunity and support systems was a major theme in the discussion of career advancement inhibitors. Focus-group participants stated that their career advancement opportunities were not challenging enough, inaccessible, or nonexistent. Though most participants reported pursuing advanced degrees as a means of introducing opportunity, they concurred that the inaccessibility of role models, mentors, and networks inhibited promotion. Participants discussed how they had become discouraged due to the absence of career guidance from senior-level executives, the lack of access to mentoring programs or networks, and the lack of minority representation in top management positions.
Moreover, participants stated that their desire to advance to leadership roles was not supported by their colleagues or managers, who advised them to be patient and downplay their intelligence. In general, participants were unclear about how one could obtain more leadership responsibility or advance their careers in health-care organizations. Some struggled with whom to enlist in the process of identifying career opportunities, while others felt that the right opportunities had not been created for them because they did not have the necessary mentorship. Still others felt that their attempts to attain additional credentials and responsibilities were shunned by managers and peers.
Organizational Diversity Climate and Stereotyping
Describing this process as “the quiet fight,” several participants reported feeling a void or loneliness given the relatively low numbers of health-care professionals of color in their employing organizations. In addition, they experienced the workplace diversity climate as unwelcoming or sending mixed messages about opportunities for professionals of color. Many participants, especially Black males, commented on the necessity of tempering their emotional expressions in order to advance in their careers. Specifically, several participants believed that despite their attempts to exhibit friendly and nonthreatening demeanors, White colleagues continued to respond with surprising levels of apprehension. Participants also felt that their passion and enthusiasm for work was often misperceived as threatening, and that advocacy for diversity causes may be confused with overemotional behavior. Others worried that their interests in minority health would constrain their future leadership opportunities.
One focus group participant stated, “I felt like I was dying. They were appreciating me as I was dying. All the stuff about me, all the stuff that made me special, the Black side of me, it was all just dying. And they were happy. It made them comfortable. And I felt like I was wilting” (group 3).
Implications of Career Inhibitors: The Leaky Pipeline
Most studies of diversity in health care refer to the underrepresentation of certain ethnic groups in leadership roles. Our data helped to explain why many professionals of color plateau in or exit their health-care careers. Participants identified a number of individual limitations to career advancement associated with health-care organizations’ diversity climate. Frustrated by the lack of opportunity and stagnant careers, participants noted that many of their underrepresented minority counterparts had left the organization, industry, or region altogether. In their roles as caretakers for biological children and extended families, some participants cited the personal sacrifices they made for their profession (e.g., financial challenges of undergraduate and graduate student loan debt, moving away from family) and wondered whether these sacrifices had been worthwhile. This tension leads to a “leaky pipeline” phenomenon, in which underrepresented talent enters the system (e.g., science, technology, engineering, and mathematics or health-care pipeline) at early career stages but stagnates or leaves altogether when opportunities for advancement are not apparent and the benefits of remaining do not outweigh the financial and psychological costs of remaining in a disaffirming or constraining environment. In sum, many professionals of color find it too great a sacrifice to remain in the organizations where they (perceive they) are receiving fewer rewards and having little impact.
In the words of one clinician,
I didn’t come to Harvard with the idea of ending up in an underserved area, just tossed into the trenches, do your work, get your visa, and leave.… I think once you are sent to an underserved area within the system, there’s no support to grow. You’re supposed to take care of “them” and that’s it.… All of these quiet fights in the racist environment. For me, it has been draining, really draining. I’m ready to leave. I’m waiting for this year to end and then I’m leaving. It has been so draining for me that I really feel that I’m almost going to change careers.… And I suddenly feel that I have become a mediocre person, a mediocre professional. And it’s not what I came here for. (Group 3)
Findings: Participants’ Suggestions
In light of the aforementioned challenges, participants provided suggestions both to minority health-care professionals seeking to advance within health care and to senior executives seeking to maximally engage minorities. We summarize these suggestions in this section.
Advice for Minority Health-Care Professionals Seeking to Advance within Health Care
- Gain skills and industry knowledge for successful leadership.
- – Pursue advanced degrees.
- – Pursue activities that distinguish minority professionals as leaders, including serving on committees and being involved in high-visibility change initiatives.
- – Pursue opportunities to become more knowledgeable about the US health-care system, financing, and their difficulties.
- Balance assertiveness, advocacy, and self-promotion to pursue opportunities and navigate interpersonal interactions.
- – Network with senior-level executives and actively seek opportunities that align with one’s desires for career advancement.
- – Gauge tone and temper one’s responses to situations at work in order to establish credibility as a leader.
- – Refrain from advocating too frequently or intensely for diversity issues, unless one is willing to deal with the possibility of being pigeonholed as the diversity champion for the organization.
- – Use caution to avoid adapting one’s style too much, given the deleterious psychological impact of inauthenticity. (See the earlier quote: “I felt like I was wilting.” See also chapter 6 in this volume, in which Patricia Faison Hewlin and Anna-Maria Broomes provide a detailed review of the negative outcomes associated with inauthenticity.)
Advice for Senior Health-Care Executives Seeking to Maximally Engage Minorities
- Clarify and expand the rationale for diversity.
- – Extend beyond quota-based diversity practices to understand how to best leverage diversity within one’s organization.
- – Cultivate diversity as an organization value.
- Establish support systems.
- – Encourage top-down supported formal and informal mentoring, encouraged by senior leadership.
- – Provide opportunities for minority professionals to network with one another.
- Promote from within.
- – Actively search within one’s organization before consulting executive search firms.
- – Invest in training and development programs for minority professionals that will equip them to succeed in senior-level positions.
- Conduct exit interviews.
- – Actively consider factors surrounding resignations as a means of uncovering systemic challenges within one’s organization.
- – Proactively seek feedback from departing minority professionals about how to increase support, development, and retention of other minority professionals.
Our Recommendations
Our findings are similar to those of past research that suggest that a number of barriers to career advancement exist for underrepresented minorities in health care, yet it extends the discussion by considering the roles of both executives and minorities in improving talent management and leadership development. We have built on these findings in order to offer general recommendations for creating maximal engagement in the management of diverse talent in health care. First, this study proposes that in order to develop and retain diverse talent in health care, senior executives and minority professionals each need to be able to articulate the value of diversity within their organizations in order for diversity management to become more tangible and institutionalized. Second, it infers that a range of contributors facilitate and inhibit the success of underrepresented minorities, including organizational practices and personal actions. Personal attributes, role models and mentors, training and education, and networking were all defined as facilitators of success. Positive individual traits were related to the ability to take initiative in establishing trust with managers, pursuing educational opportunities, and accessing professional networking opportunities. Yet our recommendations extend far beyond minority professionals’ personal characteristics. This study shows that by offering strategies to both senior executives and underrepresented minorities, the pathway to senior leadership in health care would be more easily navigated and organizations would better engage the full range of talent in their workforce. Together, these inclusive practices would contribute to more effective health-care delivery.
Diversity Climate
Of particular significance is the diversity climate that leaders create in health-care organizations. Focus-group participants reported receiving mixed messages about the relevance of diversity in their health-care organizations. Regardless of the public commitment to increasing cultural competence and reducing health disparities, professionals of color feel constrained by limited expectations for their roles in health care. In their view, they were hired to contribute to diversity initiatives (e.g., cultural competence and community partnerships), but once hired, they felt their ability to lead deep change within the organization was constrained.
For example, one participant commented, “For me, that’s the struggle of being this cultural broker when it’s convenient for them. And then when there’s other times that I think that there are cultural issues that need to be addressed that they don’t want to hear, then they don’t want to hear it” (group 3).
Therefore, participants reported feeling unable to contribute fully or to build credibility as thought leaders. As a result, they feel they have a limited leadership impact in health care. This dynamic persists because dialogue about diversity is often inhibited, particularly in discussing the unique challenges that members of various national, ethnic, and socioeconomic groups face.
Minding these challenges, participants in this study proffered several recommendations to increase diversity among senior health-care leadership. An overarching theme was that the ability to comprehend and articulate the value of diversity within health-care settings was critical to the success of diversity programs and a valuable skill for all persons concerned. One participant remarked, “If you really want to promote diversity, it needs to be some sort of an organizational value. It needs to be something that’s cultivated.” Other participants in that focus group agreed with this conclusion and believed that without setting this precedent, an organization’s future diversity efforts would be substantially less effective.
We also suggest that leaders enrich the diversity dialogue to account for the various dimensions of difference that exist and their accompanying challenges. Participants believed that there has been “inhibited dialogue” within their organizations. Differences in class, ethnicity, and gender were all highlighted as affecting both working relationships and career advancement; yet discussions related to these concepts were not generally viewed as prevalent in diversity conversations. In terms of class, participants indicated that the hierarchical divisions predominant within health-care institutions often separated clinical and administrative staff and further alienated in-group minorities from their cohorts elsewhere in the organization. One physician reported being reprimanded by a White supervisor for speaking to other same-race staff who held lower-level positions. Since levels of educational attainment are often pronounced in health-care settings, class differences may inhibit adequate social networking and may also inhibit more-senior professionals of color from mentoring their lower-status counterparts in their health-care career advancement. Adia Harvey Wingfield offers a more detailed discussion of class dynamics among minority health-care professionals in chapter 8 of this volume.
Conclusion
One of our goals in selecting focus groups as a method of gathering data was to gain insight into the most relevant questions and topics that should be pursued for future research. Through this effort, we have been able to identify a number of underexplored areas in the research whose investigation may further explain why diverse talent continues to be significantly underdeveloped in the health-care industry. Suggested topics for future research include stereotypes, prejudices, and fear as barriers to diversity management; class distinctions in hierarchical health-care organizations; majority group members’ attitudes toward diverse talent management as factors affecting institutionalization; and professional and social networking systems used by underrepresented minorities for career advancement in health care. We also recommend empirical research that examines the linkages between effectively leveraged and empowered professionals of color and organizational effectiveness in health care, as measured by well-being and performance indicators. While these suggestions do not represent an exhaustive list of topics that may shed some light on the experiences of diverse professionals in health care, they offer an appropriate starting place to delve into the issues with which organizations are grappling. With the changing face of the American health-care system, organizations’ abilities to attract, retain, and advance diverse professionals are critical. The future of health care will depend on our ability to shine a light on the pathways to leadership for diverse talent.
NOTES
1. The Partnership is a not-for-profit organization dedicated to providing talent management solutions for professionals of color. As the region’s premier resource dedicated to talent management, the Partnership provides tailored workplace solutions to senior executives and leadership training for professionals of color, conducts research into the latest trends and issues, and convenes thought leaders to identify best practices.
2. Please contact the first author for more information on the study protocol.
REFERENCES
Ambrose, L. (2003, September/October). Mentoring diversity: Serving a diverse patient population calls for diverse leadership. Healthcare Executive, 18(5), 60–61.
Barney, S. (2002, November/December). The inclusive, diverse workplace: We are not there yet. Journal of Healthcare Management 47(6), 356–359. Retrieved from https://
Black, B. P. (2016). Professional nursing: Concepts & challenges. Saint Louis, MO: Elsevier.
Bleich, M., MacWilliams, B., & Schmidt, B. (2015, March/April). Advancing diversity through inclusive excellence in nursing education. Journal of Professional Nursing, 31(2), 89–94.
Bowen, D. (1994, January/February). Action steps to enhance minority opportunities. Healthcare Executive, 9(1), 43.
Brooks-Carthon, J., Nguyen, T., Chittams, J., Park, E., & Guevara, J. (2014, July/August). Measuring success: Results from a national survey of recruitment and retention initiatives in the nursing workforce. Nursing Outlook, 62(4), 259–267.
Carter, B. M., Powell, D. L., Derouin, A. L., & Cusatis, J. (2015, March/April). Beginning with the end in mind: Cultivating minority nurse leaders. Journal of Professional Nursing, 31(2), 95–103.
Chyna, J. (2001, March/April). Mirroring your community: A good reflection on you. Healthcare Executive, 16(2), 18–23.
Colville, J., Cottom, S., Robinette, T., Wald, H., & Waters, T. (2015, February). A community college model to support nursing workforce diversity. Journal of Nursing Education, 54(2), 65–71.
Day, L., Gonzalez, S., Mendoza Ladd, A., Bucobo, J., Pickett-Blakely, O., Tilara, A., & Christie, J. (2016, January). Diversity in gastroenterology in the United States: Where are we now? Where should we go? Gastrointestinal Endoscopy, 83(4), 679–683.
Dolan, T. (1993, November/December). Mentoring in the 1990s. Healthcare Executive, 8(6), 3.
Dolan, T. (2013, March/April). Increasing diversity in governance and management. Journal of Healthcare Management, 58(2), 84–86.
Dotson, E., Bonam, C., & Jagers, J. (2017, Spring). Redefining race as a process: Implications for healthcare leadership. Journal of Health Administration Education, 34(24), 295–318.
Dreachslin, J., Jimpson, G., Sprainer, E., & Evans, R., Sr. (2001, November/December). Race, ethnicity, and careers in healthcare management: Practitioner response. Journal of Healthcare Management, 46(6), 397–410.
Dufault, K. (2007, March). Diversity at the top. Trustee, 60(3), 28–29.
Gates, S. A. (2018, April). What works in promoting and maintaining diversity in nursing programs. Nursing Forum, 53(2), 190–197.
Gathers, D. (2003, Summer). Diversity management: An imperative for healthcare organizations. Hospital Topics: Research and Perspectives on Healthcare, 81(3), 14–20.
Henault, R. (2004, March). Race matters. Modern Healthcare. Retrieved from https://
Hubber, D. (2018). Leadership and nursing care management (6th ed.). Saint Louis, MO: Elsevier.
Jeffreys, M. R. (2016). Teaching cultural competence in nursing and health care: Inquiry, action, and innovation. (3rd ed.). New York, NY: Springer.
Jessamy, H. (1997, May). Opening up to diversity. Modern Healthcare. Retrieved from https://
Kahn, L. (1994, January/February). Career development strategies for minorities. Healthcare Executive, 9, 40–41.
King, C. (2005, November/December). Conquering health disparities. Healthcare Executive, 20(6): 34–36.
Kitzinger, J. (1995, July 29). Qualitative research: Introducing focus groups. BMJ. Retrieved from http://
Larson, L. (2006, March). Getting to the “C” suite: What will it take to see diversity across health care leadership? Trustee, 59(3), 12–19.
Moore, J. D., Jr. (1999, December). Tapping hidden resources. Modern Healthcare, 29(50), 30–36.
Murray, T. A., Pole, D. C., Ciarlo, E. M., & Holmes, S. (2016, May/June). Nursing workforce diversity project: Strategies for recruitment, retention, graduation, and NCLEX-RN success. Nursing Education Perspectives, 37, 138–143.
Odom, K., Roberts, L. M., Johnson, R., & Cooper, L. (2007). Exploring obstacles to and opportunities for professional success among ethnic minority medical students. Academic Medicine, 82, 146–153.
Phillips, J. M., & Malone, B. (2014, January/February). Increasing racial/ethnic diversity in nursing to reduce health disparities and achieve health equity. Public Health Reports, 129, 45–50.
Romano, M. (2005a, February). Diversifying healthcare. Modern Healthcare. Retrieved from https://
Romano, M. (2005b, September). Opening doors. Modern Healthcare. Retrieved from https://
Selvam, A. (2012, April). Diverse perspectives: Minority executives and their peers tout the benefits of broader representation in the C-suite, boardrooms. Modern Healthcare, 42(15), 6–7.
Silver, R. (2017, February). Healthcare leadership’s diversity paradox. Leadership in Health Services, 30, 68–75.
Sloane, T. (2006, April). Through the Teflon ceiling. Modern Healthcare. Retrieved from https://
Valantine, H. A., & Collins, F. S. (2015, September). National Institutes of Health addresses the science of diversity. Proceedings of the National Academy of Sciences, 112(40), 12240–12242.
Villarruel, A., Washington, D., Lecher, W. T., & Carver, N. A. (2015, May). A more diverse nursing workforce. AJN: The American Journal of Nursing, 115(5), 57–62.
Voges, N. (2006, April). Diversity in the executive suite. Modern Healthcare, 36(15), 24–30.
Winkfield, K., Flowers, C., Patel, J., Rodriguez, G., Robinson, P., Agarwal, A., … Hayes, D. F. (2017, August). American Society of Clinical Oncology Strategic Plan for Increasing Racial and Ethnic Diversity in the Oncology Workforce. Journal of Clinical Oncology, 35(22), 2576–2579.
Witt/Kieffer. (2015). Closing the gap in healthcare leadership diversity: A Witt/Kieffer study (Report). Retrieved from http://