Workforce diversity and inclusion in the health care industry have been discussed for years—but progress has been slow. Here are some of our recent research findings on how hospital and health system leaders can achieve a more inclusive environment and a diverse workforce.
Slide deck: How to build a more racially diverse health care workforce
1. Why boost diversity? Higher revenue, better decisions, and more collaboration.
Although the aim of achieving an inclusive environment and a diverse workforce speaks for itself, workforce research provides a slew of statistics affirming that diversity and inclusion produce better business outcomes. For instance, according to cross-industry research, companies with more diverse management teams have higher revenue and are more profitable. In addition, leaders who are rated as more inclusive also have higher-performing teams, make better decisions, and enable more team collaboration.
2. The health care front line is diverse…
Within health care, reliable and regular statistics on workforce diversity are surprisingly difficult to find. However, in Advisory Board research's annual turnover, vacancy, and premium labor benchmarks, we found that at a hospital or health system performing at the median of workforce diversity, about one-third of frontline staff are from racial or ethnic minority groups.
3. … but leadership ranks are not.
However, level-specific data shows that diversity drops off steeply in hospital and health system manager and leader ranks. At the median-performing organization, 16% of managers—and only 10% of director or executive leaders—are from racial or ethnic minorities groups, strikingly less than at the frontline level.
And all-industry data makes clear that significant barriers exist for people of color, women, and especially women of color to reach top leadership positions. For instance, while white men hold one-in-three entry-level roles, they represent 70% of the roles in the C-suite. In comparison, women of color represent 18% of frontline roles, but only 4% of C-suite roles. That's clearly not because women of color or women in general are not qualified for those positions, but because of subjective—and biased—promotion decisions along the way.
4. Most organizations don't set sufficiently clear diversity goals.
Our research shows that only a minority of hospitals and systems have executive goals tied to diversity and inclusion or a documented plan to increase diversity among their leadership. To improve, you don't necessarily have to tie diversity goals to financial incentives—but it is important to at least know what you are working toward.
In developing explicit diversity goals, consider:
- Making the organization's overall level of workforce diversity mirror that of the communities it serves;
- Specifying the types of racial and ethnic diversity the organization aims to cultivate, based on identities present in the organization's communities—as opposed to "people of color"' generically; and
- Pushing for greater diversity within specific roles, especially higher-paying roles, with a well-defined career progression.
Diversity and inclusion goals must be owned by whole executive team—not just HR or the diversity and inclusion lead. And goals should also be cascaded; for example, have division or service line leaders look at goals around increasing diversity within their organizational purview.
5. Cultivating diverse leaders starts with better succession management.
To improve the progression of minority frontline staff into leadership roles, you have to look at how you conduct succession management—that is, grooming specific high-potential people to fill higher-level roles.
Organizations must ensure they're assessing and selecting these high performers in as objective a manner as possible—such as by looking at outcomes-based goal performance—to avoid falling into common biases, such as picking someone who superficially resembles current leaders or over-relying on credentials or degrees.
To correct for these biases, organizations can, among other tactics:
- Train leaders to use a consistent methodology to assess potential, such as developing frameworks around specific dimensions of potential, such as whether the candidate has " talent at the things the next role calls for" or the "ability to inspire others";
- Hire an external assessment service that uses an evidence-based tool; and
- Better calibrate talent by having have someone in the room during leadership succession discussions who is familiar with stereotypes and can flag them when they creep into the conversation.
6. Future leaders need a boost from the bottom up.
Best-in-class organizations also work to retain talent and remove barriers for their high-potential staff.
Two major ways to help under-represented future leaders include:
- Purposeful fostering of mentor relationships. Women and people of color are often left out of informal mentorships or sponsorship opportunities, so it's important to create mentorship connections systematically, rather than leaving it up to staff to seek people out; and
- Creating identity-specific leadership cohorts. Developing leadership cohorts specifically for people of color or women not only benefits individual participants but enables the organization as a whole to learn what might holding staff back in their careers—and take steps to fix it.
7. Address bias in the hiring process.
The hiring process is riddled with the potential for bias, as evaluators very often hire based on snap judgements and gut decisions.
Better-performing organizations on diversity have brought more structure into the search and decision-making process, such as:
- Standardized criteria for recruiters evaluating applications;
- Consistent interview questions;
- Guidance to help make interviewers more objective when assessing answers;
- Formal candidate assessments for quantitative reasoning or reading skills and overall fit; and
- Guidance from external assessment partners, if any, about how to keep bias out of their tools and algorithms.
8. Identify disparities in your employees' experience.
Surveys that ask about equal opportunity have found that 69% of white men perceive that they have equal career opportunities—versus 56% of black women.
Health care organization should leverage the data they have to better understand disparities in experience of their own employees. For instance, organizations can:
- Cut engagement data by identity groups within roles to see if there are patterns in differences of experience and better understand what factors may lead staff to feel that they are not included in the workplace;
- Analyze turnover data and conduct listening sessions with groups of team members who are leaving at higher rates; and
- Systematically conduct and gather feedback from "stay" interviews. Talk to your current employees in underrepresented groups to learn about the professional barriers they face and how managers can help remove those barriers.
9. Foster effective employee resource groups.
Many organizations already have employee resource groups to provide a safe space for staff with shared identities to connect with others. However, some organizations are more effective than others at enabling these groups to promote inclusivity across the organization.
Organizations with more successful groups tend to:
- Make sure identity groups are employee-generated. Rather than creating top-down groups, gather employee feedback, and start with the one or two groups that staff say are important to have;
- Engage groups on top challenges. Ask groups for views and suggestions on issues related to organization-level workforce priorities, such as how to de-bias the interview process;
- Hardwire the groups as feedback generators. Create occasions for organization leaders to join group sessions or otherwise hear conclusions generated by the group;
- Carve out time for employees to participate. If organization with an hourly workforce pays employees to participate, for instance, that sends a strong message;
- Support logistics. Don't over-burden group leaders; task HR staff or a diversity and inclusion team member to help execute on logistics, understand goals, and exist within a structure.
10. Commit and sustain the effort toward anti-racism.
Race, racism, and anti-racism are at the forefront of people's minds at the moment. To use this momentum positively, leaders must demonstrate their commitment, not just through words and aspirations, but through action.
Know that success will not be apparent overnight. It should be measured by what leaders and the organization are doing next year, and the year after next—not just the energy in this moment. You must ultimately ask, "What does sustained action look like?"
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