How predominantly white hospital leadership teams hurt care for people of color

Last year, my father, a Jamaican immigrant with Medicaid insurance, passed away from a heart attack. He was only 63 years old.

As he received care, he expressed discomfort with the predominantly white teams handling his case. He believed that both clinicians and non-clinical staff discriminated against him because of his racial and ethnic identity, as well as his public insurance status.

I have to say that I believe he was right: The lack of diversity among his physicians and leadership team contributed significantly to his passing. Though he had complained about occasional chest pains, no one examined his heart. And when he finally reached out to an administrator to express his concerns, the medical director told him to complete a patient satisfaction survey, which he never received.

That might not seem like clearly biased treatment. But racism in health care is not always obvious; it can be subtle and deeply ingrained. For instance, Black people may experience differential treatment compared to their white counterparts, be more likely to be labeled “noncompliant” in doctor notes, or face misdiagnosis or delayed diagnosis due to biased assumptions.

But while lots of attention has been paid to whiteness of physicians providing hands-on care, far too little time has been spent on the persistent lack of representation of underrepresented groups in leadership roles. Nearly 90% of CEOs in the health care industry identify as white, despite 4 out of 10 Americans identifying with a race or ethnic group other than white.

As a health services researcher deeply committed to promoting health equity and advancing diversity, equity, and inclusion work, I constantly ponder what health care systems can do at the organizational level to prioritize diversifying leadership teams. It’s a crucial line of inquiry because, while diversifying the provider workforce is critical, health care leadership teams are the decision-makers and play a pivotal role in shaping organizational policies and plans that directly impact patient care. Leaders who lack exposure to diverse perspectives may develop “blind spots” related to racism and discrimination within the system and the communities it serves. Furthermore, leadership diversity matters for talent development and nurturing diverse future leaders in the longer term.

Patients from marginalized communities often pay the price for this lack of diverse leadership. When patients from underrepresented groups do not see diverse representation across the organizational hierarchy, they may be less likely to trust health care providers and follow through with medical recommendations. This perpetuates a vicious cycle in which the lack of diversity within health care leadership and care teams perpetuates health inequities for BIPOC individuals.

The result? Black Americans experience some of the worst health outcomes of any racial group. Black men have one of the shortest life spans of all Americans, while Black women are three times more likely to die from pregnancy-related causes than white women. The lack of diversity in health care leadership teams and care teams can be a significant barrier for patients seeking medical attention. Research shows that Black patients are more likely to experience racial discrimination in the health care system, and Medicaid use is stigmatized. It is alarming to think about how many other individuals in the United States, with identities like my father’s, may be avoiding care and/or suffering sub-optimal care due to the lack of diversity within health care leadership and care teams.

Despite some progress, BIPOC leaders in health care still encounter obstacles when attempting to secure senior leadership roles and attain C-suite level positions. Even when they do manage to get a “seat at the table,” their roles often revolve around DEI or health equity. A chief diversity officer, for example, would focus on building a diverse and inclusive organizational culture, while a chief health equity officer would focus on developing solutions that advance health equity and better serve underserved communities. Though these are critical goals, unfortunately, both roles are often perceived as “box-ticking exercises” or thankless tasks with no budgetary support.

To compound the issue, health care organizations are failing to support and retain these leaders. A recent study revealed that the average tenure of chief diversity officers at large publicly traded U.S. firms is less than two years, a concerning trend that is likely mirrored in health care. We know even less about individuals who accept executive positions focused on health equity, but it is likely they face similar obstacles in securing long-term positions of influence. In my own dissertation work, I’m examining the leadership experiences of executive leaders who are BIPOC and hold senior DEI or health equity-related positions. I suspect that, similar to other sectors, many of the chief diversity and health equity officer positions will be inaugural roles, in early stages, or prone to significant turnover rates.

Diversifying the health care workforce beyond physicians and nurses may have a positive impact on the experiences of employees across the health care system, as well on the experiences of the patients they serve. Research indicates that employees are more likely to report job satisfaction, engagement, and commitment to their organization when they feel a sense of belonging and see individuals who look like them at work. In contrast, employees in environments that lack diversity are more likely to experience workplace discrimination, bias, and exclusion, thus negatively affecting their mental health, job performance, and retention.

By diversifying leadership teams and creating a culture of inclusion, health care organizations can mitigate these issues and create a more positive and safe working environment for all employees. This, in turn, can lead to improved patient outcomes and overall organizational success, as well as attracting and retaining a diverse and talented workforce.

The health care industry has a duty to address this issue and prioritize diversity, equity, and inclusion, as well as health equity, in all aspects of their operations, including leadership teams. By proactively seeking out and elevating marginalized voices to positions of power, health care organizations can work toward dismantling the systemic barriers that perpetuate health inequities.

To achieve this goal, chief DEI officers and chief health equity officers need resources, including financial support, adequate staffing, mentorship, and robust organizational support through a strategic plan. Organizations must scrutinize policies that prevent historically marginalized patients and employees from achieving their healthiest lives, and be willing to transform the corporate culture and power structure to create a healthier, more equitable system for all.

However, achieving effective change in addressing the issue of overwhelmingly white leadership teams requires a profound organizational transformation — a step that I’m uncertain many organizations are currently prepared to undertake. Bounded justice, a conceptual and analytic framework, challenges the notion that inclusion efforts alone are sufficient, highlighting how racism and other deeply rooted -isms are intricately woven into well-intentioned attempts to address health disparities. It suggests that roles like chief health equity officer and chief DEI officer often operate within constraints imposed by larger societal, systemic, and structural factors. Nevertheless, I firmly believe there are tangible and actionable steps we can take to begin diversifying health care leadership teams.

For starters, we need to prioritize diversifying pipeline programs for health care administrators right from the early stages of their careers. It’s not enough for health care organizations with administrative fellowship programs to simply state that they value DEI and health equity principles in their applicants; they must actively develop training options that place these principles at the forefront. By offering robust training in DEI and health equity, future leaders can cultivate a deep understanding of the challenges and opportunities associated with equity and inclusivity in health care.

Moreover, as organizations create new roles, it is essential to reimagine strategic planning processes, starting from the hiring process and the selected applicant’s first day. Too often, chief DEI and health equity officers are burdened with the task of building strategic frameworks from scratch, without clear direction or adequate staff support. By prioritizing robust training in pipeline programs and revamping strategic planning processes, health care organizations can begin to diversify leadership teams and nurture a new generation of leaders who are prepared to address the complexities of health care disparities and drive impactful change in the industry.

Unfortunately, my father’s story is not unique. Countless others have endured the devastating impact of racism and inequities within the health care system. We cannot bridge the gap in health care disparities and access without diverse administration teams.

Tiffany Cornwall, MPH, is a Ph.D. candidate studying health services organization and policy, specializing in management and organizations, at the University of Michigan School of Public Health. She is a health equity scholar supported by the Bill and Melinda Gates Foundation.