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Diversity in the C-suite and on hospital boards is critical as hospitals push forward with population health and new models of care. Increasing the racial, ethnic, gender and generational diversity of health care leadership is essential for the provision of culturally competent, value-based care. However, for many hospitals and health systems, the makeup of the leadership team doesn’t often reflect that of the communities they serve. In July Health Forum convened a panel of hospital executives in San Francisco to examine the challenges and best practices in recruiting and retaining a diverse management team and board. Health Forum would like to thank all participants for their candid discussion, as well as B. E. Smith for sponsoring this event.

MODERATOR (Pam Thompson, R.N., American Hospital Association and American Organization of Nurse Executives): : Why is it important that we have management, governance and clinical leadership support around the issue of diversity? How does this help hospitals and health systems to achieve high-quality, value-based care?

LINDA BURNES BOLTON, R.N. (Cedars-Sinai Medical Center): To achieve value, we have to truly engage the consumer as a partner. If we’re not as inclusive as possible, then we’re not going to be successful in engagement. Engagement can bring people to the table, but if they don’t trust that you are genuine in providing care that matters to them, they won’t come back. Unless you are genuine in terms of diversity and inclusion — and the inclusion piece is extremely important — you will not gain their trust. Leadership has to be at the table and represent all the groups you’re trying to engage.

ANTON GUNN (Medical University of South Carolina): Value means different things to different people. It’s a personal belief. As we think about health care delivery, it’s very personal. The communities that we serve are growing more diverse every day. You may not have in your community today people of Aboriginal descent from Southwest Australia, but you could tomorrow via air transportation. And their value proposition could be completely different from that of anybody else in the community. As our communities grow and become more diverse, hospitals and health systems are faced with new challenges and opportunities. Leadership has to be keenly tuned in to seeing the world from different perspectives, and having a diversity framework for your leaders is critically important. It’s not just diversity in terms of physical characteristics, or what I call genetic characteristics; we need diversity in thought and experience.

The consumerization of health care is occurring and will have a big impact on our organizations. When we talk about creating value, we need to figure out how to achieve individual value for every single person. That’s a complex challenge we’ll have to meet over the next decade, and it’s going to take a lot of work. But, the key to doing that is having the right leadership at the table.

JOAN REEDE, M.D. (Harvard Medical School): To that end, it’s important to have members of the community at the table to help guide the organization as you continue to assess and update policies and practices. Historically, when we talked about diversity, we talked about it in terms of numbers. But numbers do not accurately reflect whether the organization’s diversity initiatives are having an impact on the kind of decisions that the organization makes.

DOUG SMITH (B. E. Smith): The very core of what hospitals and health systems do is to provide care, and we know that diversity improves the care provided to patients. Hospital executives also have to run a fiscally responsible organization, and we know that diversity can improve the fiscal responsibility of the organization. Leadership diversity is about improving patient care and improving operations in the hospital.

CRISTY GARCIA-THOMAS (Aurora Health Care): Valuing the differences in others is going to elevate our ability to meet the expectations of our consumers. The more we’re able to embrace, accept, learn and value what difference of thought brings to the conversation, the better we will be at meeting patient satisfaction and growing our market share.

MODERATOR: Several of you mentioned inclusion. Why is inclusion as important as diversity?

REEDE: The name of my office is the Office for Diversity Inclusion and Community Partnership, not diversity comma inclusion. It’s diversity inclusion. The role of my office is to embed diversity and the benefits of diversity across the multiple segments of our institution. How is diversity embedded in our education, research and clinical care? My job is not to be a diversity champion, but to change how we do business within the organization.

BOLTON: The concept of being inclusive is really important. When I talked about being genuine, to me, that requires inclusion. I’m one of the products of the movement to make sure there’s a representative at the table. I was the first African-American to graduate from the Arizona State University College of Nursing and Health Innovation. But being the sole representative isn’t what we’re about, and it’s not what we’re trying to do. We’re trying to make room at the table for all. And that means we’re seeking their knowledge, thoughts and participation to help us achieve the mission and vision of the organization. It means allowing everyone an opportunity to contribute in a meaningful way. Inclusion, to me, means that we allow individuals to be inclusive and we provide opportunities for them to lead.

REEDE: If we’re not inclusive, then what we’re actually doing is casting aside a large part of the human capital available to us. We’re not capturing the full benefit of what people can contribute. From a management perspective, inclusion is just smart business.

GARCIA-THOMAS: We’re a people business. We’re not selling widgets; we’re not selling soap. To meet expectations, there has to be an inclusive environment with a two-way street. Health care, my health care, is about me. Being able to have a voice at the table with my care team around what is in the best interest of my personal health care is what’s important. There has to be an inclusive conversation around the best health care outcomes for me.
If health care isn’t successful at getting this piece right, we will not be the leaders that we are today. This is critically important to how we continue to evolve, how we work and care for the communities that we serve. Inclusiveness is critically important because it changes the conversation. The word 'diversity’ brings many different connotations. When you lead with inclusion, that changes the conversation altogether. I sometimes wonder if that’s just how we need to focus going forward.

MODERATOR: Diversity seems to be the topic, but inclusion is the behavior, and it’s really the behavior of inclusion that makes the difference.

RYAN PARKER (Robert Wood Johnson University Hospital): I conduct orientation every two weeks and I talk for an hour to employees about diversity and inclusion. I share with our new hires the evolution of diversity and inclusion, starting with Affirmative Action, community affairs and multicultural affairs. One day, someone said, “Oh, this is about diversity. We have all this diversity, but we don’t know what to do with it.” That’s where inclusion comes into play. I’ve tried to simplify it, and this is the best way that I can: Diversity refers to the mix; inclusion refers to how you manage it. In other words, inclusion becomes the verb of what you now do with diversity for the sake of ensuring that equity ends up being what we’re experiencing.

MODERATOR: What are the barriers to diversity and inclusion within your organization and across the continuum of care? What’s worked, or holds promise, to help overcome these barriers?

REEDE: Too often, in our organizations, we have the diversity moment, a diversity day and/or a diversity office. The problem is that they are not integrated and aligned with the organization’s mission and vision. So, that’s the work of my group, integrating diversity and inclusion policies and practices to build a successful, sustainable program.