Smashing the Glass CeilingFinal Essay 1
Smashing the Glass Ceiling:
Female and Minority Executives in the Healthcare Industry
Final Essay
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Smashing the Glass Ceiling: Female and Minority Executives in the Healthcare Industry
Though females and minorities represent more than half of the United States’ population and a large proportion of the US workforce, they are still woefully underrepresented at the executive level of operations. This is particularly true within the healthcare industry, where, according to a 2013 report by the American Hospital Association’s Institute for Diversity, a mere 12% of executive leadership positions within the healthcare industry are occupied by minorities, despite the fact that minorities comprise an estimated 31% of the patient population nationally (Jayanthi, 2016, n.p.). It is incumbent upon us within the healthcare industry to recognize that this is an urgent and growing problem within our field and to proactively seek to build a workforce and leadership profile which more accurately reflects our patient populations and our nation as a whole. A 2016 study by Witt/Kiefer found that 26% of white survey respondents and 10% of minority respondents felt that minorities were well represented at the executive level in the healthcare industry (Rosin, 2016, n.p.). Despite this recognition of need, there remains as yet no definitive and effective plan to end this debilitating disparity. Our organization, however, intends to continue its long history of innovation and leadership by building the most diverse and inclusive executive leadership force in the industry. The mission strategy to be presented here is a pioneering platform for retooling our organization from the ground up, innovating recruiting, retention, and development to ensure that our workforce in general and our leadership in particular truly reflect who we are, will be, and want to be. The ultimate end of this strategy is the development of an executive cohort comprised of at least 50% minority and female leaders by the end of five years. It is an ambitious and challenging goal, but it is also a goal that is not simply worthwhile but essential—and, with the concerted efforts of all personnel and stakeholders, it is a goal that will be achieved.
Recruiting and Retention
At the heart of these efforts to build a more inclusive executive cohort is through effective recruiting and retention. Flores and Combs (2013) assert the importance of selective, focused recruitment increasing minority representation within the healthcare industry. They write, “If racial and ethnic minorities perceive insurmountable barriers in the recruitment process, perceptions of other organizational barriers become moot” (p. 25). In other words, change begins at the ground level, at the very first stages of contact between the student, trainee, aspirant, and new or transitioning professional. In order to build a more diverse workforce, it is imperative that new talent understands that vast opportunities open to them at this organization.
Significantly, undergraduate, graduate, and professional training programs are seeing a marked increase in minority student populations. A study by the Association of University Programs in Health Administration, approximately 42% students in graduate healthcare management programs nationwide during the 2009-2010 academic year were minority students (Selvam, 2013, n.p.). These programs are where the first line of attack must take place. Recruiting initiatives and outreach must occur at every level within these programs. These points of contact will meet minority and female students where they are at each particular stage in their professional development, from coaching first year students through the development of a training and career launch strategy to supporting matriculating students as they prepare to transition into the workforce.
A significant component of this initiative will be the development of career planning protocols whereby focused recruits and prospective talent will partner with relevant organizational stakeholders, from practitioners to administrators and executives, to evaluate both the student’s short-term and long-range goals and the goals of the organization to determine where and how these can be aligned. Once the student begins to develop a clear, cohesive image of him/herself as a professional, particularly a professional within our organization, this will help to ensure that such recruiting protocol are successfully brought to fruition, which, in this case, means the onboarding of top minority and female talent who are being groomed for executive leadership positions. This protocol corresponds closely with guidelines provided by the American College of Healthcare Executive’s recommendations, provided by ACHE’s Institute for Diversity (2016), which lauds the importance of innovative student outreach, including internships and research opportunities, to facilitate recruitment, particularly by overcoming barriers to inclusion.
Retention, however, is the essential counterpart to recruitment. After all, high turnover can not only curtail progress toward the achievement of inclusivity goals, but it can also wreak financial havoc. Ballinger, Craig, Cross, and Gray (2011) underscore the potentially catastrophic costs of turnover, citing current estimates which suggest that training new employees can encompass anywhere from 24% to an astonishing 500% of an employee’s annual salary (p. 111). Despite the obvious financial incentives to prevent turnover, however, Hochenedel and Kleiner (2016) note that a climate of increasing regulation and patient demand and decreasing budgets and compensation have made retention a particularly urgent problem within the healthcare industry.
Our success in meeting our diversity goals, then, depends not only on our ability to recruit top minority and female talent but also to keep them. At the heart of these efforts will be a profound emphasis on mentoring in particular and on relationship management in general. Maryland (2008) emphasizes the role of mentoring in promoting the success and development of female and minority employees. Maryland suggests that mentoring is particularly helpful for these populations because it provides support for the unique challenges these populations face, challenges which the system, founded in its traditional white male orientation, is likely ill-equipped to recognize or accommodate. Maryland cites her own experiences in being mentored, describing it as instrumental to her success, but she also acknowledges deficiencies within the system. As a minority female, Maryland was nevertheless most often mentored by those dissimilar to her in many ways (i.e. typically white males). As such, there was difficulty in using the relationship to brainstorm coping strategies and to secure support in confronting the unique challenges a minority and/or a female face in the professional world.
The mentoring program to be instituted by our organization will ensure that every professional is paired not only with a principal mentor, but also with an array of contact points, a network of support which will help employees better cope with personal and professional challenges, and with finding an appropriate balance between them. Sexton, Lemak, and Wainio (2014) argue that this program of multilayered support can be particularly helpful for female employees. However, these authors argue that mentoring is, in fact, only one element of an essential, concerted effort to support these personnel. The authors contend that mentoring must be combined with career planning and, in particular, with sponsorship, as a means to recruit, advance, and retain female employees. Sponsorship promotes not only support and advice but also the creation of or capitalization upon career advancement opportunities. The goal of a strong sponsorship network is to drive the development of female recruits, students, and employees by linking them to work, research, and training opportunities.
These insights also align with Broscio’s (2014) study of the role of career panning in retention and employee development. Broscio writes, “each toehold on the career lattice can be strengthened by establishing a career plan, identifying potential barriers, and making use of available resources” (p. 395). This will be a major focal point of the recruiting, mentoring, and sponsorship services we will provide to new and established talent. As Broscio notes, the most effective career plans are those which are adaptable, frequently reviewed, and adjusted as needed to ensure employee development, secure evolving employee goals, and promote employee retention by ensuring continued alignment of employee and organization objectives. Gathers (2003) found that these strategic recruiting and retention techniques are essential to building a diverse workforce because these can remove the “artificial barriers that can individually hinder the advancement of qualified women and minorities. These barriers included various recruitment practices and the failure to include women and minorities in ‘corporate developmental exercises,’ such as key rotational assignments, mentoring, and training” (p. 14). Prospective, new, and established talent must understand that there is a place for them within the organization, both today and tomorrow. Recruiting and retention must be focused on supporting employees in developing a vision not only of themselves as professionals, but also of the organization—its present as its future. Above all, these recruiting and retention practices must enable employees to see how these two images align, to see the organization and their unique and invaluable role in it, both in the current moment and in the years to come.
Outreach and Communication
Another essential aspect of achieving our diversity goals is in the cultivation of clear, effective outreach and communication strategies specifically tailored to our target communities. This is important because research has shown that disparities in communication protocols can exert a profound influence on behaviors and relationships. In a study of technology-utilization by minority patients Hyun Kim, Samson, and Lu (2010) found that minority patients tend to be less likely than white patients to use sophisticated communications technologies provided by some hospitals. What is salient for the purposes of this proposal, however, is that such studies illustrate the effect of communication habits on behavior and interpersonal interaction as a whole. In order to be successful in building a diverse executive leadership, it is incumbent upon use to develop communication and outreach programs which are attune to those in use in minority and female communities. Recruiting, development, and retention strategies that are heavily technology-based, such as internet-reliant methods, will inevitably exclude certain populations which by choice or necessity infrequently use them. For this reason, our organization will focus on analyzing the most effective and prevalent communication and networking practices in place within target communities and on tailoring our outreach to meet our targets’ communication needs, requirements, and expectations. Only then will it be possible to begin to develop the kinds of relationships on which diversity recruiting and retention depend.
One of the greatest challenges we will face in this endeavor to build a thriving, effective, and customized communications and outreach strategy, however, is the sheer size and complexity of our organization. Richard, Roh, and Pieper (2013) found that diversity initiatives are typically less successful in larger organizations. In large part, the authors suggest, this can be attributed to the more competitive, performance-driven ethos of large organizations. Another challenge is that these large institutions tend to erase individuality, instituting an image of the workforce as a departicularized, singular entity comprised of anonymous parts. Workers’ individuality can be lost in this mammoth system, making it more likely that those traditional competitive business models will prevail. Thus, as Richard et al. assert, the key to overcoming the particular challenges of large organizations is to make concerted efforts to ensure stakeholder buy-in, particularly in ensuring that executives and decision-makers are on board with, committed to, and engaged in established diversity efforts. When it comes to communication and outreach in particular, stakeholders may be persuaded the more they understand the positive effects on performance and revenue when these protocols are implemented. Kmec and Skaggs (2014) found that there still exists a dearth of sound research on diversity practices, including EEO protocol implementation, and the impact on organizations and industries at local, state, and federal levels. The institution of complex, multivalent, adaptive, and proactive communication and outreach protocols must be based in and proven by evidence-based practices to ensure cohesion and cooperation at all levels and to drive the efficacy of the practices themselves.
An example of evidence-based practice in outreach and communication is Northeastern University’s “Shadow Day” program, which, as Larrieux, Izzicupo, Kapadia, and LaTorre (2012) have shown, has been highly effective in recruiting minority students into the healthcare field. Likwise, Osborne (2008) found a similar positive effect between communication and outreach and the success of black female nursing professionals, as they sought to rise to the executive level. Similar to the mentoring and sponsorship protocols previously discussed, the significance here is that the methods followed will be customized to the needs and requirements of the target minority and female population. Our organization will need to employ professionals trained in communications and diversity outreach to ensure that effective methodologies are consistently developed and, as needed, revised, in order to build the awareness, relationship, trust, and investment within the target communities.
Performance in Female-Led Organizations
The challenges of promoting cohesive and effective diversity initiatives in large organizations, especially in the face of insufficient research proving their effectiveness, illustrate the powerful role that research will play moving forward. Thus, another core element of the work we do in this program will be to ensure on-going, rigorous research analysis of existing, proposed, and potential methodologies. For example, Dezso and Gaddis Ross (2012) have found that female-led organizations tend to outperform counterpart organizations led by men. This presents an important research opportunity as we seek to understand and capitalize on this research data as a means to identify future best practices for our own organization. Our diversity initiatives, then, must feature a heavy emphasis on research, a focus on continuous professional development derived from on-going employee training, conference participation, and research to identify, assess, develop, and improve diversity protocols.
Managing Change: The Great Ideological Divide
At the most fundamental level, the diversity initiatives proposed here must center upon change management. A definitive cultural shift must occur if diversity goals are to be met. The reality is that despite an avowed commitment to inclusion in recent decades, the wide gaps in employment and achievement which still exist point to a systemic problem that is far more ideological than logistical. Branin (2009) argues, for example, that the wage gap between male and female executives, as well as the disproportionate number of males at leadership positions, in comparison with the larger distribution of predominantly female personnel at the lower levels, reveal the continuing impact of outmoded perceptions of women in the workplace, including punitive attitudes and behaviors toward those women who incur employment gaps for the purposes of caring for children or aging relatives. A corollary to this is the perception that women’s wages are, in essence, tangential to the upkeep of the household. Such ideologically-informed practices in executive development and compensation are informed by anachronistic and sexist models of the traditional patriarchal family structure, in which the male is the primary breadwinner. In the face of increasing numbers of female-headed households, or of households in which the female is the primary wage earner, then, once again, we have an organization whose leadership structure does not in any way correspond with the daily lives and realities of either our patients or our staff.
To combat these crippling ideological norms, which inform our organizational practices even when we are not consciously aware of them, we must operate across the next five years from a perspective of change management. This will require strong, effective leadership to help galvanize this change. Herrmann and Nadkarni (2014) in their study of the effect of CEO personality on change management in crisis situations found that the most effective leaders were those who combined clear authority with strong, supportive relationship building grounded in effective communication and a shared vision of future success and each individual’s role in achieving success.
This is the work that must be done in our organization as well, and it must center upon understanding why disparities in minority and female representation, achievement, and compensation at all levels, and particularly, the executive level, continue to exist. This will be arduous and painful work, as it may require uncovering some difficult truths about our organization and ourselves that we perhaps never knew and do not want to acknowledge. Only by bringing such subconscious attitudes, values, and objectives to light, however, can we begin to understand, evaluate, and change them. This is the cultural shift that must occur within the organization if it is to be as diverse and inclusive as we claim to desire.