Health Equity

Managing executives who don’t recognize the value of diversity

In this Health Evolution Confab Leaderships Series installment, CEOs discuss tactics for advancing equity with data, trust, accountability, appropriate actions and more.

Tom Sullivan | May 12, 2021

Diversifying the C-suite, senior leadership and workforce is a journey for the nation — and for health care CEOs it is also becoming an important aspect in the pursuit of organizational excellence.

The work starts at the top, of course, but not every member of a CEOs leadership team will understand the reasons to undertake it. Complicating matters, discussions about racism, poverty, sexism, inequity and all disparities are sensitive in nature and difficult to begin.

CEOs can lead work to advance equity in the leadership team by employing the following:

    • Using data to illustrate the problem’s scope    
    • Building a safe neutral space to discuss uncomfortable topics
    • Establishing executive and enterprise-wide accountability
    • Paying attention to actions as opposed to identities
    • Recognizing when an individual is not suited to the mission

Using data to illustrate the problem’s scope
As difficult as discussions around diversity and inclusion and other sensitive topics can often be, leveraging data serves as an important tool in creating an informed foundation to more effectively understand and ultimately address the problem.

“It starts with just looking at the data and then it becomes about how we interpret this and how willing we are to move forward,” said Carrie Byington, MD, Executive Vice President, University of California Health. “Using data is really an important step, especially for leaders accustomed to making data driven decisions.”

As an example, Sachin Jain, MD, President & CEO, SCAN Group and Health Plan, recounted an experience with a leader on the team who felt that increasing the organizational focus on diversity and inclusion was actually being unfair because it was already in progress.

“That person just hadn’t seen the data,” Jain said. “The reality was our data showed a gap between the population demographics of Medicare eligibles in our service areas and our membership, and once they saw that they got on board pretty quickly.”

That’s not to suggest illustrating realities about disparities will convert every C-suite executive or member of the leadership team. Leveraging data, however, also brings the benefits of not inadvertently alienating people with good intentions and enabling CEOs to identify individuals unlikely to change their thinking relative to diversity.  

I conducted discussions for the senior most leadership. It was gut-wrenching. It was revealing. It was hard, but I'm happy to say in many cases it was also transformational.

Lloyd Dean, CEO, CommonSpirit Health

Building a safe neutral space to discuss uncomfortable topics
The natural extension beyond understanding the data is to create trust in the workforce and, when appropriate, the broader community to facilitate sensitive discussions and educate people who want to do the right thing.   

“It can be very difficult to find out that something that you have done or that you believed in is somehow causing harm,” Byington said. “CEOs need to create enough trust that people can talk about their positions without feeling blamed.”

Executives and employees, instead, should be encouraged to want to work together in tackling disparities and provided with the direction, ability and knowledge to do so. Another key component of building trust into the culture also requires bringing people at all levels into the organization who are aligned with the mission to improve diversity, said Mandy Cohen, MD, Secretary, North Carolina Department of Health and Human Services.

“When you are hiring people you have the opportunity to asses for that alignment,” said Lloyd Dean, CEO, CommonSpirit Health. Executives and the workforce already on staff are another matter altogether, Lloyd said, for which education is essential. As is accountability.

Establishing executive and enterprise-wide accountability
Dismantling disparities is unquestionably difficult work that is made more complex due to health care structures that uphold long-standing systemic inequities.

SCAN, for instance, investigated its own membership data and found it is under-penetrated in racially and ethically diverse communities, which presented both a problem and an opportunity. Jain said there is something about how SCAN positions itself that makes it more appealing to Caucasians than African Americans, Latinos or Asians and SCAN realized it could serve an even broader base of the Southern California population. Doing that requires substantive changes to business functions, such as network contracting and marketing to appeal to specific populations.

“We’ve also tried to drive greater internal and external transparency around our performance as it relates to serving diverse populations,” Jain said. “We’re actually tying 15 percent of our annual bonuses to whether we can close those gaps.”

When disparities are understood and enough trust exists to discuss not only the problem but also solutions to advance equity, organizations can only make limited, if any substantive, progress without incorporating accountability in upper management and throughout the enterprise.

Dean explained that such accountability needs to be firm for everyone. The executive team in particular must adhere to the organizational priorities, measurement of activities and leadership structures put in place to advance equity.

Paying attention to actions as opposed to identities
Conversations that take place in the board room and C-suite include the difficult reality that no leaders should be presumed as aligned with diversification efforts without specifically assessing whether a particular individual is operating appropriately or ethically from a diversity and inclusion perspective.

“I’ve worked with and for minority leaders who don’t care about these issues and I’ve worked for people who are non-minorities who cared a lot about these issues,” Jain said. “We tend to talk about the Black CEO or the woman leader in charge of this or that — and it’s a distraction.”

Rather, CEOs should evaluate C-suite and upper management colleagues based on the behaviors as well as any and all actions that follow their leadership because every group has its own set of dynamics.

“If you’re an Indian American leader, there are chances you could demonstrate bias toward Indian Americans,” Jain said. “If you’re a woman leader, you could do the same thing around women’s leadership.”

CEOs should not be entirely comfortable with the notion that hiring or promoting a leader from a different background will naturally result in diversity. That doesn’t always translate. It needs to be the right person.

Recognizing when an individual is not suited to the mission
Diversity and inclusion have to become part of the organization’s culture to have any promise of lasting.

During the height of racial demonstrations taking place in the nation, CommonSpirit’s leadership felt that it was imperative to host what Dean described as “courageous discussions,” that were “transparent but very deep,” including different points of view about Black Lives Matter and politics, as two examples.

“This was important because when you have 150,000 members of an organization, you’re going to have different points of view represented in the different communities,” Dean said. “I conducted discussions for the senior most leadership. It was gut-wrenching. It was revealing. It was hard, but I’m happy to say in many cases it was also transformational in that people realize there is such a thing as racism that is unintentional and that some of the behaviors we began to talk about were institutional even in how care was being delivered.”

Likewise, when Cohen began at North Carolina HHS the leadership team was not diverse. “It required us making leadership changes to make room for folks from diverse backgrounds, which means I had to actually ask a couple of senior people to not be part of that leadership team anymore in order to bring on leaders that reflect the communities we serve,” Cohen said.

Some of those people stayed with the organization in different roles, not in senior leadership roles. “The hard thing as a leader is that you have to make those choices,” Cohen said.

Cohen added that leaders set the tone and expectations. Beyond that, if some colleagues or employees do not align with the enterprise’s mission those individuals may not need to be part of it moving forward.

“There’s an opportunity to continue to evolve people’s thinking, but in health care we have this view that everyone needs to get bought in eventually. And my view is if they’re not bought in quickly, they’re off the bus,” Jain said. “If they don’t get it then they don’t have a role on my team. It’s just that simple.”

What’s clear is that CEOs must thoroughly think through diversity and inclusion issues and consider how to surround themselves with the most impactful executives in the C-suite, board room and senior leadership teams to advance equity.

Indeed, achieving diversity and equity holds considerable potential to ultimately make organizations more successful. But the work is hard and requires that CEOs be intentional and clear about it, then dedicate enough time to ensure it is conducted properly and not become empty rhetoric.

“Organizations that see equity in the same vein as continuous quality improvement tend to be organizations that have embraced high quality in every aspect and they are the higher performing organizations,” Byington said. “This is another layer to establishing the excellence of an organization that is likely to thrive in the future.”



The in-person Health Evolution Confab 2022 is scheduled for September 15-16 in Nashville at The Joseph Hotel. Learn more or apply to attend.
Related articles from Confab 2021: 
From the frontlines of addressing inequity: ‘Health equity is quality and safety work’
Is the concept of ‘social determinants of health’ inhibiting progress toward equity? 
For health care leaders, a fork-in-the-road moment in addressing health inequity 
How health care leadership is evolving amid the crises of 2020-2021

About the Author

Tom Sullivan, EVP & Editor-in-Chief of Digital Content

Tom Sullivan brings more than two decades in editing and journalism experience to Health Evolution. Sullivan most recently served as Editor-in-Chief at HIMSS, leading Healthcare IT News, Health Finance, MobiHealthNews. Prior to HIMSS Media, Sullivan was News Editor of IDG’s InfoWorld, directing a dozen reporters’ coverage for the weekly print publication and daily website. Contact: or @SullyHIT on Twitter.