March 12, 2021 – The dramatically heightened national attention to racial justice has foregrounded the discussion of diversity recruiting in every industry sector, and healthcare is no exception. The issue has multiple contours, and progress depends on a deeper understanding of all of them. A new report by AMN Healthcare draws on independent research and experience to present information on current industry status, influences that must be addressed, and promising success strategies in three key areas: diversity, equity and inclusion (DEI); recruiting (which includes growing the academic pipeline); and workforce development. The analysis takes into account the implications of the coronavirus crisis.
At the outset, the relationship should be noted between diversity, equity and inclusion, a synergistic triad, said AMN. Despite some definitional variation, diversity generally refers to hiring people with different backgrounds; equity suggests fair treatment and opportunities for all individuals; and inclusion describes ensuring that all feel they belong and are valued. “When executed well, this triad is conducive to a healthy, engaged, and participatory workforce,” the report said. Another important foundational concept is that diversity is multidimensional. AMN has consistently identified what it terms the ‘complexity of diversity.’
DEI must become deeply embedded at all strata of the organization chart, from entry level to senior management, according to the AMN report. “Too often, diversity programs have concentrated narrowly on upper levels creating unintentional diversity barriers,” the report said. “Comprehensive, meaningful diversity depends on addressing the range of administrative and clinical roles, including emerging ones. Doing so helps avoid gaps that can thwart a broadly diverse culture. Each organization will navigate this complex matrix differently, but keeping the framework in view is essential to taking an integrated approach, not simply having a diversity program.”
Building Momentum for Change
AMN Healthcare points to several powerful forces that are providing impetus for renewed focus on DEI in healthcare. Below are some of the primary ones:
Impact of COVID-19 Crisis
“Perhaps most prominently, the coronavirus crisis has spotlighted inequalities. It has been widely documented that COVID-19 has disproportionately affected the health of minority and economically disadvantaged populations,” the report said. “So too has the crisis’ economic fallout, manifested in problems such as health insurance gaps. Women have also lost healthcare jobs due to the pandemic at notably greater rates than men.”
Importance of Diversity
Many analyses across industries have concluded that diverse organizations tend to outperform less-diverse peers in:
- Dealing with complexity. As AMN’s Dr. Bernard Godley said in a recent panel, “Difficult problems and complex organizations are best addressed by diverse teams.”
- Innovation. Companies that have achieved diversity on multiple dimensions are stronger innovators than those that haven’t.
- Improved board performance. Conference Board analysis indicates that cognitive diversity can expand a board’s knowledge base, increase director independence and engagement, and improve board culture and decision-making.
- Financial results. A cross-industry study found that “female leaders and gender-diverse boards are linked to better stock prices and profitability.”
- Talent management. In a recent global study 80 percent of respondents said their DEI strategies are critical to attracting and retaining talent, with 47 percent increasing their investments.
Pinpointing progress in achieving DEI objectives helps establish strategic baselines, according to the AMN report. There have been relatively few healthcare studies over the years that consistently benchmark attainment levels. A recent survey by McKinsey that included healthcare companies and providers offered some illumination. Women occupy 30 percent of C-suite positions and people of color represent 16 percent. The latter appears to be up slightly, as previous estimates have hovered around 10 percent. The numbers improve for women at the VP/SVP levels, but show little increase for executives of color. The picture looks brighter at lower management levels, except for a persistent static percentage for men of color.
Proactive diversity recruiting programs have a way to go in healthcare. The AMN Healthcare Leadership Diversity survey saw only 43 percent of organizations claiming to make diversity a primary recruiting focus. The concern is that “an organization’s lack of diversity is often tied to inadequate recruitment rather than an empty pipeline.”
AMN Healthcare offered these DEI improvement steps:
- Start at the board level. It clearly helps if hospital and health system boards possess meaningful diversification. One expert urges ensuring that recruiting is not limited to the usual board member networks and having multiple directors interview candidates with an emphasis on discerning the level of cognitive diversity the candidate proffers.
Executive recruitment firm AMN Leadership Solutions named former oncology clinical nurse specialist Christine Mackey-Ross as president of the firm’s executive and physician leadership search practice. Bernard Godley will add leadership of the academic and life sciences practice to his current title of lead physician executive for AMN Healthcare, continuing his dedication to recruiting visionary physicians and scientists to key leadership positions. Jennifer Schaulin has been named as pediatric practice lead for AMN Leadership Solutions, a division of AMN Healthcare. She will take over as the leader of the pediatric practice, focusing on physician leadership and c-suite searches.
Newly launched AMN Leadership Solutions, a division of AMN Healthcare, provides a complete range of healthcare leadership search and talent solutions including executive and physician leadership search, interim and leadership search, physician and advanced practice recruitment, recruitment process outsourcing, and leadership and talent optimization services.
- Set specific targets for recruiting women and underrepresented minorities. Evaluate legitimate, achievable goals for all organizational levels and roles. An assertive corollary is to require diverse candidate panels for certain searches.
- Create diverse search committees. Diverse hiring committees make a clear statement to candidates and bring varied perspectives to the process.
- Set clear evaluation criteria. A leading consultant asserts the value of setting evaluation criteria in advance of the process, with full transparency to bolster the perception that the hires are merit-based.
- Seek more leaders from outside the organization. Hiring from outside rather than relying heavily on internal promotions can augment diversity. There is some evidence that this move can be beneficial for gender diversity at key senior executive levels. Nearly half of vice president and higher positions were occupied by externally recruited individuals.
Workforce and Leadership Development
DEI programs that successfully tackle the “complexity of diversity” rely on diligent attention to workforce management and leadership development activities. The report cited four strategies that merit consideration:
- Focus on advancement across management levels. Women and minorities remain stubbornly underrepresented in senior management. Analytics can uncover specific advancement stress points. For example, one study documented that a particular hurdle for women of color in healthcare is the jump from manager to senior manager/director. Promotion pathways may need alteration.
- Reconsider implicit bias training. Several analysts question whether these training programs “result in permanent, long-term reductions of implicit bias scores or, more importantly, sustained and meaningful changes in behavior.” Instead, some propose two alternative tactics to counteract bias. First, collect and analyze data, allowing people to see the evidentiary bias patterns. Second, replace subjective judgement in relevant decision-making with objective criteria.
- Concentrate on proven development techniques. Meaningful mentoring and sponsorship help emerging leaders learn, advance, and engage deeply with their organizations. Unfortunately, such opportunities are less available to an underrepresented minority (URM). A recent poll showed that 27 percent believe “lack of mentors or sponsors is the most important issue facing persons of color in the healthcare industry.” Well-constructed, culturally sensitive development programs are important.
- Increase inclusion. Many levers can be pulled in service of inclusionary outcomes. Research suggests that leadership modeling and a culture of inclusion are key success factors.
Staying the Course During the Covid-19 Crisis
The serious dislocations from the coronavirus crisis have prompted concern that diversity efforts may take a back burner in this environment, according to the AMN Healthcare report. What can be done to preserve momentum? “While some constraints on budgets and management attention are inevitable, two factors should be considered,” the report said. “First, building sustainable DEI success is a long-term endeavor that can be seriously set back by interrupted investment. Second, the current moment presents a significant – even unique – opportunity to achieve major progress.”
The pandemic has curtailed face-to-face hiring, medical school interviews, and others. Video interviews, virtual experiences to showcase residency opportunities to candidates, and others help keep DEI programs on track. One analysis adds that many professionals of color may find virtual networking more comfortable and authentic.
“Arguably, breakthrough progress in healthcare DEI has never been more achievable – even amidst a pandemic.,” said AMN Healthcare. “A path to success can be delineated by a set intersecting strategies in the vital areas of recruiting, growing the academic pipeline, and workforce/leadership development. Deploying these with commitment offers promise to accelerate realization of healthcare that is truly, effectively, and sustainably diverse.”
Contributed by Scott A. Scanlon, Editor-in-Chief; Dale M. Zupsansky, Managing Editor; and Stephen Sawicki, Managing Editor – Hunt Scanlon Media