Because patients in the health care system represent every racial, ethnic, and religious group in the United States, one might expect that health care administration would also reflect this diversity. However, like management in most other industries, administration in health care is not representative of society. Recent efforts by organizations like the American College of Healthcare Executives to promote diversity and encourage members of minority groups to pursue careers in health administration show an important new commitment to change. This chapter addresses the current climate, conditions, and attitudes faced by members of minorities in health administration. It focuses in particular on the experiences and expectations of African Americans and includes interviews with six successful African American health care executives.
In 1990, the American College of Healthcare Executives issued a public policy statement asserting its intention to increase opportunities for minorities in the profession of health care administration. If you are a member of a minority group and you are pursuing a career in health administration, you should look at this document as a firm promise by the professional society of health care management that you have a future in the profession.
Despite this new commitment, however, it may be some time before we can say that equal opportunities truly exist. We need a concerted effort to put theory into practice. As is the case for women,the paucity of highly placed administrators from any minority group still impedes the progress of those just starting out. Why is this case? First, because with the exception of members of religious orders, who have a distinct career path, women and members of minorities with aspirations for top jobs historically have had few role models (although before desegregation, there were black administrators in so called black hospitals). It is role models, mentors, and contacts putting in a good word for a candidate who can make the difference. Role models are very important in career development, especially in the early stages. Mentors help when needed, and good contacts can open doors.
Second, and quite unfortunately, research shows that among whites there is more support for preferential hiring for women than for ethnic and racial minorities. Because of these attitudes, you may receive different treatment, even though such treatment is illegal and unethical. Although ideally affirmative action policies would counteract such tendencies, in practice that is not always the case.
One important study, "Shaping the Organizational Context for Black American Inclusion," reviews the problems that arise at the recruitment, entry, and promotional stages for African Americans. The researchers identify three possible biases:
- Negative racial stereotypes
- The solo role, when you are the only African American in the work group
- The token role, when, as a new employee, you are viewed by co workers as incompetent merely because you have been hired under an affirmative action policy
- Biased and stressed recruitment practices
- Assumed dissimilarity and exaggerated expectations on entry
- Polarized evaluations of performance
- Segregated networks at the candidate stage
- Information bias at the entry stage
- Statistical discrimination at the entry stage
- Internal markets at the promotion stage2
My number one strategy for finding a great job in health care is networking. But make sure that you do not limit yourself to networking with members of the ever growing African American professional class. Because health care is one field in which blacks are particularly underrepresented in the management ranks, you are doing yourself a disservice by not networking across racial lines. Dr. Peter Weil, FACHE, and Nat Wesley, FACHE, who both worked on the study, recommend belonging to both the American College of Healthcare Executives and NAHSE as a way to maximize your professional network.
The most significant study on opportunities for African Americans in health care administration, "A Racial Comparison of Career Attainment in Healthcare Management: Findings of a National Survey of Black and White Executives," was conducted jointly by the American College of Healthcare Executives and the National Association of Health Service Executives and published in 1993. Its three objectives were to compare career attainments, account for any differences, and consider social policies that might redress any inequities discovered. The study quantifies differences and sheds light on this issue with a solid statistical foundation. Everyone in health care administration can learn from the anonymous responses of 853 health care executives, black and white, on the often gray issue of race.
To follow up, we spoke with a few of the lead researchers, Peter Weil, Ph.D., of the American College of Healthcare Executives, and Nat Wesley, Kevin Lofton, and Howard Jessamy of NAHSE. The comments of Nat, Kevin, and Howard, who are also members of theAmerican College of Healthcare Executives, can be found in their respective interviews.
Peter describes the difference in focus between the ACHE/ NAHSE study and the following six profiles as follows: In grade school, most of us were part of a group picture, with some in the first row, some in the middle, and some in the top. The study is like a group picture of 853 administrators. In contrast, the six profiles of outstanding African Americans who have achieved a high degree of professional achievement, found in the following section, are like individual snapshots. These six people demonstrate the range of successful strategies for minorities who aspire to executive positions in health care.
Peter is optimistic about increased opportunities for minorities in health care administration. The American College of Healthcare Executives is no longer an "old boys' club", so he encourages minority women and men to join. He also has some general insights for everyone leaving a graduate program and just starting out: "Any ambitious individual must substitute the risk taking spirit needed in real life hospital management for the spirit of inquiry cultivated in a graduate program. Grab the earliest possible chance to test yourself as a manager. Ideally, one should marry a single discipline with an assistant departmental job rather than executive assistant to gain executive experience." This advice pertains especially to African Americans, who typically serve in staff positions such as finance, which do not offer enough opportunities for running a department or a program, and who therefore miss the management experience needed for advancement to top level positions.
Interviews with African Americans in Health Care Administration
I interviewed six African Americans who have achieved top positions in health care administration. I hope you can benefit from their success stories. Because I am interested in how theory can be transformed into practice, I asked these people about their own experiences with achieving professional success in the competitive world of health care employment. Significantly, all six acknowledge that African Americans face varying degrees of discrimination, but they have found strategies for overcoming attitudinal barriers.
Howard Jessamy, President of the National Association of Health Services Executives, and President, District of Columbia Hospital Association
Career path and general outlook on minorities in the profession
Currently, Howard is the president of the District of Columbia Hospital Association, and the first African American to head one of the 52 states and district hospital associations in the United States and Puerto Rico. Since earning an M.H.A. from the University of Michigan in 1972, he has held a series of leadership positions in health care organizations, from his successful turnaround of the troubled Mound Bayou Community Hospital in the mid 1970s to his 1993 election as president of the National Association of Health Services Executives (NAHSE). He has steadily built his career and professional reputation.
Outlook for minorities in the profession
Howard encourages you to view the entire spectrum of health care administration as you seek opportunities. The under representation of racial minorities exists in all areas, and likewise the opportunities for professional advancement. Despite the decreasing number of traditional hospitals, Howard remains bullish on institutional organizations. The growth areas of managed care and health care financing whether traditional insurance or the systems that will follow health care reform will provide new positions for minorities as well.
