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Column | Leadership

Joe Fifer: DEI at the healthcare leadership level: Where do we stand?

Column | Leadership

Joe Fifer: DEI at the healthcare leadership level: Where do we stand?


Joe Fifer


As the nation marks Black History Month, there is no shortage of commentary in the media about progress (or the lack thereof) in diversity, equity and inclusion (DEI) on a societal level, and in the healthcare industry overall. But I don’t see as much attention to where healthcare stands when it comes to DEI at the leadership level.

Assessing progress

I wanted to know whether the industry has made progress in this area since my first message to the HFMA community about DEI-related issues in July 2020. The short answer is: As an industry, we can do better.  In HFMA’s 2021 report, Workforce of the Future, Bluford Healthcare Leadership Institute President and Founder John Bluford estimates that perhaps 14% of healthcare administrators in C-suite positions are Black or Hispanic, compared to a minority patient base of 32%. 

“Even though there has been a focus on increasing the diversity of the workforce, we have made little progress,” Bluford tells us. “Not nearly enough.”

Like many other healthcare organizations today, we at HFMA are focusing more on diversity. And that’s an essential first step. But we count ourselves among the organizations that can do better. We know we need to go further.

Expanding the focus to include implementation

Across the industry, healthcare leaders realize that achieving DEI goals will require more than increasing focus. The rigor that is brought to all major business goals should apply to executing on diversity goals as well. There is a sound business case for enabling all Americans to participate fully in the workforce and reach their maximum potential, as the W. K. Kellogg Foundation lays out. In this era of workforce shortages, the business case is even more compelling.

Recognizing the scope of the challenge

The DEI challenge goes beyond hiring, of course. If diversity is inviting everyone to the table, inclusion is involving everyone in the conversation. A June 2021 commentary in the New England Journal of Medicine urges healthcare leaders to realize that diversity is necessary but not sufficient to create a just and inclusive culture. These are areas where leaders may have blind spots, the authors tell us. They cite research suggesting that managers tend to have more favorable perceptions of their organization’s diversity and inclusiveness than employees who are not managers — regardless of the race of the manager. 

Taking an active role

That brings me back to the heart of my message to the HFMA community in 2020: Stop, listen and care. We all have ideas about what racism is and how it applies, or doesn’t apply, to us and to our organizations. Whatever our ideas may be, we should pause and do our best to set them aside when an opportunity arises to listen to the ideas of others. When we listen with curiosity and empathy, and without defensiveness, we may learn what microaggression (i.e., everyday racism) feels like. We may discover that someone’s lived experience as an employee is not consistent with the DEI values our organization purports to hold. Finally, we must summon the energy to care enough about what we’ve learned to follow through with action, when appropriate.

The late Martin Luther King, Jr., famously said that “the arc of the moral universe is long, but it bends toward justice.” There is reason to hope that’s true. But good intentions are not enough. As former U.S. attorney Joyce White Vance pointed out recently on Twitter, the moral arc of the universe is not going to bend itself.

About the Author

Joseph J. Fifer, FHFMA, CPA,

is president and CEO, HFMA, Westchester, Ill.

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