Top-Down Approach as a Solution for Diversity in Healthcare Workforce

Mounika Kata

Demographics in the United States are rapidly changing. By 2043, the nation will be “majority-minority” according to projections by the U.S. Census Bureau [1]. The nation is already experiencing this shift with minorities accounting for 98% of the population growth in large metropolitan areas [2]. This shift will have significant implications for decision-making and care delivery as the healthcare industry transitions from a physician-led model to a patient-centric model.

As the U.S. population becomes more diverse, the business case for the healthcare workforce to reflect the racial, ethnic, and socioeconomic backgrounds of the total population is compelling [3]. Such a representation is essential in addressing the barriers to healthcare access which ultimately lead to quality and culturally competent service delivery. This is also important in addressing healthcare disparities among minority communities who are often impacted by other socioeconomic factors such as income, education, and lack of insurance [4].

Despite these pronounced benefits, minorities have been historically underrepresented in the healthcare workforce. For example, in 2000, African Americans accounted for approximately 12.7% of the population but represented only 4.4% and 8.8% of physicians and nursing staff, respectively [5]. Furthermore, in 2015, only 5.7% of medical school graduates were African American [6]. This disconnect is expected to worsen due to anticipated physician shortage in the coming years, combined with lack of representation in the pipeline. The latter can be overcome by equipping these groups with preparation and resources for academic success, mentorship programs for talent recruitment, and increased awareness of healthcare opportunities [7]. Some programs, such Winston-Salem State University, have already implemented these changes into their curriculum with a commitment to expand the pipeline with diverse and qualified candidates to reduce healthcare disparities [8]. Also, state and federal policymakers are calling for training programs to encourage underrepresented students to explore health careers through academic support, financial incentive programs, and lectures and workshops supplementing the K-12 curriculum [7].

In addition, diversity in senior management positions can better serve the growing minority patient populations. This broadening would expand thought diversity at the “top” of the organization, and the benefits of this are often underestimated. According to a 2015 McKinsey report, companies in the top quartile for ethnic and racial diversity in management were 35% more likely to have financial returns above their industry mean [9]. This report further established that for every 10% increase in racial and ethnic diversity at the ‘top’, pre-tax earnings rose 0.8% [9].

Yet, minorities are disproportionately failing to attain such high-level positions, specifically at the C-suite level or the Board of Directors. In a 2013 Institute for Diversity survey, minorities represented 31% of patients nationally [10]. However, they represented only 17% of front- and mid-level management positions. These figures worsened with 14% and 12% representation at the executive and board levels, respectively [10].

Companies with diverse executive teams enforce stronger governance practices and increased successes with innovation and operations. These teams are also more likely to remain objective, challenge their conscious and unconscious biases, and apply various perspectives in decision making [11]. In addition, diverse leadership teams also demonstrate opportunities for minority groups.

With minorities’ underrepresentation, the ‘trickle-down effect’ becomes increasingly important. The leadership sets the tone, and the teams follow their example. This executive team’s behaviors and practices drive the underlying interactions between employees and consumers. Such passing down of values-based behaviors can stifle a company’s progress in the diversity of their workforce, management teams, and senior executives. The lack of diversity at this level could lead to unawareness of unconscious biases and unchallenged assumptions. As a result, their perspectives and policies would be inclined towards hiring and promoting those with similar characteristics. This would also influence the front- and mid-level management to adopt similar behaviors and practices, thus causing a domino effect. Due to lack of shared values, recruiting diverse talent and retraining a diverse workforce becomes challenging. This will have a negative impact on the organization’s overall performance. Thus, diversity initiatives must be expanded to both executive management and the workforce.

To further explore the influence of diverse leadership, CHI is organizing the 8th annual Diversity, Inclusion, & Health Equity Symposium on 6/27/18 in Chicago, which is a leading annual, collaborative event focusing on health equity and health disparities in the U.S. The symposium brings together leading healthcare professionals, executives, physicians, patient groups, patients, researchers, academics, clinical trial professionals, and diversity and inclusion advocates to discuss health equity in the life sciences and the health sectors. The symposium focuses on the latest trends, challenges, opportunities in both the marketplace and workplace, with a specific focus on how to best serve an increasingly diverse patient base. We also aim to address the broader health disparity challenges in the U.S., and the symposium equips attendees with the latest insights and ideas. Attendees will learn practical solutions, share perspectives, and meet new industry and marketplace colleagues. Visit for more information and registration.

1. U.S. Census Bureau Projections Show a Slower Growing, Older, More Diverse Nation a Half Century from Now. U.S. Census Bureau. Accessed April 17, 2018.
2. White neighborhoods get modestly more diverse, new census data show. Brookings. Accessed April 17, 2018.
3. 2015 Kelly Report: Health Disparities in America. Office of Robin Kelly. Accessed April 17, 2018.
4. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Institute of Medicine. Accessed April 17, 2018.
5. Fact Sheet: The Need for Diversity in the Health Care Workforce. Health Professionals for Diversity Coalition. Accessed April 17, 2018.
6. Diversity in Medical Education: Facts & Figures 2016. AAMC. Accessed April 17, 2018.
7. Racial and Ethnic Disparities: Workforce Diversity. National Conference of State Legislatures. Accessed April 17, 2018.
8. Improving Diversity in the Health Professions. North Carolina Medical Journal. Accessed April 17, 2018.
9. Why Diversity Matters. McKinsey & Company. Accessed April 17, 2018.
10. Diversity and Disparities: A Benchmark Study of U.S. Hospitals in 2013. Institute for Diversity in Health Management. Accessed April 17, 2018.
11. Why Diverse Teams are Smarter. Harvard Business Review. Accessed April 17, 2018.

Mounika Kata

About Mounika Kata