Results from the key informant interviews revealed that White executives and
executives of color agree that people of color are underrepresented in executive healthcare
leadership roles. Responses support findings from the literature review such as the
importance of mentoring, perspectives about barriers that prevent executives of color from
getting beyond the middle management plateau, and the importance of cultural competency
in promoting access to healthcare to people of color.
Research Question 1: What are the opinions of White healthcare executives and executives of color regarding the race of healthcare executives and how it may affect access to care for people of color?
Key informant responses indicated that both subgroups believe that diversity on the
executive healthcare leadership team is important. Responses suggested that more diverse
executive leadership teams are more apt to make decisions that increase access to healthcare
services for people of color. Informants believe that the level of diversity can have a positive
influence on guiding access to healthcare for people of color. Informants also believe that the
race of healthcare executives can impact access to healthcare by people of color.
Responses from informants point to the identification of community touch points as
one way in which more diverse leadership teams can improve access to healthcare. The most
frequently mentioned example of a community touch point was the African American
Church. This idea is supported by a previous study that was conducted by Aaron, et al. The
more likely to access healthcare services and engage in healthy behaviors [57]. White
healthcare executives and executives of color alike observed that these community touch
points might be missed if the leadership team does not have representation from people of
color.
Research Question 2: To what extent do White healthcare executives and executives of color vary in their opinions about solutions for improving access to healthcare for people of color?
More than any other response, cultural competency was stated by informants as the
way in which they would approach solving healthcare disparities for people of color.
Healthcare executives of color and White healthcare executives are in agreement as it
relates to cultural competency, healthcare reform, and improving physician reimbursement as
ways to combat healthcare disparities for people of color. While these tactics represent
agreement of perspective among the subgroups, it is important to note the secondary
suggestion for improving disparities, which was Education, was unique to executives of
color.
Looking at responses on an aggregate level, the most important tactics to improve
access to healthcare for people of color as 1) Cultural Competency, 2) Education, and 3)
Healthcare Reform.
In addition to be being important for the identification of community touch points,
cultural competency was described as providing the ability to see blind spots within policy
making that might arise in situations where the perspectives of people of color are not
present. Informants described the benefit of culturally competent leadership as a safety
mechanism that helps leaders avoid policies that might otherwise limit access to healthcare
The focus of this research project deals with the primary tactic of assisting institutions
with increasing diversity as a means of increasing cultural competency which will in turn
increase access to healthcare services for people of color. The suggestions from informants
to use education, healthcare reform, and improving physician reimbursement to address
healthcare disparities provide the subject matter for future research projects.
The analysis of the career pathways of the informants involved in this study shines
light on how to address the underrepresentation of people of color in executive healthcare
leadership roles. The personal accounts of some of the executives of color interviewed
illustrate the additional barriers that prevent executives of color from attaining executive
leadership roles to the same degree as their White counterparts. Their personal accounts are
supported by an updated study that was conducted by ACHE and NAHSE. The 2008 study is
an update to the previously cited study that was conducted in 2002. The purpose of the
original study and its subsequent updates was to assess the career attainments of members of
both professional societies. The assessment was done in an effort to compare career
attainments across racial and ethnic strata. Probably the most salient points from the ACHE/
NAHSE study were the reports by people of color that discrimination had caused them to not
be hired, prevented them from receiving fair compensation, and subjected them to
performance evaluation standards that were inappropriate [5]. Almost forty percent of
African Americans in the ACHE/NAHSE study stated that they were not promoted because
of their race or ethnicity.
The ACHE/NAHSE study supports two assertions that were made by executives of
reported that they felt that executives of color usually have to be more qualified than others
to get ahead in their organization. They also expressed a greater desire for their respective
organizations to increase the representation of people of color in senior leadership roles [5].
In 2011, Witt/Kieffer surveyed healthcare leaders across several dimensions. The
Witt/Kieffer study found that White executives explain the absence of people of color from
executive leadership ranks as being the result of an absence of candidates of color in the
applicant pool. In contrast, executives of color said that a lack of commitment by top
management to recruit, retain, and promote candidates of color is the primary barrier for
career attainment [58].
The findings highlighted in the ACHE/NAHSE study and the Witt/Kieffer studies
resonate with comments made by informants during the interviews conducted for this
research project. All three studies highlight the need for commitment from the most senior
executives within institutions to build more diverse and culturally competent leadership
teams. The second most important commonality between the studies is the need for
formalized mentoring programs to assist in the development of executives of color.
The implementation plan developed as part of this research addresses the issues
associated with getting more candidates of color into the selection processes for executive
healthcare leadership roles. The implementation plan provides a pathway for both
individuals and institutions to follow from the earliest stages of career development to
executive leadership roles. As more and more candidates of color navigate this pathway and
overcome the barriers to career attainment, institutions will realize greater levels of diversity
Limitations of the Research
One of the limitations of this research project is that it was geographically limited to
North Carolina and South Carolina. The majority of the executives of color are African
American. There was one executive of color who is of Native American descent. The
ACHE/NAHSE study and the Witt/Kieffer study were national studies with representation
from a larger array of executives of color. Additional ethnic groups such as Asian American,
Pacific Islander, and Hispanic were included in those studies but were not represented in this
study. One of the disadvantages to geographically limiting the informant pool was that a lack
of participation by informants in one state translates into a greater focus on responses from
informants from the other state. This was illustrated in the key informant descriptive data.
A small number of participants from South Carolina naturally meant that the majority of
responses would come from informants in North Carolina. Another disadvantage to the
geographical limitation placed on informant selection is that it essentially limited the
selection of people of color to primarily African American executives. There were a number
of instances during the informant interviews when the author reminded both HECs and
WHEs that references to people of color were meant to encompass all people of color and not
just African Americans.
The research study was also limited in that the number of informants was small. The
intent of this study was to identify an equal number of White executives and executives of
color willing to participate in this study. Midway through the interviews of executives of
color, it was observed that a number of recurring themes had already been established. These
themes reoccurred in the remaining HEC interviews. This was not the case, however, with
HEC interviews was not observed in the WHE interviews. This suggests that the study may
have been benefited from interviewing a larger number of White executives. In many of the
scholarly works cited in this study, the sampling frames have included much larger numbers
of respondents. Replicating this research study on a larger scale and within a longer
timeframe might provide the research community with yet another future research
opportunity.
Bias may have been introduced in this study because of the selection of key
informants with whom the primary author had an existing relationship before conducting this
research. The author made a conscious effort to mitigate selection bias by extending
invitations to participate in this study regardless of what the author thought their perspectives
on the subject matter of this study might be. The author did not choose people based on how
the author thought they might answer the questions. There is a possibility that some of the
informants interviewed and the author might share similar or same perspectives on the
subject matter involved in this study. In some cases, this might be a result of having worked
alongside some of these informants in organizations with specific corporate values such as
inclusion, succession planning, and a culture focused on diversity.
Bias may have also been introduced if there were instances in which an informant
chose to provide a socially acceptable answer to an interview question as opposed to