## Keynote Address: The Challenge for Minority Women in Health Care Leadership: The Journey Continues

(Title slide)

**Good morning** and let me say...I am truly honored to be a part of
this conference. When I asked the planners for this session what they
wanted me to talk about, they answered back...tell us about you. And
when I asked ...but why...they answered back, because you live and
breathe the challenges diversity brings ...as a woman and as a person of
color ...who is also in a role rarely held by that combination of
characteristics. And with less than 10 women of color running hospitals
throughout the United States today, they thought I would have a
something to say about diversity in health care leadership, it's
implications for the future and the patients we care for throughout our
communities. Very humbly, I will give it my best shot.

*(Change slide -- shot of you and cousin)*

As in many cultures, we often express ourselves in storytelling. I want
to begin by telling you a story. Let me introduce you two children...One
African American male and one African American female (that would be me
and my cousin Stewart). We are exactly three days apart in age, born of
working, loving parents with almost identical economic advantages and
challenges. We both attended the same primary and secondary schools and
spent after schools and summers with our Nana (our grandmother) until
our parents came home form work. If our IQ's were measured, I would
suspect we would be very close in scores. We both had a thirst for
knowledge and loved the sciences. My parents told me; however, that I
had an edge over Stewart...it's that unyielding determination that you
can probably see on my face as a young child.

*(Change slide -- Nana)*

On sunny days, after doing our afternoon chores, we would sit with Nana
on the front steps of her house and she would try to teach us things
about life that she thought was important. There is one afternoon in
particular that is etched in my memory. This afternoon, Nana told us a
story about what our life's journey would be like. "*For you Stewart*",
she said*..."you will always have the burden that all black men
carry...but you will always have more advantages than Jackie.... she has
the burden of being a black woman...her journey will be harder.... she
will need to prove herself three fold for every one act you are judged.
Looking at both of us, she said, please don't be discouraged...continue
to be the very best you can be and see the good in others. You will both
need courage and inner strength like all those who have struggled before
you."*

*(Change slide -- you and Nana)*

I really didn't understand Nana's message until much later in life...but
her words could not have been more true. My journey, like that of so
many other minorities, has been full of misperceptions about who and
what I am. Discrimination permeated my schooling and career path (as a
woman and as a minority). It was sometimes blatant, sometimes
underhanded, sometimes done without conscious knowledge from the
deliverer...and sometimes because it was just the societal norm for that
time in history. It seemed as if the outer presentation of me was both
my judge and jury, before I even got a chance to say a word. For my
cousin...it seemed as though, just being male gave him a little bit more
opportunity to be heard.... and somehow.... made him more marketable,
more accepted. So being a minority female-carried two strikes.

But there's more.... what Nana forgot to tell me about my future...is
that just being female had a burden that could stand all by itself. My
typical day would probably never mirror that of my male counterpart no
matter what job I held. There were other roles I needed to fulfill that
didn't have a paycheck attached to them or were part of my 5-year career
plan.

*(Change slide -- a typical day)*

Here's a typical day. Let's see if I hit anybody's buttons:

Okay.... 5am-alarm sound...

Wake up...what a crazy day I have today...Darn, I forgot to pick up the
dry cleaning last night...I really wanted to wear that red suit today
(power meeting at work)...why couldn't I have just five minutes of quiet
time for coffee and the paper...who set up a 7am meeting? Dog barking,
husband snoring...who said I was queen of letting the dog out in the
morning?

Starbucks on the way in...I really need espresso...three shots
please...now I'm wired...at least through the first meeting of the day.
Man, I forgot to pull down the chicken for dinner.

Here I am again, the only woman leader at the gathering of white male
leadership in our organization. They are all talking about sports and
I'm worried about if I will have enough time to do the laundry tonight.
Okay, stay with the meeting...be heard...not invisible.

This day is at a very high pace.... office is a revolving door ...fires
to put out, emotions to calm, planning underway...my Mom called very
distressed about her lab test (my parents are seniors with health
challenges 3000 miles away). I've always been the caretaker in the
family. I have to find time to call her back. Both daughters
called...one about wedding plans and the other with questions about
caring for my grandson with a cold. Boss called...needing data. Oh man,
it's one o'clock...did I eat lunch? I think I have a power bar in my
desk. How long has this been here.... it will just have to do.

Next meeting-finance...be assertive, lead, teach...be heard...not
invisible. Husband called...yes, I love you and yes I'll be home around
6 and yes I will call the travel agent to get plane tickets for our trip
next month and your blue shirt is on the futon in the guest room.

Check e-mails, return phone calls...what on earth will I have with the
chicken...man; I have to go to the grocery store for potatoes. One more
meeting...I need to settle this account...I know it won't be pleasant.

Great 5:35...walking out the door...please let me get to the car without
being stopped.... thank-you...I made it! Dinner on the table by 7pm...I
know my husband's talking to me about something important...so
tired...can't keep eyes open.... kids want something.... can't
think...so tired...kid's asleep...

11pm.... why am I downstairs still in my clothes from work...to bed.

Wow...I am a multitasking female machine!

Did any of this sound familiar?

For some of the men in the room this may not ring any bells. But, for
millions of women throughout the country...the rituals of our days
described previously, are real. We are wives, mothers, and teachers,
caretakers, repairpersons, disciplinarians, housekeepers, chefs and some
of us are leaders in business. We are master schedulers and often the
nucleus around which an entire family is organized.

And, we women.... we want it all! And isn't that our choice. The
numerous roles women assume daily are a part of our make-up and
influence how we interact with the workplace. They cannot be separated
when talking about diversity or the advancement of women of any
ethnicity in leadership. For women leaders...success in business means
we have to find the way to balance all these roles. For example, current
societal expectations in the workplace are rarely flexible or
accommodating to working mom's.... so that forces women to choose. Add
in the expectations or norms for people in leadership...like 12-14 hour
days.... and this balancing act becomes more challenging.

Two unique characteristics that belong to me.... being a woman and being
a minority.... both having an influence over my interactions with the
world and definitely having an impact on my career journey.

*(Change slide -- the journey)*

When you were a kid and daydreamed about what you wanted to be when you
grew up...I bet few of you considered that your gender, race, age,
religion or any characteristic that makes you unique could:

-   Be used to determine your competencies

-   Block your chances from being considered for certain jobs, or

-   Cause uncomfortable workplace relations

Yet we know this is real for many minorities and women in the workplace
today.

In the late 1800's equality for men and women was declared, in the
1960's Martin Luther King, Jr. fought for civil rights and in many
communities, African Americans just got the right to vote, in the 1970's
desegregation occurred at community hospitals throughout the country and
today we see the definition of marriage being challenged in many states
based on two individuals declaring love for one another.... not based on
gender. People who are proud of their multi-racial backgrounds are
challenging even the U.S. Census Bureau. No longer will we accept having
to arbitrarily choose one box for race.

Our world, for over 200 years, has evolved to be more inclusive of our
differences...even laws exist today that protect us from discrimination.
Yet, we still struggle with how our differences play out in the
workplace. Prejudices and preconceived ideas about who and what we are
still reign throughout society.... though they may be less overt today.
200 years of progress and in many ways, with regard to diversity, we
stand still.

Now, some of you may be thinking to yourself...we are so far removed
from the images we have of the civil rights movement of the 60's and
70's...those days are in the past. The behaviors we witnessed through
the media with regard to discrimination could not possibly be the same
today.

I would challenge those assumptions and say-my experiences and the
experiences of many minorities and women today are alive and kicking....
delivered, not in the media...but behind closed doors.

Just to make this real for you.... I want to share some of my
memories.... and for the record, I am not quite 50 years of age.

*(Change slide -- you in nursing school -- older you animates on
automatically)*

I have vivid memories:

...Of being accepted into Nursing School being one of three black
students in a class of 300 and being hauled into a professors office and
told within the first two weeks that they do not graduate your kind
here.

**I remember** my interview for my first CEO position right after the
birth of my second child. I had an interviewer question my ability to be
a CEO and breast-feed my daughter.

**I remember** walking into a room of all white men at a prestigious
hospital where I was the hired consultant and being told that I must be
in the wrong place. They had not asked for a photograph before they
hired me over the phone for the job.

**I remember** being told that there would never be a minority female
allowed to be a Hospital CEO in my hometown as long as the good old boy
network was in play...get over it.

**I remember** being judged as not having the right qualifications for a
leadership post...even before anyone looked at my credentials or asked
me a question.

**I remember** being hired into a leadership role and having to work for
the first six months proving that I was not just the minority or female
hire...I really did have skills...that were just assumed to be there in
my white male counterparts.

With regard to diversity...we continue to stand still.

*(Change slide -- What is diversity?)*

Diversity is a collective mixture of individuals, cultures and
organizational expertise. It is much more than skin color, gender, or
background. It's internal and external. Skin color is the result of the
level of pigment in our skin; it's a biological event. It doesn't
determine how we think, feel, or believe. Gender is random gene
selection; we had no choice. It doesn't decide our goals, ambitions, or
careers. As children, we learn about morals, values and religious
beliefs. But these are relearned, changed or adjusted over the course of
our lives. Each of us is diverse in many ways-chosen and random. It is
these differences that make each of us unique and commonalities that
connect us. So diversity is both visible and invisible...even though the
"visible" is what usually provokes the reaction.

**Okay...by now you are probably saying. So, what**. Why do we need to
hear your story? Why is diversity becoming the focus of conferences like
this one all over the country? And, why is this important in health
care?

*(Change slide -- Demographic table)*

Shifting demographics are quite visible throughout the United States.
Here's a snapshot of our world today. Population of the United States by
Race and Hispanic Origin, 2000 Census Results

Current total U.S. population (284,800,000) is from the U.S. Census
Bureau, and is based on current growth rates applied to the 2000 Census
figures.

  -------------------------------------------- ----------------- --------------
                                               **Total\          **% Of\
                                               population**      population**

  **Total population**                         **281,421,906**   **100.0%**

  White                                        211,460,626       75.1

  Black or African American                    34,658,190        12.3

  American Indian and Alaska Native            2,475,956         0.9

  Asian                                        10,242,998        3.6

  Native Hawaiian and other Pacific Islander   398,835           0.1%

  Some other race                              15,359,073        5.5

  Two or more races                            6,826,228         2.4

  Hispanic or Latino                           35,305,818        12.5
  -------------------------------------------- ----------------- --------------

NOTE: Percentages add up to more than 100% because Hispanics may be of
any race and are therefore counted under more than one category.

*Source:* U.S. Census Bureau, Census 2000.

Between 1990 and 2000, minorities accounted for approximately 80% of the
largest 10 year U.S. population growth in history! New census data
released in late September show double digit increases in Latino and
Asian populations between 2000 and 2003.

To succeed in our multicultural society, any organization must value the
difference of our diverse population, respect the individuality of all
employees and customers, and maintain a climate in which everyone is
treated with dignity. And doesn't that mean the same opportunities to
succeed and advance to the very top of the organization.... no matter if
you are Black, White, Latino, female, male, Catholic, Jewish, 30 or 50
years old, have facial hair or dreadlocks...or any characteristics that
makes you the unique individual that you are.

In health care, we know that we still have a long way to go in
advancement to the top.

The field of health care management continues to be old boys' network
and getting even whiter despite efforts to promote racial and gender
diversity in the ranks of health care leadership, according to a new
study by the American College of Health Care Executives. This study is
based on a survey of over 1600 health care executives in 2002.

***(Change slide -- males)***

![](media/image1.wmf)Here's the numbers:

The 62% for white males is up substantially from 1997, when only 51% of
white male respondents held these positions. In this case we took a
giant step back in workforce diversity!

***(Change slide -- females)***

![](media/image2.wmf)

White females however took a jump forward from 1997, from 35% to 40%.
Still disappointing, as compared to male respondents, but at least we
were not standing completely still. Not much movement at all for
minorities male or female.

***(Change slide -- Why the inequities?)***

So, why, why, why such inequities??? There are differing opinions.

-   Inequities in hiring and promotion practices

-   Lack of applicants-expertise and education

-   Lack of "same group" mentors or role models (It's sometimes hard to
    hold on to your dream of what you can be, when you don't see anyone
    who looks like you in those roles)

***(Change slide here -- talk about Dr. Elders)***

**I had the honor to have our former Surgeon General-Dr. Joycelyn Elders
as one of many mentors and role model. I admired her tenacity.... but
most of all her compassion to do the right thing for our communities and
her ability to maintain her integrity no matter what.**

**Having a same group role model is the ideal...but not the key. Having
a mentor... someone who encourages, supports and pushes you
professionally...even if they are different from you...is really
critical. For the record...most of my mentors were white men.**

***(Change slide -- more inequities)***

***Let's look at some other reasons for inequity:***

-   Cultural differences and the "good old boys' network" (when
    headhunters call existing CEO's and ask "know anyone who might be
    good for the open CEO job?" The answer is rarely someone outside of
    his or her network. So we get more of the same) you all have an
    opportunity to break this cycle...it's called succession planning.
    Think outside your inner circle.

-   Lack of organizational initiatives, recruitment, incentives (How
    many leaders actually recruit, for instance, at historically black
    universities...then wonder why they do not have a diverse pool of
    applicants?)

-   Folks stay within their comfort zone-differences are seen as a risk,
    not a business advantage (For example.... if we do not begin to
    address accommodating working Mom's in healthcare-where majority of
    the workforce is female...including incoming physicians...we may not
    have an effective workforce in the future. And, not all minorities
    are indigent. They are viable paying customers of services we have
    to offer. Do we even consider minorities as a market advantage?).

-   Racism- "A person's perception is their reality". How many times
    have you been in a room and you are the only woman and definitely
    the only one of your race or culture? This is of particular concern
    when this scenario exists in communities where your race or culture
    is dominant. There has to be other forces at play.... these gaps are
    not coincidence.

*(Change slide -- The Solution)*

*Whether we are talking about career advancement or in general, the need
to create a more inclusive workplace representative of the communities
we serve is an essential business strategy.*

Everyone needs to better understand other cultures, as well as other age
groups, gender groups, and lifestyle groups. Are we even aware of
possible offenses against others, especially people we work with? There
are many issues that can create misunderstandings, including racial,
cultural, sexual, physical, mental, and verbal issues. Are we even aware
that our actions (overt and covert) may create barriers to inclusion?

Are we open to?

-   Having humility with regard to someone who is different than
    ourselves, or do we maintain a sense of arrogance? In other
    words...because we have certain characteristics...do those
    characteristics make us better than another person or just
    different? And, shouldn't we respect those differences?

-   Listening verses teaching our way. Oftentimes when we think we are
    better...we try to influence others that our way is the right way?
    Does that block how we view another's belief or practice? Think
    about how this could play out in health care.

-   Changing based on new experiences verses standing on old beliefs
    that may not be grounded in today's reality. How many people today
    hold onto the past\...past impressions...what our parents taught us
    to believe about others that may be misperceptions about an entire
    culture or people? How would that influence how you interact with
    co-workers and patients?

To move from our starting point over 200 years ago.... we have a lot of
work to do.

For our patients.... it could be mean the difference between life and
death. Culture and language can affect whether a patient takes the
proper dose of medication or even agrees to take the medication at all.
Not offering the proper translation services could lead a hospital to
misdiagnose the condition of a person with limited English-speaking
skills. We have a professional, moral and ethical obligation to take
diversity seriously. It cannot be a program of the month...it should be
a business imperative.

There's an old saying...***you don't know...what you don't know. We may
not know all the cultural nuances for people we try to care for or work
with ...but we need to have the wisdom to ask appropriate questions and
the openness to change or revise our traditional views.***

To date, few health care institutions have successfully hardwired the
services and philosophies necessary to ensure culturally competent
patient care, and even fewer have committed resources to diversify their
workforce...starting with it's leadership.

> Leadership in health care must thread diversity awareness and training
> throughout all aspects of work life, including employee orientation,
> corporate compliance training, job descriptions and performance
> reviews. And, have zero tolerance with regard to discrimination of any
> kind.
>
> When I joined Providence Health System 5 years ago.... we were just at
> the front door of this journey in diversity. It took us a while and
> lots of wrong turns to move diversity:
>
> **FROM**

-   Only being defined as racial

-   A one man, one department responsibility

-   A celebration each month

> **TO**

-   **Being incorporated into our mission and core value system**

-   **Embraced and led by Senior Leadership at every PHS facility**

-   **Being a part of all strategic plans, with measurable objectives,
    actions and outcomes**

-   **Being viewed as a business imperative for our workforce and
    patients.**

**Now we are not perfect ...I am still the only female and only minority
Hospital Administrator for PHS in Oregon. But the right dynamics are in
place to change the future and we have engaged and committed leadership
at the top to make sure we deliver on our strategic outcomes.**

> At the very heart of this journey is really RESPECT for others around
> you and the desire and courage to change the course of the future....
> starting with a real hard look inside yourself.
>
> ***(Change slide here -- series of photos animates)***
>
> With many variables working against me...I did make it...maybe it was
> the seeds planted by a very wise woman early in my life. Maybe it was
> my Mom and Dad telling all three of their daughters that they had to
> be better than the best in order to be successful in this world. Maybe
> it was the numerous mentors that I had throughout my life pushing me
> and believing in me. Maybe it was all the employers who took that risk
> on me. Maybe it was all the employers who shut the door or found it
> necessary to break me down or put me in my place...I learned from them
> what I never wanted to be as a leader. Maybe it's internal fortitude
> and just plain tenacity to get there.
>
> **My Daddy told me, *"N ever let anyone tell you what you cannot
> be*".** Today, I am one of those few minority women in health care
> leadership. I worry about all those with great potential and talent,
> who give up because the fight is too hard to sustain. I would ask you
> to think hard about what role you play and what actions you can take
> to change the course of history.... to remove some of the obstacles.
>
> ***(Change slide -- first half of RFK quote)***

**Finally, I will leave you with this thought from Robert F. Kennedy.
RFK was a strong white male leader during a time when it was not really
popular to challenge the status quo. He states:**

***"It is from numberless diverse acts of courage and belief that human
history is shaped. Each time a man stands up for an ideal or acts to
improve the lot of others, or strikes out against injustice, he sends
forth a tiny ripple of hope.***

***(Change slide -- second half of RFK quote)***

***And, crossing each other from a million different centers of energy
and daring, those ripples build a current that can sweep down the
mightiest walls of oppression and resistance."***

***(Change slide -- end title)***

***Thank you.***