Progress or Performance? A Critical Analysis of Healthcare Organizations' Efforts to Address Diversity, Equity, and Inclusion and Health Equity in the Healthcare Workforce

Abstract

For years, scholars have studied the impact of race and racism on the clinical workforce. However, less attention has been given to understanding how race and racism has been historically and structurally built into healthcare organizations and the implications this has on the healthcare administrative workforce. This oversight affects: 1) the recruitment and retention of a diverse administrative workforce, 2) the development of effective diversity, equity, and inclusion (DEI) and health equity strategies, and 3) the training and development of early career professionals.

The COVID-19 pandemic and the “racial reckoning” of 2020 highlighted the need to address these issues. The pandemic disproportionately affected Black, Latino, and Native American communities, while anti-Asian racism surged. The killing of George Floyd sparked national protests and calls for organizations to adopt anti-racist policies. Disparities in healthcare leadership are stark: 98% of hospital CEOs are white, 87% of hospital boards lack diversity, and fewer than 5% of physicians identify as Black. Although organizational scholars have begun to explore reasons for the slow progress toward workforce diversification, gaps remain, particularly regarding the consequences of healthcare organizations confusing health equity with diversity, equity, and inclusion (DEI). What does it mean when organizations fail to understand the difference? Does this confusion negatively impact healthcare workforce diversity?

This dissertation uses a qualitative approach to examine the healthcare administrative workforce at three career stages: early, mid, and late career. The first paper evaluates the integration of DEI and health equity principles in healthcare administrative fellowship programs and analyzes job advertisements for racial and gender biases, revealing a troubling lack of prioritization and persistent biases. The second paper explores how middle management roles and hierarchical positions affect perceptions of organizational progress toward advancing health equity. While middle managers generally view progress positively, they struggle to measure outcomes effectively. The third paper investigates the role of race and racism in strategic goal-setting and its impact on Black Chief DEI and Health Equity Officers. Findings show that these leaders often feel tokenized, unsupported, and face racism, leading to widespread dissatisfaction in their roles.

This dissertation demonstrates the critical need to recruit and retain diverse administrative talent and dismantle racist policies and procedures within healthcare organizations. Such changes are essential for improving employee experiences—particularly for people of color—and addressing racial disparities in health outcomes. It also serves as a call to action during a politically charged period when efforts to undermine and erase DEI and health equity initiatives are intensifying in the United States.