Advancing Inclusive Leadership In Healthcare
In 2013, researchers examining diversity in senior healthcare leadership positions in the Greater Toronto Area (GTA) found that while communities receiving healthcare are diverse, the sector’s leadership is not. Surveying twenty-eight hospitals and five community care access centres, the study showed that women were well-represented in senior management and board positions, 61% of senior management positions, and 40% of governance board members, yet visible minorities comprised only 16% of senior management positions and 14% of board members, 3% – 4% of leaders were reported to be LGBQ individuals, and only 1% of leaders were reported to be people living with a disability. These conclusions were in stark contrast to the demographics of the GTA, which at the time of the report, showed that 47% of the GTA’s population was comprised of visible minorities, 16% of Ontario’s population reported having a disability, and general estimates of Ontario’s LGBQ population was 10%-15%.
Four years later, with Canada’s population only becoming more diverse – are we doing any better? What actions can we take to change the course of exclusion in leadership that places our healthcare system at risk? DiverseCity onBoard convened a panel of senior experts in the healthcare field to address these questions and provide tangible steps on how to advance leadership and governance through the lens of diversity, inclusion, and equity. Moderator Elaine Lam, Executive Director of Business Development at The Chang School was joined by the lead author of the 2013 study, Dr. Samir K. Sinha, Director of Geriatrics, Sinai Health System and the University Health Network Hospitals, Julia Hanigsberg, President and CEO of Holland Bloorview Kids Rehabilitation Hospital, Cathy Hecimovich, Chief Executive Officer of Central West Community Care Access Centre, and Ken Chan, Board Chair of Sherbourne Health Center.
Moving Beyond Tokenism
The panelists agreed that it is imperative to ensure that diversity and inclusion practices on board recruitment are not based on ‘checking off boxes’ of different diversities around the board table. Rather, board recruitment needs to be skill based, and actively support the full participation and contribution of individuals on the board. The panelists challenged the notion that representation is the marker of inclusivity, noting that good governance and good decision making require full participation beyond ‘representation for representation’s sake’. They noted that without a diversity of people around the table to ask the right questions to address the needs of our local populations, we are setting our healthcare system up for failure. Tokenism disempowers the individual and the organization because different perspectives are left out of important decision-making processes.
Where does the accountability for driving meaningful change within the healthcare system lie? While representation is important, system change requires more. The panelists noted that leadership must step up and create lasting change that instills inclusivity within their organization and that change requires a process of thoughtful planning and introspection – it is not an overnight transformation.
Inclusive leadership is about making the voices of those who can’t always be around the table heard. One panelist reminded the audience that the communities most in need are often the ones that are silent, remarking on efforts within her own organization to seek out communities at the periphery of the healthcare system. Leaders need be proactive in engaging communities left out of mainstream healthcare models rather than wait for communities to come forward with unmet needs.
Another panelist discussed the responsibility of senior executives to speak up when confronted with prejudice and to understand their obligation to act and address situations in which bias impacts decisions surrounding hiring and board recruitment.
Moreover, one panelist noted, boards own the governance of the organization and need to consider diversity and inclusion as equally important to quality and improvement plans, for example. Responsibility must lie with the board to first ensure diversity and inclusion among directors, and second, to think beyond the day to day operations to ways the organization can be inclusive in all aspects of governance and operations.
Leadership Goes Beyond the Boardroom
If we don’t know who we are serving, or how to serve them well, we are not going to achieve the outcomes we desire. The panelists discussed the need for leaders to engage with community actors to provide culturally sensitive services. One example is Langar Seva Meals & Support Services, which supplies Punjabi vegetarian meals for those who are chronically ill or elderly and unable to cook. Recognizing barriers to the mainstream Meals on Wheels program for Punjabi seniors, a community group was able to take a culturally sensitive approach to meal delivery and ultimately better serve those in need of the service. Boards that recognize the immense benefits of culturally sensitive services, and take concrete actions to support these services through governance of the organization, will better serve communities and stakeholders.
Practical Steps to Inclusion
The panelists noted that a focus on inclusion often gets lost in the numerous procedures associated with board governance. They provided practical steps that boards can take to be more inclusive, and ultimately, more effective:
- Inclusivity starts by recognizing what gaps currently lie within the board and organization and taking tangible steps to address them.
- Be more open to recruiting directors at different levels of experience. Don’t discount lived experience as a vital asset to the board.
- Put term limits on directors to ensure that the board creates space for new voices at regular intervals.
- Conduct recruitment processes with openness and transparency. Make postings publically available on websites and databases, use a skills-matrix to ensure directors are selected based on the skills they bring and actively seek out new avenues to reach out to a diversity of candidates.
- Create a pipeline of board directors through committees, directors-in-training programs, or community member committees like Sherbourne Health Centre.
- Limit the number of boards individuals can serve on at a given time to ensure more opportunities are open to others.
Want to learn more? See the live tweets from the event.