Unconventional Leadership

by Nancy M Schlichting

  The long and short of it is that diversity in health care is enormously relevant because it affects the ways we deliver care. And our community is getting ever more diverse, so from a strictly business perspective, some of our greatest growth potential lies in serving diverse communities. We want to make sure that we are known as a place that is extremely open, welcoming, and receptive to the special interests and needs of those communities. There’s a cause and effect here that becomes apparent when you connect the dots.

  How to Do Diversity

  In order to create an organization where diversity is a central tenet, inclusion needs to be considered in all major decisions. And the culture needs to be such that all employees have an opportunity for advancement, are treated with respect and dignity, and can contribute their diversity of thought, work style, background, and experiences. That is a lot to accomplish, and it requires effort in short bursts as well as ongoing determination. The rest of this chapter outlines that ways that I, along with others at HFHS, approach making a diverse organization that serves the needs of twenty-three thousand staff as well as the larger community.

  Define Diversity Broadly

  In the context of organizational diversity, it is mission critical to take into account the many dimensions that extend beyond race, ethnicity, sexual orientation, and gender. Diversity encompasses not only these important differences but also more subtle dimensions such as work style, lifestyle, physical capacity, behavioral differences, and other human characteristics. And even beyond human workforce characteristics, diversity is highly relevant as it pertains to the workplace, the marketplace, and even the organizational structure. In keeping with our progressive approach at Henry Ford, we define diversity broadly and apply the following principles that serve to extend the way we think about it:

  Sensitivity to family structure and lifestyles

  The health and well-being of employees

  Flexibility for accomplishing work assignments

  An organizational culture that supports and leverages the talent and skills of all employees

  Recognition and respect for efforts and contributions of all employees

  Social responsibility and commitment to community

  One of my personal favorites to foster is cognitive diversity—or thinking differently. As I mentioned earlier, my mentor Al Gilbert had a notable capacity to work effectively with physicians. Although this is a bit more radical, he also valued the perspective of individuals who were branded as “troublemakers.” If an employee gained a reputation for going against the grain, Al would really listen. Al knew that these people were thinking differently, and that they might have something valuable to impart. This is an unconventional practice that I have emulated. Disrupters are not necessarily beloved by their managers or HR, but they have different perspectives that are worth hearing. Diverse thinking is hard to come by, and it is often an undervalued or misunderstood type of diversity that can make any organization better.

  Maintaining a broad definition of diversity not only creates a bigger safety net for individuals in your organization, it also helps leaders remove the barriers to difference so that it can be valued and leveraged.

  Look for People Who Are Underutilized

  When I was at Riverside Methodist Hospital I got to know an African American gentleman named Zakaria Nyongesa who was an assistant parking supervisor for us on the weekends. He was an insightful, humble, and fascinating individual who did a fine job. But I had a hunch that his talents were being wasted, so I struck up a conversation with him. It went like this:

  “Zak, tell me about yourself,” I said.

  “Nancy, you know, I have a PhD,” he replied.

  “You do?” I said, “What is it in?”

  “It’s in African studies. I teach at Ohio State part-time.”

  “That’s amazing. What are you doing as a parking supervisor?”

  “Well, I just needed a second job.”

  “Really?”

  After that, I couldn’t stop thinking about Zak. When I was working on the front lines at hospitals in roles such as admitting clerk and nurse’s aide, I saw so many talented people like Zak who were being underutilized. These were people who didn’t have a big title or status but who had training, ideas, and experience that would have helped us if we could have put them to work in the right roles. Sometimes they needed encouragement to further their training or finish their degree, but many other times they simply needed to be given a chance.

  I spent a lot of time with Zak and created a job for him as our first director of diversity. This was more than twenty years ago, when Riverside was informally known as “The Riverside Hilton.” It was not especially racially diverse or progressive in terms of diversity practices; therefore, appointing Zak was a major move. I recall African American nurses and others saying to me, “Nancy, do you really want to do this?” The appointment was counter to the culture they were accustomed to working in. The amazing thing was that Zak, and the people he brought in to help him, changed the organization for the better. Together, we created the type of change that was long past due.

  Another person I met around that time at Riverside was Wanda Dillard. Wanda was trained in respiratory therapy, served in the military, and was an evening shift manager in the process of earning an advanced degree. An African American woman, Wanda confided in me that people often said very subtle things to her that were intended to cut her down. When I got to know her I found that she had an incredible passion for community development. I become a mentor to Wanda and in time I made her director of community health. Again, it was a game changer at Riverside. Later, Ohio State hired Wanda to set up a community development program similar to the one she had created for me at Riverside.

  Part of diversity, for me, is creating new ways to take better advantage of people’s gifts and talents. The best way that I know to do this is to look for individuals in the organization who are underutilized and open doors for them. I acknowledge that this can be a high-risk, high-reward approach. It doesn’t pan out every time, but when it does it can make an important difference in the organization and send a powerful message that talent and diversity really matter.

  Create Support Structures

  While opening doors for people who are different is important, diversity also requires an active commitment to creating formal and informal support structures. Many diverse candidates have either been discouraged, like Wanda, or denied advancement, just as I was when I was forced to walk away from my job after being outed as a lesbian. When that type of thing happens, many people feel discouraged and isolated. As a gay person, for instance, I grew accustomed to hearing comments and jokes about gay people. Before I was strong enough to speak up, I remained silent. At times, these episodes made me feel powerless and alone. Although I never let the attitudes I encountered hold me back, the reality is that I could have been tremendously impacted by these negative forces. Fortunately, I have received support, from my family, who encouraged me when I was growing up, to numerous mentors all through my training and career who have opened doors and guided me to the next opportunity. They saw something in me and they opened their hearts and their minds to what I could do.

  Because of the chances I have had and because I understand the power of support structures, I always give back, supporting others the way that I was supported. Regardless of my personal passion for encouraging difference, and my desire to be an active mentor, making diversity work at HFHS was a system-wide priority that started before I arrived and will be ongoing when my successor, Wright Lassiter III, takes over as chief executive.

  At Henry Ford, informal support for diversity includes mentorship, sponsorship, and full inclusion, and this practice opens doors for diverse employees. More formal support includes training programs, networking opportunities, and employee resource groups (ERGs) for those who are Hispanic/Latino, of Middle Eastern descent, African American, or LGBT, as well as for members of other diverse and minority groups. Employe
e resource groups at Henry Ford provide professional and personal growth opportunities and peer networking, as well as education and awareness for participants and other employees around various dimensions of diversity.

  Diversity will always be the foundation on which Henry Ford Health System stands, and in many ways diversity defines us. The culture and the support structures contribute to making it possible for people to work here in an open, safe, and honest manner. Unencumbered by fear, they can bring their best selves to work.

  Consider All Stakeholders

  Just as it’s important to apply a broad definition to diversity itself, so, too, should we apply the ideals of diversity beyond the workforce to include all the stakeholders in health care, including patients and their families as well as neighbors, community partners, and suppliers. Let’s look at how HFHS applies this principle, because we have dedicated considerable time and resources to develop best practices in the area of diversity.

  In terms of striving for culturally appropriate and inclusive care for patients and their families, we look for insight from the Institute on Multicultural Health at Henry Ford, led by Dr. Kimberlydawn Wisdom and Dr. Denise White-Perkins. Both are nationally known physicians and health disparity experts who have shaped the vision for the institute, which seeks to improve the health and quality of life for underrepresented racial and ethnic populations and to eliminate health care–related disparities. The institute approaches this goal by conducting research to identify health disparities and gaps in care for minority groups, and it disseminates outcomes locally, regionally, and nationally, developing community-based programs aimed at improving the health of underrepresented populations. It also offers training to improve the cultural competence of researchers and health-care providers. For instance, it works with hearing-impaired patients and their families to determine how to improve the quality of care with respect to the patients’ preferences and special needs. In addition, it looks at how the socioeconomic status of minority groups impacts health and health care.

  HFHS’s diversity programs don’t stop with the needs of patients and their families, however. We have a diversity initiative designed to provide all suppliers, including women entrepreneurs and minority-owned businesses, with equal access to procurement and contracting opportunities within the organization. An inclusive and transparent sourcing process ensures that we seek the most talented, innovative, experienced, and cost-competitive suppliers available. Doing business with diverse suppliers makes good business sense and it contributes to the financial stability of the many local communities to which Henry Ford delivers health-care services.

  I’m proud that Henry Ford is recognized locally and nationally for both its multicultural care and its supplier diversity initiative—and both are best practices in the health-care industry.

  Require Diversity at the Top

  Leadership is still the most challenging arena for diversity, and yet it is arguably the most important when it comes to altering the way society and organizations think about equality. Diversity at the top of an organization is a challenge for a number of reasons: the pipeline of diverse candidates is not as robust as it should to be, leaders continue to mentor and promote people with backgrounds that are similar to their own, and, in many cases, diversity at the executive level is not mandated.

  At HFHS, we tend to rely on internal staff for many of our leadership-level searches because the top executive search firms in Chicago and New York don’t send us enough minority candidates to satisfy our diversity requirements. This has been the case for as long as I can remember. Our community is highly diverse, while our leadership is not as diverse as our community. With that in mind, we challenged ourselves to catalyze diversity at the top. For example, we’ve mandated that at least 20 percent of employees in Henry Ford leadership training academies and succession plans must be women and minorities. In addition, candidates interviewed for director- and board-level positions must reflect the diversity of the available applicant pool and the communities that we serve. We also provide mandatory cultural-competency training to our entire workforce, including physicians and leaders.

  Is this enough? Probably not, but it’s a solid start and we’ve witnessed some positive results. When I arrived in Detroit, for instance, only two of Henry Ford’s senior leaders were women. Today, there are sixteen—that is a huge step forward and I am incredibly proud of our progress. To be frank, however, I think the dramatic increase in female leaders here has less to do with our concerted effort to recruit women and more to do with the fact that they are looking at our organization and saying, “This is an enlightened place. This is where I want to be.”

  Despite notable progress, I would say that we have achieved more modest improvement in hiring African Americans for top leadership roles. But that may change quickly when my successor, Wright Lassiter III, who is African American, takes the helm in 2016. As our new CEO, I suspect that he will enhance our ability to attract top talent from the African American community, just as my presence likely helped attract more of the best women. Wright is an exceptional fit to lead Henry Ford. His experience running a diverse health system, his considerable leadership talents, and his alignment with our core values are just three of the reasons my board and I chose Wright as my successor.

  Be Intentional

  In order to continue to make progress, we need to mindfully cultivate the diversity pipeline and make sure we are bringing in people—whether they are filling administrative or clinical roles—who are capable of providing top leadership for systems and hospitals. And I believe that we can do it. Henry Ford has been the easiest place I’ve ever worked to build a diverse team of leaders because we’re so mission focused and community minded. That is what earned us the number-one spot on DiversityInc’s 2015 list of most diverse health systems in the country.

  Is the fact that a gay woman is leading the organization another reason we are seeing some progress in recruiting diverse candidates to fill top roles? Perhaps. Reaching a tipping point is an uphill battle, but once you are there it becomes simpler to maintain. In order for our industry to get over that hump, and become better, we need to continue to make diversity in top leadership roles a priority. A hospital or a health system is very much like a city or a community: by its nature, it is incredibly complicated and diverse. We need to be attentive to those aspects of our environment or we can’t serve patients, employees, or other stakeholders nearly as well as we would like and they deserve.

  The common denominator in leadership diversity, and indeed in all types of diversity, is an intentional commitment. For us, diversity is built into every pillar of performance that we focus on at Henry Ford. What that serves to do is embed diversity into our strategies. For example, a component of our focus on quality is eliminating racial disparities in health care. Every initiative has a diversity element, whether it’s supplier diversity or an employee resource group that supports the gay community—it all creates more ways for people to feel supported, valued, and able to reach their full potential.

  CHAPTER SEVEN

  Detroit: Partner for Renewal

  . . . In conclusion, I will state that it is my intention . . . to go forward with plans for a complete and credible hospital for the benefit of Detroit.

  —Henry Ford, from his letter to the

  board of the Detroit General

  Hospital Association, June 1, 1914

  When I joined Henry Ford in 1998, almost everyone else was rushing in the opposite direction. People were leaving Detroit in droves, and some seemed shocked that I was excited about joining Henry Ford. They would ask, “Why did you come here?” I always replied, “I’m here because I’m working for a great leader, Gail Warden at Henry Ford. I am here because Henry Ford is a national model for health care. And I’m here because I really like Detroit.” The common refrain was: “Really? You like Detroit?”

  Detroit—A Love Story

  Yes, I really do like Detroit. Detroit has always felt like hom
e to me. When I was young, my family visited the city and the memory stayed with me. Coming from Akron, Detroit seemed like a big metropolis with so much to offer. Yet, that impression aside, Akron and Detroit have some striking similarities. Both have been one-industry towns, by and large—Akron had the rubber industry and Detroit the automotive. Historically, they’ve both had not only a strong middle class but also enduring opportunities that allowed working class individuals to support their families and have a great life. Both have a major union presence, too. Finally, corporations have invested significantly in these communities, allowing them to develop culturally in ways that they would not have otherwise.

  The vibe in Detroit, as well, suits me in a number of ways. I’ve always considered myself to be pretty scrappy, for one. I felt like I had to fight a little harder to succeed in my career because I am a woman and because I am gay. Likewise, Detroit had been fighting relentlessly to turn itself around since before I arrived, and the populace was fighting right along with it. The grit and determination you’ll find here is something that many people remark upon. It inspires me to keep working to improve not only our organization but also the community as a whole. In addition, I am an egalitarian—Detroit has less of an established hierarchy than many other places I’ve lived. If you appreciate the city and have the requisite respect for its diversity, you can come in and have a voice.