BY: EVERARD O. RUTLEDGE, PhD, FACHE
Diversity has become a vital concern to the Catholic health ministry. In
view of that fact, Health Progress is publishing a series of interviews with
people who have undertaken significant leadership roles in fostering diversity
in their organizations and communities.
The interviews were conducted by Everard O. Rutledge, PhD, FACHE, vice president,
community health, Bon Secours Health System, Marriottsville, MD. This, the second
interview in the series, was with Thomas Royer, MD, president and CEO of Dallas-based
CHRISTUS Health. Sr. Teresa Stanley, CCVI, PhD, CHA's senior director of
sponsor services, also participated.
Rutledge: When you examine the makeup of local hospital and health
system boards in Catholic health care organizations, do you see sufficient ethnic,
cultural, and gender diversity — diversity that is reflective of the communities
Royer: I think, in general, there is not, and I would add one more kind
of diversity to the list — "required expertise" diversity on
the board. What are the issues that this board is dealing with? What
are the major issues that are really reflective of the community that the
board is serving, and do they have people sitting at the table who
not only reflect the community's ethnic, cultural, and gender diversity,
but expertise diversity as well?
Historically, I think, well-known people who were able to donate financially
to the organization were more likely than others to be appointed to boards.
As a result, boards usually lacked the diversity we are looking for today.
Certainly in CHRISTUS we are doing many, many things to make that change, and
I know we are moving in the right direction. But overall, I believe, boards
are generally not where they need to be with regard to diversity.
Rutledge: How should we plan to maintain our current levels of diversity,
or increase it where necessary, within our local or national boards?
Royer: First of all, I think we need to be very attuned to and educated
on the demographic profiles of the communities that our organizations are serving,
and we need to keep those profiles current. We need to do a demographic profile
on our communities at least every other year, as part of our strategic planning
process. Then, whatever that percentage of diversity is, we should commit to
attaining that same ratio in our workforce at the management level, at the leadership
level and ultimately at the board level. We need to do this at every level of
the organization. We must make it a high priority.
Rutledge: What do you see as our greatest obstacle in achieving board
composition that is reflective of our communities that we serve?
Royer: In looking at our experience within CHRISTUS over the last five
years, I would identify three major reasons why we have difficulty in getting
the diversity required. First, we've had some difficulty persuading the
diverse people in our communities to serve. The problem is that many other organizations
are looking at diversity and seeking the diverse population available to serve.
Therefore, people are often torn as to which organization to serve — , for
example, the Rotary, Kiwanis, church, or the hospital board? Their willingness
to serve and their willingness to invest the time required are also a significant
The second obstacle is lack of preparation. People tend to believe they need
expertise in a specific area to be a board member. Because people with diverse
backgrounds don't always have the experience that nondiverse people have,
they may question their capability to serve. Of course, this is sometimes true
of people with nondiverse backgrounds as well.
And the third obstacle, I think, is good self-esteem. We've seen it in
our system's leadership development programs, particularly in the CHRISTUS
Education and Research Fund, which encourages employees to develop new skills
and move up in the organization.* It's our preparation ground for future
CHRISTUS leaders. Some of our diverse associates seem to lack the self-esteem
that gives them the confidence to say, "You know, I am able to participate
in that and. therefore, I'm going to put my name in the application pool."
Sometimes a lack of self-esteem fails to give them the confidence to say yes
when we approach them about service.
Rutledge: Is there a need for increased education on diversity and/or
related topics at the governance level of our organizations? How can we best
go about increasing the competencies of board members?
Royer: Diversity has to become a high priority in board discussions.
At CHRISTUS, both the board and our member organizations have asked me to make
it a very high priority. As a result, our senior team is in the process of developing
a defined and measurable plan to create more diversity in our organization.
People in general, and board members specifically, need more education about
culturally diverse populations, recognizing that we need to give serious consideration
to how we can best serve them and build programs around them. It is most important
to have the policies in place to ensure that diversity is represented in your
governance process. We need to recognize that ideal patient care is delivered
to multicultural communities by diverse teams and leaders, all governed by multicultural
boards representing the communities we serve. If we fail to do that, we'll
inevitably provide less than high-quality services, because we will be doing
it from our own perspective rather than through the eyes of the person we're
serving. That is why diversity at all levels of our organization is important.
Education on diversity and then having diversity measurements as part of our
goals and objectives is key. Leadership must be held accountable for giving
both verbal and written reports on a periodic basis to the board to make sure
that we are accomplishing what the board expects.
Rutledge: Is there anything else that you would like to share with
regard to CHRISTUS's experience in enhancing diversity within your governance
Royer: CHRISTUS has a system nominating committee that is responsible
for creating diversity of ethnicity, gender, and expertise on our regional boards.
When these boards want to add new members, they first submit the names to the
system nominating committee and then to the full board for ultimate approval.
In considering new board members, CHRISTUS assesses a profile of the present
board: How many women are members? How many men? How many members are lawyers?
How many possess financial expertise? What are their cultural backgrounds? By
looking at the profile of the current board, we can determine its diversity
needs — the voids that should be filled — and then ask ourselves: "Do
the new board members who are replacing retiring board members actually enhance
our diversity, moving us closer to reaching our diversity goals?" We review
these profiles on an annual basis and send written reports back to regional
nominating committees. These reports say, for example, " You are making
progress, but the next time we expect to see more African Americans, more Hispanics,
or more people with financial expertise."
We also look at the "years of experience" diversity. Are the younger
board members balanced with more experienced people? We have board profiles
computerized so we can review them on an annual basis. Because our boards have
term limits, we know the backgrounds of members who are rotating off. By identifying
the expertise that we need to fill those rotational voids, we can make sure
that the new boards members narrow that gap and create a more diverse organization.
This process has been in place since we¯started five years ago. On a scale
of one to 10, we believe that we started out at a two or three. Today we're
probably between seven and eight. The process has given us the ability to make
significant progress. Sr. Teresa Stanley, who knows CHRISTUS well, would agree
with that, I think.
Sr. Teresa: One thing I might add is the fact that when you look
at the profile of a CHRISTUS board, you see a reflection of the profile of the
Royer: Yes, exactly.
Sr. Teresa: A CHRISTUS board is a little map of the organization
as well as of the community. I found that very helpful. Because when you're
trying to set a direction for your organization, you need a profile of the community
as a kind of guide.
Royer: I think the point you make so well, Sr. Teresa, is critical to
our progress. Using the profile, we can measure the percentages of our various
constituencies and then strive to have all levels of the organization reflect
the community we serve.
Rutledge: Are there other observations that you'd like to share
with Health Progress readers?
Royer: Yes. I feel strongly that if diversity is going to be addressed
appropriately, it has to also be part of a board's self-evaluation. It
has to be part of the board's goals for the year. It has to be part of
the CEO's responsibilities and accountabilities from the board level. A
board must have regular reports so it can measure the progress made. Unless
diversity is a goal in all these parts of the organization, it is probably not
going to improve.
At the board level, the people who are most willing to serve are those who
have served before and want to continue serving. In order to get real diversity,
you have to actively seek potential board members. Once you've found them,
you must encourage them to serve and then prepare them to do so. At CHRISTUS,
we educate new board members so that they feel competent. We address any self-esteem
issues as quickly as possible. Serving on board committees is a good way to
develop more confidence; it helps make people more willing to move into a board
office. Identifying potential candidates early — even a year in advance — gives
you time to prepare them to take this board responsibility.
So, for me, diversity has to be a part of our leadership soul and well as part
of your goals. It requires as much focus as we give to finance and quality.
Sr. Teresa: Before we close, I'd like to mention a related issue.
We've had discussions at CHA recently about the possibility of creating
a kind of information exchange concerning board members. If we had such an exchange,
the ministry could stay informed about the availability of, for example, an
experienced person whose term was up on one organization's board but was
willing to serve on another. I wonder if we shouldn't encourage that type
of exchange, one in which an organization could tell others, "We have somebody
who's highly qualified and is leaving our board. You might want to invite
him or her to join your board".
Royer: I think that's really important for the national boards.
CHRISTUS hasn't had any names to share yet, because we haven't had
anyone rotating off. But members will begin rotating off in 2006, and we plan
to start providing some name to systems.
Clearly, a strength we have in Catholic healthcare is the number of women serving
on our boards, which you often do not see in some other health care systems.
So we have a strong foothold on gender diversity. We need to be as successful
in other areas of diversity as well.
* The $1.25 million CHRISTUS Education and Research
Fund sponsors GED classes, technical education programs, job fairs, and skill
assessments for system employees.
Copyright © 2004 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.