Health system chief diversity officers: who are they and what do they do?

Abstract

The Chief Diversity Officer, or CDO, is an increasingly common leadership role within U.S. health care delivery systems. Very little is known about the CDO role across hospitals and health systems. To map the responsibilities and characteristics of how CDOs are positioned within health care, we first searched the web pages of health systems to identify which systems have CDOs, or what we call “CDO-equivalents.” Second, we expanded the search of public documents to new-hire announcements and the online social/professional media site, LinkedIn, to identify information regarding each identified leader’s roles and responsibilities. Finally, text from these documents describing the leader’s roles was uploaded to Atlas.ti, a qualitative analytic software, to identify common themes. There were 60 diversity leaders among 359 U.S. health care systems. Seven consistent roles and responsibilities were identified reflecting a very broad scope of work. Future research should focus on exploring the scope of this leadership role.

Keywords

Health equity diversity equity and inclusion health care leadership

In a summary of the country’s upcoming 10-years goals, the Centers for Disease Control and Prevention (CDC) have identified racial/ethnic and socioeconomic disparities and established the goal of reducing or eliminating them.¹ One mechanism is ensuring that hospitals and health systems are culturally competent² ——defined as an organization that provides high-quality care to patients with diverse values, beliefs, and behaviors.³ Evidence has linked culturally competent health care organizations to better health outcomes,⁴ including better patient experiences.⁵ Similarly, health care organizations with structured diversity interventions report better health outcomes.⁶ One element of culturally competent health care organizations is diversity among the executive leadership of an organization. Hospitals with greater ethnic and minority representation among top leaders placed greater emphasis on reducing disparities.⁷ Taken together, these findings highlight the importance of diversity leadership to create and sustain culturally competent health care delivery organizations that can best meet the needs of the complex, diverse, and ever-changing populations served.

Several national health care organizations now include diversity in their competency models for leadership. For example, the National Center for Healthcare Leadership emphasize the importance of cultural competency in their diversity demonstration project⁸ and one of their leadership competencies is diversity in leadership, which is defined as the organizational leader’s commitment to cultural competency and diversity in leadership, including the presence of an “onsite leader or group dedicated to diversity management.” (8) Additionally, the American Hospital Association (AHA), the American College of Health Care Executives (ACHE), and other national organizations have joined forces to eliminate health care disparities through increasing diversity in health care governance and leadership.^3,9

In light of this focus on diversity in leadership, many hospitals and health systems have implemented an executive-level diversity officer,¹⁰ commonly titled the Chief Diversity Officer (CDO) of Chief Diversity Officer. The CDO typically oversees diversity efforts throughout the organization, which may help institutionalize diversity management practices throughout an organization and legitimize diversity management behaivors.¹¹ The development of a CDO position may be a way to institutionalize diversity into the mission and strategic direction of the organization to ensure that the hospital or health system is welcoming to all employees, patient experiences and identities.^12,13 Despite the growing trend towards adopting this new position, very little is known about the breadth of the CDO role in hospitals and health systems across the United States. Overarching questions remain regarding CDOs’ education and training, job responsibilities listed in CDO position descriptions, and the level these individuals operate within organizations.

Methods

To explore these questions, we searched various public sources of information to identify which systems have CDOs. Since not every individual in charge of diversity or inclusion efforts at a health system might hold the exact title of a CDO, anyone holding such a position not officially called a CDO, we call ‘CDO-equivalent.’ After our search, we reviewed these public documents to identify common themes regarding what CDOs and CDO-equivalents do, how they are evaluated, and their educational background.

Sample selection

We identified 359 unique health systems in the U.S. using the American Hospital Association’s (AHA) System Identification number and system name. We focused our search on health system websites and not the websites of individual hospitals within systems. The search took place between March and June 2019 to identify those systems with a leader whose primary role was associated with diversity (e.g. Chief Diversity Officer; Chief Diversity and Inclusion Officer; Vice President for Diversity and Inclusion; Vice President for Diversity and Health Equity; Director of Diversity; Director of Diversity and Inclusion; Diversity and Inclusion Officer; System Director for Diversity and Inclusion; Director of Employee Health, Wellbeing and Diversity; Workforce Diversity Manager). Therefore, in our search, we used terms like “diversity”, “inclusion,” and “equity”. We also examined the titles of individuals leading diversity and/or inclusion efforts. For the purposes of this manuscript, we refer to any title other than CDO as CDO-equivalent.

Data collection

For each diversity leader identified via a Google search we searched for role information on the organization’s webpage. At times, we were unable to locate a description on a delivery system’s webpage so we utilized the CDO’s LinkedIn (the social/professional media site) profile. We also utilized these descriptions to determine if the role operated at the system level, or within the administrative structure of a particular hospital. For each leader, we recorded whether the individual was listed on the health system’s website and if the person was officially listed as part of the system’s leadership team, as well as the office-holder’s education. Next, we obtained new-hire announcements, health systems web page information, and LinkedIn announcements regarding the roles and responsibilities of each CDO or CDO-equivalent.

Data analysis

All of the information gathered was uploaded and analyzed in Atals.ti 8 Mac. Authors THH and LS separately reviewed health system websites, new-hire documents and LinkedIn profiles to determine which health systems employed a CDO or CDO-equivalent. A grounded theory approach was used, which allows for data coding and iterative analysis of emerging themes. For this approach, together, both authors first brainstormed commonly occurring themes across position descriptions. This initial codebook was based on each coder’s initial review of all descriptions. Following the establishment of the initial codebook, to achieve high reliability, the primary and secondary authors independently coded a sample of five documents. After coding the initial five, both coders discussed any coding discrepancies and verified the emerging codebook. At this point, we merged two codes into one and added two additional codes. Based on this newly developed codebook, the coders coded the remaining documents and no new codes emerged.

Results

We identified 359 health systems from the AHA data. We individually searched all 359 health system websites to identify if there was a CDO or CDO equivalent. CDO or CDO equivalents were identified in 60 of the health systems. Most of these roles were not listed as part of the health system leadership team but were found elsewhere on the system’s website. Titles ranged from executive-level leadership titles such as “Chief Diversity Officer” or “Director of Diversity and Inclusion” to more administrative titles like “Inclusion Program Manager” or “Diversity and Inclusion Program Administrator.” Most commonly, we were able to identify Chief Diversity Officer titles, followed by director titles (like the Director of Diversity or Director of Diversity and Inclusion), and senior vice president titles. Among the 60 CDOs or CDO-equivalents, 28% had a business-related master’s degree (e.g. MBA, Masters in Human Resources, or Organizational Leader) and 12% had a doctorate. Twenty-two percent (22%) were medical doctors (MDs), 10% had a non-clinical bachelor’s degree, 8% were attorneys (JDs), and 3% were registered nurses (RNs, including BSNs). These results are also found in Table 1. Since more detailed background information was not available for each individual, we provided anecdotal descriptions for a few CDOs or CDO equivalents. For example, one individual with an MBA and the title of Chief Diversity and Inclusion Officer has been in that role for about 4 years. Prior to that, the individual held director level and managerial level diversity roles at different organizations. A second example is a RN, BSN with the title of Director of Diversity and Inclusion and Employee Relations, who has also obtained a Master’s degree in a healthcare-related field and has been in that role with that organization for almost two decades. A third example is an MD in the role of Chief Diversity and Inclusion Officer. The individual has been in that role for that particular organization for about 6 years and has held different diversity roles prior to the CDO role for that same organization.

Table 1.

Degree of CDO or CDO-equivalents”.

Degree	Percent of total, %
Business related master’s (e.g., MBA, MHR)	28
Doctrate	12
Medical doctor	22
Non-clinical Bachelor’s degree	10
Juris doctor	8
Registered nurses	3

Seven themes emerged from the examination of website documents describing the roles and responsibilities of the diversity leader:¹ Integration of diversity into institutional goals and strategy;² Equity of care delivery;³ Employee education and training;⁴ Organizational change;⁵ Workforce diversity;⁶ Community engagement;⁷ Supplier diversity. We briefly discuss each of these themes and provide sample quotations taken directly from the websites for illustration purposes below.

The first theme, Integration of diversity into institutional goals and strategy, describes how the CDO is responsible for integrating diversity and inclusion into the overall organization through strategic planning. Our findings suggest that CDOs may be responsible for leading a specific diversity and inclusion strategic plan and also for overseeing the integration of diversity and inclusion into the organization’s broader strategy.

Example: “[In] his new role, he will develop and lead a strategic plan for diversity and inclusion throughout the [health system].”

Across multiple organizations, a consistent theme was that diversity would play a part in the organization’s strategy and the CDO was responsible for leading and overseeing the process. In addition, multiple examples specifically identified that the CDO is responsible for a system-wide strategy, indicating that the CDO has responsibilities that span the entire health system.

The second theme, Equity of care delivery, describes the responsibility of addressing disparities in patients' health care outcomes and addressing access to care among community members served by the hospital. Within this theme, we identified quotations that describe the CDO as a leader whose responsibility it is to address disparities in health care outcomes.

Examples: “[I]mproving the health of those disproportionately affected by poor health outcomes” and “helping members of different racial, ethnic and socioeconomic groups receive care that results in the best outcomes.”

Our findings within this theme also suggest that the CDO is responsible for utilizing data to reduce health care disparities in their organization, specifically by enabling the organization to measure, research and improve health outcomes for diverse members. This indicates that the CDO commonly oversees data and outcomes for specific populations within the patient mix or community.

The third theme, Education and training of employees, describes how the CDO is responsible for overseeing employee development regarding diversity and inclusion topics. Within this theme, we were able to identify that the CDO may be both a resource and a teacher when it comes to these topics.

Examples: “[The CDO] serves as lead teaching faculty on topics related to health equity, social determinants of health and cross-cultural health care.” Secondly: “[The CDO is] to provide education and training across the vast areas related to diversity and inclusion, cultural competency, unconscious bias and more.”

We also found that CDOs are also responsible for addressing education areas that cover a breadth of topics that may include improving how clinicians care for patients and how they work with colleagues.

The fourth theme, Organizational Change, encompasses statements that CDOs are responsible for leading and promoting change in the organization related to diversity and inclusion. e identified statements using verbs describing the organization as changing or working toward something within this theme.

Examples: The CDO will be “building relationships and breaking down barriers” or “lead XXXXXXXX’s [name of organization] diversity efforts to further create and sustain a cultural competency that supports the mission of the organization.”

Statements such as this acknowledge that the organization is in need of cultural change and identify that the CDO is the individual responsible for this. As a part of this theme, we also found statements that indicate the CDO is responsible for changing how individuals within the organization think. For example, one site stated “Every day, [the CDO] seeks to be more curious, open and willing to change. She also works to help foster that mindset in others.”

The fifth theme, Workforce Diversity refers to responsibilities related to recruitment, retention, and engagement of underrepresented minority employees. Within this theme we found evidence to suggest that the CDO is responsible for leading efforts within the health system to improve and increase the diversity of the workforce.

Examples: The CDO will “empower a diverse workforce – Recruit, develop, promote and retain a diverse and inclusive workforce” or “partner with the HR Leadership Team in developing goals and objectives in support of growth in diversity of the talent pool and pipeline while supporting the overall mission of the organization” or “serve as a resource for faculty and staff recruitment across [the system].”

Furthermore, we found that the CDO is responsible for working and collaborating with other parts of the organization, most notably human resources, to increase workforce diversity. For example, one website stated that the CDO may provide consultation to other departments within their system regarding recruitment, retention and diversity. This could mean that the CDO is not primarily responsible for recruitment but helps others achieve goals in this area. In addition, within this theme, we found that CDOs may also oversee mentoring programs for underrepresented minorities. For example, one health system’s web page stated, “an important outcome of our diversity efforts will be successful mentorship, development and preparation of diverse individuals for leadership roles.”

The sixth theme, Community engagement, describes how the CDO is responsible for engaging with the organization’s community. For example, a few websites stated that one of the job responsibilities is “community engagement and relationships.” As a part of this theme, the CDO was described as someone who leads relationships and engagement efforts on behalf of the organization.

Example: The CDO will “drive community collaborations – continue to engage relationships and partnerships that support and build capacity in the communities that we serve” and “[The CDO] will be responsible for corporate diversity and inclusion for the system including […] diverse community engagement.”

The seventh theme, Supplier diversity, encompasses indications that the CDO will be responsible for ensuring a diverse supplier base is used by the health system. Within this theme, several organizations stated that the CDO would oversee “supplier diversity” with few details about how this would be achieved.

Examples: The CDO “oversees organizing our business process to promote minority participation reflective of the diverse business community to enhance economic growth in the communities we serve.”

In sum, these quotations reflect a broader responsibility and connection between the organization and the community, which goes beyond the traditional notions of providing health care and serving the community’s health care needs. Table 2 provides an overview and additional illustrative quotations to provide further clarification and details of each theme.

Table 2.

Illustrative quotes of results.

	Theme	Illustrative quotes
1	Integration of diversity into institutional goals and strategy	“[The CDO] has overall responsibility for the creation and implementation of the enterprise-wide diversity and inclusion strategy."
1		“Partner with senior leaders to set strategic direction, implementation, and alignment of diversity and inclusion
2	Equity of care delivery	“Patient inclusion; and health equity”
2	Equity of care delivery	"And help lead the efforts of the [organization’s cultural competency institute], dedicated to driving studies to ensure members’ cultural needs are considered and respected at every point of contact between the member and the organization."
3	Employee education and training	“Education and training – Provide intentional and focused culturally competent care education opportunities to all team members”
3	Employee education and training	“Assesses awareness of diversity educational needs for co-workers and leaders”
4	Organizational change	“[CDO name] develops and executes a coordinated and comprehensive diversity plan that cultivates an inclusive academic health sciences center”
4	Organizational change	“Instrumental in envisioning and developing innovative approaches”
5	Workforce diversity	“Mentorship, development and preparation of diverse individuals for successful careers”
5	Workforce diversity	“Recruitment, retention and advancement leadership/Talent development”
6	Community engagement	“Community engagement and relationships”
6	Community engagement	“Diverse community engagement”
7	Supplier diversity	“Improvements to the organization’s supplier diversity program”
7	Supplier diversity	We are supporting women and minority-owned local suppliers

Discussion

In recent years, we have witnessed the emergence of senior leadership roles focused on diversity within U.S. health systems.^14,15 Such roles signify efforts in our delivery system to build health systems that align their strategic assets to promote health equity for all individuals in their community. Improving institutional diversity and inclusion has the opportunity to improve institutional effectiveness. The emergence of leaders whose primary functions are related to diversity within their health system also mirrors trends in organizational settings outside of health care, including professional sports leagues, academia, technology companies, and philanthropic entities. Our study evaluates the roles and responsibilities of diversity leaders through the qualitative analysis of CDO leadership role descriptions available on organizational webpages or LinkedIn. Through this search, we established 60 of 359 U.S. health systems currently list a senior diversity leader. However, many of these individuals are not listed under the “leadership” section of the website, but were found on other parts of the health system’s website or in a small number of cases, were only identified through LinkedIn. This finding was surprising given the recent news stories in Modern Healthcare and Becker’s Hospital Review that the role of senior diversity leadership is proliferating and is commonly housed within the executive team.^10,16

Overall, CDO roles and responsibilities reflect a very broad and extensive set of expectations, which all link to the organization’s formal efforts to achieve its mission. Many of the diversity leader job descriptions were daunting——spanning clinical, organizational, and physical boundaries within the health system. We identified roles and responsibilities ranging from strategy to human capital and supply chain, raising the question of how a single individual leader could engage, let alone lead, in all these areas. These findings are in line with studies examining the role of CDOs in other industries, such as academia, where CDOs often are responsible for a broad and extensive set of roles and responsibilities.^14,15 Some of the variation in roles and responsibilities may reflect the varying mission and vision of health care systems throughout the U.S., but may also reflect the complexity associated with leading an organization to be more inclusive and reducing disparities in our health system. While we anticipated variation in the diversity leadership roles and responsibilities, the lack of standard roles and responsibilities, combined with diversity leaders’ daunting job descriptions, may impede the influence of such leaders within their organizations. The functions associated with the different components of each job description would require CDOs to be able to mobilize and lead multiple functional areas within an organization. For example, many CDOs oversee training and education efforts related to implicit bias and are responsible for improving the quality and safety outcomes of historically marginalized populations. Training and education often lie within the human resource function of the organization. At the same time quality and safety span multiple clinical functions (medical staff, nursing) within an organization, each having its own function leader established in the leadership team. It is unclear how a single individual can lead such a broad array of functions, as well as responsibilities that span a multitude of departments within an organization. We posit that such work would take significant partnerships with each function leader to mobilize the appropriate resources to enact change. It is not to say that these leaders cannot lead across functions in a health care setting; however, more research is needed to understand how they can lead change and effectively manage their responsibilities.

While our research brings a new understanding of the role of CDOs in health care organizations, there are limitations to our study which should be noted. First, we relied on websites for our data sources. This poses some limitations to our outcomes as web pages may not be accurate or the most-up-to date source of data. Next, we were unable to obtain race, ethnicity, and gender as a part of this study, and these are important outcome outcomes when examining DEI leadership in health care. We also cannot guarantee we captured all CDOs or CDO equivalents as a part of our search, and there is a chance we may have missed a CDO in our search. Lastly, there are limitations to qualitative research in which our outcomes may have been impacted by personal bias. Two independent researchers coded all documents to reduce bias and produce reliable results.

While recent research has focused on culturally competent health care organizations and associated outcomes, a more robust research design is needed to understand the roles and responsibilities in more completeness, as well as the required expertise and the scope of the diversity leadership. Our findings are an important first exploratory step in this research agenda. Future research should more deeply investigate and define the day-to-day practices of CDOs, their reporting structure, responsibilities and evaluation metrics, and the infrastructure needed in an organization to support the work they are leading. Additionally, qualitative work is also needed to explore why organizations choose a particular title for their diversity leader——our research revealed no consistent title, as noted earlier. This will enable a clearer picture of the degree to which different organizations emphasize this role and might also shed light on why many diversity officers are not listed as part of the health system leadership team. In the field of higher education, the National Association of Diversity Officers in Higher Education has developed guiding standards around the knowledge, practices and scope of the Chief Diversity Officer role.¹⁷ A similar standardization of this role within health care could enhance the overall goal of developing a culturally competent health care organization and ultimately reducing health disparities.

Conclusion

Among the 359 U.S. health systems examined, only 60 listed a CDO or CDO-equivalent position on their website. Arguably, to encourage diversity and inclusion in health care, this position should be much more common across health care organizations and encourage diversity, equity and inclusion efforts within healthcare organizations. We found substantial variation exists in the professional backgrounds of leaders in CDO roles, including business-related master’s degrees, MDs, PhDs, JDs, and RNs. Further, an analysis of publicly available job announcements and LinkedIn pages revealed seven typical roles and responsibilities of the diversity leader:¹ Integration of diversity into institutional goals and strategy;² Equity of care delivery;³ Employee education and training;⁴ Organizational change;⁵ Workforce diversity;⁶ Community engagement;⁷ Supplier diversity. Our results show that substantial variation exists in CDO and CDO-equivalent roles and responsibilities. Future work should focus on exploring the scope of this leadership role and more clearly understanding how such leaders are evaluated and the resources available to ensure diversity leaders can create and sustain culturally competent health care delivery organizations that can best meet the needs of complex communities.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Tory Hogan

References

About Healthy People: Office of Disease Prevention and Health Promotion; 2021 [Available from: https://health.gov/healthypeople/objectives-and-data/browse-objectives

McCalman

Jongen

Bainbridge

, et al. Organisational systems’ approaches to improving cultural competence in healthcare: a systematic scoping review of the literature. Int Journal Equity Health 2017; 16(1): 78.

Trust

HRE

. Becoming a culturally competent health care organization. Chicago, IL, 2013.

Lieu

Finkelstein

Lozano

, et al. Cultural competence policies and other predictors of asthma care quality for Medicaid-insured children. Pediatrics 2004; 114(1): E102–E110.

Weech-Maldonado

Elliott

Pradhan

, et al.. Can hospital cultural competency reduce disparities in patient experiences with care? Med Care 2012; 50: S48–S55.

Zeh

Sandhu

Cannaby

, et al.. The impact of culturally competent diabetes care interventions for improving diabetes related outcomes in ethnic minority groups: a systematic review. Diabetic Med 2012; 29(10): 1237–1252.

Herrin

Harris

Spatz

, et al.. Hospital Leadership Diversity and Strategies to Advance Health Equity. Joint Comm J Qual Patient Saf 2018; 44(9): 545–551.

Dreachslin

Weech-Maldonado

Gail

, et al.. Blueprint for sustainable change in diversity management and cultural competence: Lessons from the National Center for Healthcare Leadership diversity demonstration project. J Healthc Manage 2017; 62(3): 171–183.

Dolan

. Increasing diversity in governance and management. J Healthc Manage 2013; 58(2): 84–86.

10.

Castellucci

. Health systems turn to chief diversity officers to promote inclusive workforce. Mod Healthc 2017; 23.

11.

Fisk

Silvera

Haun

, et al. Developing and Defining Diversity. Public Integrity 2019; 21(3): 286–300.

12.

Williams

Wade-Golden

. The chief diversity officer. Stylus Publishing, LLC., 2013.

13.

Williams

Wade-Golden

. The chief diversity officer. CUPA HR JOURNAL 2007; 58(1): 38–48.

14.

Wilson

. Emerging trend: The chief diversity officer phenomenon within higher education. J Negro Educ 2013; 82(4): 433–445.

15.

Leon

. The Chief Diversity Officer: An examination of CDO models and strategies. J Divers Higher Educ 2014; 7(2): 77–108.

16.

Gooch

. 15 hospital, health system chief diversity officers to know: ASC COMMUNICATIONS, 2016. (updated 6 January 2016).

17.

Worthington

Stanley

Lewis

Sr WT

, et al. National Association of Diversity Officers in Higher Education standards of professional practice for chief diversity officers. J Divers Higher Educ 2014; 7(4): 227–234.