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51 The New Look of Diversity in Healthcare: Where We Are and Where We're Headed By Akanksha Jayanthi I t's not easy to define diversity. It's a fluid concept, one that evolves alongside society and changing ideologies. However, diversity itself is a solid pillar of good governance and leadership. And in healthcare, a diverse leadership — or lack thereof — has lasting effects on care delivery. Traditionally, diversity referred to people of different racial and ethnic backgrounds, a term linked to phenotypic characteristics. Gender, too, has historically been included in the diversity umbrella. But now, diversity encompasses a much larger spectrum including life experiences, lifestyle choices and ideas. It even takes into consideration the social determinants of health. is newer, all-inclusive definition of diversity is perpetuated by the millennial generation. According to a 2015 study by Deloitte and the Billie Jean King Leadership Initiative, millennials tend to define diver- sity in the context of experiences, opinions and thoughts, while older generations focus on religion, demographics and representation. Considering this emerging definition and the fact that millennials are the most diverse generation in the U.S. population (By the traditional definition, at least. A 2014 White House fact sheet says 42 percent of millennials identify with a race or ethnicity other than non-Hispanic white), current healthcare leadership doesn't reflect those it serves. Diversity in leadership In 2013, a survey from the American Hospital Association's Institute for Diversity found minorities represent 31 percent of patients nationally, but minorities constitute just 14 percent of hospital board members, 12 percent of executive leaders and 17 percent of first- and mid-level management positions. Healthcare executives aren't blind to this gap. A 2015 survey from healthcare executive search firm Witt/Kieffer found 26 percent of Caucasian respondents and 10 percent of racially and ethnically diverse respondents believe minority executives are well-represented in health- care management teams today. Catholic Health Initiatives is trying to change that. At the Englewood, Colo.-based system, diversity is embodied throughout the organization, says Rosalyn Carpenter, CHI's chief diversity officer and vice president of diversity and inclusion. "CHI is very unique in the healthcare indus- try in that three of our senior-most leaders are diverse," she says. "So how do we embody it? We are actively living it." Ms. Carpenter mentions Kevin Loon, CEO of CHI; Michael Rowan, COO and president for health systems delivery; and Patricia Webb, executive vice president, chief administrative officer and chief human resources officer; all of whom are black, as evidence of the system's com- mitment to diversity. At CHI, embodying diversity means incorporating it into the recruit- ment process, but it's not a matter of seeking out diversity for diversity's sake; rather, it's a business strategy. "In addition to ensuring the candi- date has the skills for the position and is a good fit for the organization, we must consider diversity because a diverse workforce is about the diversity of perspective, thoughts and ideas necessary for an organiza- tion to be competitive," Ms. Carpenter says. is sentiment is reflected in Witt/Kieffer's study, in which 66 percent of respondents said diversity recruiting enables an organization to reach its strategic goals. What's more, the Deloitte survey found, "millennials frame diversity as a means to a business outcome, which is in stark contrast to older generations that view diversity through the lens of morality (the right thing to do), compliance and equality." With millennials now the largest generation in the workforce and with the diversity mindset they have, hospital boards and executive leader- ship teams will likely look a lot different just a few years down the road. The intersection of diversity and population health While diversity is critical for strategy and business, it also has a pos- itive effect on patient care, especially as healthcare turns its focus to population health. is idea is manifested at Great Neck, N.Y.-based Northwell Health. Within Northwell Health's Office of Community & Public Health resides the Diversity, Inclusion and Health Literacy division, led by Jennifer Mieres, MD, senior vice president and chief diversity and inclusion officer. Dr. Mieres' definition of diversity reflects the newer millennial mind- set, which includes cultures, lifestyles and different ideas. She says Northwell seeks to create a diverse environment that places patients' needs at the center of their care. One pillar of Northwell's inclusion strategy is a commitment to diverse culture, which includes having a leadership team, board of trustees and frontline workers that reflect the community served. "Having a workforce that reflects the diverse cultures and ethnicities and the diverse lifestyles of the community has helped us formalize strategies to be a much more inclusive health system," Dr. Mieres says. To achieve this, Northwell calls upon its frontline workers to advocate for patients through the system's business employee resource groups. Employees voluntarily join the groups to advise leaders on how to bridge gaps in care for different patient populations, including veterans, multicultural patients and the LGBT community. For example, the VALOR group — Veterans and Allies: Liaisons of Reintegration — has been around for three years, and it prompted the hospital to change protocol for treating veterans who present in the ER. Clinicians ask veterans questions that are sensitive to PTSD symptoms and note if behavioral services may be required. In addition to better serving the veteran population, Dr. Mieres says such changes also make the hospital a more attractive workplace for veterans. Diversity for diversity's sake? People tend to feel more comfortable around similar individuals, or those who share certain traits, demographic or otherwise. But having a workforce that mirrors the patient population may, in some areas, result in a homogenous organization. Look at Los Angeles and Burlington, Vt. ese two cities were among the highest and lowest, respectively, for diversity in Brown University's 2010 American Communities Project, which makes available sociologi- cal data on metropolitan areas. Los Angeles scored 79.6 on the diversity scale, while Burlington, Vt., scored 23.5. Given the demands of population health and the theory that people