Healthcare leaders deeply recognize the industry’s shortcomings in delivering equitable patient care. Despite many advances in healthcare in our society, health outcomes vary widely based on race, ethnicity, gender, and socio-economic standing. Racial and ethnic minority groups are more likely to be uninsured and to experience disparities in access to healthcare services than non-Hispanic White individuals, according to the Centers for Disease Control and Prevention, and Black Americans are more likely to die from a range of health conditions than White Americans, including heart disease, stroke, cancer and diabetes, as reported by the Kaiser Family Foundation.
Unlike in other industries, healthcare providers take a public oath to provide care for patients regardless of their circumstances, reflecting the profession's inherent commitment to equity in care delivery. However, in the United States, the healthcare system's inequities have become starkly evident. Leadership is the key to all positive change, so it’s up to healthcare leaders to change the system, and this requires specific leadership qualities for success.
In our work with healthcare leaders around the world, we have identified five core capabilities that leaders note are essential to address healthcare disparities:
Strategic vision and execution
A leader focused on health equity must not only be able to develop a clear strategic vision, but must also be able to execute upon this vision: equity should be strategically embedded as a priority within the organization's goals, rather than a “side project.” This looks like pursuing both financial sustainability and equity together, and ensuring internal consistency by integrating equity into day-to-day operations. “You need to have a clear link to how equity can help leaders across the organization advance their work,” explained Joseph Betancourt, President of the Commonwealth Fund. “I often tap into the patient experience, cost, and value—priorities everyone cares about—and work to show how equity impacts each of those areas.”
Equity leaders must also be willing to challenge prevailing myths and ask the right questions to enable the organization to delve deeper into the underlying causes of inequities. It’s critical to ask “why” as many times as needed to uncover the root causes. From there, they can develop an inspiring vision that helps elevate the collective ambition of the organization, community stakeholders, and the board. “Imagine having zero inequities as the next step on our journey—we’re going to eliminate the death gap, the life expectancy gap,” said David Ansell, Senior Vice President for Community Health Equity at RUSH University Medical Center. “In our system, you have to articulate that vision and then connect to people’s sense of purpose and why.”
This is especially true for board engagement and alignment, where the CEO needs to make the case that health equity initiatives also make good economic sense. "I tell my board that we are investing in the community as seed capital for the future; for example, today's Medicaid patient is tomorrow's commercial patient," explains Thomas Jackiewicz, President of the University of Chicago Health System.
“In our system, you have to articulate that vision and then connect to people’s sense of purpose and why.”
David Ansell
Senior Vice President for Community Health Equity at RUSH University Medical Center
Leaders should also acknowledge that each community has unique needs. The approach to achieving health equity must be tailored to specific contexts, recognizing that a one-size-fits-all playbook does not work. By connecting the dots between various challenges and needs, leaders can develop creative, multi-dimensional solutions that address multiple dimensions of inequity simultaneously. One such example is how the University of Chicago Health System is tackling worker shortages. The organization is recruiting locally from the South Side of Chicago, where there is an estimated 400,000 unemployed people, and is developing community training programs for radiology and respiratory technicians to build long-term career planning support, which addresses workforce, patient and community needs.
Photo: RUSH Medical Center
Inclusive influencing and trust-building
It is not enough to raise the issue of health equity; executives must be able to influence action. Leaders should actively seek out and listen to new and diverse perspectives, inviting individuals with different experiences, expertise and backgrounds to participate in decision-making processes. Additionally, building trusted relationships with community voices is essential for engaging and incorporating them into healthcare decision-making. By dispelling myths and recognizing the capability within communities, leaders can establish authentic partnerships that drive equitable outcomes. This was key in the South Side Health Transformation Initiative, which was co-developed with local safety net hospitals and local Federally Qualified Health Centers (FQHCs) and other clinics, connecting all groups through a single software infrastructure. "We knew our local FQHCs, and safety net hospitals didn't have resources, but we had to exchange medical data,” Jackiewicz explains. “So, we built a creative solution to connect core data infrastructure across our systems."
By dispelling myths and recognizing the capability within communities, leaders can establish authentic partnerships that drive equitable outcomes.
To forge these types of partnerships, trust is key, and leaders must engage both hearts and minds by presenting the moral case for equity alongside the business case, aligning principles with the needs and priorities of different stakeholders.
“When it comes to trust, it's one thing to learn about the communities you're serving; but it's another thing to understand the history of the communities you’re serving. I have learned trust is like a glass; once it's shattered, repairing is difficult.”
Tosan Boyo
President of Sutter Health East Bay Market
However, they also must be prepared for potential roadblocks and have plans to address these across stakeholder groups. David Lubarsky, Vice Chancellor of Human Health Sciences and CEO of UC Davis Health, shares an example related to securing contracts to care for Medicaid patients. “I was told it could bankrupt us,” he says. “But we created an anchored institutional mission and developed a true partnership with the county that strengthened during the pandemic.”
Egon Zehnder’s Inclusive Leadership Framework includes core pillars that are exemplified in the perspectives above. Inclusive leaders respond to differences with curiosity and openness, overcome the tendency to gravitate towards others with similar style and motivation, and effectively collaborate with, influence, and develop others who are different from themselves.
Boards should be asking,
What changes have we made in health disparities over specified periods of time?
Tenacity and hyper-focus on results
Healthcare leaders must shift from acknowledging problems to institutionalizing solutions. They should maintain a focus on results and outcomes, holding themselves and their teams accountable accordingly. Boards play a vital role in this accountability by consistently asking for progress made in reducing health disparities. They should be asking, “What changes have we made in health disparities over specified periods of time?” and they should understand what data is being tracked and how.
It’s this data that will drive real work and interventions to achieve measurable change. "We need to approach the health equity issue as a quality improvement issue for leaders,” said Maulik Joshi, President and CEO of Meritus Health. “This should all have a measurable aim, a dedicated team, ongoing testing of interventions, and clear tracking all the way. There’s a difference between hope and actual improvement.”
Leaders must also be sure the success stories are being told. By demonstrating what is possible through tangible improvements, leaders can inspire further action. “At RUSH, we reduced the 50 percent mortality disparity between Black and White women with breast cancer,” Ansell noted. “That gives us optimism to solve what seems to be an intractable problem that in actuality is solvable.”
Adaptability and resilience
Leaders must exhibit flexibility and creativity, finding novel solutions to long-standing problems. They should be highly curious, self-aware, open to gaining new knowledge, and willing to grow as individuals. “You can’t believe you have all the answers,” Jackiewicz noted. “If you think you have a playbook, you are deluding yourself. You have to update that playbook constantly.”
Resilience will be especially important when health leaders face resistance to change. “As leaders, we have to think about the currency for change and then leverage it in this environment,” Betancourt explained. “You have to ask yourself, ‘How can I identify the resistance, and then what is the strategy to get past it?’
“If you think you have a playbook, you are deluding yourself. You have to update that playbook constantly.”
Thomas Jackiewicz
President of the University of Chicago Medical Center
Like with other challenges for leaders in healthcare and other industries, the ability to navigate through polarities and paradoxes, such as balancing short-term financial performance with long-term access and quality outcomes, has never been more essential. Leaders should create a culture that embraces complexity and adapts over time. “As a leader, you have to be so much nimbler than before,” Jackiewicz noted. “What's needed today will change by tomorrow.”
Photo: RUSH Medical Center
Transparency and courage
Leaders must have the courage to challenge their own organizations and engage in positive, solution-oriented discussions. They should be comfortable talking openly about the current state with clear data, using transparency to measure and report disparities. Taking a “guide with truth” approach to sharing statistics that may at the outset appear to paint a system in a bad light actually helps build trust and enables leaders to address inequities head-on. When the RUSH leadership team embarked on the closing the death gap imperative, it was an eye-opening experience for many in the health industry and spurred a larger community movement.
By shining a light on systems of inequity and making explicit what is often implicit, leaders can drive meaningful change. Their courage to address issues directly is crucial for making a difference and ensuring equity is at the forefront of healthcare transformation.
By shining a light on systems of inequity and making explicit what is often implicit, leaders can drive meaningful change.
Addressing equity in healthcare is a long-term commitment for leaders and institutions. It requires time, resources and people who can envision a better future for care and who can inspire others to help bring it to life. By exemplifying these five qualities, healthcare leaders can drive transformative change, foster equitable healthcare systems, and ultimately improve not only health outcomes but the quality of life for all individuals, regardless of their circumstances. “If you understand healthcare as a human right, you’ll realize that improving patient health is greater than just improving their glucose control,” explains Dr. Omar Lateef, CEO of RUSH. “It means you’ll enable improvements in jobs, in housing access opportunities and in food insecurity.”
Delve deeper: Read our interviews with healthcare leaders
Marwa Zohdy
CONSULTANT, CHICAGO
Marwa Joy Zohdy is an active member of Egon Zehnder’s global Health Practice. She draws on first-hand executive leadership experience and deep technical expertise to advise clients across the healthcare continuum from technological discovery to delivery of patient care. Marwa is passionate about helping the healthcare industry benefit from diversity in terms of ideas, experiences, expertise, and backgrounds.
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