Race and Diversity Management

Since the civil rights era, many industries and organizations have begun to address the need to recruit and retain more workers of color in high-status professions. Having previously been composed mostly of white male workers, occupations in legal, medical, and financial fields (among others) now wrestle with becoming more racially and gender inclusive in order to reflect changing demographics. More diversity means that organizations can benefit from a broad slate of workers in leadership and management roles.

In the immediate aftermath of the civil rights reforms, many private-sector companies began to hire black professionals in high-ranking managerial roles. These positions provided black workers with opportunities for organizational leadership, as well as comfortable incomes that allowed a middle-class lifestyle. However, these jobs came with some caveats too. For one thing, they frequently involved managing newly created community relations or urban affairs departments, which meant that black managers in these jobs became the go-to people when organizations needed someone to address internal or external racial issues. Second, they rarely offered clear-cut paths to upper-level management positions or any other sort of upward mobility. Ultimately, black professionals operated on a parallel track wherein their leadership roles were relegated to managing racial issues rather than being effectively integrated into the organizational structure (Collins, 1988).

In time, changes in the political economy and the rise of anti–affirmative action discourse weakened social and organizational support for race-conscious policies designed to draw in workers of color. Whereas organizations once prioritized affirmative action and devoted specific attention to rectifying racial and gender inequality, today they emphasize a diversity discourse. In this context, rather than dwelling on structural or institutionalized processes that restrict opportunities for groups who have been systemically disadvantaged (women of all races, racial minority men), managers today frame diversity in bland terms that are divorced from cultural and institutional biases, emphasizing factors such as regional diversity, diversity of opinions, and diversity of thought (Dobbin, 1997). Following this logic, Apple vice president for diversity and inclusion Denise Young Smith stated to an audience at the One Young World Summit in 2017, “There can be twelve white, blue-eyed, blonde men in a room and they’re going to be diverse too because they’re going to bring a different life experience and life perspective to the conversation.” This perspective allows companies to ignore the ways systemic and structural processes continue to exclude black workers in particular from high-status occupations that would allow them to take a decisive role in leading organizations (Collins, 2011; Dobbin, 1997; Moore & Bell, 2011).

It is perhaps not surprising that with this popular framework and the persistent underrepresentation of workers of color, many researchers have concluded that diversity initiatives as currently implemented have failed to bring racial minorities into leadership roles in the top ranks of organizations. As Williams, Mueller, and Kilanski (2012) have noted, most studies assess these programs by examining the success (or lack thereof) of widely used policies or through interviews with (mostly white) managers themselves. In a study of corporate managers, Embrick (2011) found that most were unaware or dismissive of company policies that focused on issues of diversity. Kalev, Dobbin, and Kelly (2006) found that most of the commonly used policies for increasing diversity—trainings, mentoring programs, and so on—do not actually generate results, and that the most effective measure, which involves tying diversity outcomes to managerial responsibilities, was underused. Ely and Thomas (2001) also note that when organizations explicitly highlight the importance of racial and cultural change, they can achieve greater minority representation. Yet despite this evidence from research studies, many organizations do not follow this path. Edelman, Fuller, and Mara-Drita (2001) conclude that diversity measures are designed more to shield organizations from liability and litigation than to create real systemic change or to restructure organizational leadership.

These are important methods for addressing whether and how diversity initiatives are able to achieve concrete changes, but they do not offer insights into how workers who are affected by these programs perceive them and their ability to shape organizational outcomes. We know that diversity trainings often engender resentment and pushback from white professionals who see them as unnecessary efforts that waste valuable company time and resources (Berrey, 2015; Kalev et al., 2006). But there is very little study of how the presence of these sorts of programs affects blacks who work in predominantly white professions or organizations. Do they find that diversity initiatives seem to serve as valuable resources? Do diversity programs provide or cultivate effective leadership? What other categories engender differences in black professionals’ responses?

Black Professionals in Predominantly White Environments

For black employees, working in professional settings can pose certain challenges. Only 34 percent of employed black women work in professional or managerial jobs, and just 26 percent of black men are in this occupational category (Bureau of Labor Statistics, 2013). In many cases, this underrepresentation can lead to stereotyping, marginalization, and isolation. Black workers encounter difficulties tapping into and leveraging the social networks that are critical for advancement and leadership roles in professional work (Kaplan, 2006). They may also lack familiarity with the sort of cultural practices and hobbies that managers value in elite professional service workers (Rivera, 2014). For black women, race and gender may render them doubly excluded, exacerbating difficulties in finding mentors and being taken seriously, particularly if they work in male-dominated professions (Bell & Nkomo, 2001; Evans, 2013; St. Jean & Feagin, 1998). Black men have more opportunities to form gender-based bonds with their white male colleagues, but they, too, are often stereotyped as incompetent, unintelligent, or unsuited for high-status work (Wingfield, 2012). All these factors can make it difficult for black workers to access the sort of leadership roles that allow for organizational change and transformation.

This positionality uniquely situates black professionals to evaluate modern-day diversity initiatives in the occupations in which they are employed. In many professions, they are acutely aware of their minority status and the way it informs aspects of their work ranging from their available emotional responses to their ability to expect respect (Harlow, 2003; Harris & Sellers, 2017; Wingfield, 2010). Thus, their perspectives on the current successes and failures of diversity work are informed by their firsthand experiences with the challenges present for those who are underrepresented in these environments. Given this vantage point, what assessments of diversity initiatives do they offer? Do they agree that diversity programs are failing to position underrepresented minorities for leadership roles, or do they see some value in the organizational efforts that exist?

Black Doctors: “Another Box to Check”

It might seem that black doctors would strongly support diversity initiatives. Recent research indicates that white doctors continue to adhere to racial stereotypes in their treatment of black patients, erroneously believing that blacks are biologically different from whites in ways that include skin thickness and susceptibility to pain (Hoberman, 2012; Hoffman, Trawalter, Axt, & Oliver, 2016). The results of studies like these, as well as others showing that patients of color respond more favorably when their practitioners are of the same race, help explain why professional medical associations now publicly acknowledge that it is critical to attract more doctors of color in order to treat a rapidly diversifying patient population more effectively (Alsan, Garrick, & Graziani 2018; Greenwood, Carnahan, & Huang 2018; Skrentny, 2014).

Perhaps as a consequence of these studies, some organizations now attempt to replicate black practitioners’ successes treating diverse patient populations. In practice, this has meant that doctors in some facilities are required to undergo cultural competence training, which usually consists of periodically administered online modules. These modules emphasize the importance of understanding that patients’ cultural views and backgrounds can have an effect on their medical decisions and treatment preferences. But how do black doctors perceive the efficacy of these sorts of diversity efforts, particularly when it comes to increasing access to leadership roles?

The physicians interviewed for this study were largely indifferent. Though they expressed appreciation for the idea behind cultural competence training, it did not offer a vehicle or a pathway through which they felt they could improve their access to organizational leadership. In fact, more than a few doctors interviewed expressed annoyance at these sorts of measures. In these cases, doctors generally regarded these initiatives as cumbersome bureaucratic intrusions that cut into their other priorities—namely, practicing medicine. Esther, an obstetrician-gynecologist, told me, “It’s kind of a pain, to be honest with you. It is just another box to check. I already have a million things to do and this just becomes one more kind of bureaucratic hassle.” Esther did not consider diversity initiatives useful or helpful in her work as a physician. Rather, she found them irritating and somewhat intrusive. They interrupted what she thought of as her real work of treating patients.

Ricky, an emergency medicine doctor, offered a similar assessment. In response to a question about what diversity measures he saw in medicine and whether they helped to attract more people of color, he scoffed: “It’s the right idea, but that stuff doesn’t mean anything. Nobody takes it seriously! The way they do it, the trainings and modules, it’s just one more box to check. They just want quick fixes. Doing the hard work, really changing the profession to get more black and brown people in here—that’s not sexy.” Like Esther, Ricky was not enthusiastic about the diversity initiatives at the hospital where he worked. He even uses the same metaphor of “checking a box” to describe the routinized, bureaucratic feelings that this process evokes.

For doctors like Esther and Ricky, diversity initiatives fell flat because they were limited to training modules that did not go far enough to create real change. Not only were they perceived to be ineffective in opening doors to leadership roles, but black doctors saw these diversity outreach efforts as unable to do the basic work of bringing more people of color into the profession. As a consequence, these initiatives actually created more work for black doctors, who resented the intrusion into their time practicing medicine, especially when the trainings did not produce the desired result. When doctors, who are already notoriously stretched thin and bombarded with paperwork, had to complete these cultural competence modules without seeing organizations also do more to attract minority physicians, they grew to resent them and regard them as a waste of valuable time. This sort of diversity initiative offers a nod to black physicians’ awareness of how cultural and social factors matter in health care but does little to reform institutional pathways that make it more difficult for black physicians to access leadership roles. The emphasis is not in a place that would create more avenues for their mobility.

Black Nurses: Being “Diverse on Paper”

A few nurses stated that they had undergone cultural competence training, but by far the most stated that the diversity efforts at their workplaces consisted of official statements in support of this principle. As a result, nurses, like doctors, expressed skepticism about their workplaces’ commitment to diversity initiatives in place. They, too, noted the juxtaposition between organizational rhetoric and practices. As a result, black nurses did not evince confidence that statements in support of diversity were enough to engender leadership opportunities, particularly because they believed little other action was forthcoming. Janice, a geriatric nurse and a faculty member at a university, told me, “One of the things that I know that a lot of nursing schools are pushing towards, and a lot of schools in general, is diversifying their faculty. That said, I think if that actually does happen, in more of a real way as opposed to kind of on paper as it is happening now, I think that that will really benefit black nursing students.”

Janice was clear to emphasize the distinction between the tepid written statements in support of more diversity and the practices that universities like hers could take if they truly wanted to create an infrastructure that supported faculty and students of color. This discrepancy left her doubtful that the nursing school with which she was affiliated would really attract or retain more minority nurses.

Sean was even more explicit in expressing his suspicions that organizations do not genuinely want to diversify: “When you look at schools, the more people say that they’re diverse, the more that they are not diverse. They’re diverse on paper because you have to be. But if you’re diverse on paper, you ought to be diverse in practice. One cannot go without the other.” Again, from Sean’s perspective, it was fairly easy for organizations to profess their commitment to and belief in diversity. However, they seemed to be less proactive when it came to doing the work necessary for creating a multiracial faculty and student body.

Janice and Sean were also dismissive of diversity initiatives, but for different reasons from Esther’s and Ricky’s. While doctors completed cultural competence trainings that they believed were insufficient without broader systemic action, the facilities where Janice and Sean worked did not take even those ceremonial steps. Their organizations produced statements saying that they valued diversity but did nothing more. Consequently, these respondents did not believe that the institutions in which they worked were genuinely serious about wanting to see an influx of workers of color. They certainly were not convinced that diversity initiatives in these forms could enhance leadership opportunities for black nurses. Instead, to nurses, diversity appeared to be window dressing and a superficial organizational attempt to appear to be doing the right thing. Incidentally, many researchers agree with this assessment, describing private-sector organizations as more concerned with evading antidiscrimination lawsuits than truly committed to creating systemic and institutional change (Collins, 2011; Edelman et al., 2001; Moore & Bell, 2011).

Technicians: Looking for Change from the Top

Unlike doctors and nurses, black technicians reported that they rarely, if ever, were subject to organizational policies related to improving diversity. They were not required to undergo the cultural competence training that doctors completed, and did not know whether the schools or institutions where they worked professed a commitment to diversity at large. Thus, when they evaluated diversity initiatives, they offered beliefs regarding whether diversity initiatives, broadly speaking, seemed to be effective.

Ironically, however, of the three groups of health-care workers interviewed for this study, black technicians expressed the least ambivalence and the most hope about diversity initiatives. Unlike black doctors and nurses, they were less likely to regard these efforts as well intentioned but toothless or, less charitably, empty promises designed to appease critics. Black technicians spoke favorably about how the organizations where they worked made efforts to acknowledge and endorse the need for a diverse workforce. Catie, one technician, stated, “I just want to say that I think most hospitals are really on board with the diversity training, and I think that’s such a wonderful thing that these companies are doing. I think that is helping out a lot in the workplace. I think it stands for what we’re not tolerating. You’ve got to respect one another and people’s cultures and backgrounds. And I really think that it’s a good start. It’s a start in the right direction.” Catie’s comments contrast sharply with those of doctors like Esther and nurses like Sean who are much more lukewarm about the diversity efforts in their workplaces. Unlike them, she is proud that these initiatives are offered and believes they are having a favorable result.

Jared, another technician, believed that these initiatives would be helpful in assisting white health-care workers with understanding cultural nuances that could potentially inform how patients of color behaved and responded to treatment. In observing the high numbers of immigrant women patients in his hospital who had undergone female genital mutilation, he noted that some of his white women coworkers could benefit from more familiarity with this issue: “Usually, I catch it when they, usually when they come back into the staff area and they’re talking about it, and some of the Caucasian nurses say, ‘Well, I never heard of that,’ or ‘I never saw that.’ It’s out there. And these are nurses that have been around for ten or fifteen years, you know? I go, ‘No, it’s out there, it exists. You just got to expand your horizons.’ ” From Jared’s viewpoint, additional diversity training and education could only help, as it would serve to bridge some of the racial gaps that exist between mostly white practitioners and the patients of color they serve, particularly when those patients have unfamiliar social or cultural practices that could affect their health care.

It is important to note that while technicians were the most optimistic about diversity efforts, they also were the group least likely to experience them directly. Indeed, diversity initiatives are much more likely to focus on bringing workers of color into high-ranking, high-status occupations that have the potential for institutional leadership than they are to address the small numbers of white workers in lower-status jobs (Berrey, 2011, 2015). This certainly was the case for technicians, who were not required to complete any sort of diversity modules or trainings in order to be certified for their work.

What, then, explains their support for these programs? Technicians professed the most appreciation for diversity initiatives because they believed they would help doctors and nurses avoid missteps when treating minority patients. Note that in Jared’s earlier quote, he expressed hope that this sort of training would make white nurses more familiar with various cultural practices that affect patients of color. Ayana, another technician, expressed a similar viewpoint: “I don’t think that it’ll impact the work that I do just because of my minimal patient contact that I have. But as far as everyone else, I do believe that it’ll impact them. I’m thinking of the nurses and doctors that are being trained. It might make them go a little bit more of the extra mile to make sure everyone is comforted and kind of on the same level. Of course they always go the extra mile, but now it’s just adding another key role.” Note that like Jared, Ayana is optimistic that diversity efforts will help the white doctors and nurses with whom she works to be a bit more sensitive. Hence, black technicians are the most supportive of diversity efforts though, paradoxically, they have the least direct involvement with them. Technicians like Jared do not categorize diversity management as an organizational effort that will open doors for black leadership. Instead, they limit its potential to helping improve patient outcomes and creating more racial equity in care.