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Missed opportunities: lack of advancement of African American females into senior executive healthcare leadership
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Content
Running head: LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 1
Missed Opportunities: Lack of Advancement of African American Females
Into Senior Executive Healthcare Leadership
Brandy Florence
A Dissertation Presented to the
FACULTY OF THE USC ROSSIER SCHOOL OF EDUCATION
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF EDUCATION
May 2020
Copyright 2020 Brandy Florence
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 2
DEDICATION
Thank you for giving me the strength and perseverance to endure even when I didn’t see
my way. Throughout this journey, my faith was tested and I was constantly reminded to “Trust in
the Lord and to lean not on my own understanding” (Proverbs 3:5). Several times I wanted to
throw in the towel, but I had to keep reminding myself of my “why” and my reason for starting
this journey, and my faith kept me going despite the obstacles.
This dissertation is dedicated to my parents, Randy and Cynthia Florence. Thank you for
always believing in me and supporting me in all my educational endeavors. Your prayers and
support carried me along the way. This dissertation is dedicated to my late grandparents, who
were always present at every one of my graduations. I know you are all smiling down on me
from above. To my brother, Branden, I love you.
Lastly, I dedicate this dissertation to myself for all the hard work, dedication, late nights,
early mornings, and sacrifices. This was one of the hardest things I have ever done in my entire
life, but in the end, it was worth it.
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 3
ACKNOWLEDGEMENTS
To my advisor, Dr. Darline Robles, my assistant writing advisor, Dr. Adrian Donato, and
my committee members, Dr. Monique Datta and Dr. Gayla Ivery: Thank you for pushing me
beyond my limits and for believing in me when I didn’t believe in myself. To my student support
advisor: Reginald: Thank you for keeping me sane these last 3 years. To my classmates, thank
you for encouraging me and holding me accountable these past three years.
Thank you to my boss for your patience and support throughout this process. Thank you
to my friends who prayed for me and with me, kept me sane, and put up with me and my mood
swings throughout this tumultuous journey.
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 4
TABLE OF CONTENTS
DEDICATION .....................................................................................................................2
ACKNOWLEDGEMENTS .................................................................................................3
LIST OF TABLES ...............................................................................................................7
LIST OF FIGURES .............................................................................................................8
ABSTRACT .........................................................................................................................9
CHAPTER ONE: OVERVIEW OF THE STUDY ...........................................................10
Introduction to the Problem of Practice .............................................................................10
Related Literature ...............................................................................................................12
Importance of the Problem .................................................................................................15
Healthcare Diversity ..........................................................................................................17
Description of Stakeholders Group ....................................................................................17
Stakeholder Group of Focus ..............................................................................................18
Purpose of the Study and Questions ..................................................................................19
Methodological Framework ...............................................................................................19
Definitions ..........................................................................................................................20
Organization of the Dissertation ........................................................................................22
CHAPTER TWO: REVIEW OF THE LITERATURE .....................................................23
Influences on the Problem of Practice ...............................................................................24
Knowledge, Motivation, and Organizational Influences ...................................................31
Conceptual Framework: The Interaction of Stakeholders’ Knowledge,
Motivation, and the Organizational Context ......................................................................44
Conclusion .........................................................................................................................47
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 5
CHAPTER THREE: METHODS ......................................................................................48
Overview of the Research Design ......................................................................................48
Participating Stakeholders .................................................................................................49
Data Collection and Instrumentation .................................................................................51
Data Analysis .....................................................................................................................52
Research Design .................................................................................................................53
Credibility and Trustworthiness .........................................................................................54
Validity and Reliability ......................................................................................................54
Ethics ..................................................................................................................................56
Limitations and Delimitations ............................................................................................56
Qualifications of the Researcher ........................................................................................57
CHAPTER FOUR: RESULTS AND FINDINGS .............................................................58
Participating Stakeholders .................................................................................................59
Data Validation ..................................................................................................................60
Results and Findings for Knowledge Causes .....................................................................61
Declarative Knowledge ......................................................................................................62
Procedural Knowledge .......................................................................................................64
Metacognitive Knowledge .................................................................................................66
Results and Findings for Motivation Causes .....................................................................69
Utility Value .......................................................................................................................70
Attributions ........................................................................................................................72
Goal Orientation .................................................................................................................74
Results and Findings for Organizational Causes ...............................................................76
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 6
Cultural Models .................................................................................................................77
Cultural Settings.................................................................................................................81
Summary of Validated Influences .....................................................................................82
CHAPTER FIVE: DISCUSSION OF FINDINGS ............................................................89
Recommendations for Practice to Address Knowledge, Motivational,
and Organizational Influences ...........................................................................................89
Implementation and Evaluation Framework ....................................................................100
Organizational Purpose, Needs, and Expectations ..........................................................101
Evaluation of the Components of Learning .....................................................................109
Strength and Weakness of the Approach .........................................................................115
Limitations and Delimitations ..........................................................................................115
Future Research ...............................................................................................................116
Conclusion .......................................................................................................................116
References ........................................................................................................................118
Appendix A: Interview Questions ...................................................................................135
Appendix B: Informed Consent .......................................................................................137
Appendix C: Immediate Evaluation Instrument ..............................................................139
Appendix D: Delayed/Blended Instrument Levels 3 and 4 .............................................140
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 7
LIST OF TABLES
Table Title
1 Organizational Mission, Performance Goal, and Stakeholder Group ..........................12
2 Knowledge Influences, Types of Assessments for Knowledge Gap Analysis ............34
3 Motivational Influences, Types of Assessments for Motivation Gap Analysis ...........41
4 Organizational Influences; Types of Assessments for Organizational Gap Analysis .44
5 Demographic Profiles ..................................................................................................60
6 Knowledge, Motivation, and Organizational Influences and Types ............................86
7 Summary of Knowledge Influences and Recommendations .......................................90
8 Summary of Motivation Influences and Recommendations ........................................93
9 Summary of Organization Influences and Recommendations .....................................98
10 Outcomes, Metrics, and Methods for External and Internal Outcomes .....................102
11 Critical Behaviors, Metrics, Methods, and Timing for Evaluation ............................104
12 Required Drivers to Support Critical Behaviors ........................................................105
13 Evaluation of the Components of Learning for the Program. ....................................110
14 Components to Measure Reactions to the Program ...................................................111
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 8
LIST OF FIGURES
Figure Title
1 Increase in the Number of African American Female Healthcare Executives. ...........45
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 9
ABSTRACT
This study presented the perspectives of 19 African American women occupying middle
management and senior executive leadership positions in healthcare administration in the State
of California. Specifically, data from this research indicated how education, mentorship,
recruitment and retention, and diversity and inclusion influenced participants’ career trajectory
into healthcare leadership. Participants shared any perceived barriers and challenges as well as
the impact of any organizational support they received as they aspired to climb the ladder toward
senior executive leadership positions. The researcher used a semi-structured, open-ended
interview style to conduct face-to-face and telephone interviews. Data from the study indicated
that African American women needed mentorship, advanced degrees, and organizational support
to advance into senior executive positions. Every African American woman who participated in
this study presented her unique experience as she aspired to advance into senior leadership
positions in healthcare. Every participant proactively pursued middle management and senior
executive positions.
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 10
CHAPTER ONE:
OVERVIEW OF THE STUDY
Introduction to the Problem of Practice
Results from this study indicated workplace barriers that prevented African American
(AA) women from obtaining executive-level positions in healthcare. Existing research on career
advancement showed that women have made considerable progression with advanced executive
management careers. White men, however, still predominantly hold executive management
positions in many organizations (Gathers, 2003). De Anda, Dolan, Lee-Eddie, Ellison, and
Honkawa (1998) found that although the gap in male executive positions has narrowed, female
executives have not yet experienced a significant change in career advancement. There are
currently no AA female CEOs in Fortune 500 companies and AA women hold just two percent
of middle management positions.
According to Hutson (2010), women of color who are aspiring to advance into executive-
level positions still face challenges. AA women lack representation in executive healthcare
leadership roles, do not receive the same opportunities, do not have the same access to mentors
as male counterparts, and do not have AA female leaders to look up to within these same
organizations. AA women lack mentors who they can consult with about their future career and
who can provide advice about the necessary steps to become a successful executive in healthcare
(Beckwith, Carter, & Peters, 2016). The healthcare market today is fast-paced and continues to
grow and evolve to meet market, societal, and population demands.
Statistics from the Centers for Disease Control and Prevention (CDC; 2013) indicated
that health disparities such as higher death rates, a lower life expectancy, and higher infant
mortality affect AA individuals more than people of other ethnicities. Healthcare administrators
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 11
need to find knowledgeable and culturally competent leaders to represent the interests of diverse
patient populations and manage a myriad of cultural perspectives. Despite health disparities and
changing demographics, data indicate that demographic and cultural diversity of hospital board
representatives and the presence of African Americans in senior leadership experienced little
change (Selvam, 2012). Women of color experience even lower representation in corporate
leadership roles. In 2015, women of color comprised 38% of the nation’s female population and
20% of the U.S. population. These women, however, held only 3.9% of executive- or senior-
level official and manager positions and just 0.4% of CEO positions in those companies (Census
Bureau, 2015).
Lantz and Maryland (2008) found that women CEOs led only 15 of the top 100 acute
care hospitals in the United States. Data from the American College of Healthcare Executives
(ACHE) and the National Association of Health Services Executives (NAHSE) indicated that
“African American women only make up 26% of top female executives” (Lantz & Maryland,
2008, pp. 293-294). Silva (2012) showed that employees without the same access to senior-level
mentors had a decreased likelihood of gaining access to vital positions that promote career
advancement.
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 12
Table 1
Organizational Mission, Performance Goal, and Stakeholder Group.
Organizational Mission
Organizational
Performance Goal
Stakeholder Group
of Focus
Staff in healthcare
organizations (HMOs)
uphold a commitment to
excellence and strive to
improve the health of the
population they serve by
diversifying leadership
teams and providing
affordable, quality care.
To increase the number of
African American women
who aspire to obtain a
senior executive-level
position within a healthcare
organization.
African American female
middle managers
Related Literature
Data from research literature indicated several challenges that negatively impacted the
careers of AA women and presented common barriers hindering their advancement to the
executive level (Bilimoria, 2009). Data from this research showed why AA women remained
underrepresented at the executive level in healthcare (Bell, 2005; Fairfax, 2005). Common
barriers hindering the career advancement of AA women to the executive level include negative
stereotypes, recruitment and retention, lack of informal networking opportunities, mentorship,
and lack of organizational diversity and inclusion (Cooper, 2013; Davis, 2016; Giscombe, 2011;
Tarmy, 2012; Toson, 2012).
AA women hold fewer executive leadership positions than males, regardless of male
ethnicity. Statistics from a Catalyst (2014) survey showed that only 16.5% of the workforce in
Fortune 500 companies consisted of women, which breaks down to 9.4% of women in first- and
mid-level official or manager positions, 3.9% of women in executive or senior-level official
positions, and 0.4% of women in CEO positions. In each of these categories, AA women still
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 13
hold fewer leadership positions, at 3.8%, 1.2%, and .2%, respectively (Catalyst, 2014). These
statistics show that AA women who aspired to become executives encounter many obstacles on
their career path. A disparity is apparent in the lack of representation of AA women in positions
of healthcare senior leadership (Johns, 2013). Employers in healthcare organizations need to
explore and expand their current recruitment methods to hire influential leaders, including
women of color. According to Kerby (2012), “Women of color comprise 33% of the female
workforce and are twice as likely to hold low paying service roles” (p. 2). In fact, more AA
women work in service occupations than in decision-making roles. Organizations must tailor
their hiring practices to attract more diverse leadership and a workforce comprised of more AA
women.
AA women in leadership positions face many challenges. Because AA women need to
work harder to outperform their counterparts, they may find themselves excluded from social
informal networking events and missed out on sponsorship opportunities (Beckwith et al., 2016).
Byrd (2009) showed that pursuing an executive career required specific characteristics such as
passion in that field, drive and ambition, advanced knowledge of the subject, education, and
expertise. The researcher noted that although AA women possessed these characteristics, they
still faced challenges in attaining these positions. Although specific professions and industries no
longer exclude AA women from entering the workforce, hindrances to job growth still exist
during the advancement stage of their career (Giscombe & Mattis, 2002).
In leadership positions, AA women face more challenges compared to workers in other
racial groups. AA women are more vulnerable to stereotypes, finding themselves viewed as
confrontational and overly aggressive (Edmondson Bell & Nkomo, 2003). Negative stereotypes
damage the professional careers of AA women (Johnson & Thomas, 2012), who already face
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 14
adversities, social inequalities, and stereotypes. One such stereotype is that of the “angry Black
woman,” which labels women as too loud, aggressive, demanding, and uncivilized; another is the
“independent Black woman,” which refers to narcissistic, overachieving, financially successful
women who emasculate the Black males in their life (Edmondson Bell & Nkomo, 2003). These
stereotypes can lead to the desensitization of AA women who suppress their feelings to avoid
further judgment. AA women also face a “double glass ceiling,” a barrier related to both their sex
and their race (Exkano, 2013). For decades, AA women experienced disadvantages as they
strove to build successful careers. Exkano (2013) examined the experiences of AA women in
various administrator positions across industries and discovered that even women who possessed
high-level degrees often encountered the common factor of social inequality based on gender,
race, and social class.
Despite the progress made by women in terms of gender and racial diversity in their
advancement to the executive level, AA women remain severely underrepresented. According to
ACHE (2008), “Only 13% of AA women held chief executive roles; while the percent of Whites
stands at 24%; Hispanics 22%; and Asians 7%” (p. 3427). Overall, AA women do not receive
the same opportunities offered to their white peers, which contributes to AA women not
excelling to the next level in their careers (Bolat, Bolat, & Kihc, 2011). Some researchers found
these upward opportunities linked to the empowering and altering perspectives of mentor and
mentee relationships.
AA female executives need mentoring and sponsorship to break down isolation barriers
effectively, something Cain (2015) found in declaring that individuals on a successful career path
require mentoring. Mentors introduce their mentees to people, opportunities, and places. If
organizations properly implemented mentoring programs, the number of AA females in upper
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 15
management would increase. Additionally, 31% of AA women noted a lack of company role
models of the same racial or ethnic group as a barrier in the workplace (Brown, 2004). Mentors
also provide encouragement and support to disadvantaged people and women of ethnic minority
groups as they break through glass ceilings (Garvey, Stokes, & Megginson, 2014). AA women
benefited from having mentors who guided them throughout their careers and provided insight
into advancement strategies into higher levels of workplace leadership. With a mentor, mentees
build self-confidence, become more willing to take risks in the workplace, develop independence
and maturity in the workplace, learn the importance of feedback both positive and negative, and
accept criticism for the betterment of their career development (Ensher & Murphy, 1997).
AA women should seek mentors who provide advice and objective perspectives that help
them develop their careers. Grant (2012) noted that AA women in mentoring programs, whether
in professional or graduate school settings, excelled because of the mentoring relationship. AA
women and their mentors shared cultural experiences; accordingly, Grant suggested that mentors
could help advance the careers of their mentees based on characteristics similar to parenting
(Grant, 2012). Henderson, Hunter, and Hildreth (2010) discussed the quality of mentorship for
AA women and created a framework for the tension and resistance areas they endure.
Importance of the Problem
Healthcare employers need to examine the lack of advancement of AA female
executives. Addressing problematic practices in the healthcare field is needed to uncover the
barriers that affected or impeded AA women from reaching, aspiring, or finding themselves
selected for executive-level positions in the healthcare profession. This study was a means to fill
gaps in knowledge regarding AA women in executive-level positions in healthcare
administration. Research from this study may help healthcare executives to affect the career
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 16
advancement of the AA women in their employ. Healthcare employers may use these findings as
a foundation to establish policies and procedures that provide AA women the opportunities
necessary to advance in their careers. Understanding the role of mentoring and networking in the
career development of AA women through analysis of personal experience enhanced the existing
research on AA women serving in executive-level management. Additionally, AA women with
leadership aspirations in healthcare administration may use the results from the study to direct
their career paths. Healthcare executives can refer to these data as they seek to improve
healthcare leadership opportunities for ethnically, culturally, and racially diverse individuals.
Healthcare executives need to recognize and address the problematic inequalities, lack of
exposure, and harmful stereotypes and perceptions experienced by most AA women (Parker,
2001). There is a need to change the culture of corporations to provide a level playing field for
both female and male executives. Employers must recognize the problem of racial bias and
become more willing to take responsibility by providing mentors to AA women (Cain, 2015).
AA women still lack representation in executive leadership roles in the 21st century. Wise-
Wright and Zajicek (2006) noted that researchers who drew conclusions about the inability of
women to acquire senior-level positions included only a limited number of AA women in their
studies.
According to Parker (2001), images that idealize senior-level managers stereotypically
feature middle-class White men and women. AA women experience more obstacles when it
comes to acquiring senior-level positions not only because they are women, but also because
they are women of color. McGirt (2017) stated that barriers remain in place for AA women,
something to which researchers recently referred to as the “Black ceiling” comprised of complex
socioeconomic factors. AA women are at a disadvantage when they try to bridge the familiarity
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 17
gap with White men in positions of power because, according to the talent management research
firm Catalyst, AA women are “double outsiders” (McGirt, 2017).
Healthcare Diversity
Healthcare administration is a profession that requires employees with strong leadership
and diversity. Healthcare leaders have begun to understand that both clinical and executive staff
should be reflective of the gender, racial, and ethnic diversity of the communities they serve
(Dreachslin, 2007). Dr. David Satcher (2009), former U.S. Surgeon General, stated that to make
valuable changes within the healthcare system, such as improving the quality of life, healthcare
leaders must establish policies, develop effective collaborations, and increase diversity within
their ranks. Improving diversity among healthcare professionals reduces disparities in healthcare,
improving health outcomes among the increasing racial and ethnic minority populations (Dotson
& Nuru-Jeter, 2012). According to the Health Research and Educational Trust (HRET; 2011),
minorities will comprise close to 54% of the U.S. population by 2050. The provision of
culturally competent care improves healthcare access by promoting the quality of medical
outcomes and eliminating disparities in care delivery processes (HRET, 2011). At the patient
level, the presence of culturally competent employees build trust, create patient confidence, and
reduce costs connected with various types of medical errors (HRET, 2011). The HRET, as a
consequence of the study, recognized the need for a diverse workforce in healthcare. Arguably,
healthcare leadership must embrace diversity as part of the organizational mission as a matter of
national healthcare delivery (HRET, 2011).
Description of Stakeholders Group
Stakeholders in healthcare organizations include chief administrative officers, assistant
med group administrators, medical doctors and department administrators, human resource
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 18
consultants (HRCs), and middle managers, which are employees who currently hold department
administrator (DA) or director-level positions. For this study, the main stakeholder group
affected by this problem of practice was AA female middle managers who aspired to move past
the middle manager plateau. The researcher conducted one-on-one interviews to explore the
lived experiences of AA middle managers at health maintenance organizations (HMOs) in the
State of California.
Stakeholder Group of Focus
This study was a means to uncover the challenges, barriers, and experiences faced by AA
female middle managers aspiring to obtain an executive-level position within a healthcare
organization. The researcher investigated the influence of all potential stakeholders to fully
understand the cultural, educational, and socioeconomic background as well as the motivational,
knowledge, and other sources of perseverance and resiliency exclusive to this population of
women. Accordingly, study stakeholders comprised AA female middle managers within
healthcare who aspired to obtain executive-level healthcare positions. The middle managers’
insight can contribute to the strategic planning of recruitment outreach that staff from healthcare
organizations can use to attract a more diverse pool of candidates. AA women who held
executive-level healthcare leadership positions participated in interviews to provide their
perspectives on how diversity at the leadership level may improve the culture of an organization
and increase individual career advancement. In this study, AA women in executive-level
healthcare leadership positions shared the perceived barriers they experienced as well as the
organizational support they received while advancing in their executive careers.
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 19
Purpose of the Study and Questions
This study entailed the evaluation and assessment of the influences that affected the
advancement of AA female middle managers aspiring to become healthcare executives in the
State of California. The researcher examined the barriers preventing AA women from
overcoming issues surrounding mentors, recruitment, retention, and advancement. Although data
from a complete study would have included additional stakeholders such as the chief
administrative officer, medical doctor, and a human resource consultant, the stakeholders in this
analysis consisted of AA female middle managers working in the HMO sector of a healthcare
organization. The researcher focused on identifying the characteristics and lived experiences that
impacted the skills, knowledge, and organizational and motivational influences of AA women in
HMOs by posing the following research questions:
1. What are the stakeholders’ perceptions of the various knowledge and motivational
influences related to the lack of advancement of African American females in
healthcare leadership?
2. What are the perceived barriers that have contributed to the lack of advancement of
African-American females into the ranks of healthcare executive leadership?
Data analysis led to recommendations for organizational practices in the areas of
knowledge, motivation, and organization (KMO).
Methodological Framework
The gap analysis model (Clark & Estes, 2008) served as a general conceptual framework
for this qualitative study to address the KMO barriers as well as the global performance goal of
AA women. The framework was a means to explore the perceived barriers and potential next
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 20
steps to address the lack of advancement of AA women currently working in healthcare
leadership. An in-depth explanation of the framework appears in Chapter Two.
Definitions
This section presents a list of key terms used in the study to convey a common
understanding.
Acute care hospital: In an acute care hospital, patients receive treatment for brief but severe
episodes of illness, conditions that are the result of disease or trauma, and post-surgery recovery.
African American: According to Lloyd-Jones (2009), the terms African American and Black
are synonymous to refer to Americans of African ancestry.
American College of Healthcare Executives: ACHE is a professional healthcare association
that provides the tools, guidance, and support needed to assist healthcare executives in enhancing
relationships, marketability, professional education, and leadership skills.
Assistant Med Group Administrators: AMGA administrators assist the chief administrative
officer (CAO), have direct oversight of hospital departments, and oversee all the department
administrators.
C-suite level executives: These executives hold senior-level positions identified as chief
executive officer (CEO), CAO, chief operating officer (COO), chief financial officer (CFO),
chief information officer (CIO), and the president or senior vice president within an organization.
Diversity. Within an organizational context, diversity refers to an array of identity characteristics
that may include gender, age, disability, race, language, ethnicity, class status, religious
orientation, sexual orientation, and education (Chin, Desormeaux, & Sawyer, 2016; Weisinger,
Borges-Méndez, & Milofsky, 2016).
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 21
Diversity and inclusion. This compound phrase refers to representation that reflects various
demographic groups and an environment that proactively cultivates having those diverse
individuals equitably and meaningfully engaged in the organization (Chin et al., 2016).
Executive: An executive is a person or group selected and given the responsibility to manage the
business of an organization and the authority to make decisions within specified boundaries
(McCrimmon, 2012).
Healthcare organization: According to Olden (2015), a healthcare organization is a “large
hospital [system] that provides a wide range of acute care and other services spanning many
parts of the continuum of care” (p. 6).
Health maintenance organization: An HMO provides comprehensive healthcare to voluntarily
enrolled individuals and families in a geographic area by member physicians with limited
referrals to outside specialists. HMO financing comes from fixed periodic payments determined
in advance.
Human resources consultants: HRCs are responsible for recruiting, screening, testing, and
performing all preemployment requirements for potential candidates.
Inclusion. Within an organization, inclusion represents practices and policies that affirm respect
for all persons, including employees, leaders, consumers, stakeholders. Inclusion requires
organizational leaders to exemplify cultural competence that treats all groups fairly (Chin &
Trimble, 2015).
Medical doctors: MDs are those licensed to practice medicine who have trained at a school of
medicine or a school of osteopathic medicine. In general, a physician uses medicine to treat
illnesses and injuries.
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 22
Mentoring: Mentoring is developmental assistance provided by a more senior individual within
an organization (Higgins & Kram, 2001).
Middle managers: The middle managers consist of department administrators, assistant
department administrators, and directors. Their roles involve managing employees and the day-
to-day operations of a department to ensure it runs efficiently.
National Association of Health Services Executives: NAHSE is a professional association of
AA healthcare executives who promote the advancement and development of AA healthcare
executives.
Phenomenology: A phenomenological study is a qualitative strategy of inquiry in which the
research identifies the essence of human experiences about a phenomenon as described by
participants (Creswell, 2009).
Organization of the Dissertation
This dissertation consists of five chapters. In Chapter One, the researcher introduces the
problem of practice, the importance of addressing this problem, the stakeholders’ group, the
organizational context, and the questions guiding this study specific to AA female middle
managers in healthcare by presenting research questions, definitions of key terms, and the
methodological framework. Chapter Two includes a review of the literature related to the study
and specific to the concepts of recruitment, employee retention, mentorship, and diversity and
inclusion that may have collectively impacted AA women’s experiences in healthcare leadership.
Chapter Three presents the methodology used for this study, along with the sampling method,
participant inclusion criteria, and data gathering protocols as well as a description of the
researcher’s role and the participants’ protection. Following a thorough description of data
analysis and the resultant findings in Chapter Four, Chapter Five includes a summary of the
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 23
study and implications based on the study and the existing literature. The chapter concludes with
recommendations for policy, practice, and future research.
CHAPTER TWO:
REVIEW OF THE LITERATURE
A review of extant literature began with general research on the challenges of
recruitment, employee retention, mentorship, and diversity and inclusion within the healthcare
industry as it relates to AA aspiring female middle managers and current C-suite and senior
executives. The chapter begins with an overview of contributing factors that prevent AA women
from passing the middle management plateau. Reviewed are the reasons for the lack of AA
female advancement into leadership roles, as well as barriers AA women have personally
encountered, the lived experiences of AA women, and the organizational culture of AA female
middle managers and current C-suite and senior executives in healthcare. Prior scholars
identified common barriers hindering the career advancement of AA women to the executive
level with regard to negative stereotypes, recruitment and retention, lack of informal networking
opportunities, lack of mentorship, and lack of organizational diversity and inclusion (Cooper,
2013; Davis, 2016; Giscombe, 2011; Tarmy, 2012; Toson, 2012). An overview of literature
indicates the inaccessibility of mentors for AA women compared to their White colleagues, with
mentors identified as being imperative to the career growth of AA women.
Also in this chapter will be an in-depth discussion on the benefits of the mentee-mentor
relationship and the successful outcomes of such alliances. Next will be a series of discussions of
personal narratives from AA female middle managers and C-suite and senior healthcare
executives chronicling their journey and experiences over their careers with regard to the barriers
that still exist today. Following the general research literature is a closer look at the Clark and
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 24
Estes (2008) gap analysis model that served as a guide for this study. The gap analysis model
served as a framework to explore the KMO influences of the AA female middle managers’
professional and personal experiences.
Influences on the Problem of Practice
Conducting a literature review entailed exploring the problem of the lack of AA women
who hold executive-level positions in healthcare organizations. Women in leadership positions
are less likely to hold departmental head positions compared to men, who usually work as CEOs,
COOs, or vice presidents (Maryland, 2008). According to Kirchheimer (2007), women comprise
at least 78% of the workforce in healthcare and are also the largest consumer of healthcare.
AA women continue to lag in representation in leadership roles in corporate America.
Currently, AA women make up 12.7% of the U.S. population, yet they represent only 1.3% of
senior management and executive roles of S&P 500 firms and 2.2% of Fortune 500 boards of
directors. Presently, there is not a black female CEO in the Fortune 500 (Smith, Watkins, Ladge,
& Carlton, 2018). The Equal Employment Opportunity Commission (2013) reported that despite
the business workforce representing women and men at 51.1% and 48.5%, respectively, the
number of AA women in business leadership positions was notably lower than men and women
of other ethnicities. Without the buy-in and support of upper executive management to diversify
the industry and hire more AA women executives, low numbers of AA women in executive roles
remains an issue (Gathers, 2003). Due to the lack of representation in executive leadership
positions in healthcare, there was limited research on AA women in healthcare and their
perspectives on the discrepancy.
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 25
Recruitment
Employers need to devise recruitment strategies specific to the organization and the
population they seek to recruit. To compete effectively for the best candidates, recruiters must
learn to identify potential employees with the right skillsets and attributes that best fit the
organization (Wiley, 2000). Healthcare organizations need to focus on satisfying employees’
needs, creating an effective recruitment and retention environment and offering the right
incentives (Ramadevi, Gunasekaran, Roy, Rai, & Senthilkumar, 2016). Offering employee
incentives is not a new strategy in recruitment and retention practices. Knowing what motivates
employees and potential employees makes incentives more effective (Wolf, 2001). Employees of
different generations with different lifestyles and at different points in their careers respond to
different incentives. Kaiser Permanente organizations motivated their employees by offering
cash bonus incentives for referrals that resulted in hired and retained employees (Olson &
Jackson, 2007).
Additional identified recruitment and retainment methods that promoted diversity
leadership for minority executives included the creation of a chief diversity officer (CDO) role in
the human resources (HR) department at the executive level of top-performing hospitals
(Associations of American Medical Colleges [AAMC], 2012). The job of the CDO is to ensure
members of the organization are following the policies and procedures created to improve
workforce diversity (AAMC, 2012). Researchers at the Institute for Diversity in Health
Management (2010) identified methods to recruit and retain minority leaders in executive and
board positions, including the use of executive recruitment agencies that specialized in minority
recruitment. Recruiters typically attempt to connect the patient’s or community’s minority
representation to minority leadership representation. These organizations worked in collaboration
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 26
with the healthcare organization to identify minority candidates (Diversity in Health
Management, 2010). Research indicated that a lack of professional opportunities and
discrimination were the leading causes of attrition and lack of advancement of the AA female
executive population (Diaz & Dunican, 2011).
Employee Retention
Successful employee retention is essential to an organization’s stability, growth, and
revenue. Employee retention strategies are a key part of an organization’s vision, mission,
values, and policies and should start with employee orientation. Employee retention strategies
must offer opportunities for employee training and development (Cloutier, Felusiak, Hill, &
Pemberton-Jones, 2015). Eckert (2013) said that employers need employees to develop a
different skillset with supplemental training to understand the issues employers face and the
decisions they make; in turn, employees’ enhanced skill sets will lead to promotions and better
pay. Organizations can implement various strategies to decrease employee turnover rates. In
most companies, HR managers develop strategies to improve employee retention; however,
many experts believe that acting as a leader instead of just a manager is the most important
retention tool, suggesting that managers must recognize the potential of employees and
appreciate workers for their performance (Al Manum & Nazmul, 2017).
For hospitals to remain competitive in the marketplace, HR managers must master this
skill set of utilizing retention tools and continue to develop the workforce based on individual
desires and goals of staff within the hospital (Deloitte Center for Health Solutions, 2013). The
implementation of retention model programs showed promising outcomes and best practices in
hospitals. Employers who utilize effective employee retention strategies consider both
employees’ personal aspirations (e.g., reward, recognition, and career development) and
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 27
organizational aspirations (Michelman, 2003). Healthcare employers serious about retaining key
talent create a work environment that allows for growth, development, and flexibility
(Michelman, 2003). Turnover costs, in general, range between three fourths to two times the
salaries of the departing employee based on the organizational costs associated with the
recruiting and hiring of new employees (Hayes, Bonner, & Pryor, 2010).
Healthcare organizations should tailor efforts to identify employees’ needs, which might
include focus groups organized around age, gender, position, and experience (Hutchinson &
Purcell, 2003). There is no one way to attract or retain all employees. Until employers in
healthcare industries recognize that every employee has unique needs, organizations may
continue to experience higher turnover rates due to employee dissatisfaction (Hutchinson &
Purcell, 2003).
Voluntary employee turnover in the healthcare industry is one of the most expensive and
disruptive business problems these organizations encounter. Healthcare organizations can expect
employee replacement costs to represent up to 125% of a departing employee’s annual salary in
new employee acquisition and decreased productivity (Collins, McKinnies, Matthews, & Collins,
2015; Kurnat-Thoma, Ganger, Peterson, & Channell, 2017; Rubin, 2007). Some employers do
not consider employee wellness and engagement a priority, even though poor employee wellness
and engagement lead to absenteeism and low morale (Rubel & Kee, 2013). Job satisfaction refers
to employees’ attitudes toward their jobs and includes organizational support, employee
involvement, pay, and benefits (Drydakis, 2015; Gözükara & Çolakoğlu, 2016; Leider, Harper,
Shon, Sellers, & Castrucci, 2016). Employers need to focus on improving job satisfaction, which
would benefit the organization by increasing productivity and lowering turnover rates (Ravid,
Malul, & Zultan, 2017).
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 28
Healthcare employers must understand the correlation between successful employee
retention strategies and organizational performance and the proven positive outcomes of the
relationship (Gajendran, Harrison, & Delaney-Klinger, 2015). Healthcare organizations with
increased employee turnover lose high-performing healthcare employees. Accordingly, high
employee turnover increases organizations’ medical risks and costs and diminishes the quality of
expected patient care (Heinen et al., 2013).
Mentorship
According to Higgins and Kram (2001), mentoring offers both the mentor and the protégé
personal and professional development. Mentors offer insight into specific skills and duties on
the job. Researchers describe mentoring as the developmental assistance provided by a more
senior individual within an organization (Higgins & Kram, 2001). Mentoring promotes
professional advancement as well as employee loyalty and upward mobility within the
organization (Eisenberger, Armeli, Rexwinkle, Lynch, & Rhoades, 2001).
Mentoring has two distinct models, formal and informal, which each develop differently
(Raggins & Cotton, 1999). Informal mentoring relationships originate based on interpersonal
comfort and mutual identification from the mentor to the mentee. Individuals involved in
informal mentoring self-select partners with whom they enjoy working and have a mutual
attraction or chemistry (Raggins & Cotton, 1999). In contrast, formal mentoring relationships
begin with a program or by means of an application process. Unlike in informal mentoring,
interpersonal comfort and mutual identification are not parts of selecting a mentor in formal
mentoring. Although mentorship facilitates an individual’s advancement within organizations,
not all individuals receive either formal or informal mentoring opportunities (Raggins & Cotton,
1999)
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 29
Although having a mentor benefits individuals’ achievement as well as their career goals,
data indicate a lack of mentoring among AA female leaders (Johnson, 2002). Leaders at Kaiser
Permanente, a nonprofit healthcare organization, found that providing opportunities for growth
and development through mentoring programs helped to retain top performers (Olson & Jackson,
2007).
Within the healthcare industry, as in most industries, interaction and relationship with the
right mentor provide an invaluable experience. Unfortunately, because research indicates a low
number of AA female healthcare executives, AA women find partnering with a well-established
mentor challenging. The further AA women advance, the lower the likelihood they will find
mentors who look like them (Kogut, Colomer, & Belinky, 2014). AA women need career
mentors who help them compete with the majority of employees enjoying more success, both
vocationally and socially. Women mentors not only provide professional advice but help
mentees understand the social and mental aspects of the workplace (Breakfield, 2010).
Diversity and Inclusion
Diversity in healthcare management improves the quality of healthcare, quality of
workplace culture, and community relations, thus positively influencing community health
outcomes (ACHE, 2008). Diversity continues to be an essential and vital resource in the United
States. Diversity struggles persist in healthcare and continue to attract more attention from the
public, indicating an overwhelming desire to develop and establish diversity initiatives.
Healthcare organizations need diversity in leadership roles to flourish (Winston, 2001). Diversity
not only achieves ethical and legal aims, but it benefits businesses, as well (AAMC, 2012).
Diverse leadership is more likely to successfully address the problems of health and healthcare
disparities among minority populations (AAMC, 2012). For example, many CDOs collaborate
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 30
with HR to design recruitment strategies, training and leadership development programs,
community engagement activities, and student outreach efforts (AAMC, 2012).
In a benchmark study, the Institute for Diversity in Health Management (2012) identified
reducing disparities in minority representation in healthcare leadership and management as a
main focus in high-performing hospitals and healthcare organizations. By identifying successful
minority recruitment and retention efforts in healthcare organizations and then publicizing the
results, the Institute intended to reduce disparities by cultivating industry-level programs that
lessened disparities (Institute for Diversity in Health Management, 2012). Disparity-reduction
strategies identified as successful included a multidimensional effort and the following activities:
diversity in leadership and governance, strengthening the minority workforce toward
management careers, cultural competency for managers involved in recruitment, and engaging
minority communities (Institute for Diversity in Health Management, 2012).
Wallerstein and Duran (2006) identified the use of community-based activities by
employers in healthcare organizations seeking to reduce disparities. These activities included
conducting research in the community and collaborating with community organizations
representing underrepresented minority groups. Another successful tactic identified by
Wallerstein and Duran specific to reducing disparities in minority representation in healthcare
leadership involved targeting graduate students already serving in community healthcare
organizations. A culture of diversity is essential in the recruitment and retention of minority
leaders in healthcare. Minorities’ perceptions of a hostile culture in healthcare administration
present barriers to representation (Price et al., 2005).
Organizational culture changes are not solely dependent on incremental change as more
minorities enter leadership positions. The culture itself is a barrier to prospective minority
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 31
candidates who eschew careers in an industry they perceive to be hostile to their advancement
(Institute for Diversity in Health Management, 2010). Organizations need to construct an
intentional, diverse cultural climate of minority inclusion that counters this dynamic (Institute for
Diversity in Health Management, 2010). Organizations with documented and funded policies
and programs for diversity leadership tend to administer them under the direction of a CDO.
Medical schools, public hospitals, and teaching hospitals likely employ a CDO responsible for
several aspects of diversity, including leadership recruitment and retention, cultural competency,
and diversity in the nonmanagerial workforce (AAMC, 2012). Responsibilities of the CDO
include designing, implementing, and evaluating minority leadership policies and programs
(AAMC, 2012).
According to McCormick (2007), “Healthcare leadership does not look like America, and
that must change” (p. 23). Although diversity in U.S. population continues to grow, only a “small
number of minorities . . . occupy executive, senior, or even mid-level positions” (Sandrick, 2010,
p. 19). Ironically, White male leaders must be the first to accept diversity efforts, a paradox
Gathers (2003) identified in early efforts to promote diversity management in healthcare
organizations. Policies and programs to recruit and retain minority leaders included the use of
recruitment agencies, establishing diversity goals, succession planning, leadership development
programs, and relationships with organizations and communities serving minorities. These
methods, however, were largely absent from most healthcare organizations (Altheimer, 2015).
Knowledge, Motivation, and Organizational Influences
With the overarching goal to increase the number of AA women who aspire to executive-
level positions in healthcare, the researcher investigated three influences: knowledge, motivation,
and organization. Organizational stakeholder and performance goals are only achievable when
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 32
the gap between actual performance and ideal performance closes (Clark & Estes, 2008). To
assess the stakeholders’ knowledge of the barriers that negatively impacted recruitment,
retention, mentorship, and diversity and inclusion, the researcher evaluated their metacognitive,
declarative, and procedural processes. There was an observation of the stakeholders’ motivation
and how that motivation related to their values, attributes, and goal orientation, resulting in
having confidence in their abilities and the value of persistence in their profession. Ultimately, an
assessment of organizational influences provided an understanding of the culture, processes, and
resources available for the attainment of overall organizational goals. This framework was a
means to present a unique perspective that identified and addressed performance gaps within the
stakeholder group and the healthcare employer’s efforts to increase recruitment, retention, and
mentorship of AA female middle managers.
Table 2 presents the knowledge influences of declarative, procedural, and metacognitive
issues within an organization that affect its global goal. The researcher used these influences to
demonstrate how knowledge can increase the number of AA women who aspire to obtain
executive-level positions within healthcare organizations.
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 33
Table 2
Knowledge Influences, Types of Assessments for Knowledge Gap Analysis
Knowledge Global Goal
To increase the number of African American women who aspire to obtain an executive-level
position within a healthcare organization.
Assumed Knowledge Influences Knowledge Influence Assessment
African American female middle managers
need to know the education level/skill set
requirements to obtain senior leadership
positions. (declarative)
Interview question: What is your current level
of education?
Interview question: How has your educational
background impacted your career
advancement?
African American female middle managers
need to understand how to set and achieve
their own personal and professional goals.
(procedural)
Interview question: What skills were critical
for you to have in order to navigate the
leadership track in healthcare?
African American female middle managers
need to be able to identify barriers that are
affecting their career advancement.
(metacognitive)
Interview question: What barriers/challenges
have you faced as an African American
woman in healthcare leadership?
Interview process: African American female
middle managers will take part in interviews
in person or via telephone to identify specific
barriers and how they have impacted their
career advancement within HMO healthcare
settings.
Knowledge and Skills
Knowledge influences. There are four primary types of knowledge influences: factual
knowledge, conceptual knowledge, procedural knowledge, and metacognitive knowledge
(Krathwohl, 2002; Rueda, 2011). Factual knowledge is the what in the knowledge dimension and
refers to specific details or elements to uncover before proceeding to the next steps (Rueda,
2011). The second type of knowledge dimension, conceptual knowledge, is also the most
complex and involves the understanding of different approaches to obtain knowledge (Rueda,
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 34
2011). Procedural knowledge, the third dimension, refers to the knowledge of a task, which
could be as simple as riding a bike to as complex as building an aircraft (Rueda, 2011).
Understanding one’s role and essential job duties is an example of procedural knowledge; an
individual cannot be held accountable for a requirement of which they were unaware. Finally,
metacognitive knowledge is a distinction not widely recognized at the time of implementation or
development (Krathwohl, 2002). Factual knowledge is what gives AA female middle managers
the tools needed to address barriers that have negatively impacted the recruitment, retention, and
mentorship of this population in the healthcare community. The researcher assessed the
knowledge, motivational, and organizational factors (KMOs) and determined which approaches
presented answers to the research questions.
Importance of diversity recruitment. According to Silver (2017), a diverse healthcare
workforce is more culturally competent and better equipped to meet the needs of an increasingly
diverse population. Data from contemporary literature also presented a phenomenon known as
the “middle management plateau” to explain the lack of diversity in executive healthcare
leadership roles (Parker, 2001). HRCs need to consider candidates’ needs throughout the
recruitment process and determine what employees need to succeed in their new positions. The
recruitment process should also include informing the senior executives of what role they will
play in the employee’s success (Rueda, 2011).
Redesign current recruitment strategies. Employers in professional organizations
engage in a variety of efforts that promote minority leadership at the professional, industry, and
organizational levels. Organizations must continually evolve to succeed. As such, employers
should continually explore ways to improve current workflows and implement best practices
(AAMC, 2012). These efforts include designing minority leadership recruitment programs and
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 35
policies, conducting studies that document the lack of minority leadership, advocating for
minority leadership, and collaborating with organizations and other professional bodies to
encourage minority leadership (AAMC, 2012; Dotson & Nuru-Jeter, 2012; Gathers, 2003;
Institute for Diversity in Health Management, 2010, 2012; Mitchell & Lassiter, 2006; Richman
et al., 2001; Rosenberg, 2008).
Redesigning recruitment strategies entails evaluating and assessing current workflows
and providing recommendations for specific areas in need of improvement. According to Power
(2010), implementing these behavioral changes is often difficult because employees require
training to perform tasks in ways beyond what they are accustomed. In collaboration with senior
leadership, an HRC should focus on diversifying the organization’s ranking by increasing
minority application rates and implementing forward-thinking strategies. HRCs must understand
that diversity representation plays a critical role in how minorities view organizations (Ford,
2004). Second, the HRC should determine what message the recruitment materials convey about
the organization’s commitment to diversity and underrepresented groups (Avery, 2003; Grier &
Brumbaugh, 1999; Young, Rinehart, Jury, & Baits, 1997). Third, the HRC needs to identify the
best ways to recruit potential employees, such as job fairs or community events. The HRC also
needs to identify who is responsible for recruitment to determine whether females and minorities
are part of the decision-making process.
HRCs are aware of how these factors affect an employer’s ability to promote diversity
and enhance minority attraction. To discuss the specifics of these strategies and their
effectiveness, the researcher needed to comprehend the theoretical background of attraction and
the conveyance of organizational information. Understanding the theoretical background helps
employers at an organization to develop and utilize a more targeted selection process that
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 36
identifies certifications, licensures, competencies, and behaviors critical for job success in every
role (Sutter Davis Hospital, 2014).
The literature indicated different recruitment approaches for front line staff, middle
managers, and executives (Hollenbeck, 2009), one of them being headhunters. According to
Hamari (2010), headhunters at executive search firms fill as much as 54% of all U.S. positions
with annual compensation of $150,000 or above. This strategy became more common due to
employers increasingly selecting their next leader outside of their current organization. Executive
search firms select candidates from large organizations with reputations for good performance.
Candidate selection was based on the strength of the organization, not necessarily the strength of
the candidate (Hamari, 2010). Although many researchers have identified organizational-level
minority leader recruitment and retainment methods in healthcare, the literature indicated
professional-level efforts of recruitment, as well.
Motivation influences. AA female middle managers must have confidence in their
managerial skill sets and value working in the healthcare profession. To avoid burnout, AA
women need to remind themselves why they want to work in healthcare and advance in the
industry (Gascon et al., 2013). Motivation stems from one’s internal desire to complete a task or
achieve a goal (Mayer, 2011). Middle managers rely heavily on motivation to obtain goals and
accomplish tasks. As Mayer (2011) noted, individuals who are motivated to perform at high
levels attained both organizational and personal achievements. Individuals who committed to be
involved persevered and exerted the energy, drive, and mental effort necessary for success (Clark
& Estes, 2008; Grossman & Salas, 2011). Stakeholders need motivation for the level of
commitment required to reach their goal, which requires them to function outside of their normal
roles to gain new perspectives (Rueda, 2011). HRCs not only need to reach the goal of recruiting
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 37
more AA female executive candidates, but organizations need to hire these candidates
successfully. Bringing AA female candidates on board will have a direct impact on the care
provided to the diverse patient population (Khatri, Baveja, Boren, & Mammo, 2006). Various
motivational influences applicable to constructs and performance goals are available, to include
unity value, attributions, and goal orientation.
Value. Individuals’ beliefs determine their ability to organize and execute the course of
action required to attain the designated levels of performance (Bandura, 1986). Value refers to
the importance an individual attaches to a task in asking, “Why should I perform the task?”
(Eccles, 2006). High self-esteem, a strong belief in personal ability, and value in the involved
task increased an individual’s performance level (Eccles, 2006). When employees consider their
value related to performance goals, they evaluate how well the tasks align with their goals or
desires, such as rewards, and the direct impact of cost value on how much time, effort, or
resources are necessary for the task (Eccles, 2006; Rueda, 2011). Individuals working in
healthcare may value helping others, which is considered one of the most selfless acts of
kindness. Other individuals may value the professional or financial status that working in
healthcare provides. However, holding a healthcare executive role comes at a high cost for many
employees, with long hours requiring them to spend more time away from family and friends.
An employee’s motivation and desire to persist in a profession regardless of the cost has a direct
effect on retention and advancement (Dembo & Eaton, 2000; Pintrich, 2003). When employees
expect their efforts or contributions to increase a specific performance metric, they became more
motivated and work harder to succeed (Rueda, 2011).
Attributions. Employees often worked harder at a task when they believed their level of
effort dictates the outcome (Wiener, 2005). Employee motivation comprises three aspects:
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 38
stability, locus, and control. An employee who prioritizes stability looks at whether job
attributions are permanent or temporary. Employees who consider specific external or internal
factors identify any provisions put in place before implementation (Wiener, 2005). Employees
who consider control examine the factors within their control and determine the impact of
control on subsequent behavior and emotions (Rueda, 2011). Many employees began to ask
themselves “why?” questions during the control phase of attribution theory. During the control
phase, employees begin to recognize that failing to meet a previous goal is not a permanent
outcome; accordingly, they acknowledge that an increase in effort could change the results of
their efforts (Rueda, 2011). Under attribution theory, employees consistently try to make sense of
the larger social environment and their place within it, as well as the role of attributions in the
sense-making process.
Attributions emerge from beliefs about the causes of one’s successes and failures in terms
of rewards and punishments, emotions, behavior, and influence expectancies (Martinko, Harvey,
& Douglas, 2007). Most organizational scholars agree that, beyond rewards and punishments,
attributions also influence behavior; accordingly, attributions also affect the range of
organizational behaviors influenced by rewards and punishments (Martinko et al., 2007).
Individuals place importance on rewards and punishments as well as their causes.
Goal orientation. A goal is something a person wants to achieve, whether personally or
professionally. Goal orientation comprises two components, mastery goal orientation and
performance goal orientation (Locke & Latham, 1990). Individuals with mastery goals focused
on learning a new task or skill, obtaining new competencies, and accomplishing a challenging
task. Employees who demonstrated performance goals focused on their goals, became more
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 39
confident in their abilities, chose to demonstrate their abilities in front of others, sought rewards
and recognition, and did not fear negative judgment from their peers (Rueda, 2011).
Research shows that motivated employees are more eager to engage in the workplace if
their organizational environment encourages them to make mistakes. When employers allowed
mistakes, employees experience room for growth and learning, akin to the adage “If at first you
fail, try again” (Hayward, 2010; Radda, Majidadi, & Akanno, 2015; Ünal & Turgut, 2015:
Woodruffe, 2015). Once employees’ confidence levels increase, they begin to believe in their
abilities to achieve organizational goals, become more engaged in the workplace, and begin to
approach workplace obstacles in different ways (Ames, 1992). This type of goal orientation is
related to achieving a performance goal and directly impacts obtaining the overall stakeholders’
goals for the organization (Rueda, 2011).
Table 3 identifies three motivational influences that focus on unity value, attributions,
and goal orientation. The researcher used these influences to demonstrate how motivation
affected the recruitment outreach strategies in healthcare organizations.
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 40
Table 3
Motivational Influences, Types of Assessments for Motivation Gap Analysis
Motivational Global Goal
To increase the number of African American women who aspire to obtain an executive-level
position within a healthcare organization.
Assumed Motivational Influences Motivational Influence Assessment
Unity value: African American female middle
managers saw the value in making the
management pool more diverse.
Interview question: Can you describe the
level of commitment your organization has
toward diversity?
Attributions: African American female
middle managers felt that the current process
for candidate selection was due to a lack of
recruitment efforts.
Interview prompt: What do you think may be
the cause for the lack of African American
female candidates applying or being
interviewed for these executive-level
positions?
Interview question: Are you aware of the
effective recruitment strategies your
organization uses to recruit or retain African
American female leaders?
Goal orientation: African American female
middle managers need to do more than
required to show senior leadership that they
are not just checking off boxes and doing the
bare minimum.
Interview question: What are the factors you
perceive as contributing to your leadership
experience as an AA woman?
Organization
General theory. An organization’s culture inevitably impacts all attempts to improve
performance; accordingly, the success of the performance improvement depends on the specifics
of that culture (Clark & Estes, 2008). Regardless of how skilled, knowledgeable, or motivated a
person is, missing or inadequate processes and materials may prevent the achievement of an
organizational performance goal (Clark & Estes, 2008). According to Clark and Estes (2008),
any time an organization changed workflow or processes, employees’ jobs changed. If employers
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 41
did not change how employees performed their jobs, then the organization experienced no
change. As part of organizational influences, the researcher of this study explored and compared
the cultural settings and models that currently impact the recruiting strategies of HRCs in various
industries to the cultural settings and models of HRCs in healthcare organizations.
Work process. During this phase, organizational goal achievement is by a system of
interactive processes that require specific skill sets in knowledge and motivation to operate
successfully (Clark & Estes, 2008). The HR recruiting process includes marketing and outreach
that increase diversity at the managerial level.
Culture. Clark and Estes (2008) defined culture as “a powerful force in performance and
a difficult characteristic to identify and to influence” (p. 108). According to researchers, culture
indicates individuals’ core values, goals, beliefs, and learned processes. Change and culture
processes often interact destructively, which is one reason performance issues resulting from
change require special attention (Clark & Estes, 2008). Gallimore and Goldenberg (2001)
dissected organizational culture based on the cultural settings and models within it. Distinct and
employee-specific cultural settings included employees’ tasks, the means of and reasons for task
completion, and the social context where employees work. Shared mental schemas comprise a
culture model illustrating best practices used within an organization (Gallimore & Goldenberg,
2001).
Stakeholder-specific factors. From a culture model perspective, the researcher applied
two specific factors to understand the cause of organizational problems within current recruiting
workflow processes. These were (a) HRCs understanding the necessity of changing current
strategies to achieve the goal of increasing the number of AA female healthcare executives, and
(b) HRCs needing to target specific communities to increase the organization’s presence and
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 42
customize marketing strategies to appeal to that racial group. Healthcare organizations
successfully utilized process management tools that allowed them to identify and manage key
processes and define roles and responsibilities. Change within an organization entails alteration
of values, beliefs, myths, and rituals (Clark & Estes, 2008). With clearly defined roles,
employers can hold employees accountable for specific standards and expectations (Clark &
Estes, 2008). Achieving the stakeholder’s organizational goals requires innovative thinking and a
new way of doing things for all parties involved. In this study, the researcher sought to address
healthcare industry HR recruiters’ current strategies and lack of knowledge regarding the
absence of diversity at the executive level (Michelman, 2003). According to Clark and Estes
(2008), many performance gaps tend to be interconnected: If a problem did not exist in one part
of the system, it occupied a different part. Employers need to identify the root cause of the
problem from an organizational standpoint before implementing new processes. Developing and
changing the culture within an organization or environment directly impacts performance (Clark
& Estes, 2008).
Table 4 presents the organizational mission, goal, and information specific to
organizational influences, organizational influence assessments, and the influences that identified
inefficiencies in the current recruitment process in healthcare organizations.
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 43
Table 4
Organizational Influences, Types of Assessments for Organizational Gap Analysis
Organizational Global Goal
To increase the number of African American women who aspire to obtain an executive-level
position within a healthcare organization.
Organizational Influences
Organizational
Influence Type
Organizational Influence
Assessment
There needs to be an
understanding and willingness to
change the current organizational
culture surrounding recruitment
strategies.
Cultural models Interview question: Have any of
the organizations you’ve worked
for, including your current
organization, had specific
initiatives geared toward the
advancement of African American
women into senior leadership
roles?
There needs to be a culture of trust
within the hospital between
administrators and human
resources consultants to achieve
the organizational global goal of
increasing the number of African
American female executives.
Cultural models Interview question: Do you feel
you were afforded an equal
opportunity as an African
American woman to obtain an
executive level position within
your own healthcare organization?
Human resources consultants need
to enhance their recruitment
strategies specifically within the
demographics they are targeting to
improve their recruitment process.
Cultural settings Interview question: Can you
explain your observations and the
ways leadership in your
organization promotes or supports
diversity and inclusion?
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 44
Conceptual Framework: The Interaction of Stakeholders’ Knowledge, Motivation, and the
Organizational Context
According to data from Clark and Estes’s (2008) gap analysis model, the analytical,
systematic method is a means to identify the gap between an organization’s preferred
performance level and its actual performance level. A conceptual framework is a way to present
variables and concepts between knowledge and motivation and show how these variables may be
influential within an organization. Maxwell (2013) and Miles and Huberman (1994) defined a
conceptual framework as a written or visual product explained either graphically or in a narrative
form and the presumed relationship among them. In this study, the qualitative approach enabled
the researcher to review interview results, answer the research questions, and uncover ways to
address the lack of AA female executives in healthcare. When healthcare employers fail to
incorporate cultural diversity into their organizational culture, the organization also fails to
provide patients with comprehensive, quality, patient-centered care. Figure 1 is a graphic
representation of this concept.
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 45
Figure 1
Increase in the Number of African American Female Healthcare Executives
Global organization: healthcare organizations
Cultural settings: predominantly male executives
Cultural model: increase diversity in executive
positions
Stakeholder:
Knowledge: Metacognitive – African
American middle managers need to be able
to identify the barriers that are affecting
their advancement
Knowledge: Conceptual – African
American middle managers need to
understand current recruitment strategies.
Motivation: Utility value – African
American middle managers need to see the
value in making senior leadership more
diverse.
Organizational domain goal:
Increase the number of African
American women that aspire to obtain
executive-level positions within a
healthcare organization
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 46
The conceptual map in Figure 1 is a visual component similar to that mentioned by
Maxwell (2013). This design map displays the main problems or missing components by
showing the connections between specific factors and allows for the opportunity to make better-
informed decisions based on the overall picture. An illustration of the stakeholder goals
embedded within the knowledge and motivational influences depicts how the knowledge and
motivational components can work together to achieve the organizational goal. The blue circle,
Organization, presents healthcare organizations from a global perspective in this study. In
alignment with data from this study, which showed the majority of executives’ positions being
held by men; accordingly, the cultural model needed more diversity when it came to AA female
executives.
The orange circle represents stakeholder Knowledge and Motivational factors. The
researcher selected these factors to bring awareness to middle managers, influencing them to
acknowledge the barriers affecting their advancement and helping them understand current
recruitment strategies to gain career path insight. Selected factual and conceptual knowledge
factors comprise this study.
To discover the source of the problem, individuals must perform their due diligence.
After discovering barriers, individuals must find the motivation to reach the goal. The orange
circle lists the motivational influence of value specific to stakeholders’ acknowledgment of a
lack of diversity in the pool of candidates and senior leaders. AA middle managers need to
understand the value of increasing executive pool diversity in the executive pool and the positive
impact of increased diversity on achieving organizational goals. The blue and orange circles
connect with the yellow square via the blue arrow, which is the organizational global goal to
increase the number of AA women holding executive-level positions in healthcare.
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 47
Conclusion
This study entailed an examination of the common challenges and barriers directly
impacting the lack of advancement of AA female executives in larger HMO healthcare
organizations. According to Clark and Estes (2008), organizations need to understand which
knowledge, motivational, and organizational influences to apply to find solutions to the problem.
Accordingly, this researcher explored factual and conceptual knowledge influences to address
the importance of diversity recruitment and the necessity of redesigning current recruitment
strategies. This chapter included a discussion of motivational influences such as utility value,
attributions, and goal orientation. Organizational concepts, such as general theory and work
processes, presented the culture of the organization, indicating employees’ level of success in
performance improvement. Employers need to change the culture of corporations and provide a
level playing field for both female and male executives (Cain, 2015).
Chapter Three presents the study’s methodological research approach and design. The
chapter includes a rationale for the phenomenological design and qualitative methodology of the
study as well as information on the research questions and population. Along with the informed
consent and sampling rationale for the participants, there is an examination of data collection,
instruments, analysis, credibility, and trustworthiness of the research.
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 48
CHAPTER THREE:
METHODS
Overview of the Research Design
In the study, the researcher explored barriers that prevent AA female middle managers
from advancing executive-level leadership roles in healthcare. This study was a means to
understand the narratives linked to the experiences of AA women, how the KMOs impacted the
experiences of AA women, and barriers AA middle managers encountered when aspiring to
executive-level positions. The participants selected for this study continue to overcome
adversities and barriers discussed in the literature review while seeking and obtaining success in
leadership roles.
This chapter includes a discussion of the qualitative phenomenological approach used to
answer the research questions. Also presented are the rationale behind the selection of the
qualitative method, the restated research questions, the data collection instruments, the target
population, interview techniques, data collection procedures, the protection of human subjects,
and the data analysis plan. A qualitative phenomenological design was appropriate to explore the
lived experiences of AA female middle managers working in healthcare. Data analysis was a
means to answer two research questions:
1. What are the stakeholders’ perceptions of the various knowledge and motivational
influences related to the lack of advancement of AA women in healthcare leadership?
2. What are the perceived barriers that have contributed to the lack of advancement of
AA women into the ranks of healthcare executive leadership?
After analyzing the data, the researcher provided recommendations for organizational
practices in the areas of knowledge, motivation, and organization.
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 49
Participating Stakeholders
Participants and stakeholders were AA women currently working in healthcare in the
position of middle manager. Participants came from the researcher’s personal network of
working women within organizations fitting the criteria, women working at various healthcare
facilities, and women contacted on LinkedIn. Prior to the study, leaders of these organizations
provided permission to gain access to employees. The researcher purposefully selected study
participants from an accessible convenience sample of organizations. Although convenience
samples may come with limitations and biases, this method of participant selection also has
benefits (Merriam & Tisdell, 2016). The researcher gained trust with these women based on
awareness or membership within these organizations, affiliations that enabled accurate
interpretation of responses. Additional participants came from snowball sampling, which entailed
requesting referrals from original participants (Patton, 2015).
Inclusion Criteria for the Sample Middle Managers
To be eligible to participate in the study, women needed to meet the following criteria:
• AA female middle managers who currently hold a management position in health
administration. Healthcare settings included public health facilities, large medical
group practices, and hospitals, both private and public.
• Must have held a management position for more than 2 years in a healthcare
organization and must have supervised five or more employees. The researcher
selected this criterion to ensure that the middle managers interviewed had sufficient
team management and supervisory experience to provide insight into barriers that
impeded advancement into executive leadership roles.
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 50
Inclusion Criteria for the Sample Senior/C-Suite Executive
Representatives of the target population for this study needed to meet the following
criteria:
• The senior or C-suite executive must be an AA woman who currently holds an
executive position in health administration. Healthcare settings included public health
facilities, large medical group practices, and hospitals, both private and public.
• The senior or C-suite executive must have held an executive position in a healthcare
organization for more than 1 year and must have overseen five or more middle
managers. The researcher selected these criteria to ensure that the senior or C-suite
executive interviewed had sufficient experience to provide insight into the barriers
they encountered in their current executive leadership role.
Recruitment Strategy and Rationale
The researcher used purposive and snowball sampling recruitment strategies for this
study. The intent was to interview 19 participants in a one-on-one setting using a semi-structured
approach (Merriam & Tisdell, 2016). The final sample comprised 10 AA women holding middle
management positions and nine AA women holding senior or C-suite executive positions.
Participant selection occurred based on the criteria mentioned.
The first step was to contact participants from the researcher’s network of colleagues
within her organization. Next, the researcher scoured the Internet for organizations with AA
women in healthcare positions and sent e-mails to those organizations seeking potential
participants. Of the several organizations contacted, the local NAHSE chapter president provided
a list of members who met the participation criteria. The NAHSE is a professional association of
AA healthcare executives who promote the career advancement and professional development of
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 51
AA healthcare executives. The researcher next contacted these women via e-mail or by telephone
to invite them to participate in the study. Following information on the purpose of the study,
participants learned of their right to anonymity and that there would be no negative repercussions
as a result of their participation. There was no monetary compensation for participation. The
researcher did not have a personal connection with any of the participants.
Data Collection and Instrumentation
Data collection was through semi-structured, one-on-one interviews with open-ended
questions. Participants discussed their experiences working in a senior or C-suite or middle
management healthcare position who aspired to executive-level leadership roles. Interview
questions followed the ethical guidelines of respect for persons, beneficence, and justice outlined
in The Belmont Report (National Commission for the Protection of Human Subjects of
Biomedical and Behavioral Research, 1979). Selected participants received a formal letter
confirming their participation in the study. Interview scheduling entailed the participant selecting
a date, time, and location from a list provided via e-mail, which also included the options of
telephone, online, or in-person meetings.
Due to the timeframe of the study, interviews occurred within 15 to 30 days to prevent
delays in data collection. The researcher established a rapport with the participants to ensure the
women felt comfortable and willing to share their opinions openly and honestly without fear of
judgment. Upon scheduling the interview, participants received a consent form to review and
sign, as well as the interview questions for their review.
Interviews
The interviews occurred face to face, online via Skype or Zoom, or by telephone and
consisted of 14 predetermined questions, allowing room for follow-up queries, as needed.
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 52
Interviews lasted between 30 to 60 minutes, depending on the depth of the respondents’ answers.
Prior to beginning the interview, the researcher reviewed the informed consent form, including
the right to audio record the interview, which each participant needed to complete before
responding to any questions. A researcher-produced interview protocol meant that each
participant heard all interview questions in the same order. The researcher informed participants
of the potential for later contact should clarification be necessary. If the researcher needed
additional inquiry, the researcher discussed the best contact methods and times for additional
inquiry at that time.
A handheld audio-recording device placed midway between the researcher and the
participant for in-person interviews and next to the speaker for telephone interviews enabled the
capture of participants’ words. Upon completion of the interview, the researcher saved each
audio file with a distinct participant identifier (e.g., Participant 1) and transmitted the interview
to a transcription company via a telephone application or the Internet. Due to time constraints in
completing the study, the participants did not review transcripts. Upon receipt of each transcript,
the researcher reviewed the collected information.
Data Analysis
First-level coding was a means to identify subject areas, themes, similarities, and
differences among the participants’ responses. The second level of coding enabled the
identification of the differences and similarities among participant responses. In this step, a
researcher identifies patterns and general themes at the sample level rather than the individual
level (Auerbach & Silverstein, 2003). Full descriptions of the similarities and differences
prevented generalized and simplistic conclusions. Researchers accomplish the third level of
coding, triangulation, by cross-referencing multiple various data sources, which in this study
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 53
included extant literature, researcher field notes, and interview transcripts. Upon the first
transcript review, the researcher made notes in the margins to highlight pertinent content and
emerging dimensions. The coding process entailed the identification of similar words, phrases,
experiences, or influences of 19 participants, thus indicating commonalities between more than
half the participants.
The researcher developed a codebook to analyze the data more thoroughly and to create a
visual of the participants’ responses and resultant themes. The codebook allowed for
disaggregation of data and the identification of axial, open, and selective codes. The researcher
summarized participants’ responses in an Excel spreadsheet, and color-coded the interview
questions and responses according to whether the response referred to knowledge, motivational,
or organizational influences. Open coding occurred with the identification of specific words,
statements, or phrases from the data. According to Maxwell (2013), using multiple methods of
coding helps a researcher obtain insight from different perspectives of the study. The
trustworthiness component of triangulation receives further discussion in Chapter Four.
Research Design
A qualitative phenomenological approach was appropriate for this study, a design
recommended by Creswell (2005) and Creswell, Hanson, Plano Clark, and Morales (2007) to
explore and obtain a deep understanding of the problem. Qualitative research allows for semi-
structured, in-depth interviews used to explore participants’ lived experiences. This approach
enables understanding of participant views through relating’s of their experiences and lived
world (Kvale & Brinkmann, 2015). Qualitative studies allow researchers to assess individuals’
perceptions, experiences, opinions, and motivations. The phenomenological design allows a
researcher to identify the essence of human experiences through an examination of participants’
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 54
lived experiences of the phenomenon (Creswell, 2005; Moustakas, 1994). According to Creswell
(2009), phenomenological research is “a strategy of inquiry in which the researcher identifies the
essence of human experiences about a phenomenon as described by participants” (p. 13).
Credibility and Trustworthiness
A researcher must take steps to establish the credibility and trustworthiness of findings
(Merriam & Tisdell, 2016). The first step was employing the research methods of narrative
inquiry and phenomenology as part of the qualitative investigation (Merriam & Tisdell, 2016).
Patton (2003) defined reflexivity “as a way of emphasizing the importance of self-awareness,
political/cultural consciousness, and ownership of one’s perspective” (p. 64). This approach
impacts data interpretation, which may compromise the credibility of findings. It is also
necessary to develop a familiarity with participants’ background and culture before conducting
interviews (Merriam & Tisdell, 2016). Further trustworthiness came from the triangulation of
data, incorporating prior research, researcher field notes, and one-on-one interviews with AA
women who met the criteria for participation.
Validity and Reliability
Qualitative results must be both valid and reliable; however, neither is clear nor fully
possible using this approach (Morse & Richards, 2002; Onwueqbuzie, 2000). The concept of
validity is controversial in qualitative research, with many qualitative researchers abandoning the
concept of validity entirely. Prominent scholars have argued that any concept of validity that
refers to a real world is incompatible with a qualitative approach, as there may be a separate
reality outside of the constructions of different individuals and societies (Denzin & Lincoln
2005a; Guba & Lincoln, 1989).
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 55
According to Maxwell (2013), qualitative research requires descriptive validity,
interpretive validity, theoretical validity, generalizability, and evaluative validity. Descriptive
validity refers to the accurate account of the information without exaggeration; interpretive
validity comes from the accurate interpretation of the experiences to derive meanings; theoretical
validity focuses on the researcher constructing appropriate concepts and correctly linking the
concepts; internal generalizability entails a focus on interpreting the participants’ responses
accurately within a short period; and, finally, evaluative validity refers to the researcher’s ability
to answer questions related to the research and framework used (Maxwell, 2013). In addition to
addressing the validity of the data, the researcher applied quality criteria to the study itself and
the chosen research methodology. To achieve trustworthiness, qualitative researchers must
address credibility, transferability, and dependability (Morse, 2006).
Researcher Bias
As the researcher is also an AA woman working as a midlevel leader in healthcare and
thus had informed knowledge of the topic under study, it was necessary to keep in mind personal
experiences. This entailed the use of bracketing as a means to first acknowledge and then set
aside any biases or preconceptions as a result (Dickson-Swift et al., 2007; Fossey et al., 2002).
According to Creswell (2007), bracketing allows researchers to put aside personal experiences
and ensure their focus remains on the participants’ words and experiences. Accordingly, the
researcher suppressed any statements or thoughts indicative of presumptions, biases, or
prejudgments to obtain and present only the participants’ experiences.
Lincoln and Guba (1985) noted the risk of researcher bias in qualitative research studies.
Bias can occur during the semi-structured interview, sampling method and population, data
interpretation, and data presentation (Patton, 2005). Bias can also emerge through nonverbal
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 56
communication and the phrasing of leading questions that may inadvertently cause the
participant to respond differently than they would otherwise. Therefore, it was necessary to
collect only the information provided by participants without the interjection of personal
thoughts or opinions.
Ethics
A researcher is responsible for anticipating and managing all possible ethical risks. Per
standards set by the Academy of Management Code of Ethics (2015), the researcher maintained
the highest standards of professional conduct, emphasizing privacy and confidentiality while
gathering confidential information. Ethical considerations related to recruitment require a
researcher to “develop . . . trust with the participants, protect the participants by maintaining
confidentiality, promote the integrity of the research, guard against misconduct and impropriety
that might protect their organizations or institutions, and cope with new problems” (Creswell,
2009, p. 87). A researcher must maintain the dignity and welfare of all participants, protecting
them from exposure to mental, physical, or emotional harm (Trochim, 2006).
As part of maintaining ethics in the study, it was necessary to the rights of each
participant and to keep all identities confidential. Assigning participants, a pseudonym in lieu of
their names ensured no information gathered from the study included identifiable information.
Ethical considerations also entail using all data collected solely for research. Stored in a secure
location to which only the researcher has access, all collected digital and physical materials will
undergo destruction 2 years following the completion of the study.
Limitations and Delimitations
The researcher considered several limitations when interpreting the findings of this study,
such as: The intended sample size was smaller than anticipated due to a limited population of
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 57
individuals meeting study criteria. Some participants may have been afraid of backlash or other
negative repercussions in their organizations or industry; accordingly, they may not have been as
forthcoming in their responses. There may be an issue obtaining accurate data specific to the
number of AA women in healthcare leadership because prior research is limited for both the
middle manager and C-suite executive populations. Participants may have withheld explicit
truths of their lived experiences.
Qualifications of the Researcher
Theoretical sensitivity refers to a personal quality held by an individual conducting
research and indicates an awareness of the meaning within the data collected (Daiute, 2004). The
researcher approached the study with a firm understanding and a level of sensitivity while
comparing data and findings to the literature. To understand the experiences of AA women in
healthcare, it is necessary to understand oppression and stereotypes that present challenges and
obstacles to AA women seeking leadership roles.
The researcher is an AA female who worked in healthcare in various leadership roles.
Accordingly, the researcher was knowledgeable about the challenges these women faced, which
led to her interest in this group. In addition, the researcher was single but had witnessed the
struggles between work and family life balance that AA women encountered.
The researcher was aware of the need to maintain trustworthy interactions with each
participant. Establishing researcher-participant trust made it easier for each woman to share her
experiences openly. It was important that the researcher not impose personal opinions onto the
participants, avoid bias, take steps to acknowledge personal perceptions, reflect on participants’
experiences, and validate the participants’ perspectives that differed from the researcher’s
expectations
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 58
CHAPTER FOUR:
RESULTS AND FINDINGS
This study was a means to explore the barriers and challenges that contribute to the lack
of advancement of AA women into senior executive leadership positions in healthcare. A
qualitative phenomenological approach enabled exploration of the KMO influences of AA
women seeking to improve their chances for further advancement. Utilizing the KMO
framework of Clark and Estes (2008), the researcher organized the results of this study by the
categories of assumed knowledge, motivational, and organizational causes and supported
influences developed in Chapter Two. Tables 2, 3, and 4 in Chapter Two indicate the foundation
to align assumed influences and interview questions. Collected qualitative data was sufficient to
validate the assumed influences. The study entailed conducting semi-structured interviews to
gain clarity and insight specific to the KMO factors for improving the advancement of AA
women into senior executive leadership positions in healthcare. A set of researcher-created
interview questions was in alignment with the ethical guidelines for researchers (Kvale &
Brinkmann, 2015). Each interview took place at a date, time, and location convenient to the
participant.
This study entailed interviewing 19 AA women working in healthcare leadership in
either middle management or a senior leadership capacity. A predetermined interview protocol
consisting of open-ended questions enabled queries about various experiences, values and
beliefs, barriers, length of time in the field, and demographics. Upon completion of the audio-
recorded interviews, the researcher hired a company to transcribe recordings, subsequently
reviewing, coding, and analyzing the data. Chapter Four presents the KMO influences and
interview findings, major themes that emerged from the data, individual descriptions of the
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 59
participants, and comparisons and contrasts drawn from each group. The resultant findings were
sufficient to answer the two guiding research questions.
1. What are the stakeholders’ perceptions of the various knowledge and motivational
influences related to the lack of advancement of African American females in
healthcare leadership?
2. What are the perceived barriers that have contributed to the lack of advancement of
African-American females into the ranks of healthcare executive leadership?
The researcher analyzed the data and provided recommendations for organizational
practices in the areas of knowledge, motivation, and organization.
Participating Stakeholders
The target population for this study was AA women in healthcare leadership positions.
To answer the research questions, the researcher conducted a 14-question, semi-structured
interview with individuals from two groups of stakeholders—middle managers and senior
executives—in the Southern California area. The 19 participants agreed to share their
experiences candidly, share how they overcame barriers and challenges, and describe critical
turning points that may have affected their career trajectory. Two interviews took place in a face-
to-face setting, with the remaining 17 occurring via telephone. Interviews lasted between 30 and
60 minutes.
The first group of stakeholders consisted of 10 AA women working as middle managers
(directors, department administrators, and executive directors) and managers ranging in age from
35 to 50 years; eight of the 10 women held advanced degrees in healthcare. The second
stakeholder group comprised nine senior executives (associate or assistant medical group
administrators, CEOs, COOs, CNOs, compliance officers, and senior executives) between the
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 60
ages of 38 and 55 years. All the senior executives held advanced degrees, two having doctorates
in nursing and two pursuing a doctorate. Findings from this study may serve as a resource for
other AA women who desire to obtain a senior leadership role in healthcare and would thus be
secondary stakeholders. Table 5 presents the demographic data of participants.
Table 5
Demographic Profiles
Pseudonym Leadership level
Years of experience
in healthcare
leadership Education level
Nykeia Senior executive 20 Master’s
Brechelle Middle manager 15 Master’s
KeAnna Senior executive 30 Doctorate
Jessika Senior executive 25 Master’s
Regina Middle manager 30 Master’s
Erin Middle manager 10 Master’s
Dana Middle manager 35 Master’s
Apryl Senior executive 35 Master’s
LaNiesha Senior executive 20 Master’s
Alexsys Middle manager 30 Master’s
Shaunie Senior executive 15 Master’s
Britney COO 35 Master’s
Akosua Middle manager 25 Master’s
Charnisha Middle manager 20 Master’s
Shanell Middle manager 20 Master’s
Joya CNO 25 Doctorate
Bianca Middle manager 35 Bachelors
Ieshia CEO 35 Master’s
Chloe Middle manager 20 Bachelors
Data Validation
During each interview, the researcher took participant-unique field notes, recording
phrases and nonverbal cues that added value to the research. Upon completion of all interviews,
Rev.com transcribed the audio recordings. Upon receipt of transcripts, the researcher grouped
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 61
each transcript with corresponding field notes, assigned participants pseudonyms, and began the
process of reviewing each transcript. Collecting and comparing data from the AA female middle
managers and senior executives enabled the identification of commonalities that emerged across
the data sources. This process further ensured that analyzed data represented an accurate
depiction of the phenomenon of interest. Nineteen participants proved sufficient to achieve data
saturation, or the point at which subsequent respondents provided no new information regarding
the KMO influences.
Results and Findings for Knowledge Causes
All 19 participants agreed that the lack of advancement of AA women into senior
leadership positions needed attention. The first research question pertained to stakeholders’
perceptions of the various knowledge and motivational influences related to the lack of
advancement of AA women in healthcare leadership. Three types of knowledge influences
emerged: declarative, procedural, and metacognitive. Declarative knowledge showed that
obtaining a higher level of education was important for this population’s visibility and
opportunities for further advancement. In line with procedural knowledge, AA women identified
the skill sets needed to navigate within the healthcare leadership realm. Finally, metacognitive
knowledge indicated that AA women needed not only to understand barriers and perceptions but
to identify the barriers and perceptions that contributed to their lack of advancement. In general,
these findings indicated the importance of higher education for AA women and the necessity of
identifying the barriers and challenges impacting further advancement.
In this section themes derived from the data specific to the participants knowledge will be
discussed in response to each influence. Supporting data will be presented through verbatim
stories told by the participants. The common themes specific to the knowledge influences were
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 62
as follows: Advanced degrees are essential for advancement of AA women, AA were often
perceived as the angry black woman, and finding a good mentor is necessary.
Declarative Knowledge
African American Female Middle Managers Need to Know the Required Educational
Level for Advancement into Senior Healthcare Leadership
Interview findings. All participants emphasized the necessity of academic preparation
for career success. Some of the women stated that they had received attention because of their
degree, without which an employer might not have considered them for various opportunities.
Seventeen of the 19 participants held advanced degrees with two pursuing doctorates. The
trending theme among all the participants was that education opens more doors for opportunity;
however, having an advanced degree is essential for further advancement for AA women. Even
those participants who held advanced degrees stressed the importance of continued learning for
further advancement, stating that the key was to become an expert in one’s field by remaining
current on the changes that impact the industry. This influence presented a two-part question
related to the participant’s current educational level and if she felt her educational background
impacted their career. Responses varied based on the educational level.
Bianca, who has a bachelor’s degree in psychology, expressed a belief that it is essential
for women of color to obtain an advanced degree for consideration for more opportunities. Dana
said, “My master’s degree opened the door and got me looked at for certain positions.” KeAnna
shared:
Even though I have a Ph.D. in counseling, it has helped me with the critical thinking that
has been required for me to navigate within my leadership roles. However, I feel that a
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 63
degree specific to healthcare will continue to open more doors. . . . I am currently in
school pursuing that degree.
LaNiesha said:
Everyone in the organization has a Master’s degree mostly; it opens doors but you can
pay to get one nowadays. It opens more doors than closes, so I felt the need to be
stimulated and challenged. That’s why I decided to pursue my doctorate.
Apryl shared:
Although my educational background has impacted my career in allowing me to apply, it
was what I needed to apply because, for a while, I got to a point where I had the
experience and I was doing the work, but then I hit a barrier. Certain positions I could not
apply for because I didn’t meet the requirements from the educational standpoint so I
couldn’t even apply.
Britney said:
I think it was a great starting point and I also feel that you will be looked at more when
you have a degree from a prestigious university.” Jessika, who currently has a Master’s
degree, stated, “It’s helpful and needed to become a successful leader and AA women
should consider being more educated.
Joya said, “My educational background has supported my career and it’s been the tool
I’ve used to do my job.” Chloe said she does not feel an advanced degree has an impact, since
she was obtaining her education during her career transitions. However, her advice to others was
to advance their education earlier in their career to see the impact.
The consensus of the participants was that others were more likely to view the women as
experts in their field if they held an advanced degree. According to Ieshia, “Although education
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 64
has a direct impact on career advancement and will get you in the door, your work ethic and
performance is what will set you apart from your peers.” However, an advanced degree alone
was not necessarily beneficial in the field of healthcare, especially for those participants who
held advanced degrees but still encountered barriers that impacted further advancement.
Charnisha said:
It’s more than about just obtaining the degree; it’s the skillsets you acquire along the way.
The discipline it takes to pursue an advanced degree teaches you the importance of
resiliency, critical thinking, and teamwork, which are all critical skills a good leader
should possess.
Summary. All the AA female middle managers validated the assumption that they
should know the educational level and skill sets required to obtain a senior leadership position.
From past experience, the participants understood that an advanced degree was the minimum
requirement for consideration for an advanced job in healthcare. Just obtaining a degree was not
enough to ensure promotion consideration, however. AA women must pursue opportunities to
continue education, attend conferences, and join other organizations to become an expert in their
field.
Procedural Knowledge
African American Female Middle Managers Need to Understand How to Set and Achieve
Their Personal and Professional Goals
Interview findings. When asked about the skill sets needed to obtain a leadership
position in healthcare, the participants had various responses. Among their suggestions were
learning to maintain balance, being collaborative, understanding stakeholders and what they
want and need, and having strong presentation skills. Common themes included good
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 65
communication, relationship-building, responsibility, and decisiveness. According to Ieshia,
“You have to be decisive and make a decision and know what makes the organization successful,
and be able to influence others to be successful.” Nykeia believed an individual “must be a solid
communicator and be able to work at all levels of the organization—being able to work in the
balcony and also on the dance floor.” Shanell offered, “Be very collaborative and understand
your teams’ strengths and weaknesses.”
The research indicated that participants needed skill sets not only for their own success,
but for that of their supervisors and supervisees, as well. Accordingly, an employee’s skill set
can help determine the outcome of a situation depending on the individual’s response. Jessika
added, “You must first recognize the higher up you go, the more political it will become.
Mentoring is key to learn from the right person to show you the potholes you should avoid.”
Bianca stated:
You need to understand and know your stakeholders and understand their agenda, which
shows you how to navigate within your position and teaches you the skillset to be able to
deliver the right message to your audience; the message will vary depending on the
recipients.
Erin said:
It is very important as a healthcare administrator that you remain up to date on what is
going on in healthcare, which will allow you to maintain your confidence in leading your
organization. There is no way you can carry a company without looking ahead to ensure
you have strategies in place to mitigate challenges.
Nykeia said, “You must be proactive in finding your own mentor to help guide and show
you ways to better navigate down your career path.” Lastly, Dana reiterated the importance of
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 66
maintaining balance as in achieving goals saying, “Don’t be married to your job or sacrifice your
family; balance is key to achieve and maintain.”
The participants were clear on what critical skillsets are required to set and achieve both
personal and profession goals to be successful. There was no specific blueprint; all participants
had unique experiences that had affected their career path in one way or another. The most
common theme among the participants was that a woman must first be a great communicator to
be an effective leader. She must know her audience and know how to build a solid team, having
compassion and being passionate about her work and leading by example.
Summary. All participants confirmed that AA middle managers needed to understand
how to set and achieve personal and professional goals. Each woman identified required critical
skills that have benefitted them during their career. Participants also discussed the importance of
setting personal goals for themselves. The participants understood that they need to be more
proactive in their pursuit for career advancement, remaining diligent in seeking out the
information required to excel. Most of the participants stressed the need to be confident in their
abilities and not be afraid to go after the position they want, not letting other decide what they
are capable of achieving.
Metacognitive Knowledge
African American Women Need to Identify Barriers That Have Affected Career
Advancement
Interview findings. All 19 participants said they have experienced challenges of some
form. The findings indicated circumstances that hindered the advancement of AA women into
senior leadership positions. Not every participant viewed the barriers as adverse circumstances,
however; some participants saw barriers as opportunities for growth. According to Dana:
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 67
Throughout my career, I have been blackballed by other African American bosses and
have been undermined, but I never viewed these barriers negatively. I always looked at
these barriers as a learning opportunity to improve my skill sets to prepare me for my
next role.
One hundred percent of the participants validated this influence, saying they could
identify perceived barriers to AA female career advancement in healthcare. Identifying barriers
to career advancement is vital, but does not make navigating AA female career paths easier.
Participants were also aware of obstacles in their future. Shaunie shared:
Juggling a very demanding job and having a family and not having a typical nine-to-five
is a barrier within itself. Not all barriers come from the external sources of organization;
it’s about learning how to balance work and life.
Apryl said she “felt I had to always look a certain way when it came to my appearance
and size, because people see you before they see what you can do. I’ve witnessed new
administrative fellows come into the organization and be placed into higher-level positions with
little to no experience, all because of who they know.”
Charnisha, in turn, spoke about the juxtaposition of a woman’s role in leadership: “You
have to play the man’s game but not be seen as aggressive. I’ve had to deal with being
interrupted in meetings and having to remain quiet to not be seen as the angry black women for
speaking up for myself.”
Shanell said she felt a perceived challenge as to why she was overlooked for a position
was because she was more vocal and ambitious than others. She was neither aggressive nor
assertive, but she spoke up for what she believed in and advocated for others, “and that
sometimes didn’t follow the norm.”
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 68
KeAnna shared having sacrificed her personal life to pursue a career, sometimes working
12- to 16-hour days. She had to attend executive training to be taught how to look and dress like
an executive. She had to learn how to become adaptable in any situation and to come in, fail fast,
and try new things.
Ieshia believes that some barriers are strictly based off others’ perceptions. She related
having “often been perceived as the mad black women, and when you have an argument at
home, you’ll bring it to work and make everyone else pay. It sometimes feels that is how I am
being perceived when speaking up for myself.”
Joya added, “I don’t fit the textbook look for the current position, I don’t look like my
peers; growing up in the segregated South prepared me for this experience of being isolated.
Because this is an isolated experience, being an AA in healthcare where no one looks like you
and they don’t expect you to have the ideas or the energy or the expertise that you do and you’re
questioned on a daily basis. You are constantly asked to prove yourself and do more than your
peers.”
Although participants identified career barriers and challenges, awareness beyond
processes is needed to help them move beyond their current role. Being able to identity the
barriers are helpful; however, if the organization does not see the need for change, then it will be
up to the wineb to determine if they want to stay in that role and continue to be overlooked or to
take a leap of faith and move on to another organization. Ieshia said, “We can only perform and
know that we’re doing a good job. If you feel like you’re not being respected or getting your
credit, you have a conversation, but don’t hang around in an organization or in a position waiting
for someone to recognize you.” Ultimately, the participants need to take responsibility for their
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 69
career advancement, making the necessary adjustments necessary and not waiting for others to
make decisions for them.
Summary. The assumed influence was that AA female managers need to be able to
identify barriers that have affected their career advancement, which 100% of the participants
validated. The research indicated that success involved more than identifying barriers; AA
women must also determine a strategy or process to overcome barriers and find a way to
continue to excel, even if that meant leaving their current employment. Although the participants
were able to identify the barriers, it does not negate that barriers exist. Some of those barriers are
based solely on perception, and individuals cannot change how others view them. The
participants can only change how them view themselves and shift their mindset to focus on being
a good leader and not be solely focused on leading as an AA woman. The key is to continue to
learn themselves and how they respond or react in certain situations. Becoming more self-aware
will aid in changing the narrative of how the participants are being perceived. The participants
also stressed the importance of networking and surrounding themselves with other AA women in
similar roles to learn from each other’s mistakes and successes.
Results and Findings for Motivation Causes
From data collected in the 19 interviews, three findings emerged regarding the
motivational influences of improving the lack of advancement of AA women into healthcare
leadership. The second research question pertained to the perceived barriers that contributed to
the lack of advancement of AA women into healthcare leadership. Findings from the data
analysis showed participants’ motivation to understand their perceived barriers through three
types of motivation: utility value, attribution, and goal orientation. In this section, themes derived
from the data specific to the motivation influences are as follows: lack of recruitment efforts,
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 70
must be better than peers and always have to overperform, diversifying the management pool is
necessary, and organizations talk a good game with no real efforts seen. The themes were
supported by the data through verbatim stories told by the participants.
Utility value showed that AA women in healthcare need to place a higher value on
improving the management diversity pool. Only 19 participants exhibited awareness of
attributions, thus indicating an area requiring improvement. Over one fourth of participants were
aware of the specific processes for recruitment strategies. With regard to goal orientation,
participants clearly knew what factors contributed to their leadership experiences. These findings
indicate that utility value, attribution, and goal orientation contributed to motivating AA women
to improve their chances of advancement into senior leadership positions in healthcare.
Utility Value
African American Women See the Value in Making the Management Pool More Diverse
Interview findings. When asked if they could describe their organization’s level of
commitment to diversity and inclusion, participants gave varied responses depending on the type
and size of the organizations. Participants who worked in larger, public organizations believed
their employers frequently discussed change; however, the woman did not see change in the
diversity of employees, especially at the executive level. On the other hand, participants who
worked in a private organization had a direct impact on change, with the C-suite executive
participants having even more oversight.
Regina stated, “There is a high level of effort being placed in improving diversity and
inclusion.” Jessika said, “At the very top of the organization, we have a Black man running the
organization, but at the other levels, the lack of diversity [is] obvious; there is more talk than
action.” Bianca reported having less insight into the process, relating, “They have programs in
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 71
place, but not everyone in the organization knows about them. You usually only find out when
you are recommended by a senior leader.”
Ieshia said, “Hospitals are in very diverse markets, and I think it’s important that you
have individuals that look like the people that we’re serving because they able to relate to those
that may have had some of those same life experiences or look like them,. [Patients] will feel like
they’re in good hands and will be taken care of.”
Joya reported being aware of some new initiatives that have been put into place. She
shared, “There’s a diversity and inclusion committee, a special committee that will begin to meet
soon. So, there is an expectation and movement to be more diverse and inclusive; the staff makes
the organization diverse, but the leadership team is very homogenous.”
Finally, Apryl believed her organization was “not that committed to making a real
change.” In line with the findings, the level of commitment to diversity depends on the
executives running the organization and the commitment of employees in senior leadership to
acknowledge the need for change.
Although the participants saw the value and importance in diversifying the management
pool, there is only so much they can do; ultimately, the onus is on the organization. Leadership
needs to see the importance in diversity to better serve the current population of patients. The
participants can continue to bring awareness and get more involved with programs that will
promote diversity within the organizations at the management and executive level, but they only
can do so much within the constraints of their current positions. The 19 AA women in this study
understand the significance in seeing these changes occur within their current organization.
Summary. Findings did validate the assumption that AA women saw value in making
the management pool more diverse. Only 53% of the participants said their organization was
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 72
committed to making a change in the diversity of employees. Many AA women saw their
employers talking about diversity without taking real actions because, they indicated, supporting
diversity was the politically correct thing to do. AA women suggested their organizations talked
about diversity just enough to give the perception that leadership is committed to diversity at a
higher level. The AA women participants who held senior executive positions were able to speak
not only to the importance of diversifying the pool, but also to the initiatives or direct impact
they have had in assisting with ensuring that the pool continues to become more diverse. The AA
middle managers can only speak from the perspectives of what they are aware of or have seen;
they are not privy to what is happening at the executive level within their organization. The
consensus among all participants was that it is important to diversify the pool of candidates to
better serve the patient population.
Attributions
African American Middle Managers Feel the Current Process for Selection Is Due to Lack
of Recruitment Efforts
Interview findings. Participants discussed their awareness of effective recruitment
strategies their organization used to recruit and retain AA female leaders. Most of the women
chuckled before saying “no”; others were aware of one recruitment strategy that occurred only at
the executive level, where employers could be specific with HR about the quality and
demographics of a candidate they were seeking. Jessika said:
[I’ve] never heard of any, but at the higher level, they can be specific with HR about the
quality, traits, and the demographics of the candidate they are seeking and if they want
them to be [an] internal or an external candidate.
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 73
Erin works with an AA staffing agency to assist her with the recruitment process to find
those specific candidates. LaNiesha said she had no awareness of specific recruiting strategies,
despite her organization receiving recognition as one of the most diverse healthcare
organizations to work for. She speculated “that must be based on the workforce population,
where that can be seen but not leadership specific.”
Nykeia echoed the sentiment of what most participants said: “There are not any specific
recruitment strategies in place for AA women.” Britney said she is currently working with an
executive recruiter with an emphasis on AA women with the criteria for leadership positions”
Apryl reported, “Yes, there are recruitment strategies that occur at the executive level
where you can be very specific with HR as to what you are looking for, down to the specific
demographics of the candidate. . . . At that level, senior leaders can handpick the person they
want for the position. Ieshia said, “Our organization focuses on this more so than other
organizations. Along with our chief diversity officer, who is also a female, there are individuals
at the highest level of the organization within HR that are minority females. There is that
comradery among the female executives within the company, so often when they are looking to
fill positions, they reach out to us to see if we know people in the industry or are there people
that we would recommend.”
Study findings aligned with data from the literature regarding the importance of
recruitment. Also common was the need to develop specific strategies based on the level of
applicants’ employers wish to attract. The responses from the participants showed that
employers’ diversity efforts had at least improved, as five of the 19 women were aware of
current recruitment strategies for AA candidates. Additional research will be required to assist in
determining the specific recruitment strategies that would improve the advancement of AA
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 74
women into senior leadership positions. The findings did show that some healthcare
organizations do see the value in making these changes within their current organizational
structure; however, other organizations have not identified the lack of diversity to be a problem,
speaking about diversity without making any changes.
Summary. In their responses, participants validated the assumed influence that AA
female middle managers felt the current process for selection was due to the lack of recruitment
efforts. The majority of participants were not aware of any specific recruitment strategies within
their organization. The five participants who did know of specific strategies worked in a senior
leadership capacity, where they have the authority to impact the current recruitment process at
their organization. Many the participants were unaware of specific recruitment strategies
previously used or currently in place to recruit or retain AA women. The lack of recruitment
efforts has played a significant role in the lack of advancement of AA women in senior
leadership positions.
Goal Orientation
African American Middle Managers Should Want to Do More Than the Bare Minimum to
Show Senior Leadership Willingness
Interview findings. Participants discussed any factors they perceived as having
contributed to their leadership experiences as AA women. Participants said career success
involved finding a good mentor, working twice as hard as one’s counterparts, exhibiting
resourcefulness, and embracing special projects that may not result in immediate reward or
recognition. Chloe suggested “find a good mentor and continue to place yourself in different
spaces to gain different exposure with other departments. Take every advantage to learn
something new.” KeAnna, expressed similar sentiments, saying, “Being under a mentor, joining
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 75
a winning team. If you join a team that’s not winning, you will never [be] seen.” Bianca stated,
“Some of it is just what is innately within us, our legacy and upbringing and what we have been
taught and what we come to the table with.”
Nykeia credited her father for encouraging her to become a leader and attending college.
She remembered him telling her, “You’ll probably have to work harder that most people to
achieve and get to the next level, to be independent and resourceful; nobody is going to hand you
anything.” She suggested that AA women “keep your eyes open for every opportunity to gain
exposure.”
Jessika said, “Focus on being twice as good and you may only get half as much, but
continue to push yourself to obtain higher education and more exposure.” Britney reiterated, “Be
careful how you speak and to understand that you have to be 150% to 200% better than your
peers.” Ieshia stated, “Individuals may have misconceptions about an individual and their
abilities from just seeing them, but as they get to know you, their opinions will change.” Apryl
offered encouragement to AA women wanting to advance in their careers, identifying factors
such as “refusing to give up. Keep pushing, no matter how long it takes. Don’t be afraid to ask
questions and surround yourself with great people.”
All participants in this study validated this motivational influence. The women were
aware of the perceived factors that contributed to their leadership experience. In addition, they all
credited the mentors who had helped them along the way. Other participants stressed the
significant role of leadership strategies, and the importance of learning to lead from top down
and having a collaborative leadership style. The participants also spoke on having versatility and
self-awareness, being both book- and street-smart, as well as encompassing a sense of political
savviness to know when to give an answer. For the participants in this study, seeking
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 76
advancement was more than just putting in the long hours; it was also about investing time in
self-development and trainings outside of their job to be well-rounded and completely prepared
when an opportunity presents itself.
Summary. The researcher validated the assumed influence that AA middle managers
must do more than the bare minimum to show senior leadership their willingness to work harder
than other employees. Responses from more than 80% of the participants indicated that AA
women should work longer hours and do more for less pay or recognition without the luxury of
relaxing on the job. Participants noted that AA middle managers must always show up and
outperform their non-AA counterparts by more than 150%, even when they feel unmotivated.
Results and Findings for Organizational Causes
Answering the second research question involved exploring the barriers participants
perceived as preventing the advancement of AA women into healthcare leadership. Data from
showed one cultural setting and two cultural models as discussed in Chapter Two. The cultural
setting pertained to the current recruitment strategy used by HRCs as well as employers’
willingness to understand and change the current organizational culture. Application of the first
participant-specific cultural model, the researcher questioned participants to discover if AA
women received equal opportunities to obtain senior leadership positions in their organizations.
The second cultural model emerged from participants’ observations on how senior leaders
promoted and supported diversity and inclusion in the workplace. The organizational influences
findings were similar to the cultural models and settings that impacted the lack of advancement
of AA women into senior leadership positions. The themes that emerged from findings specific
to organizational settings and models were as follows: lack of exposure to senior leadership,
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 77
opportunities for advancement not equal, and no initiatives in place to improve advancement for
AA women.
Cultural Models
Employers Need to Be Willing to Change Current Organizational Culture
Interview findings. When asked if any of their employers, including their current one,
used specific initiatives geared toward the advancement of AA women into senior leadership
roles, participants gave unexpected responses. Only two of the 19 participants said their
organization implemented initiatives that focused on the career advancement of AA women. Ten
percent of the participants saw their organization attempting to change the organization’s
diversity culture, indicating that 90% of other organizations do not see the need to shift the
current organizational culture.
Asked if she had noticed initiatives in her organization, Shaunie responsed, “Not at the
executive level.” Dana said she has heard about specific initiatives for the LGBTQ community,
but none specifically for the AA woman. Related NyKeia, “There are programs in place to
develop leaders, but not specific toward AA women who are looking to advance into senior
leadership.” Jessika said she had “never heard about anything like that in all of the organizations
I have worked for.”
Charnisha was aware of several development programs, but none specific to AA women.
She said, “The senior executive level us still predominantly men. [There is] nothing specific to
African American [individuals] in general, for men or women.” More encouraging was Ieshia’s
recognition of “a new program that has been created just for this initiative.” Apryl stated,” It
appears as if the organization may be leveraging to give the appearance of changing the culture,
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 78
while others are willing to whatever it takes just to get into the position, even if it means
compromising their integrity and morals.”
The findings showed that organizations still need to improve initiatives to make their
culture more racially diverse. Change in an organization’s initiatives expand from the top down.
If executives do not see the value of improving diversity in the workplace, AA women will
continue to struggle to advance their careers. Organizations often put forth an image of being
vested in changing the culture. The workforce may be diverse, but those same efforts are not
translating into leadership positions, especially for AA women.
Summary. The researcher validated the assumed influence that employers needed to
understand and desire to change their current organizational culture in order to improve current
recruitment strategies. The researcher validated the assumed influence as 90% of the participants
stated that their organization did not establish specific initiatives to improve current recruitment
strategies for AA women looking to obtain senior leadership positions. Ten percent of
participants stated that organizations do see the importance in changing the culture; however, this
assertion was solely based on new initiatives put into place, with no data to support the success
for these initiatives at the time of the study.
There Needs to Be a Culture of Trust Between Administrators and Human Resources to
Achieve Organizational Global Goals
Interview findings. The researcher asked if participants, as AA women, felt they
received equal opportunities to obtain an executive-level position within their healthcare
organization, receiving varied responses. Some participants said they had equal opportunities,
whereas others felt shunned and overlooked for positions. One participant believed her skin color
had no impact on whether she had an equal opportunity. Only six of the 19 participants perceived
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 79
having received equal opportunities to obtain senior leadership positions. As only 31% of
participants indicated having equal opportunities a percentage well below the validated average
of over 50% this is an area in further need for improvement.
Dana related having an equal opportunity to obtain a middle management position but not
a senior-level role. Although her employer interviewed her for those positions, nothing ever
came out of them; in addition, they offered no explanation for why they did not select her for the
position.” Similarly, NyKeia said some people had given her an opportunity but not all. Her
belief was that one needed to “know the [people] who are truly committed to diversifying the
leadership teams.”
Initially, Bianca said, she did not feel excluded; however, as she advanced in her career,
she believed she hit a glass ceiling where those senior leadership opportunities were no longer
available to her. Apryl also felt she did not have the opportunities of her colleagues. In addition,
she had recently learned her White counterpart received a higher salary, even though Apryl was
more qualified. She had noticed other employees hired as fellows and promoted into leadership
positions with no real experience outside of their recent fellowship.
KeAnna asserted, “We have an equal opportunity like everyone else because of the
program and initiatives, but it depends on the individual. You must be doing something for them
to want to promote you.” Alexys said, “Later in my career, I felt I was given an equal
opportunity, but early on, it seemed as if we pitted against one another, all fighting for the same
position, because we were unaware of what else was available or worried that another
opportunity like that would come around.”
Jessika stated, “I’m not sure if it was truly an equal opportunity. It’s more about the fit
and who they want in the role and your qualifications won’t matter if you are not the candidate
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 80
they wanted for the position.” Ieshia felt she was given an equal opportunity because she is
unique in the sense that not a lot of people in the country do what she can do, being the first
CNO of AA decent in the country.
Britney said she felt she was given an equal opportunity as well as an advantage. She
shared being fortunate to come into the organization as a fellow who happened to attend the
same university as previous fellows; they were pleased with the previous fellows so she was
promoted much faster.
Ieshia, too, was fortunate early in her career. She attributed her success to the White male
CEO who at that time created a COO development program for which she was selected in the
early 2000s. She remembered him telling her that “unless we as leaders put forth an effort or
unless we actually say we’re going to make sure that we have minorities on our teams are at the
table, it’s never going to happen, because people just naturally will promote the people they feel
comfortable with all the time.”
Findings indicated that workplace discrimination was a real and ongoing problem.
Regardless of their education and experience, AA women still lacked equal opportunities to
obtain leadership positions in healthcare. Some felt they were given an equal opportunity, which
they attributed to having someone willing to take a chance on them and mentoring them; in most
cases, the mentors were older White men within the organization who understood the
significance in making the change. Other participants had to leave their organization to receive
that same equal opportunity, because they had hit a glass ceiling and did not see any potential for
further advancement. One of the participants left an organization she had been with for over 20
years because she was told by senior leadership that he had no intention on promoting a Black
woman.
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 81
Summary. Findings showed validation for the assumed influence that a culture of trust
between administrators and HRCs is necessary for employers to achieve the organizational goal
of increasing the number of AA women considered for executive positions. The participants felt
they had not received equal opportunities for career advancement. This sentiment also applied to
senior leaders in the organization who trust that HRCs will bring the most qualified candidates
and will speak out against a lack of diversity at the executive level. Such recognition is necessary
for the organization to change its culture. To see true change, everyone must be united, with a
vested interest in the culture shift; otherwise, a change in senior leadership will not be sustained.
Cultural Settings
Human Resources Needs to Enhance Recruitment Strategies to Be Demographic Specific
Interview findings. Participants shared their observations on leadership in their
organization that promoted or supported diversity and inclusion. More than 40% of the women
felt that employers in their organization did what appeared to be politically correct; however,
they did not focus on what was good for the organization and what would result in improvement.
NyKeia stated, “Lip service is all they are doing, because it’s the right thing to do or is politically
correct, but if we peel back the layers, diversity really doesn’t exist.” Similarly, Shanell stated,
“They talk a good talk, but the organization still looks like a snowdrift at the executive level. It
resembles the four fathers from the Constitution.” Of her organization, Akosua said, “They are
not committed to making a real change.”
Ieshia suggested that organizations should “look for individuals who are diverse, focused,
and willing to make the change.” To AA women hampered by a lack of diversity, she said,
“Don’t be afraid to leave to find another organization that sees [your] value [and] knows your
worth and what you bring to the table.”
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 82
Apryl said, “I think the organization is trying to go about supporting diversity and
inclusion a lot differently. Now they have begun to implement more compliance trainings that
bring awareness to the forefront surrounding the need for change.”
The data findings showed that only 42% of the participants could identify how their
current leadership supported and promoted diversity and inclusion. Most participants felt that
individuals in leadership positions talked about diversity without actually making the needed
changes to their organization’s employment strategies. Accordingly, there is a need for HRCs
and organizations to develop more inclusive recruitment efforts.
Summary. The researcher validated the organizational influence that HRCs need to
improve demographic-specific recruitment strategies, a directive that must come from the senior
leadership team. Not all organizations enforced the instruction to improve recruitment strategies.
Eleven of the women (57% of the participants) could not identify specific ways leadership in
their organization promoted or supported diversity and inclusion; rather, they observed only
surface-level efforts to make it appear as if there was diversity in hiring.
Summary of Validated Influences
Knowledge
Three types of knowledge influence AA women need to improve their lack of
advancement into healthcare leadership positions emerged from data analysis. The first,
metacognitive influence, presented AA women’s need to identify barriers affecting their career
advancement 100% of the participants validated this influence. Common themes that emerged
from influence assessment of the participants’ responses included that AA women sometimes
avoided speaking up in meetings for fear of appearing negative or aggressive, lacked a mentor
who looked like them at higher levels of management, experienced blackballing by AA bosses,
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 83
needed to work twice as hard to receive half the pay, and felt the need to outperform their
coworkers.
The second knowledge type, procedural influence, appeared in AA female middle
managers’ need to understand how to set and achieve their personal and professional goals.
Again, 100% of the participants identified the critical skills required to navigate throughout their
careers. The critical skills identified by participants included collaborative skills, relationship-
building skills, emotional intelligence, responsiveness, work follow-up, and passion for their
career.
The third knowledge type, declarative influence, reflected in AA female middle
managers’ need to achieve the higher educational level required for advancement. The researcher
validated this finding, as 95% of the participants held a Master’s degree or higher. Common
themes that emerged from participants’ responses included the need for AA women to obtain
advanced degrees to receive interviews or consideration for a leadership position. Participants
said a Master’s degree was the minimum requirement needed for AA female middle managers,
and that they should pursue continuing education in the field; there was no such thing as being
too educated. The knowledge influences received validation by the participants’ awareness of the
educational requirements of AA for further career advancement.
Motivation
The three motivational influences of utility value, attribution, and goal orientation
reduced the lack of advancement of AA women into healthcare leadership. Data from the first
influence, utility value, showed healthcare organizations’ need to see the value of making the
management pool more diverse. The majority of the participants (53%) felt their organization
made progress toward changing, thus validating this influence. Only 47% of the women believed
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 84
their organization saw little to no value in making a change to improve the advancement of AA
women into leadership positions. A common theme was that organizational leadership talked
about supporting diversity without making real efforts. Although organizations claimed to
support existing programs, many participants were unaware of such programs or ways to get
involved.
Data from the second influence, attributions, showed that AA middle managers felt the
current selection process was inadequate due to the lack of recruitment efforts. In alignment with
this influence, 73% of participants were unaware of any specific recruitment processes for the
advancement of AA women into leadership positions. Only 26% of the women interviewed
confirmed awareness of a process within their organization, and these participants held senior
executive roles that directly impacted recruitment. Many organizations have no specific
recruitment strategies in place that improve the advancement of AA women into senior
leadership positions, indicating a gap in need of improvement.
The third influence, goal orientation, emerged through AA middle managers’ need to
exceed standard job requirements to show senior leadership their willingness to do more than the
bare minimum. This influence received validation by 100% of the participants who believed they
needed to do more for employees to remember them for future opportunities. Data from this
theme indicates that AA women needed good mentors to help them navigate their careers and
should take every chance to participate in other projects. Mentors also helped AA women with
emotional intelligence, provided executive coaching, enhanced mentees’ resourcefulness, and
helped mentees attend training and conferences.
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 85
Organization
Answering the second research question came from the findings of one cultural setting
and two cultural models for organizational influences. Data from the cultural setting influence
indicated HRCs’ need to enhance current demographic-specific recruitment strategies that
improve the recruitment for AA women. Only 42% of the participants indicated awareness of
how their leadership promoted and supported diversity and inclusion, with the influence thus not
validated. Although participants acknowledged what they saw, their statements matched their
responses from the utility value of motivation. Participants stated that senior leadership
frequently talked about diversity and inclusion and gave the perception of full commitment to
change without actually changing. Leaders’ talk about diversity was merely a means to make
their organization appear responsive in comparison to other healthcare industry organizations.
Data from the first cultural model influence, also not validated, indicated the need for an
understanding and willingness to change the current organizational culture. Only 10% of the
participants were aware of AA-specific initiatives in place in their organization. The remaining
90% stated that either their organization lacked diversity initiatives or or that they were unaware
of any such initiatives.
Data from the second cultural model indicated the need for a culture of trust between
administrators and HR to achieve the global organizational goal of increased diversity. Only 42%
of the participants felt that organizations provided equal opportunities to obtain senior leadership
positions in healthcare, findings that did not validate the influence. The remaining 58% of
women felt their organizations did not provide equal opportunities; rather, they perceived
themselves as having hit a glass ceiling upon achieving a certain level of career success. Data
indicated that some organizations, but not all, provided AA women equal opportunities for
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 86
advancement; however, many AA women worked in the capacity of a higher position without
commensurate title or pay. Responses also indicated that employers predetermined where they
thought AA female candidates would fit, regardless of the women’s qualifications. Table 6
presents a summary of the KMO influences, types, and validations.
Table 6
Knowledge, Motivation, and Organizational Influences and Types
KMO influence KMO type Validated
Validation
percentage
AA women need to identify barriers that
have affected career advancement.
Knowledge –
metacognitive
Yes 100%
AA female middle managers need to
understand how to set and achieve their
own goals.
Knowledge –
procedural
Yes 100%
AA female middle managers need to
know the required educational level for
advancement.
Knowledge –
declarative
Yes 100%
AA middle managers see the value in
making the management pool more
diverse.
Unity value Yes 53%
AA middle managers feel the current
process for selection is due to a lack of
recruitment efforts.
Attributions Yes 73%
AA middle managers should want to do
more than the bare minimum to show
senior leadership willingness.
Goal-oriented Yes 100%
There needs to be an understanding and
willingness to change current
organizational strategies.
Cultural model No 10%
There needs to be a culture of trust
between administrators and HR to achieve
global organizational goals.
Cultural model No 31%
HR needs to enhance recruitment
strategies to be inclusive.
Cultural setting No 42%
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 87
Results from 19 semi-structured interviews provided data sufficient to answer the two
research questions. With the first question, the researcher sought to obtain stakeholders’
perceptions of the various knowledge and motivational influences related to the lack of
advancement of AA women in healthcare leadership. Answering the second question required
identifying perceived barriers that contributed to the lack of advancement of AA women into the
ranks of healthcare executive leadership. The researcher identified ten themes related to
retention, recruitment, mentorship and diversity and inclusion that have contributed to the lack of
advancement of AA women into healthcare leadership. These themes showed that although most
of the participants may have encountered some type of challenge along their journey there were
key contributing factors to helped support them in their pursuit of further career advancement.
Analysis of the collected data enabled the researcher to provide recommendations for
organizational practices in the areas of knowledge, motivation, and organization. With most of
the organizational influences not validated, there is significant room for improvement, as well as
additional opportunity for scholarly exploration. Recommendations for improvement appear in
Chapter Five.
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 88
CHAPTER FIVE:
DISCUSSION OF FINDINGS
Chapter Four presented findings to answer the two research questions guiding this study.
Answering the first question came from participants’ responses about their perceptions of the
various knowledge and motivational influences related to the lack of advancement of AA women
in healthcare leadership. For the second question, data came from participants’ perceived barriers
contributing to the lack of advancement of AA women in healthcare executive leadership. Clark
and Estes’ (2008) gap analysis model served as a framework for the researcher to identify the
knowledge and motivational gaps contributing to the lack of advancement of AA female middle
managers who aspire to senior executive-level positions.
This chapter includes a discussion of findings to provide recommendations for
organizational practices in the areas of knowledge, motivation, and organization. As presented in
this chapter, the researcher utilized Kirkpatrick and Kirkpatrick’s (2016) New World Kirkpatrick
Model as an evaluation tool to improve, develop, or maximize the effectiveness of programs.
The model was a means to establish knowledge, motivational, and organizational
recommendations to develop implementation and evaluation plans for AA female middle
managers. This chapter concludes with an assessment of the strengths and weaknesses of the gap
analysis model, limitations and delimitations of the study, and recommendations for future
research.
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 89
Recommendations for Practice to Address Knowledge, Motivational, and Organizational
Influences
Knowledge Recommendations
Two knowledge influences emerged from data analysis, as reflected in the literature
review in Chapter Two. The researcher validated and confirmed data from the study based on the
results and findings from stakeholder interviews. Both of the knowledge influences supported the
first research question. Higher percentages of participants validated the knowledge influences
determined to have the greatest impact.
The researcher determined the frequency or common themes found in the transcripts
during the final assessment phase. According to Clark and Estes (2008), a researcher must
acquire how-to knowledge and skills and practice feedback to achieve specific outcomes. In this
case, knowledge specifically indicated what barriers prevented AA female middle managers
from advancing into senior executive positions. Table 7 presents the researcher-based principles,
and the context-specific recommendations on theoretical principles.
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 90
Table 7
Summary of Knowledge Influences and Recommendations
Assumed knowledge influence Principle and citation
Context-specific
recommendation
African American female
middle managers must learn to
identify barriers affecting their
career advancement
(metacognitive)
How individuals organize
knowledge influences; how
they learn and apply what they
know (Schraw & McCrudden,
2006).
Provide African American
middle managers education
that African American
middle managers can use to
self-reflect on perceived
barriers that impacted their
career advancement.
African American female
middle managers must learn to
understand how to set and
achieve their own personal and
professional goals (procedural)
Learning and motivation are
enhanced when learners have
positive expectancies for
success (Pajares, 2006).
Provide African American
middle managers a job training
guide tailored to their
organizational personal and
professional goals.
African American female
middle managers must know
the educational level/skill set
requirements required to obtain
senior leadership positions
(declarative)
It is important in carrying out
an operation to have the ability
to command a basic
understanding of a domain or
practice to recognize
operational details and elements
of that practice (Krathwohl,
2002).
Provide African American
middle managers with job aids
that illustrate education levels
for senior executive positions.
Improving the African American middle managers’ understanding of the
importance of setting personal and professional goals. The results of this study indicated that
100% of AA female middle managers interviewed understood how to set and achieve personal
and professional goals. A recommendation rooted in processing theory has been selected to close
this procedural knowledge gap. Pajares (2006) found learning and motivation enhanced when
learners have positive expectations for success. Thus, AA middle managers will benefit from
having tangible items and goals that promote career success. A recommendation is to provide
AA middle managers with a job training guide tailored to their organizational personal and
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 91
professional goals. This recommendation will provide AA women with additional tools
necessary to track and maintain their goals and to ensure they are in alignment with their
organizational goals to increase their chances for further advancement
The AA female middle manager and her values, attributions, and orientation of goals
reflect her confidence in her abilities and the weighted value on persistence in the profession
(Clark & Estes, 2008). The more confident AA middle managers became along their career
paths, the more they realized the importance of setting career goals that challenged them at each
new level. The definition of factual knowledge pertains to the “what” in the knowledge
dimension, indicating which details or elements one must know before proceeding to the next
steps (Rueda, 2011). The suggested use of training and education provided by HR or senior
leaders may serve as a roadmap for AA women to gain the skill sets required to set and achieve
professional and personal goals. Such training not only strengthened an employee’s learning but
also served as a learning tool defining key factors important for goal-setting and information
application (Rueda, 2011). Participants needed motivation for the level of commitment required
to reach their goal, which requires functioning outside of employees’ normal roles to gain new
perspectives (Rueda, 2011). For hospitals to remain competitive workplaces, they must master
this skill set of utilizing tools and continue to develop employees based on the individual’s
desires and goals within the hospital (Deloitte Center for Health Solutions, 2013).
Improving the African American middle manager’s ability to identify barriers
preventing African American women from advancing into senior healthcare leadership
roles. The results of this study indicated that 100% of AA female middle managers interviewed
could identify barriers affecting their career advancement in healthcare leadership roles. The
researcher devised a recommendation based on information processing theory to close this
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 92
procedural knowledge gap. Schraw and McCrudden (2006) found that the way individuals
organize knowledge influences how they learn and apply what they want to know. This assertion
indicates that supporting the career advancement of AA women involved providing AA female
middle managers with the tools and skill sets required to identify career barriers. The researcher
offered this recommendation to provide AA middle managers support for self-reflection of
perceived barriers that hinder their career advancement.
Motivation Recommendations
Three motivation influences emerged from data analysis, as reflected in the literature
review in Chapter Two. The researcher validated and confirmed data from the study based on the
results and findings from stakeholder interviews. All three influences supported the second
research question which involved exploring the barriers participants perceived as contributing
factors to their lack advancement into healthcare leadership. To assess AA female middle
managers’ knowledge of barriers negatively impacting recruitment, retention, mentorship, and
diversity and inclusion, the researcher analyzed the participants’ procedural processes. At this
stage of development, a training process must be in place to identify the type of procedural
knowledge necessary to provide AA female middle managers with the tools and skill sets
required to address and identify the barriers negatively impacting their career advancement (Diaz
& Dunican, 2011). Middle managers must procure specific skill sets that help AA women to
identify barriers and enact effective strategies for their career paths (Cooper, 2013; Davis, 2016;
Giscombe, 2011; Tarmy, 2012; Toson, 2012). The organization needs to implement training that
allows middle managers the opportunity to self-reflect and identify perceived barriers (Brown,
2004).
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 93
Currently, AA women in leadership positions face more challenges when compared to
other racial groups (Beckwith et al., 2016). In addition, AA women are more vulnerable to
stereotyping and often viewed as confrontational and overly aggressive (Edmondson Bell &
Nkomo, 2003). By implementing the strategies identified in this study’s findings, AA middle
managers can effectively understand and solidify their knowledge of perceived versus actual
barriers that prevent them from advancing into senior leadership positions in healthcare. See
Table 8 presents a summary of the motivation influences and recommendations.
Table 8
Summary of Motivation Influences and Recommendations
Assumed motivation
influence Principle and citation
Context-specific
recommendation
Utility value: African
American female middle
managers see the value in
making the management pool
more diverse.
Include rationales about the
importance and utility value
of the task (Pintrich, 2003).
Provide access to candidate
pool and opportunity for
African American middle
managers to participate in
selection process, that can be
used to reflect on perceived
barriers that impacted their
career advancement.
Attributions: African
American middle managers
feel that their efforts are not
enough to be considered for a
senior executive position.
Provide feedback that stresses
the nature of learning,
including importance of
effort, strategies, and the
potential self-control of
learning (Pintrich, 2003).
Provide accurate feedback
that identifies the skills or
knowledge the individual
lacks, along with
communication that skills and
knowledge can be learned,
followed with the teaching of
these skills and knowledge
(Anderman & Anderman,
2006).
Provide African American
middle managers a job
training guide/skillsets
tailored for senior leadership
readiness.
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 94
Interest: African American
female middle managers
should want to do more than
required to show senior
leadership they are
positioning themselves for a
senior executive position.
Activating and building upon
personal interest can increase
learning and motivation
(Schraw & Lehman, 2009)
Integrate personal interests or
common interest (Schraw &
Lehman, 2009).
Provide African American
middle managers with real
time feedback and increased
opportunity for advancement
that illustrates readiness for
senior executive positions.
Understanding the importance of value in increasing the diversity of the
management pool. More than 50% percent of AA middle managers acknowledged that there is
a need to place greater value on increasing diversity within the management pool. Increasing
diversity among the management ranks directly impacts the chances of advancement for AA
women; accordingly, the researcher devised a recommendation specific to utility value to close
this value gap. Pintrich (2003) provided a rationale for the importance and utility value of the
task. In addition, Rueda (2011) identified the usefulness of utility value when individuals
believed that the task or activity increased their chances to achieve future goals. Stressing the
importance of increasing the diversity pool of candidates for AA female middle managers may
lead to organizations placing more value on diversity. Thus, AA female managers must
understand the usefulness of making the management pool more diverse.
According to Silver (2017), a more diverse healthcare workforce is a more culturally
competent workforce, better equipped to meet the needs of an increasingly diverse population.
Regardless of an individual’s levels of skill, knowledge, or motivation, missing or inadequate
processes and materials prevent the achievement of organizational performance goals (Clark &
Estes, 2008). Obtaining this goal depended heavily on the motivation of middle managers
accomplishing the task. Motivated individuals performed at high levels to attain both
organizational and personal achievement. Once an individual committed to involvement, the
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 95
individual persevered and exerted the energy, drive, and mental effort necessary for success
(Clark & Estes, 2008; Grossman & Salas, 2011). Research from contemporary literature
indicated a phenomenon known as the middle management plateau to explain the lack of
diversity in executive healthcare leadership roles (Parker, 2001).
Data from this exploration of current culture settings and models showed the impact of
HRC recruiting strategies. According to Eccles (2006), value refers to the importance one
attaches to a task and refers to an individual asking, “Why should I perform the task?” High self-
esteem, a strong belief in one’s ability, and value in the involved task increased an individual’s
performance level (Eccles, 2006). The task needed to align with an individual’s goals or desires,
such as rewards, and the cost value directly impacted on how much time, effort, or resources the
individual expended for the task (Eccles, 2006; Rueda, 2011).
African American middle managers feel that their efforts are not enough. Data from
this study showed that over 73% of the AA female middle managers and senior executives who
participated felt their efforts went unrecognized; therefore, AA middle managers felt unable to
advance into senior healthcare leadership positions within their current organization. The
researcher selected recommendations based on attributions to address this motivational principle
and close the gap. Anderman and Anderman (2006) stated leaders should provide accurate
feedback identifying the skills or knowledge the worker lacks, followed by the teaching of such
skills and knowledge. Pintrich (2003) noted the importance of providing feedback that stresses
the nature of learning, including the importance of effort, strategies, and potential self-control of
learning. This research showed that providing feedback in real-time as well as access to
mentorship and training courses improved AA female middle managers’ perception of their
ability to achieve the task. The researcher recommends that employers provide AA middle
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 96
managers feedback that stresses the process nature of interview consideration, including the
importance of effort strategies and the potential self-control of success during interviews.
According to Wiener (2005), employees often work harder at a task when they believe
their level of effort dictates the outcome. The attribution theory comprises three dimensions:
stability, locus, and control. For this study, the researcher chose the control dimension to focus
on factors within an individual’s control that determine the impact on subsequent behavior and
emotions. As employees began to ask themselves “why” questions, they began to recognize that
failing to meet a previous goal did not mean permanent failure and acknowledged that an
increase in effort could change the results. Attributions come from individuals’beliefs about the
causes of their successes and failures (e.g., rewards and punishments) emotions, behavior, and
influence expectancies (Martinko et al., 2007). By acknowledging the influence of rewards,
punishments, and attributions on behavior, senior leaders encourage middle managers by
recognizing their success and coaching them through their failures, directly impacting the
attributions of AA middle managers.
Increasing skill sets in preparation for career advancement. In this study, 100% of
AA female middle managers and senior executives agreed they needed to start doing more than
required tasks in their current role to exhibit readiness and interest in a promotion to senior
leadership positions. The researcher selected a recommendation rooted in interest to close this
motivational gap. Schraw and Lehman (2009) cited activating and building upon personal
interest can increase learning and motivation. In addition, Schraw and Lehman noted the
significance of integrating personal or common interests, showing that motivation increased
when it directly impacted personal goals and interests in a specific task or opportunity. To further
support this interest theory, the researcher recommends that employers provide AA female
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 97
middle managers with personally meaningful opportunities for engaging senior managers in a
manner that demonstrates the readiness of AA female middle managers to excel in their careers.
Organization Recommendations
Two motivational influences emerged from data analysis, as reflected in the
literature review in Chapter Two. The researcher validated and confirmed data from the study
based on the results and findings from stakeholder interviews. Both influences supported the
second research question which involved exploring the barriers participants perceived as
contributing factors to their lack advancement into healthcare leadership. The influences were
related to cultural models. Analysis of the data determined that Senior leadership lack efforts in
increasing diversity. Schraw and Lehman (2009) found when leadership offered advancement
opportunities that modeled enthusiasm or interest, employees increased their efforts. When
employees’ interests align with their personal and professional goals, the workers enjoy
improved focus and increased confidence in their abilities, desire to demonstrate their abilities in
front of others, and do not concern themselves with negative judgment from their peers (Rueda,
2011).
Next analysis determined, a culture of trust does not exist between senior leadership,
middle managers and human resource consultants. Here Clark and Estes (2008) guided the
discussion of this influence based on the idea that effective change efforts ensure that everyone
has the tools needed to do their job, and that if there are resource shortages, then resources are
aligned with organizational priorities. To increase interest, employers need to provide both
stimulating and interesting tasks, activities, and materials and offer variety in the means of
accomplishing tasks and activities (Rueda, 2011). Employers also need to assign personally
meaningful and interesting content, materials, and tasks to AA middle managers. Exploring
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 98
Maslow’s hierarchy of needs and Herzberg’s theory of motivation to examine these behaviors,
Lambrou, Kontodimopoulos, and Niakas (2010) reported that when leadership leveraged insight
into managers’ motivational drivers, leaders were better able to leverage specific staff needs and
interests to meet intended outcomes. Table 9 presents a summary of organization influences and
recommendations.
Table 9
Summary of Organization Influences and Recommendations
Assumed organization
influence Principle and citation
Context-specific
recommendation
Culture models: Senior
leadership lack efforts in
increasing diversity.
Upper management vision and
commitment clearly and
candidly communicated to
everyone and demonstrated
with visible management
involvement in the process is a
crucial factor (Clark & Estes,
2008).
Implement and develop
strategies to improve efforts in
the area of diversity recruitment
by engaging senior leadership,
middle managers, and human
resources in the beginning
stages.
Cultural models: A culture of
trust within the hospital setting
does not exist between senior
leadership, middle managers,
and human resources
consultants.
Effective change efforts used
evidence-based solutions and
adapted them, where necessary,
to the organization’s culture
(Clark & Estes, 2008)
Clear and candid
communication fostered trust
and helped people adjust their
performance to accommodate
unexpected events. Trust
increased the spread of
communication to change goals
on all levels (Clark & Estes,
2008).
Implement transparent and
accountable communications
processes to encourage and
improve a culture of trust
between the senior leadership,
human resources consultants,
and middle managers.
Implement and develop strategies to improve efforts. Less than 50% of the AA female
middle managers and senior leaders interviewed acknowledged that their senior leadership, along
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 99
with HR, contributed toward the efforts of improving the diversity of the middle management
pool. The researcher selected a principle rooted in organizational change theory to address this
gap. According to Clark and Estes (2008), upper management vision and commitment, clearly
and candidly communicated to everyone and demonstrated with visible management
involvement in the process, is a crucial factor. This research showed that to enact true change,
senior leaders must take a more active role in increasing efforts to improve diversity. The
researcher recommends implementing and developing strategies to improve efforts in the area of
diversity recruitment by engaging senior leadership, middle managers, and HRCs in the
beginning stages.
To achieve the organizational goals, stakeholders needed to exercise creativity in their
thinking to discover a new way of doing things that benefits all parties involved (Rueda, 2011).
The HR recruiting process includes marketing and outreach to increase diversity at the
managerial level (Sutter Davis Hospital, 2014). Change within an organization entails altering
values, beliefs, myths, and rituals (Clark & Estes, 2008). The researcher used this strategy to
address the problem surrounding the lack of knowledge about the lack of diversity in the
healthcare industry at the managerial level (Michelman, 2003). When leadership clearly defined
roles, employers could hold employees accountable to specific standards and expectations.
Without clear roles, however, employers find it harder to hold employees to those organizational
standards (Rueda, 2011). Thus, there is a need for employers to identify the root cause problems
from an organizational standpoint before implementing new processes.
Implement transparent and accountable communications processes. Although some
middle managers agreed that hospital settings lacked trust, more than 60% of participants felt the
lack of trust among senior leadership, middle managers, and HRCs was a bigger issue. The
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 100
researcher chose a recommendation to examine and address the organizational cultural models to
close the existing gaps contributing to the lack of trust. Effective change efforts require
evidence-based solutions adapted as necessary to the organization’s culture (Clark & Estes,
2008). Further, Clark and Estes (2008) stated that clear and candid communication engendered
trust and helped people adjust their performances to accommodate unexpected events. Trust
increased the spread of communication to change goals on all levels. This study showed the
importance of communication. Stakeholders should be clear and honest about organizational
goals with all parties involved to gain their trust. The researcher recommends implementing
transparent and accountable communication processes that encourage and improve a culture of
trust between the senior leadership, HRCs, and middle managers.
Communication about plans and progress should be constant and candid among all
involved (Clark & Estes, 2008). Culture is within the organization or environment; accordingly,
the researcher used this approach to study how developing and changing the culture directly
impacted performance. Clear and candid communication engendered trust and helped people
adjust their performance to accommodate any unexpected events.
Implementation and Evaluation Framework
The researcher used the New World Kirkpatrick Model (Kirkpatrick & Kirkpatrick,
2016), the most-used training model, as a guide for this implementation and evaluation plan. The
model incorporates four levels of training: reaction, learning, behavior, and results. The New
World Kirkpatrick Model begins with the end and works in reverse, starting with Level 4 results,
as used in planning a program (Kirkpatrick & Kirkpatrick, 2016). By starting with Level 4 goals,
an organization is able to keep the focus on what is most important. Leading indicators help
bridge the gap between individuals’ initiative and organizational results. These short-term
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 101
observations and measurements indicated the critical behaviors needed for the desired impact on
the results. Although leading indicators must remain balanced with a focus on the highest level
result, the New World Kirkpatrick Model allows participants to apply what they learned during
training when they return to the job. Participants also acquired the intended knowledge, skill sets,
attitude, and confidence based on their participation in the training. In the final customer
satisfaction phase, participants indicated if they found the training favorable, engaging, and
relevant to their jobs (Kirkpatrick & Kirkpatrick, 2016).
Organizational Purpose, Needs, and Expectations
The researcher sought to thoroughly understand the challenges, barriers, and experiences
faced by AA female middle managers aspiring to obtain a senior executive position within a
healthcare organization. The study entailed exploring the influence of all potential stakeholders
to fully understand the stakeholders’ cultural, educational, and socioeconomic background as
well as the motivational, knowledge, and other sources of perseverance and resiliency exclusive
to this population of women. According to most mission statements, healthcare organizations
uphold a commitment to excellence and strive to improve the health of the population they serve
by providing affordable, quality care. Although AA women hold more advanced degrees than
their male counterparts, AA women still lack representation at the executive level in healthcare
organizations.
The NextGen program assessed AA middle managers to assist in determining their career
goals, provide mentorship, and ensure that the program is specific to the needs of this
stakeholder group. Researchers provided assessments to AA women throughout the program to
determine if their needs were met. After assessing the results, researchers developed the program
based on existing middle managers’ insights and contributions to the strategic planning of
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 102
organizations’ recruitment outreaches to attract a more diverse pool of candidates. The women in
senior leadership positions provided insight into how diversity at the leadership level may
improve the culture of the organization. Researchers of NextGen sought to increase the number
of AA women who aspire to obtain an executive-level position within a healthcare organization.
Level 4: Results and Leading Indicators
Table 10 shows the proposed indicators in the form of outcomes, metrics, and methods
both external and internal for AA middle managers. Job aids, education, and training helped to
achieve internal outcomes. Upon accomplishing internal outcomes, managers should measure
and achieve external outcomes.
Table 10
Outcomes, Metrics, and Methods for External and Internal Outcomes
Outcome Metric(s) Method(s)
External outcomes
Increase access for AA
middle managers to
promote into senior
leadership positions
The number of AA women
who apply for senior
leadership positions.
Solicit data from human
resource departments to track
the number of AA middle
managers who are seeking
senior leadership positions.
Improve access to internal
training courses available
for middle managers.
The number of programs
available to ensure middle
managers have the skill sets
required for promotion to
leadership positions.
Quarterly review of reports on
training provided and taken by
employees presented by HR to
Hospital leadership.
Internal outcomes
Improve overall diversity
of middle management
pool within hospital
departments.
Percentages of middle
management population/
ethnicity by department.
Annual review of HR
employment reports to track
change.
Implement training
programs for new middle
managers during
onboarding.
Percentage of middle
managers who successfully
complete the training and
successfully promote.
Biannual review to track
progress of completed
training.
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 103
Level 3: Behavior
Critical behaviors. The researcher focused on the primary stakeholders of AA female
healthcare middle managers. To see improvements in effectiveness, AA middle managers needed
to exemplify five critical behaviors. First, AA managers need to obtain the necessary degrees or
certifications to advance into a senior leadership role. Second, AA managers need to do more
networking within their field, outside of their immediate organizations, and consider joining
organizations specific to healthcare leadership. Third, AA managers need to obtain support for
career advancement in senior leadership within their current organization. Fourth, AA managers
should seek mentors who assist them in navigating their career paths. Lastly, AA middle
managers must actively pursue career advancement by creating opportunities for themselves and
not waiting for others. Table 11 presents the critical behaviors, metrics, and methods needed for
improvement.
Required drivers. AA middle managers need encouragement from their direct manager
as well as senior leadership to further their education and apply the acquired tools and skill sets
for that next position. Employers should establish rewards and incentive programs to help AA
middle managers along their journey. Small wins encourage and keep employees motivated.
Table 12 presents the recommended drivers to support critical behaviors for senior leadership.
Organizational support. The AA middle managers need assistance and support from
senior leadership to advance to the next level in their careers. First, senior leadership needs to
ensure that AA middle managers have the required tools and training for advancement. Then
senior leadership needs to assist in making the AA middle manager more visible by assigning
them to assist with upcoming projects. Lastly, senior leadership needs to assist with developing a
recruitment process that promotes AA middle managers from within the organization.
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 104
Table 11
Critical Behaviors, Metrics, Methods, and Timing for Evaluation
Critical behavior Metric(s) Method(s) Timing
1. AA middle
managers need to
inquire about
educational
requirements for
promotion.
The number of
completed courses
required to obtain the
next position.
1a. Human resources
postings and consultants
can provide this
information to the AA
middle managers.
1a. During the first
90 days of
reviewer’s
employment,
quarterly; thereafter,
annually, as long as
previously
successful.
The required number
of degrees (e.g.,
bachelor’s Master’s,
etc.) needed for
advancement
eligibility.
1b. Human resource
consultants will provide
the information for
available resources (e.g.,
tuition reimbursement,
institutions) and may
also provide employee
discounts for courses.
Quarterly
2. AA middle
managers need to
inquire about
joining outside
organizations
Number of
networking
opportunities
The AA middle
managers need to reach
out to existing
organizations to
establish new
networking relationships
in areas where
support/development is
needed
Quarterly
3. AA middle
managers need to
obtain support
from senior
leadership
Number of quality
check-ins necessary
AA middle managers
will reach out to senior
leadership to facilitate
conversations, provide
education, job aids, and
or training
Monthly
4. AA middle
managers need to
find a mentor
Number of AA
managers who have a
mentor
AA middle managers
will solicit feedback and
guidance from mentors
that help establish their
”why” for advancement
Quarterly
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 105
Table 12
Required Drivers to Support Critical Behaviors
Outcome Metric(s)
Critical
behaviors
supported
Reinforcing
Provide AA middle managers a job training guide tailored to
their organizational personal and professional goals.
Quarterly 2, 3
Provide AA female Managers rationales about the usefulness in
making the management pool more diverse.
Quarterly 1, 2
Provide AA middle managers education that supports self-
reflection on perceived barriers that hampered their career
advancement.
Quarterly 1, 2, 3
Encouraging
Provide AA middle managers feedback that stresses the process
nature of interview consideration, including the importance of
effort strategies and potential self-control of success during
interviews.
Monthly 1, 2, 3
Rewarding
Provide AA female middle managers personally meaningful
opportunities for engaging senior managers in a manner that
demonstrates the readiness of AA women to excel in their
careers.
Monthly 1, 2, 3
Monitoring
Implement transparent and accountable communications
processes to encourage and improve a culture of trust between
the senior leadership, human resources consultants, and middle
managers.
Biannually 1, 2, 3
Implement and develop strategies to improve efforts in the area
of diversity recruitment by engaging senior leadership, middle
managers, and human resources in the beginning stages.
Biannually 1, 2, 3
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 106
Level 2: Learning
Learning goals. Based on participation in training, Level 2 of the New World
Kirkpatrick Evaluation Model measures the degree to which participants acquire the intended
knowledge, skills, attitude, confidence, and commitment (Kirkpatrick & Kirkpatrick, 2016).
Adjusting the training in real-time and providing feedback ensures that participants learn
effectively from the training (Kirkpatrick & Kirkpatrick, 2016). Following the completion of the
formal recommended solutions specific to personal development, the middle manager should be
able to:
1. Summarize the common barriers affecting middle managers’ career advancement
(factual)
2. Follow processes for setting professional and personal goals for middle managers
(procedural)
3. List various tools and resources appropriate for middle managers’ career
advancement (factual)
4. Integrate human resources expectations within the career advancement aspects in
mind for middle managers (procedural)
5. Value the time and effort middle managers put in their work (value)
6. Express interest in career advancement to senior leadership engagements with human
resources consultants (interest)
7. Express interest in continuing education during the middle management training
program (interest)
Program. Employers must develop and deliver training programs in a way that
maximizes learning (Kirkpatrick & Kirkpatrick, 2016). Effective training programs produce
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 107
results both during and after the training. The training program recommended for middle
managers in healthcare includes the aforementioned components. During the training process,
the middle manager stakeholder group will explore a variety of topics with a direct effect on their
career advancement into senior leadership positions. The program will accompany a 6- to 12-
month mentoring program during which middle managers who aspire to move into senior
leadership positions will pair with a senior leader mentor. The program aligns employees with
executives and higher-level managers who share similar interests, with the mentor providing
guidance, feedback, and directives to assist in their mentee’s career path.
For the first step of the plan, the senior-level executives and administrators need to
develop, present, implement, and request additional resources from the board and external
stakeholders for NextGen mentoring. Employers create a culture of mentoring by examining best
practices used in similar organizations, along with current internal practices, barriers, and
challenges for both incoming and current employees.
For the second plan of action, the HRC needs to introduce the program to senior
managers to solicit participation from potential mentors and mentees. Middle managers need
mentoring and sponsorship to help them overcome isolating barriers. Mentoring helps
organizations address the work-life conflict women experience in the workplace. The HRCs, in
partnership with senior leadership, should introduce the program to various departments and
promote its significance, thus providing a platform for employees to ask questions and relate
concerns about the newly designed program. The purpose of this plan of action is to address the
internal problem of the lack of knowledge about the existing resources available for mentoring in
career advancement (Michelman, 2003). Employers using this plan of action must focus on both
incoming and existing employees who are interested in senior management positions. During the
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 108
onboarding process, employers should solicit feedback from all new employees in their 90-day
probationary period, providing assessments and surveys to determine employees’ interests and
aspirations. Upon collection of these data, employers will pair employees with the mentors who
best fit their needs.
The third plan of action requires managers and directors to develop and sustain
relationships with new employees. The managers must create an environment that encourages
trust between the mentor and the mentee. Once the directors understand the importance of
maintaining these relationships, managers and directors will feel more motivated to aid in the
success of this program (Clark & Estes, 2008). Senior executives, HRCs, and managers
remaining committed to building a robust mentoring program with new and existing employees
model downward accountability. According to Burke (2004), downward accountability refers
only to managers (e.g., senior executives, HRCs) responsible for subordinates (employees). A
successful mentoring relationship helps to shape an employee’s life. Advantages of mentoring
include assistance with career development, organizational development, and increased
networking opportunities (Sloan, 2008). When employers clearly define the roles of employees,
managers are able to hold employees accountable to set standards and expectations. As long as
accountability remains at the forefront, the NextGen will continue to see improvement.
Implementing these recommendations to develop a robust mentoring program requires
continuous improvements in workflow and greater efficiency in processes while promoting a
collaborative work environment, and where professional accountability plays a role. Professional
accountability values professional autonomy and responds well to client (mentor-mentee) needs,
both individually and collectively. A good start for professional accountability in the workplace
involves providing as much access to mentoring opportunities for women as their male
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 109
counterparts (Key et al., 2012). If the mentor is part of the “good ol’ boy network,” a mentoring
relationship provides mentee women access to inner circles of men (Giscombe, 2011).
Evaluation of the Components of Learning
According to Kirkpatrick and Kirkpatrick (2016), learning is the degree to which
participants acquire intended knowledge, skills, attitude, confidence, and commitment based on
their participation in the program and the training they receive. Researchers must evaluate these
components from both a declarative and procedural perspective. Each learning component
contributes to the stakeholder’s success both during and after completion of the mentoring
program. Mentee attitudes and beliefs that the training program was worthwhile to implement
into their job precedes the confidence that the skill sets they acquired will be beneficial for their
next role. Stakeholders must feel knowledgeable and confident about learning and their
commitment to apply what they learned during the mentoring program. The program and training
evaluations must indicate whether the stakeholders applied the information learning throughout
the program to help them advance in their careers. The program’s success directly reflects how
well the stakeholders perform upon completing the program. Table 13 represents the program
evaluation.
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 110
Table 13
Evaluation of the Components of Learning for the Program.
Method(s) or Activity(s) Timing Goal
Declarative knowledge: “I know it”
Review and summarization of the
components of the mentoring
training program and the barriers
affecting middle managers
Prior to beginning the
program and at the 3-
month check-in
85% of AA middle
managers
Knowledge and understanding of
skill sets needed to be promoted to
the senior leadership role
After 90 days of being
in the program
90% of AA middle
managers
Procedural skills: “I can do it right now”
Provide timely feedback from senior
leaders and mentors
During monthly check-
ins
95% of AA middle
managers
Review new skill sets acquired
throughout the program
Quarterly 80% of AA middle
managers
Attitude: “I believe this is worthwhile”
Pre-assessment and post-assessment
of mentor training program
Preprogram and post-
program assessment
Discuss the value and importance of
their current roles
In-person check-ins
with program director
85% of AA middle
managers
Confidence: “I think I can do the job”
Discussion on how confident I feel in
my current role
During quarterly
evaluations
Post-assessment upon program
completion
Post--program
completion
80% of AA middle
managers
Commitment: “I will do it on the job”
Creating individual success plans During mid-program
evaluation period
95% of AA middle
managers
Discussions on training program and
real-time feedback
During mid-program
evaluation period
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 111
Level 1: Reaction
In the New World Kirkpatrick Evaluation Model, Kirkpatrick and Kirkpatrick (2016)
defined Level 1 reaction as the degree to which participants find the training favorable, engaging,
and relevant to their jobs. The program’s ongoing assessment plan allows the learners to provide
continuous, real-time feedback regarding their training. Considered the simplest tool and the
most familiar level, Level 1 presents formative methods, participant satisfaction, and
conservation of resources (Kirkpatrick & Kirkpatrick, 2016). Table 14 presents on these three
components: engagement, relevance, and customer satisfaction among AA middle managers.
Table 14
Components to Measure Reactions to the Program
Method(s) or Activity(s) Timing
Engagement
Completion of mentor training program Monthly, during the program
Gathering of feedback in real-time Quarterly, pre-program, during the program,
and post-program completion
Relevance
Participants’ feedback Quarterly
End-of-program evaluation 2 weeks post-completion
Customer satisfaction
Collect information via surveys and
participants’ feedback
Monthly
Conduct completion of program evaluation 2 weeks post-completion
Evaluation Tools
Immediately following program implementation. Employees require evaluations when
completing any type of training program. According to Kirkpatrick and Kirkpatrick (2016),
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 112
results from Level 1 and Level 2 evaluations indicate successful completion of the training.
Individual evaluations immediately following program completion allow for real-time feedback
that helps employers determine the success of the training. Data from Level 1 reactions are
simple evaluations for learning professionals (Kirkpatrick & Kirkpatrick, 2016). During this
phase of the evaluation, participants express to what degree they found the training to be
engaging and relevant to their jobs. Correctly timing the distribution of evaluations following the
program directly impacts the number of returns as well as the quality of the feedback received.
Employers must develop effective questions to obtain clear and concise feedback.
Responses to questions must show answers on the success of the program and its tools.
Administering a pre-evaluation improves the chances of receiving successful assessments that
indicate what participants hope to learn throughout the course of the program. Administering a
post-evaluation indicates to employers whether employees felt the program provided them with
the skill sets required to excel in their jobs. For the Level 1 evaluations, trainers must also
perform assessments during the program, information that will reveal how they need to adjust
training to ensure the program stays relevant to the participants’ needs (Kirkpatrick &
Kirkpatrick, 2016). Trainers must develop evaluation questions in a way that assesses whether
the program meets the needs of the participants as well as if changes are necessary for future
participants. Questions on the Level 2 assessment should be in the form of a 4-point Likert scale
survey to determine employees’ overall level of satisfaction with the NextGen program.
Delayed for a period after the program implementation. Thirty days, 3 months, and 6
months after the completion of the NextGen program, the trainers and mentors should conduct an
online webinar with participants to hear if and how the program impacted employees’ careers.
The webinar allows participants to share their experiences, their reactions, and what they learned
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 113
from the program. Each check-in point warrants different responses from employees. For
example, at the initial 30-day check-in, the participants are still determining the best way to
apply these new skill sets. Subsequently, the next two assessments provide opportunities for the
participants to articulate how the program helped them in their current positions and how it
prepared them for career advancement.
Data analysis and reporting. According to Kirkpatrick and Kirkpatrick (2016), employers
must gather and analyze data along the way to influence outcomes. Instead of simply measuring
data, gathering and analyzing data maximizes current and future program results. The researcher
developed the program based on the stakeholder group of AA female middle managers to help
female healthcare executives develop their skill sets and ensure readiness for career advancement
when the opportunity arises. Data from the study will present the outcomes of the NextGen
program.
The researcher developed the program to help more AA female middle managers attain
senior-level positions in healthcare. Findings show the learning outcomes and their experiences
throughout the duration of the program. The researcher will compare the results of the program
to the outcomes of similar programs, with the final findings presented to senior leaders to
determine if the program successfully achieved the anticipated outcomes. If the study fails, the
researcher must reevaluate the program and determine the changes needed before
implementation of the next phase. Results from participant evaluations ensure the stakeholder
group remains the focal point of the program
Employers should administer evaluation tools to the AA middle managers immediately
after the completion of the NextGen mentoring program, and then again at the 30-day, 3-month,
and 6-month marks focused on Level 4 results. Trainers, mentors, and senior leadership benefit
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 114
from the necessary feedback provided by the participants. Upon further analysis, employers will
present the results to senior leadership to illustrate the success and education of the participants.
Reaching the Stakeholder Group of Focus Goal
The implementation of the NextGen mentoring program by employers helps leadership
staff to understand organizational gaps better and provide the tools and skill sets AA female
middle managers need to prepare for a senior leadership position. Employers who implement the
program prepare AA female middle managers to obtain leadership roles and increase the
diversity pool of the middle management population with the utilization of job aids, professional
and personal development training, and a mentor who can help them navigate their path.
As shown in Figure 5, 90% of middle managers agreed the program was relevant to their
career development. Most importantly, data showed credibility for the amount of effort put into
the development of the program to improve the diversity pool of middle managers and increase
the number of AA women in senior leadership positions.
Summary
By applying the New World Kirkpatrick Model (Kirkpatrick & Kirkpatrick, 2016), the
researcher created a program that included integrated assessment tools and evaluations specific
to the outcomes of the program at each phase. The evaluation was a means to ensure employers
receive real-time participant feedback, allowing trainers to adjust or stay in alignment with the
expected outcomes of the senior leader’s vision for the NextGen program. Additionally, trainers
can ask senior leadership critical questions if the program met expectations. If the program’s
results did not meet expectations, trainers can work with senior leadership to identify and resolve
breakdowns. The next steps involve receiving recommendations for future programs that focus
on Level 4 results and work backward. Use of the Clark and Estes (2008) gap analysis model and
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 115
the KMO framework allowed the researcher to dissect the gap analysis into specific areas instead
of focusing on the whole problem, which may have led to missed influences and gaps in the data
analysis. Informed decisions are now possible based on data and not just an idea. The researcher
will present the results to the stakeholders, enabling them to make an informed decision based on
the successes and failures of the program.
Strength and Weakness of the Approach
As it related to improving the advancement of the AA female middle managers into
senior executive positions, the KMO framework established by Clark and Estes (2008) presented
both strengths and weaknesses. A qualitative phenomenological approach provided opportunity
for the researcher to understand the perspective of the participants through their lived
experiences related to their knowledge and motivation for advancement into senior leadership
positions. The researcher identified a weakness in the KMO framework in that it did not allow
for measuring the AA women’s level of resiliency that enabled them to continue striving for a
senior executive position despite ongoing barriers and setbacks. Although AA female middle
managers remained motivated to reach a higher level of success, the amount of resiliency
required varied at every level of career elevation.
Limitations and Delimitations
The researcher considered several limitations when interpreting the findings of this study.
The sample size was smaller than initially anticipated because of the limited size of this specific
population. Some participants expressed fears of backlash or blackballing in their industry.
Based upon these fears, participants may not have spoken truthfully or been forthcoming with
their responses. The researcher encountered issues obtaining accurate data specific to the number
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 116
of AA women in healthcare leadership, with only limited data available on middle manager and
senior executive populations.
Future Research
As a result of the chosen topic being relatively new to the field of healthcare, the
researcher recommends follow-up studies to expand the findings. This study entailed exploration
of AA female middle managers and senior healthcare executives and the barriers they faced
while striving for middle management and senior executive-level leadership positions. Also
investigated were the policies and strategies AA women used to succeed. Future researchers
should seek to determine how mentoring programs for AA women in healthcare leadership affect
the development of senior executives. Additional research specific to the recruitment strategies
of healthcare organizations would provide a better understanding of possibilities available to
external candidates pursued for positions by HRCs. Leadership development programs within
healthcare organizations merit study to determine the selection and educational process of AA
women striving for executive roles. A formal succession planning process involving hiring and
promoting employees from culturally diverse populations is needed in healthcare organizations
to increase the pool of qualified minority applicants for leadership positions.
Conclusion
In this study, the researcher examined the experiences of AA women working in middle
management in healthcare in an attempt to better understand the barriers and challenges
contributing to the lack of advancement of AA women into senior executive leadership positions.
The researcher explored the knowledge, motivational, and organizational factors that played a
significant role in the lack of advancement of AA women. All participants agreed that promotion
required education, continued professional development, mentoring, networking, recruitment,
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 117
and exceptional performance; however, these did not guarantee promotion. With the findings of
this study, the researcher added to the knowledge and understanding of the topic of career
attainment for AA female middle managers who aspire to obtain senior executive healthcare
positions.
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 118
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Appendix A: Interview Questions
What Is the African American Woman’s Lived Experience in Middle Management
Positions in Healthcare?
Hello, my name is Brandy Florence, and I am working on my doctoral dissertation. Data from
the research of this study presents the perceived barriers contributing to lack of advancement of
African American women into senior healthcare leadership positions and the knowledge,
motivational, and organizational factors that shaped their journey into middle management and
C-suite positions. I appreciate your willingness to participate in this study. Your responses will
be used to help the next generation of African American women who aspire to be in healthcare
executive leadership. As summarized in the consent forms, this is voluntary and you may stop at
any time.
1. Tell me about your career journey? (Participants will be instructed to tell the researcher about
themselves, what they do now, and how long they have been in the field. Then start at the
beginning to tell the researcher stories of their work/career journey and critical turning points
along the journey and explain why these events should be viewed as such.) (Knowledge)
2. What is your level of education and number of years serving in a healthcare leadership
capacity? (Knowledge)
a. How has your educational background impacted your career?
3. What were the primary reasons why you sought out this position in healthcare? (Motivation)
4. What barriers/challenges have you faced as an African American woman in healthcare
leadership?
a. What strategies did you use to mitigate these challenges? (Knowledge: Procedural)
5. What skills were critical for you to have to navigate down the leadership track in healthcare?
(Knowledge: Procedural)
6. At some point during your career, were you convinced that your efforts had gone unseen and
would have an impact on further advancement? (Motivation influence?)
7. Can you describe the level of commitment your organization has to diversity? At the
executive level? (Organization-Settings)
8. Have any of the organizations you’ve worked for, including your current organization, had
specific initiatives geared toward the advancement of African American women?
a. If not, do you believe these are necessary?
b. If so, would you say they are helpful? (Organization-Settings)
9. Can you explain your observations on the ways leadership in your healthcare organization
promotes policies and practices that support diversity and inclusion? (Organization-settings)
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 136
10. Are you aware of the effective recruitment strategies your organization uses to recruit or
retain African American female leaders? If any? (Organization-settings)
11. What are the perceived factors that have contributed to your leadership experience as an
African American woman? (Knowledge; Factual)
12. What advice or suggestions would you give other African American women who are seeking
executive level leadership in healthcare?
a. What should they avoid?
b. What attributes do you identify with successful executive leaders? (Knowledge;
Procedural)
13. Do you feel you were given an equal opportunity as an African American woman to obtain
the status of senior executive or above within your own healthcare organizations?
a. Why or why not? (Organization)
14. Are there any other comments you would like to add outside of the scope of these questions?
(Knowledge)
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 137
Appendix B: Informed Consent
Dear _________________,
Thank you for being so gracious and agreeing to take part in this research. Below I have noted
information about the scope of my study as well as a description of your involvement.
Background and Purpose
I am currently a doctoral student in the dissertation phase of my Educational Doctorate in
Organizational Change Leadership at the University of Southern California. The topic of my
dissertation is “African American Female Healthcare Executives: Missed Opportunities in
Increasing the Number of African American Women in Leadership.”
The primary purpose of this study is to explore the intersection of race and gender for African
American (AA) women in healthcare leadership and how their experiences contributed to their
personal leadership style. The goal of this study is to identify strategies used by AA women to
overcome barriers in their progression to leadership in the face of ongoing hardships and
challenges. You have been selected to contribute to this study due to your role as a leader in a
healthcare organization. I am interested in learning how you confronted and overcame any
obstacles on your journey to leadership. As a result of this study, I will provide a design matrix
that will assist organizations with successfully offering opportunities of advancement for AA
female healthcare executives.
Your Involvement
Attached, you will receive an informed consent outlining my responsibilities related to your
protection as a participant as well as the guaranteed confidentiality of your answers. Upon
signing the consent and agreeing to the terms, I will contact you via phone and email to schedule
your interview
This study involves the completion of two tools
1. A personal history questionnaire
2. An in-depth interview with the researcher. It is anticipated that the interview may take up
to an hour. The interview will be audio recorded.
You may be recalled once the data has been analyzed to affirm the accuracy of the researcher’s
work.
Here are some sample questions:
• What were the factors attributing to your ambition or lack of initiative, if any, in seeking
healthcare executive leadership positions? If you lack ambition or initiative, what were
some of the reasons why?
• Tell me about your career trajectory. What position did you hold before and what were
some of the challenges you faced?
• What were the primary reasons you sought this position?
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 138
The personal history questionnaire should only take about five minutes to complete. The
interview could take anywhere from 30 minutes to an hour to complete. A mutually agreed upon
time will be confirmed via email.
Please know that your participation in this study is COMPLETELY VOLUNTARY and if at any
time you choose not to participate, you may leave this study without any penalty or consequence.
I assure you that all information collected by me (the researcher) will remain confidential and be
carefully protected. Identifying information will not be reported to anyone, and the knowledge
gained by the researcher during the process will be reported in dissertation format. A pseudonym
will be used to identify you.
A committee of professors at the University of Southern California is overseeing my research:
Dr. Darline Robles, Dr. Courtney Malloy. If you have any questions, you may contact Dr. Robles
at drobles@usc.edu or me at bflorence@usc.edu.
Thank you again for your participation!
All the best,
Brandy Florence
Doctoral Student of Organizational Change Leadership
School of Rossier, University of Southern California.
The researcher will give you a copy of this form to keep.
Statement of Consent:
I have read the above information and I feel I understand the study well enough to make an
informed decision about my involvement. By signing below or replying to this email with the
words, “I consent,” I understand that I am agreeing to the terms described above.
Printed Name of Participants
Date of Consent
Participant’s Signature
Researcher’s Signature
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 139
Appendix C: Immediate Evaluation Instrument
Levels 1 and 2
Directions: Thank you for your
participation in the NextGen
Development Program. Your feedback
is greatly appreciated.
Strongly
Agree
Disagree Agree Strongly
Agree
1. The workshop content was relevant
and easy to follow
2. This NextGen training was relevant
to the expectations of my position
3. My learning was enhanced by the
knowledge of the instructors/mentors
4. I was engaged throughout the
duration of the program
5. I obtained new relevant knowledge
that can be applied in my
current/future position
6. I understand how mentorship
impacts career
advancement/development
7. Understanding how important
professional development is for career
advancement
8. I feel confident in my ability to
advance in my career
9. I am committed to applying the
knowledge and skill sets I obtain from
this program towards career
advancement
LACK OF ADVANCEMENT OF AFRICAN AMERICAN FEMALES 140
Appendix D: Delayed/Blended Instrument Levels 3 and 4
1. Explain how participating in this training has contributed to your career advancement toward
a healthcare executive positions (L4)
2. What information was most relevant in the NextGen program? (L1)
3. What information was the least relevant in the NextGen program? (L1)
4. What information should be added to the NextGen program in the future to increase its
relevance to incoming middle managers? (L1)
5. What information, if any, do you feel was missing from NextGen program ? (L2)
6. I have successfully applied what I learned in the NextGen program . (L3)
a. Strongly Disagree
b. Disagree
c. Agree
d. Strongly Agree
7. What other tools or skill sets, if any, do you need to apply what you’ve learned more
efficiently? (L3)
8. Have you received recognition from senior leadership regarding your newly developed
leadership skills? (Required Drivers: Encouraging)
a. Strongly Disagree
b. Disagree
c. Agree
d. Strongly Agree
9. Have you been acknowledged for your pursuit of professional development to advance your
career? (Required Drivers: Encouraging)
a. Strongly Disagree
b. Disagree
c. Agree
d. Strongly Agree
Abstract (if available)
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Asset Metadata
Creator
Florence, Brandy I.
(author)
Core Title
Missed opportunities: lack of advancement of African American females into senior executive healthcare leadership
School
Rossier School of Education
Degree
Doctor of Education
Degree Program
Organizational Change and Leadership (On Line)
Publication Date
02/17/2020
Defense Date
01/17/2020
Publisher
University of Southern California
(original),
University of Southern California. Libraries
(digital)
Tag
African American women,diversity,diversity and inclusion,healthcare senior executives,HMOs,Hospital,leadership,mentoring,middle managers,OAI-PMH Harvest
Language
English
Contributor
Electronically uploaded by the author
(provenance)
Advisor
Robles, Darline (
committee chair
)
Creator Email
bflorenc@usc.edu,msbrandyflorence@gmail.com
Permanent Link (DOI)
https://doi.org/10.25549/usctheses-c89-270560
Unique identifier
UC11674227
Identifier
etd-FlorenceBr-8180.pdf (filename),usctheses-c89-270560 (legacy record id)
Legacy Identifier
etd-FlorenceBr-8180.pdf
Dmrecord
270560
Document Type
Dissertation
Rights
Florence, Brandy I.
Type
texts
Source
University of Southern California
(contributing entity),
University of Southern California Dissertations and Theses
(collection)
Access Conditions
The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...
Repository Name
University of Southern California Digital Library
Repository Location
USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA
Tags
diversity and inclusion
healthcare senior executives
HMOs
mentoring
middle managers