Substantial lack of diversity seen in senior, emerging leadership of US cancer centers

Cultivating diversity in the cancer workforce — and particularly its leadership — has been an area of increased priority over the past several years.

The Association of American Cancer Institutes (AACI) conducted a survey to determine the extent of diversity not only at the highest levels of leadership, but also among emerging leaders in the field of oncology.

“There’s an awareness of limited diversity at the highest levels of leadership, such as cancer center directors, but we didn’t know as much about the level of diversity among emerging leaders, such as associate directors of cancer centers, deputy directors and even program leaders,” Caryn Lerman, PhD, director of USC Norris Comprehensive Cancer Center and president of AACI, told Healio. “I consider these to be the pool of emerging leaders that we would want to groom for the future and, therefore, assessed gender, ethnic and racial diversity among these individuals, as well.”

The survey included 82 cancer directors, 62 deputy directors, 639 associate directors and 795 research program leaders.

Lerman spoke with Healio about the findings, published in Journal of the National Cancer Institute, and how cancer centers can work to increase diversity at all levels of leadership.

Healio: What did your survey reveal?

Lerman: Not surprisingly, we found a lack of diversity among the cancer center directors. We were, however, very surprised to see the limited diversity at the level of deputy directors, 82% of whom self-identified as non-Hispanic white. Similarly, 72% of associate directors identified as non-Hispanic white, and the same was true for research program leaders.

We were equally surprised that, in this day and age, only 15% of the directors and 31% of deputy directors were women.

There also remains an imbalance, although not quite as dramatic, at the associate director and research program leader levels. That led us to conclude that if we are relying solely on the individuals who are already in leadership roles to cultivate emerging leaders, nothing is going to change very much.

The responsibility lies at the institutional leadership level to enhance diversity within cancer centers so that they become more representative of the communities they serve. As you move down the levels of these organizations, directors often appoint people who are known to them, or sometimes those who are similar to them. That’s why our group of authors joined together to establish best practices for creating a more diverse pool and to onboard new leaders in a deliberate, proactive way to help them succeed.

Healio: What were some of the other best practices your group recommended?

Lerman: As cancer center directors, we must look very broadly, both within and outside the organization, for individuals to appoint to these emerging leader roles, such as associate directors and program leaders. We need to be extremely thoughtful about that, while ensuring that all new leaders have the skills and resources they need to succeed.

When creating a diverse pool of leaders, rather than simply making an appointment to a role, the creation of search committees may identify a broader network of folks who could be considered. However, it will be even more challenging to attract potential leaders from different underrepresented groups and women if the search committee itself is not diverse. That sends a message and could be interpreted as reflecting the culture of the organization. In addition, it’s vital in any kind of search to have conversations about implicit biases we all may hold against people who are different from us. That could affect how search committee members perceive and rate applicants.

Healio: What did your group recommend as far as leadership in academic medicine?

Lerman: In many academic medical centers, there are no specific term limits on leadership roles such as cancer center director, department chair and division chief. People serve for decades. Unless we consider some term limits, there will not be an opportunity for a more diverse emerging leadership. That’s another key factor — the half-life of a leader. At what point should they consider doing something else so a new person can lead?

Healio: What do you advise in terms of onboarding and integrating new leaders?

Lerman: There are ways to create a much more structured, multistage process that provides key materials, such as strategic plans, financial materials, budgets and metrics. I think it’s the responsibility of the cancer center director and other members of senior leadership to ensure enough time is spent to help new leaders understand institutional culture. We want to help them build the relationships they need to succeed. Within the context of a matrix cancer center, when recruiting faculty, it’s essential to collaborate with department chairs and other leaders. Typically, the faculty appointments and promotions are handled within departments. New leaders must also understand the pathways to get things done; for example, to know whom to communicate with before you communicate with the next person. Educating new leaders regarding areas to avoid early in their tenure — the so-called third-rail issues — is also vital, as are skills in the change management process.

Other key components include offering leadership development opportunities through workshops and internal training. Finding executive coaches or leadership coaches for new leaders is also very helpful. That’s different from mentors. Mentors serve more in an advisory role, whereas coaches help people develop the types of skills and provide tools that will help them be more effective as communicators.

Healio: What is next in your efforts on leadership diversity?

Lerman: We will continue to evaluate trends in leadership diversity over time. In November, AACI is offering the first leadership development workshop for cancer center leaders, with an eye toward recruiting diverse candidates to participate in cancer center leadership. Directors will nominate individuals from their centers, and we’re urging them to focus on women and underrepresented ethnic and racial groups. We will also develop a toolkit and materials that cancer centers can use to foster leadership development among a diverse pool of promising emerging leaders at their centers.

For more information:

Caryn Lerman, PhD, can be reached at USC Norris Comprehensive Cancer Center, 1441 Eastlake Ave., Los Angeles, CA 90033; email: caryn.lerman@med.usc.edu.