Another possible explanation for disparate career outcomes might include the experiences and perceptions job holders have in their current organizations. It is through the organization's challenges that managers acquire a broad array of experiences both in tasks accomplished and interpersonal relationships. And by carefully examining an organization's structure, its demographic makeup, and policies we may begin to understand how commitment can be fostered and promotions facilitated. This section seeks to shed light on structures and processes in place that give rise to the outcomes already discussed--positions held, salaries earned, satisfaction with and commitment to the job.

First and Current Position. Do members of the race/ethnic groups vary in terms of the positions they are recruited for? And do their promotional patterns vary? Table 19 examines these questions by comparing the respondents' first and current positions in their current organization. The table shows that the plurality of respondents were recruited as department heads; there are no major differences among the race/ethnic groups in the level of responsibility for which they are recruited to the organization. But the current position shows that white women are about twice as likely to hold upper level management positions (CEO and COO) as minority women. The table shows moreover, that the average respondent has been with their organization between 4 and 6 years and in their current job between 2 and 3 years. Asian females have a somewhat shorter tenure in both the organization and in their current job.

Table 20 considers the patterns of promotion from first to current position within the employing organization by race/ethnicity. The table shows that nearly all the executives who began as CEOs remained at that level. It also shows that for white and Hispanic women, a higher than expected proportion who were recruited as senior vice presidents were promoted to CEOs. However the number of respondents was low in the case of whites and the findings should be considered suggestive only. The table shows that similar proportions of men in the various race/ethnic groups advanced to higher positions within their organizations. Again, because of limited numbers, the results should be considered suggestive.

Likelihood of Promotion. Do the respondents anticipate a promotion within the next year? Table 21 shows that except for Asian women, the groups all about equally optimistic or pessimistic about their promotion probabilities. Between 15 and 20 percent of the women expect promotions and slightly higher proportions of men (18 to 24 percent) expect promotions in the coming year. Notwithstanding the downsizing and restructuring that has occurred in the past half decade, the data are similar comparing the 1992 and 1997 respondents.

Thus far, we have portrayed the recruitment and promotional patterns within respondents' organizations. The data show that these executives are recruited at the same level and except for white women, promotional patterns are quite similar. How different are the organizations that these executive work for? Table 22 compares them in terms of their race/ethnic composition and Table 23 considers specific policies that might enhance or hinder career advancement.

Race/ethnic Composition. Table 22 shows that the organizations these executives manage are typically peopled by whites. Thus, the race/ethnicity of the respondents' predecessors is predominantly white, the organizations' employees are predominantly white as is the service area. In the case of blacks and Hispanics, there are sizable minority populations like themselves--but the single largest race/ethnic group continues to be white. Even in the departments that these managers lead, the dominant race/ethnicity is white.

Comparing 1992 and 1997 data shows interesting changes. For example, while the race/ethnicity of predecessors was similar among blacks and whites, for black executives, the service area's race/ethnicity composition changed from predominantly black to white. And, among black men, the employees' race/ethnicity in their organizations also changed from predominantly black to overwhelmingly white. These findings may be related to the fact that in 1997, blacks in the sample were included from among those who are ACHE members. Finally, Table 22 shows that even though the preponderance of direct reports for each race/ethnic group was white, each group tends to manage disproportionately more individuals of their own race/ethnicity.

Organization's Policies. Table 23 shows that the organizations these executives work for in 1997, have similar policies. In 1992, we discerned significant differences between the policies of blacks' and whites' employing organizations. Then, more white women than black women reported that their organizations offered educational support programs, job sharing and childcare services. But in 1997, these differences were more muted--fewer white women reported such policies were in effect.

In 1992, more black than white men reported their organizations held recruiting events targeted toward minorities; in 1997, both white and black men's organizations held such recruiting events to the same extent. Thus, what were apparently large organizational differences in the early 90s are becoming less noticeable in the late 90s.

Other initiatives were explored in the 1997 research that might show preferential treatment of minorities by their employing organizations. The information displayed in Table 23 shows that most of these policies were not more likely to be in place in the comparison groups' organizations. The most prevalent policy affirmed by about 20 to 30 percent was that the organizations tied diversity goals to business objectives. About the same proportions said that senior executives in their organizations were encouraged to mentor minorities.

More minorities reported that their organizations set targets for hiring minorities however. But other policies such as setting targets for promoting minorities, providing rotations for them or requiring minority candidates to be on the short list for senior-level executive positions were not widespread anywhere.

Today's healthcare organizations are challenged to embrace diversity and reach out to their communities. One recommended way is to encourage fluency in the language of the service area. Data in Table 23 show that organizations employing Hispanic executives are more likely to reward fluency in Spanish with additional pay, and, for men, by offering them more promotional opportunities.

Finally black and Asian men--but not women--reported their organizations were more likely to fill management positions with persons from outside the organization rather than through internal sources. The outstanding finding in terms of the context and policies of the employing organizations of racial/ethnic minorities and whites is that with few exceptions, the policies are similar.

Daily workstyle. Having studied the positioning and transitions of the executives within their employing firms and the policies designed to promote a more diverse corps of executives, we now consider the day to day work life characteristics of the executives in their jobs. One key measure is the hours worked per week. Table 24 shows that in contrast to 1992, when black women and whites worked similar number of hours per week at the office, today, white women state they work about 2.4 hours more than blacks and about 4.4 more hours than Asian women. On the other hand, black women say they work about 1.7 hours more than white women, at home. Men on average, worked nearly 49 hours per week at the office; Hispanic men work less at the office and more outside the office.

Apart from putting in hours, what specific activities might distinguish the race/ethnic groups? Tables 25 and 26 consider each group's involvement in recruiting for the organization and socializing with other executives. In 1992, we observed that whites were significantly more involved in recruiting for physicians than black healthcare executives. Today, the disparity continues with regard to physicians recruitment and now and has extended among the white women to recruiting nurses and administrators as well. Hispanic and black men report greater involvement than whites in recruiting nurses and non-professional staff. It is unclear from the data if lower involvement in recruiting is the result of lower positions held or if the organizations are less involved in recruiting per se.

Table 26 describes the extent to which healthcare executives socialize with both minority and white fellow managers within their organizations. In 1992, we noted that whites reported more non-work socializing with both black and white managers at lunch and by participating in sports. In 1997, white women again report more socializing at lunch than blacks. Hispanic and Asian women are also more likely to socialize at lunch with minorities and whites than are their black colleagues.

Greater participation in sports no longer distinguishes whites from blacks; it appears as if whites have reduced their participation in sports with their colleagues by over half in the five year interval. Today, Hispanic men are exceptional in the extent of their interracial/ethnic socializing with colleagues at dinners and at cultural events. It may be that such socializing is perceived as a good way to bridge cultural differences.

Fairness of organization. Apart from formal policies of recruitment and employment and their workstyles, how do the groups personally perceive their employing organizations? In 1992, whites believed their organizations were more fair than blacks in four out of eight areas surveyed. Have these perceptions altered in 5 years?

Table 27 shows that blacks continue to feel their organizations are less fair than whites in salaries paid, promotions offered, recognition given and professional membership dues underwritten. In addition, black and Hispanic men feel their organizations are not as fair relative to continuing education opportunities as whites and Asian men. Compared to 1992, more blacks and whites today agree on their organizations' fairness regarding tuition support and on physical facilities provided. In most of these evaluations, Hispanic and Asians fell between the poles established by blacks and whites.

Further indications of the dissatisfaction expressed by blacks with their employing organizations is demonstrated by data presented in Table 28. Seventy percent of blacks and only 8 percent of the whites agreed with the statement that "Minority managers usually have to be more qualified than others to get ahead in my organization." Again, Hispanics (40 percent) and Asians (29 percent) fell between the poles established by whites and blacks.

Moreover, to the general statement, "Race relations within my organization are good," similar divergent views again appeared. In fact, comparing the responses to this question with 1992, shows that today, fewer blacks and whites agreed that race relations in their organization are good; proportionately fewer women agreed with the statement than men.

Acts of discrimination. A final measure of the work environment concerned specific probes about what acts of discrimination respondents had experienced since 1992. Table 29 shows that between 40 and 50 percent of the blacks compared to 5 or fewer percent of the whites said they were not hired, were not promoted or were not fairly compensated because of their race/ethnicity. Hispanics and Asians also experienced these acts of discrimination but to a lesser extent than blacks. In addition about 45 percent of blacks but about 13 percent of the whites said they were evaluated with standards they believed to be inappropriate--white women expressed this more often than white men.

Another question focused on stalled careers because of having an accent or speaking in a dialect. This was affirmed by Asian and Hispanic respondents.

Finally, respondents were asked if they had received preferential treatment because of their race/ethnicity. In view of the contemporary shift on the advisability of affirmative action policies, it is interesting to note that 19 percent of black males and 11 percent of black females agreed that they had received preferential treatment in hiring; about half this proportion had received preferential treatment in promotions. Other minorities that benefited from preferential treatment included: 16 percent of Asian women in hiring and 12 percent of Hispanic men in hiring. Thus while considerable proportions of minorities experienced career setbacks because of their minority status, a small group benefited from their minority status as well.

Summary - Section 4. The work environment, in sum, continues to represent a fertile place for possible explanations for the lower career attainments of minorities in healthcare management. While minorities are recruited to the same level of jobs as whites, we observed that white women in particular were more likely than others to rise to senior executive positions. Still, minorities and whites are about equally optimistic (or pessimistic) about the likelihood of their being promoted in the coming year.

When we examined the context of their organizations, we saw that minorities and whites work in predominantly white organizations. Nevertheless, the immediate reports of these managers are disproportionately of their own race/ethnicity. We observed that in contrast to 1992, where more blacks' organizations held recruiting events targeting minorities; in 1997, these had declined to the level of whites' organizations. Other policies also showed greater similarity between blacks and whites today such as educational support programs, job sharing and childcare.

Individual efforts within the organization showed that white women worked longer hours than black women at work but black women reported more job-related work at home. White managers continue to be more involved in recruiting professional staff than blacks or other minorities. And black women continue to socialize less at lunch than whites and other minorities do.

Overall, blacks and whites are at opposite poles in regard to various features when considering their organizations' fairness such as salary, promotions and recognition. Blacks feel their organizations are not treating them as fairly as whites, that minorities need to be more qualified to obtain positions and that race relations need to be improved. About four out of ten blacks and less than 5 percent of whites believed they experienced racial/ethnic discriminatory acts in the past five years--acts like not being hired, promoted or fairly compensated. In these comparisons, Hispanics and Asians fell between the whites and blacks both in objective and most subjective measures as well.