It’s been a point of pride in Nashville’s health care community just how many companies trace their roots back to HCA. It’s locally known as the “family tree.” And that tight-knit business community has generated more wealth in Nashville than any other industry. But it’s also failed to build critical diversity within its upper ranks.

You can count on one hand the number of prominent Black entrepreneurs in Nashville’s health care sector. And Chris Poole has been one of the few.

“Given where society was when health care got started in this town, there just isn’t really anyone who looks like me who is in that circle,” he says.

That circle was only white men when what would become the nation’s largest hospital chain, HCA, incorporated in 1968.

Poole got his start with a health care investment fund. He now leads a startup called ThriveAP that helps hospitals support new nurse practitioners and physician assistants.

Today, Poole says the barriers for Black business leaders in health care are more subtle than they would have been 50 years ago. He recounts being up for a senior role on two occasions. He was well qualified, with an MBA from the University of Chicago, regularly ranked as one of the nation’s top business school.

Then he was beat out by people with lesser credentials but who had kids in Scouts with company executives and were members of the same exclusive country club.

“These things happen, and they happen a lot,” he says. “Now was it overt racism? It’s so difficult to sort of nail down such an absolute conclusion.”

What Poole can say with confidence, having worked in the industry for a decade, is this: “Nashville loves to do business with people they know.”

And those known quantities are not usually women or people of color. It’s a fact that’s painfully obvious to Hayley Hovious, president of the Nashville Health Care Council.

“You can’t walk into a Health Care Council event without thinking that to yourself,” she says.

‘A lot more work that we need to do’

Hovious has hired more Black staffers and focused programs on supporting more diverse young leaders in the industry, but that hasn’t resulted in changes to the council’s powerful board of directors. The board has fewer people of color than in previous years. Two-thirds of the seats are reserved for the largest companies in town, and they’re usually filled by white men.

The heads of Nashville General Hospital and Meharry Medical College — both Black men — are not currently serving.

“In a lot of ways, our audience is going to reflect the companies that are our members,” Hovious says. “And it’s pretty clear that there’s a lot more work that we need to do.”

The concerns extend beyond corporate diversity. This is an industry that has a direct effect on people’s health and their longevity. And Black patients have fared worse by most measures.

Duane Reynolds, CEO of Just Health Collective, advises health care companies on diversity policies. He says the industry was founded in an era of institutionalized racism that is still evident.

“As a result, hospitals and health systems may retain policies, procedures and processes that inadvertently lead to health disparities,” Reynolds says.

COVID-19 provides a timely example. Journalists and researchers are finding that Black people have a harder time getting a coronavirus test.

Reynolds says this is primarily because health systems have historically located hospitals and clinics in affluent areas where more people have health insurance to pay their bills. So that’s where testing has also been more accessible.

“From a business standpoint, that makes logical sense,” he says. “But from an equity and disparity standpoint, this really leads to vulnerable populations not getting the testing that’s necessary to control spread.”

And in the case of COVID-19, Black and Latino communities have suffered far more than the majority population.

Donn Jones Courtesy Nashville Health Care Council

Bobby Frist is the founder and CEO of HealthStream. His grandfather and uncle started HCA. He now chairs the Nashville Health Care Council’s board of directors and is encouraging member companies to take meaningful action on racial inequity.

“More than anywhere, this industry needs to reflect America,” says Bobby Frist, the current chairman of the Nashville Health Care Council and a literal part of its family tree.

Making a statement

His grandfather and uncle started HCA. Those connections helped him launch Healthstream, a publicly-traded company that provides continuing education for staff in hospitals.

“In some ways, success comes from success,” Frist says. “And spinoffs, they can perpetuate the existing status if you’re not careful and intentional.”

At the height of nationwide protests this year, HealthStream put out a statement condemning the police killing of George Floyd in Minneapolis and referencing a “deep crack in our foundational right to equality.” The three sentences are still at the top of the company’s homepage.

“We’re kind of through the explicit bias. We know there are laws that create equality,” he says. “But we’re not through implicit bias. We’re not through the concept of white privilege.

“I know that everyone in Nashville and our chamber and even the leaders of these companies would be really proud if, when we look at things 10 years from now … emerging leaders that are from minority groups end up earning their way to leading these corporations, being the CEOs of them.”

The Health Care Council, itself, committed to a “substantive plan of action.” It’s already begun to focus its programming primarily on diversity, with a series of events on equity and inclusion. Those launched last week and are moderated by former Senate Majority Leader Bill Frist, another health care entrepreneur from the HCA lineage.

This month, HCA released a lengthy plan to accelerate diversity initiatives and promote people of color to leadership roles in its 180 hospitals. And other companies have followed their lead. Nashville-based Envision, which primarily staffs emergency rooms, disclosed that its senior executives are 75% male and 85% white.

“In order to chart our course to becoming a more diverse and inclusive organization, we must first acknowledge our starting point,” the company said.

But it shouldn’t have taken nationwide protests to see what needs changing, says entrepreneur Marcus Whitney.

He’s a highly visible investor who is Black. He published an essay in June about his own struggles to break into the health care sector and ultimately needing a white partner, Vic Gatto, to be successful.

He says health care leaders have to accept that white supremacy played a part in creating so much wealth, primarily for white people.

“Whatever the efforts are, whatever is going on, whatever our standards of success are as it pertains to diversity, equity and inclusion, it’s not hitting the mark,” he says.

Whitney says health care is so important to Nashville’s economy, the city can’t achieve more racial equity until its leading industry does.

The Nashville Health Care Council is a financial supporter of health care coverage on WPLN News.