Over the past several years, hundreds of health systems created a new kind of executive role: Chief Health Equity Officer, Chief Diversity Officer, or some hybrid of the two. The titles carried real weight. The mandates were ambitious — close racial health gaps, rebuild trust with marginalized communities, transform how the organization operates. Many of these roles also failed within two or three years.
The instinct is to ask what went wrong with the leader. My research suggests that’s the wrong question. In my interviews with executives hired into these roles across the country, a different pattern emerged: the common factor wasn’t individual performance. It was whether the organization had built the conditions for the strategy to succeed in the first place.
The Title Arrives Faster Than the Infrastructure
Nearly every leader I interviewed described starting their role the same way: no budget, no staff, no precedent, and no internal benchmark for what success should look like. One put it simply: “I started from zero.” These weren’t underqualified hires — many held doctorates, decades of operational experience, and exactly the credentials you’d expect for a C-suite appointment. The shortfall wasn’t in who was hired. It was in what the organization built around them.
This gap has a predictable origin. The decision to create these roles often moved at the speed of public pressure. In many cases, in direct response to 2020’s social unrest. The infrastructure to support them, budget allocation, reporting lines, staff, authority, moved at the speed of internal bureaucracy, which is to say, far more slowly, if it moved at all. The result is a title without the operating mechanics of the role it’s named for. A “Chief” position with no budget isn’t a peer to the CFO or CHRO. It’s a symbol with a salary attached.
Censorship Compounds the Resource Gap
A second pattern made the first one worse: many of these leaders described being implicitly or explicitly discouraged from naming the problem they were hired to solve. Several recounted avoiding the word “racism” in strategy documents intended for external audiences, not because the data didn’t support it, but because leadership wasn’t ready to see it in writing. One executive described the calculation required to raise structural racism with her board: rehearsing tone, moderating delivery, managing how she’d be perceived before she could even get to the substance.
This is a second, quieter form of under-resourcing. It’s not just that these leaders lack budget, many also lack the organizational permission to describe the problem accurately. Strategy built on a euphemism is strategy that can’t be fully executed.
Why This Should Concern Leadership
The cost of this pattern isn’t confined to the individual in the role. Average tenure in these positions runs under two to three years, and every cycle of turnover carries a compounding cost: recruitment and onboarding spend, lost institutional momentum, and, perhaps most damaging, a credibility cost with employees, patients, and communities who watched a public commitment quietly stall. A pattern of short-tenured equity leadership becomes its own signal, whether or not it’s intended as one.
This reframes the conversation that typically follows a departure. The default explanation is usually “the wrong fit.” The data points elsewhere: a structural failure to build the operating conditions — budget, authority, reporting access, and a leadership team willing to hear the truth — that any other strategic executive role would have by default.
What This Means for Leaders Building These Roles
The political climate around this work has shifted considerably since most of these roles were created in 2020 and 2021. That shift makes the underlying question more urgent, not less: organizations that built these positions on public pressure rather than operating infrastructure are now finding that pressure was the only thing holding the role up. Before creating a senior DEI or health equity role, or evaluating why a previous one quietly disappeared, five questions are worth asking with real honesty:
- Does the role have a real budget and staff — comparable to other C-suite functions — or is it a senior title operating with junior-level resources?
- Does the role have a direct line to the CEO and board, with a seat in the rooms where resourcing decisions actually get made, or is it routed through a layer that limits its visibility and authority?
- Is the business case for this work documented in terms the organization already uses to justify any other strategic investment — retention, patient outcomes, market share, risk exposure — or does it rely entirely on cultural and political goodwill that can evaporate with the news cycle?
- Has the organization stress-tested this role against a hostile environment — reduced public appetite, legal and regulatory scrutiny, leadership turnover — or was it designed for the conditions of one particular moment?
- Is leadership genuinely prepared to hear an honest diagnosis, including naming structural dynamics directly where the data supports it, or only a version of the problem that’s been pre-softened for comfort?
If the honest answer to more than one of these is no, the organization hasn’t built the conditions for the strategy it says it wants. It’s built a title that was only ever as durable as the pressure that created it. The leaders best positioned to weather what’s happening now are the ones whose roles were embedded in operating infrastructure and business logic from day one, not the ones who were counting on the moment to last.
