At the Helm

How the health care leadership gender imbalance hurts your organization—and 4 ways to make a change

by Veena Lanka, MD

Editor's note: This story was updated on January 11, 2019.

Fixing the gender imbalance in health care leadership is a long overdue challenge. Considering that women comprise 80% of the health care workforce, the number that actually make it into the leadership ranks (3% to 9%, depending on the role) is woefully inadequate. This gap is simply too large to be attributed to a difference in qualifications alone.

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We and others have repeatedly raised this question in the last decade. Yet the industry has made few motions, if any, towards improving the workplace experience of female health care workers, expanding their career prospects, or recognizing their contributions. Instead, we've let the present-day gender gap—a result of decades of unconscious bias and outdated societal stereotypes—persist.

This situation is particularly surprising in light of the fact that health care industry tends to be ahead of most others (such as financial and legal sector) in recognizing and addressing gender disparities among the patient communities they serve. While this is commendable, it appears tone-deaf when the gender gap within their own ranks goes unnoticed. The solutions offered so far have focused on coaching women to navigate the glass ceiling by leaning in and speaking up. Not only has this failed to make a significant dent in the problem, it inadvertently masks the real drivers that continue to perpetuate the gap. It is time for those in positions of influence and authority to shift the burden of fixing this off the shoulders of the very group marginalized by it. Overcoming the long-standing norms that promote the gender imbalance will require a conscious organization-wide effort. 

How the gender imbalance undercuts the organization

We believe this is an issue that deserves to be on every hospital leadership team's agenda since it limits the organization's ability to engage their workforce and achieve just about every system-wide initiative. At minimum, the gender imbalance among leadership impacts:

  • Retention and recruitment. High-performers are less likely to stay where they perceive a gender-based glass ceiling. This is especially true with high-turnover roles such as nursing, human resources, care navigators, wellness coaches, etc. where over 90% of staff are women.

  • Physician engagement. Female physicians report even lower engagement and higher rates of burnout than their male peers. Failing to address their wellbeing is not a viable option as women now also make up majority of the younger physician workforce and the majority of future physicians enrolled in medical school.

  • Clinical outcomes. Patients treated by female physicians report higher satisfaction and fare better than those treated by men. Indeed, if men had the same clinical outcomes as women, it could prevent ~32,000 deaths every year. This makes a strong case for keeping more women in the clinical workforce and in leadership roles within that workforce. 
  • Corporate leadership. Companies with more women in leadership and board positions report 74% more equity and assets, making a strong case for promoting more women into traditionally male-dominated leadership roles.

4 ways to address the gender imbalance

Health care leaders can begin addressing this issue immediately without having to launch yet another standalone campaign (to a highly change-fatigued workforce). We propose four steps you can take to integrate the tactics highlighted by the authors into existing system priorities and initiatives:

  1. Size the problem at your organization using existing data
    • Utilize your human resource data to measure baseline gender ratios for the whole organization, as well as key departments and contrast with ratios of leadership bodies (the board, medical executive committee, clinical consensus groups, etc.)
    • Segment your annual employee engagement survey results to identify gender-based differences in engagement. If possible, segment this further by clinical/non-clinical roles, tenure, age, facility, and department to identify specific areas with largest gender gap.
    • Utilize payroll data to assess gender pay gap and rank-order roles with the largest gaps.
  2. Educate leaders in positions of authority and influence
    • Share the department-specific gender gap data you found with managers, department chiefs, and leaders and encourage them to set one to two measurable goals to address these gaps.
    • Increase transparency of performance criteria and career progression opportunities.
    • Incorporate training to address unconscious bias, workplace equality, and health disparities into leadership training events, board retreats, new hire training, and annual staff trainings.
  3. Re-evaluate how awardees and nominees are currently chosen
    • Review the last five years of existing institutional awards and peer recognition awards to identify if female employees or departments with largely female employees are under-represented.
    • Assess if award criteria, unconscious bias of selection committee, or the nomination process might be inadvertently excluding female candidates. For instance, replacing management-led nominations with peer-led nominations.
  4. Build an intentionally inclusive leadership pipeline
    • Compile a pipeline of high-performing female employees to be considered for succession planning of leadership roles. Beware of unconscious bias that leads to preferentially screening for your demographic carbon copies.
    • Utilize turnover on Board, C-suite, and physician executive councils as opportunities to rebalance ratios.
    • Pair early-career high performers with mentors of either gender to provide growth opportunities, rather than disproportionately burdening women only to serve as mentors.

Ultimately, the health care industry is strongly positioned than many other industries in this regard, due to their large female workforce and diverse set of leadership positions available. We hope they take this opportunity to lead the way.

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