Survey Says

Lean In: Do Sandberg’s observations hold up in health care?


Isabel Yoon, Survey Solutions

Sheryl Sandberg’s Lean In has revived a national discourse on women’s representation in leadership roles. But does her argument—that women “lean back” from their careers in higher numbers than men—apply to health care, a workforce mostly comprised of women?1

If you’d like a quick synopsis of Sandberg’s main points, watch her TED talk.


Opting out, but not leaning back

Sure enough, the data does point to a graceful bowing out of women along the upward path to senior leadership. While women outnumber men 4 to 1 at the frontline, this ratio declines among mid-level managers, and drops off even further at the senior leadership level.

This may be explained in part by the gender gap in agreement with the driver “I am interested in promotion opportunities in my unit/department” at all levels with the greatest disparity found among mid-level managers at 8.1%.2

However, if more women are opting out of leadership roles than their male colleagues, it does not seem to be coupled with the “leaning back” that Sandberg observes. In fact, Sandberg would be interested to learn that in health care, engagement among women appears to be virtually equal if not higher than engagement among their male colleagues at all levels of the organization.

As we discuss on Survey Says, engaged employees are those who feel inspired to perform their best work, often putting in discretionary effort to help the organization succeed—qualities that are well in line with what Sandberg refers to as “leaning in” to one’s career.



Although fewer women make it to the top, professional development drivers consistently rank among the top 10 drivers of women’s engagement at all levels of the organizational hierarchy.3


Tapping into middle manager engagement

This data supports a cautious rebuttal of Sandberg’s thesis in the health care industry. While fewer women are ascending to senior leadership positions than men, this is not rooted in a less engaged female workforce, nor one that is less committed to professional development throughout their careers.

The challenge, then, is to capitalize on the relatively high levels of engagement seen among women at the middle management level by providing compelling leadership opportunities that will entice them to reach for the top.

Have thoughts you’d like to share on this topic? Please leave a comment or email me at yooni@advisory.com with your thoughts.



  1. The Bureau of Labor Statistics reports that 74.3% of health care practitioner and technical occupations and 88.9% of health care support occupations are filled by women.The Bureau of Labor Statistics reports that 74.3% of health care practitioner and technical occupations and 88.9% of health care support occupations are filled by women. http://www.bls.gov/opub/ee/empearn201101.pdf
  2. Percentage of respondents who answered “Agree” or “Strongly Agree” to the driver.
  3. The drivers “I am interested in promotion opportunities in my unit/department,” “My most recent performance review helped me to improve,” “Training and development opportunities offered by my organization have helped me to improve,” and “My current job is a good match for my skills” are among the top 10 drivers of engagement for female frontline staff and mid-level managers.
    The drivers “I have the right amount of independence in my work,” “My current job is a good match for my skills,” “Training and development opportunities offered by my organization have helped me to improve,” and “My manager helps me learn new skills” is among the top 10 drivers of engagement for female senior leaders.
    Source: Advisory Board Survey Solutions, 2013 Employee Engagement Initiative Database.