There's no quick fix to achieve and sustain gender parity on senior leadership teams in healthcare, but there are specific steps diversity-minded leaders can take to promote women's representation.
This article appears in the September/October 2019 edition of HealthLeaders magazine.
There is no shortage of women working in healthcare, but women remain underrepresented among the industry's senior leaders.
Despite significant improvement in recent years, this persistent gender imbalance serves as evidence that much more work needs to be done, says Annette Walker, MHA, president of City of Hope Orange County.
"I think in our industry there's been a tremendous amount of progress made in executives' awareness of women and the potential of women, and you can see that there's considerably more women in the C-suite than there were even five years ago," Walker says.
"There, unfortunately, has not been the same progress in the CEO seat," she adds.
Women fill about 63% of entry-level healthcare jobs, but their representation shrinks at levels of increasing responsibility, as is the case in other industries, according to a report released last week by McKinsey & Company as part of its ongoing Women in the Workplace research.
Women fill half of all the senior manager or director-level healthcare jobs and just 30% of healthcare C-suite posts, according to the report, which studied payers, providers, pharmaceutical companies, and biotechnology firms.
"We were happy and validated to see how high some of the numbers are at entry levels, but I would not go so far as saying we've 'arrived' in achieving gender-equality at all levels across healthcare since there is still a significant drop-off at more-senior ranks," says Gretchen Berlin, RN, a partner with McKinsey & Company in Washington, D.C., one of the report's authors.
The drop-off is especially steep for women of color. While white women hold 41% of entry-level healthcare jobs and 26% of C-suite positions, women of color hold 22% of entry-level jobs and just 4% of posts in healthcare C-suites, according to the McKinsey & Company report.
Walker, who is white, says breaking through from the C-suite to the CEO position was the thickest glass ceiling she has encountered in her career thus far. Walker started out in a clinical lab before serving in leadership positions for several organizations, including as president of strategy for Providence St. Joseph Health before taking her current job with City of Hope last year.
Only 13% of CEOs for payer and provider organizations are women, according to a report by Oliver Wyman consultants who studied the profiles of more than 3,000 executives in C-suites and boards for 134 organizations. And it took women three to five years longer on average than it took men to ascend to the CEO role, according to the report.
Walker says decision-makers still have a lot of unconscious bias against women taking the top executive spot of any organization, and that has a lot to do with a lack of diversity on the boards that oversee those organizations.
"It's still a big challenge, not just for women but for diversity candidates in general," she says.
The racial diversity of boards that oversee U.S. hospitals and health systems has increased in recent years. The percentage of boards with at least one non-white member rose to 58% in 2018, up from 53% in 2014, according to the American Hospital Association Trustee Services national healthcare governance survey report released last month. (That means 42% of boards were still composed entirely of white members last year.)
The gender diversity of board membership overall has been increasing as well, albeit slowly. Almost all boards, 97%, included at least one woman in 2018, up from 95% in 2014, according to an AHA spokesperson who answered questions about the report's underlying data. Women held 30% of all board membership in 2018, up from 28% in 2014, according to the survey report. (Although the survey asked about both race and ethnicity separately, data on the intersections of the two are unavailable, the AHA spokesperson says—so it's unclear how many board members are women of color.)
For diversity-minded leaders who wish to draw more women into C-suite leadership, the Oliver Wyman report outlines three "critical actions" to bring about systematic progress, as discussed in greater detail below: boldly step up your system-level commitment, purposefully level out the playing field through sponsorship and mentoring efforts, and address misperceptions explicitly to build new habits.
1. Hold Yourself and Your Team Accountable
Speaking about diversity in broad terms is easy. Setting specific and measurable goals, however, then following through on them, is more challenging but necessary for any leadership team that wishes to pursue diversity in a serious way, the Oliver Wyman report states.
Does that mean implementing gender-based hiring quotas? Not necessarily. Among organizations with relatively strong representation of women in senior leadership roles, some organizations had established diversity-oriented hiring targets and others rejected such quotas on philosophical grounds.
"I think quotas, frankly, often backfire and are seen as negative," Berlin says. Instead, the McKinsey & Company partner says healthcare industry leaders should assess where their organizations stand, where they want to be, and track their progress, while investing in the structures women with high potential need to progress their careers.
"I think the overall aspiration of reaching gender parity is one most individuals generally align with," Berlin says. "Where the nuance comes in for specific organizations is partially based on your starting point and how quickly you're hoping to move and how boldly you're willing to tackle the issue."
The idea is to set measurable goals that are visible on a senior level and embedded into daily strategy discussions, then track your progress, as you would for any strategic priority, the Oliver Wyman report states.
"In our experience, setting goals for a year or two and reviewing annually isn't enough," the report states. "The goal is to gently remind each other this matters and to use that nudge to change how leaders spend their marginal time and effort."
2. Build a Pipeline Through Conscious Mentorship
The gender imbalance in healthcare leadership (and other industries) cannot be fixed with the flip of a switch. You have to make longer-term investments in sponsoring and mentoring emerging leaders who are still several layers removed from the C-suite, Walker says.
"People don't all-of-a-sudden become eligible for the CEO suite," she says. "They have to be developed through mid-career."
Letting sponsorship and mentorship relationships develop organically isn't enough. That's because humans naturally tend to build affinity with people who share similar backgrounds or common interests, which means male-dominated C-suites tend to form a greater number of informal connections to men than to women, according to the Oliver Wyman report.
"Leaders must find broader ways to create affinity across gender or race if they want to help diverse teams thrive," the report states. "They can't expect the 'in' group to simply ignore the influence of affinity bias. Instead, they need to be made self-aware of how such bias may color their assessment of candidates."
Men and women often have differing perspectives on what effective leadership looks like, which is why it is especially important to clarify as a team what it means for someone in the middle of their career to exhibit "leadership skills," the report states.
Keep in mind, too, that women in the middle of their careers are often also in their prime childbearing years, so you should look for ways to keep them engaged in sponsorship and mentorship opportunities that leave room for motherhood, too, Walker says.
"People don't all-of-a-sudden become eligible for the CEO suite."
Although every organization should mentor within its own ranks, Walker says it's important also to participate in collaborative programs with others, such as Women of Impact and the Carol Emmott Fellowship, a 14-month program that offers mentorship to women rising in healthcare leadership.
"Learn what other people are learning," Walker says. "That will speed up the process across our nation and across our industry."
Yale New Haven Health CEO Marna Borgstrom, MPH, agrees that collaborative problem-solving across the industry is needed, which is why she has invested in Women of Impact, the Carol Emmott Fellowship, and other initiatives as well.
"I think we're making progress but probably not rapidly enough," she says.
3. Sustain New Habits to Combat Misperceptions
Borgstrom entered the healthcare field four decades ago, when there were very few women in leadership positions. But she found men in the C-suite who saw her leadership potential and believed in the merits of consciously promoting diversity, she says.
Creating space in which women can support one another has been invaluable, but thoroughly addressing the problems in which women's underrepresentation are rooted requires more than women talking exclusively among themselves about the path forward, Borgstrom says.
"We're going to get everybody much further if we have a shared understanding of the dynamics of the environment we're creating," she says.
That's why Yale New Haven expanded its "Lean In" group—which Borgstrom says has helped hundreds of women articulate and navigate the challenges of leading in the healthcare field—to include men.
Rather than immediately naming-and-shaming men for their own unrecognized biases and assumptions, the goal should be to raise awareness across the board about how these differences in perspective inform the organization's shared self-perception and the road ahead, the Oliver Wyman report states, outlining a wide range of tactics you could employ to combat these misperceptions and misunderstandings to replace them with better habits:
- You could implement unconscious bias training or reverse-mentoring to foster conversations about where current problems exist;
- You could call in a third-party facilitator to host a discussion in which men and women are encouraged to ask questions without anyone needing to feel defensive; or
- You could pair men and women together as peer executive advisors for one another.
Walker says she hopes board members and senior leaders will embrace a broader set of leadership skills, upon reflecting on their own differing views of the skills and traits that make a solid future CEO. There has been an overemphasis, she says, on experience in finance, while women with team-building and team-sustaining expertise are overlooked.
"Yes, you need financial acumen and you need financial skills. But are they the most important to get the leader that inspires, the leader that engages, the leader that can lead people through tough times, not just make tough decisions?" Walker says. "I think being a little broader on what the senior leader needs would open doors more broadly to women."
“We're going to get everybody much further if we have a shared understanding of the dynamics of the environment we're creating.”
Steven Porter is an associate content manager and Strategy editor for HealthLeaders, a Simplify Compliance brand.
Women hold just 13% of CEO posts at payer and provider organizations, according to an Oliver Wyman report.
Women of color hold just 4% of C-suite jobs across payer, provider, pharma, and biotech firms, according to a McKinsey & Company report.
The path forward requires conscious self-reflection about your organization's identity, needs, and baked-in assumptions about the traits senior leaders exhibit.