Mind the gap. Working together to get to the top

As discussed in depth in the last issue of the HBAdvantage, the tremendous impact of the SHEconomy—the global phenomenon of women controlling trillions of dollars and influencing more economic decisions—on healthcare is clear.

It is clear that women’s voices must be heard—and their real-world experiences taken into account—to communicate effectively with those making the decisions at the patient and provider levels and to rise to the challenge of providing truly patient-centered care. Women make 80% to 85% of healthcare decisions for their families, comprise 75% of informal caregivers for the elderly, incur 57% of doctor-related expenses, and constitute more than 75% of the healthcare workforce.

It is also clear that women bring to the table the leadership skills most-needed to enable our organizations to compete in the dramatically changing healthcare landscape. A 2011 Center for Creative Leadership white paper analyzing leadership effectiveness data from nearly 35,000 people working across healthcare sectors named “the ability to lead employees and work in teams” as the No. 1 priority for leadership development in healthcare. As shown in McKinsey & Company’s Women Matter 2013 report, women leaders’ greater frequency of role modeling, people development and participative decision-making results in improved organizational performance in the areas of leadership team, work environment and values.

What is not clear, then, is why—two decades after Congress’s Glass Ceiling Commission revealed that women held only 3% to 5% of senior management positions in Fortune 500 companies—women remain vastly underrepresented in the top echelons of business and healthcare leadership. According to a report from health startup incubator RockHealth, in 2013 women accounted for only 19% of hospital CEOs, 14% of healthcare companies’ board of directors and 0% of CEOs of Fortune 500 healthcare companies. A look at the 2014 list of Fortune 500 healthcare companies tells the same story.

As with any complex issue, the reasons why the leadership gap has been so slow in closing are numerous and intertwined. However, one thing is certain: it is not a lack of ambition on the part of women. McKinsey’s 2013 survey found that women’s ambitions equal men’s when it comes to the C-suite. A full 79% of middle- and senior-management women surveyed said they would like to achieve a top management position during their career, compared with 81% of men. Notably, however, when those same women were asked if they were confident they would succeed in that goal, the gap widened significantly: just 58% of mid-level women managers and 69% of senior-level women managers expressed confidence in getting to the top (vs. 76% and 86% of their male counterparts).

The importance of corporate culture

Examining this issue further, the McKinsey group found that corporate culture is the most important factor in women’s confidence that they can succeed—and it’s twice as important as individual internal factors, such as self-promotion and ambition. The three key barriers identified were the lack of awareness amongst men of their female colleagues’ struggles to reach the top despite equal qualifications, the “anytime, anywhere” availability expected of senior leadership (which both women and men say affects women far more than men in terms of juggling a career and a family), and the perception that women’s leadership and communication styles are incompatible with the prevailing leadership style among top management. It seems, for example, that though the more frequently female leadership behavior of participative decision-making is needed now more than ever in healthcare, it’s viewed as an inability to make decisions when it comes time for promotions.

This is further bolstered by RockHealth’s The State of Women in Healthcare 2013 survey, which showed that a full 39% of women cited company culture as the reason they left their previous job.

Compounding this may be the way women are promoted and the departments from which companies draw their top leaders. A 2013-2014 research study on Healthcare Leadership and Gender by Diversified Search and the Women’s Leadership Center, which surveyed leaders of healthcare organizations across the US, found that women were much more likely to be promoted from within their organization, while men were more likely to be brought in from outside—and were more willing to relocate to take these new positions. This, the study found, may lead to lower salaries for even those women who do make it to the top due to the perceived bias of internal candidates.

The study also revealed that 66% of the men surveyed came from a background in medicine, finance or general administration, while 44% of the women came from a background in nursing. This supports the previous finding of the American College of Healthcare Executives that those women who do reach the top levels of their departments continue to be concentrated in specialized areas that do not typically funnel to executive leadership positions (i.e., nursing, planning, marketing and quality assurance). Indeed, 57% of men in management held positions in general management, compared with only 44% of women and women achieved CEO positions at about 63% of the rate of their male counterparts.

The lack of structured support for women

RockHealth’s State of Women in Healthcare 2013 report found that nearly half of the women surveyed reported a lack of leadership programs or awareness of those programs. And those who were aware of their companies’ programs said those programs were not generally formalized and were more about “checking the box” than providing real, measurable support.

According to McKinsey’s Women Matter 2013, the reason many companies’ women’s leadership initiatives do not succeed is because they are often not well implemented.

Women also lack champions in the healthcare workplace. RockHealth’s 2013 report revealed that 63% of women surveyed lacked a mentor (an informal guide and source of support) and 73% lacked a sponsor (a more senior colleague who functions as an advocate in the workplace).

Women are often touted as the “chief medical officers” of their families—the ones doing the researching, buying, coordinating and decision making for those at home (often across multiple generations as they care for young children and aging parents). When combined with the “anytime, anywhere” model of business in the US, this other full-time job can make it difficult to succeed. Women Matter 2013 revealed that although more than 60% of the women surveyed were willing to sacrifice part of their personal lives if needed to reach the top, nearly 20% fewer respondents agreed that having children was compatible for women vs. men. A full 90% said flex-time arrangements were not compatible with leadership. positions

Taking diversity beyond the idea of diversity

The HBA has been deeply engaged in the examination of this issue and the necessary actions to close the leadership gap—the actions of raising awareness of the need to work together to advance women worldwide and of holding companies’ accountable for their leadership practices while helping them to successfully implement the programs and policies needed to succeed.

In 2007, the HBA’s Empowerment, Diversity, Growth and Excellence (E.D.G.E.) in Leadership Study examined 19 leading healthcare companies in the US and Europe to not only bench- mark the current state of women’s advancement but to understand the attitudes and motivations of companies in order to develop actionable recommendations for both individuals and companies.

This study shows that a successful agenda for advancing women executives depends on at least six best practices:

1. Increase visibility of senior leadership support for change

• Increase awareness of diversity and gender issues across the organization
• Develop a strategy and plan for women’s advancement that includes a corporate vision and milestones across functions, levels and regions
• Lead by example via championing initiatives, creating diverse teams and actively demonstrating the value of diversity

2. Ensure that all selection criteria and key people processes are based on performance and merit

• Define and communicate performance expectations
• Strengthen performance evaluation processes
• Maintain pay equity mechanisms to prevent gender-influenced compensation structures
• Ensure transparency of criteria and processes

3. Introduce measurements and accountability to drive behavior and results

• Set clear objectives for advancing women
• Develop meaningful metrics to track progress
• Set up mechanisms to hold managers accountable

4. Establish recruitment practices to support representation of women

• Ensure a fair recruitment process
• Institute minimum targets for recruiting women
• Leverage female executives in recruiting efforts; representations is important to recruits
• Import talent from other industries as needed
• Break down gender stereotypes regarding functions and skill sets

5. Establish advancement programs for high-potential female employees

• Identify women with high leadership potential and follow their progression
• Focus on individual development and offer key programs to support advancement
• Provide the tools and infrastructure to encourage advancement
• Do not brand these programs specifically “for women only,” though some skill building may be gender specific

6. Establish career and work flexibility models to retain top female talent

• Develop flexible career paths
• Provide flexible work options and arrangements with the necessary structure and processes to allow them to succeed
• Communicate success stories internally and externally

These recommendations were further supported by the advice of leaders of successful women’s leadership initiatives (WLIs) at HBA Corporate Partner companies. Recently, the HBA has undertaken a study of the seven organizations that have won the organization’s ACE (Advancement, Commitment, Engagement) award to date in order to share best practices of the companies that are leading the way in supporting—and leveraging—their WLIs. In a recently published white paper, the HBA captured a wealth of insights, examples and recommendations from representative leaders of these organizations. A summary of WLI best practices is below:

•  Show measurable results—and use them as motivation for leaders to do more
•  Make an impact on the organization’s overall business performance
•  Garner support at every level of the organization, including senior leadership
•  Get men involved
•  Integrate the program—and its funding—as a critical leadership initiative
•  Establish a strong, sustainable structure of a steering committee supported by committees and local chapters
•  Communicate regularly among program committees and chapters and with the larger organization
•  Continually take the pulse of the organization and ensure the program is aligned

As we move into 2015—the 20th anniversary of that first Glass Ceiling Commission report—the HBA continues to lead the way in closing the leadership gap and advancing women in healthcare worldwide. Stay tuned for more about our strategic plans for the future.


Written by Danielle Thierry, managing editor of the HBAdvantage