Healthcare reform has sparked a conversation over the changing role of the hospital executive — the new skill sets leaders will need to develop, the challenge of dealing with change at a rapid pace. America's hospitals need bold, diligent leaders to communicate visions more than ever. It will be interesting to watch how women advance in a healthcare environment that is, at the moment, remarkably progressive.
The female hospital executive is still special in American society, largely since women are underrepresented in top executive roles given their numbers in the field of healthcare. They have made strides, as surveys spanning from the 1980s have suggested, but a 2007 study still found only 15 of the nation's Top 100 hospitals (as ranked by Solucient) were led by female CEOs.
Other findings illustrate key issues that remain serious challenges for female executive leadership development. Surveys of members of the American College of Healthcare Executives, spanning from 1990-2006, concluded that women are much more likely to have previous clinical experience than their male counterparts, and this experience is primarily as a registered nurse. This suggests that, compared to men, top leadership opportunities are more restricted for women without nursing or clinical degrees. It also means there are gender-related differences in credentials considered for executive positions.
Some researchers have also referred to healthcare's "sticky floor," a concept that might receive less attention than the widely-known concept of "glass ceilings." A sticky floor means that while women move up the ranks to attain leadership positions, their salaries will not equal men's for the same position even if experience and skill are on par. This phenomenon isn't confined to non-physician leaders. According to data published by the MGMA in 2010, male physician compensation outpaced female compensation in almost every reported specialty.
To help develop a fuller understanding beyond statistics and figures, three female leaders from hospitals around the country spoke on their experience moving up the ranks, how they balance the demands of a family and a hospital, and how they see women growing in the CEO role. Linda Efferen, MD, CMO at South Nassau Communities Hospital in Oceanside, N.Y.; Peggy Naleppa, MBA, PhD, CEO Peninsula Regional Medical Center in Salisbury, Md.; and Andrea Price, president and CEO of Mercy, based in Toledo, Ohio, have observed different trends or social shortcomings as women in healthcare, but they all agree on one thing when it comes to female CEOs: there can't be any fewer of them in the years to come.
Women in the workplace
The women who contributed to this piece discussed general observations they've developed over the years involving men and women — findings that might apply to professionals in non-healthcare settings, as well.
Dr. Efferen has observed a phenomenon she coined the "invisible person syndrome." "This is when you're sitting in a meeting, and the team around the table is mostly comprised of men. If you say something, there are occasions when that observation or suggestion is not reacted to. Then, when a man says essentially the same thing, it's immediately validated," says Dr. Efferen.
After expressing frustration, a male mentor suggested Dr. Efferen speak a few minutes after conversations evolved and people had the chance to contribute their initial thoughts — a tactic she has found helpful. She's also made conscious efforts to distance herself from behavior, like the invisible person syndrome, that could be interpreted as sexist. "There is still a subconscious barrier sometimes," Dr. Efferen says, referring to comments that carry sexist undertones, albeit unintentionally. "Not taking it personally has helped me move past it," she says.
Ms. Price noticed slight resistance to her leadership role early in her career. "As I began to get promoted to higher levels, I was challenged because I was younger than my direct reports and because I was an African American female," she says. When she assumed her role as vice president within a [a children's hospital], some men would ask the president why they had to report to Andrea Price. "Some men used to joke that they had [neck]ties as old as me!" she says, noting that she looked young for her age at the time.
Being compared to a necktie wasn't the only challenge, though. As a young professional, Ms. Price faced a pressing dilemma: whether or not to have kids. "Early in my career, I observed women not getting promoted because they were having children. I had to demonstrate that I was committed to my profession and my job. I didn't get married until I was 30, and I didn't have my first kid until I was 32. By that time, I was at the VP level — a level where I was in more control of my time," says Ms. Price.
In some cases, a woman's awareness of gender-related challenges ended up influencing their leadership style. Dr. Efferen says she does not recall being overtly challenged in regards to her gender, which she attributes partly to her proactive approach. "I've tried to avoid being vulnerable to that. I've been as transparent and fair as possible," she says.
The lack of female mentorship was a common observation among the women. Ms. Price says the shortage of female leaders resulted in men having a leg up early in her career. "I would see other men in the organization mentoring other men, but I didn't see anyone mentoring females," she says.
Dr. Efferen noted similar observations when it came to mentorship. "The people I considered significant and supportive mentors were predominantly men. It's not that other women didn't help me along the way, but there weren't and there still aren't as many women in leadership positions," she says.
Ms. Price also mentioned that when organizations contemplated succession planning, women were rarely considered. "Now that has changed. Mercy now gives me the opportunity to have an executive coach if I want one. Also, I see succession planning based on who is the best fit, the best person for the job — it's not so much about gender or race anymore," she says.
On a similar note, another observation mentioned during discussions was that of women receiving promotions based on hard work and effort, while men were more likely to receive advancements based upon their skill sets. "For example, if somebody were to advance to a leadership role, for a woman it might be because of her strong efforts or because she was a good RN, opposed to meeting broader skills around finance and budget," says Ms. Naleppa.
Striking a work-life balance
Ms. Price illustrated a day in the life of her juggling act: early mornings in the office, evening board meetings at night. "Then I'll come home and my kids will tell me they have a party at school tomorrow and need cupcakes for it. Or they need help with this science presentation," she says, noting that they wait for her to return home to ask for help with these tasks. "Despite my title and professional accomplishments, I'm still Mom. I'm still looked to as the primary caregiver in my family," says Ms. Price.
Women face some unique conditions that influence their careers — crucial decisions that men may not find as pressing, such as whether or not to have children. Many successful women have achieved work-life balance without a delineated plan, and women contributing to this story said they had not leant much thought to how they juggle it all — it just naturally happened.
Ms. Price says the work-life balance goes beyond her own life, which includes a physician husband and four children. It has become a professional responsibility, as she feels the need to create an atmosphere that fosters satisfaction for employees in regards to work-life balance. Fitness initiatives, workout facilities and a caregivers' fund for employees with sick or deceased family members help Mercy employees feel comfortable and secure, according to Ms. Price.
Some women prefer to establish firm boundaries — or as defined as possible — between work and family. "The way I find balance is through a separation and inclusion strategy," says Dr. Efferen. "By separation, I created fairly hard lines or boundaries. Barring an emergency situation, when I was home, I was home. When I was at work, I was at work. Yet, on the flip side, I also tended to push boundaries a bit."
Sometimes, Dr. Efferen couldn't silo her responsibilities as a mother and working professional. When evening dinners with a professional organization conflicted with family time and dinner with her kids, she began bringing her children with her after asking for permission. Subsequently, more parents began bringing their children, as well. "Over the years, I think there's been more of an understanding that we need to consider people's responsibilities outside of their job," she says.
A simple strategy worked best for Ms. Naleppa in achieving work-life balance: saying no. "I had to learn how to step back," she says. She was holding down a vice president position within a community hospital and raising two daughters when she began a master's program in the late 1980s. "I didn't feel I could balance full-time school, full-time senior position, mom and wife," says Ms. Naleppa. "So I stepped out of that position for the time. I had to learn for myself how to prioritize and say no."
Yet, while she has become better at prioritizing, Ms. Naleppa doesn't encourage women to over-organize. "When I think about balance, I don't think about putting things into boxes. I don't ask myself, 'Well, should I do this two hours a day, or this two hours a day?'" Throughout her career, she says her worlds as CEO, mother, wife and various other roles meshed in a way she now finds fulfilling.
The future for women hospital CEOs
One thing is certainly true: there won't be fewer women CEOs in the future. "When you look at health management programs grad schools, there are more women than men in those programs. With these changes in healthcare, I think women will play a more prominent role in leadership," says Ms. Price. "I think people want more innovative leaders, and women are going to be an important part of the mix in executive teams."
Dr. Efferen says there is still a way to go before we achieve 50/50 representation by men and women in senior leadership positions in hospitals, and a less-siloed approach to healthcare would help this greatly. "Up until now, medicine has been put into silos. Nurses go to nursing school, physicians to medical school, and then we're all thrown together and expected to play as a team," she says. An integrated approach to leadership development might not only help women advance, but the healthcare industry as a whole.
Women just coming out of medical school or healthcare management programs are likely to see more plentiful and richer career opportunities in healthcare as well, particularly in terms of leadership. It will also be interesting to see if the generation that expanded their careers without female mentorship reverses that trend and provides guidance for young women today. "My goddaughter, who is a physician, is very bright and her opportunities today will be much more broad than if she graduated 30 years ago," says Ms. Naleppa. "It's exciting. We have great national examples of female CEOs."
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