In early November, 20 executives, vice presidents, directors and other senior-level healthcare professionals gathered in Chicago to share their personal experiences and insights about gender diversity in healthcare management in a roundtable sponsored by global, research-driven pharmaceutical company Boehringer Ingelheim.
Participants in the conversation included hospital and health system presidents, chief executive officers, chief financial officers, chief operating officers, chief intelligence officers, chief nursing officers, chief experience officers and chief development officers, as well as women in the senior vice president and director levels of their provider organizations. They worked at healthcare delivery systems throughout the United States, from a major 800-bed academic medical center on the West Coast, to a major hospital operator nationwide, to a 190-bed community hospital in the Northeast.
The following article recaps the participants' robust 2-hour discussion about differences between female- and male-led leadership teams, challenges they've encountered throughout their rise to high-level roles, advice for colleagues to support gender diversity in healthcare management, and thoughts on how healthcare is changing to better empower patients as partners in care.
Gender composition in the C-suite
Of all 20 roundtable participants, roughly one third characterized their workplaces as female-dominated. The distribution of female and male professionals in described hospitals and health systems varied depending on the level of management, with lower levels generally seeing the most balance. One executive noted the Mount Everest effect, meaning opportunities for leadership narrow the higher one professionally excels in an organization.
A specific question the discussion group addressed was how a female-led leadership team differs from a male-dominated one, if at all. Females tend to cultivate a more collaborative culture — this was the most commonly discussed difference between a female- and male-led team.
The vice president at a nonprofit, 6,300-physician health system in the Midwest said her system as a whole is male-dominated, but the executive team at the system level is 70 percent women. She noted recent cultural changes, which she attributed to the number of women in the C-suite.
"I feel as though there's more collaboration on a female-dominated team than there was when it was male-dominated," she said. "That's probably the most distinctive difference."
Studies suggest it's a good time to possess a collaborative leadership style. The amount of time managers and employees spend on collaborative activities has increased by 50 percent or more over the last 20 years, according to Harvard Business Review, meaning this skill is in great demand. Inclusive and relationship-oriented management styles are especially valuable in organizations with matrixed leadership roles that seek to mitigate silos — a description that fits many hospitals and health systems today.
Furthermore, as this article later mentions, more healthcare providers are emphasizing team-based care that includes patients as shared decision makers and partners. This progression in communication and relationship-building is best suited for inclusive thinkers and leaders versus those accustomed to traditional top-down management.
"People are being invited to the table," said the vice president of research for an 820-bed teaching hospital in the Northeast. "Healthcare isn't a transaction anymore, it's a commitment to a relationship."
Amid steady praise about collaboration and cooperation, some women acknowledged these leadership values come with a risk. When collaboration is not kept in check, it can devolve to an excessive and irrational commitment to consensus. This slows decision-making and will frustrate even the most inclusive of leaders.
"There is consensus and consensus and then at some point you just have to make a decision," said the president of an 800-bed academic medical center on the West Coast. Senior leadership in her organization is split nearly evenly: 60 percent female, 40 percent male. "We're the most consensus-driven organization, and we're paralyzed at times."
Of the one third of participants who characterized their workplaces as female-dominated, many noted recent improvements in gender diversity at their organizations and credited the shift to a single female colleague, past or present, who committed to further diversify the leadership team. For instance, the president and CEO of two hospitals within a seven-hospital system said her colleagues in CEO positions are balanced in gender. "Having a female system CEO was very instrumental in increasing balance with women and men," she noted.
The confidence gap
Several setbacks or challenges women faced in their professional journeys were made clear during the roundtable discussion, beginning with the confidence gap. Some in academic and business attribute the lack of female representation at the top of organizations to inherent differences in how firmly women and men trust themselves and their abilities. The female executives in the room personally vouched for the validity of this theory, which is also backed by numerous studies and research.
"Men go after a position if they have 60 percent of qualities, whereas women will say, 'No, I don't have 100 percent of the skills so I'm not going to apply, '" said Nancy Di Dia, executive director & U.S. Head of the Office of Diversity, Inclusion & Engagement for Boehringer Ingelheim. "Men are much better risk takers than we are."
The scenario Ms. Di Dia describes stems from a real-life finding at Hewlett-Packard several years ago. The company reviewed personnel records in an effort to get more women into senior management. The internal audit found women applied for a promotion only when they believed they met 100 percent of the qualifications listed for the job, whereas men applied when they believed they could meet 60 percent of the job requirements.
The CEO of a 150-bed hospital in the Southeast agreed with the statement that men are promoted based on potential whereaswomen are promoted based on demonstrated value. "It's real, it's true. I think that comes from almost an unconscious bias," she said. "It's how men were brought up in leadership."
The phenomenon the CEO described among her male colleagues is a real psychological concept called honest overconfidence. Ernesto Reuben, PhD, an associate professor at Columbia Business School, published a 2011 study that found men consistently rated their performance on a set of math problems about 30 percent better than it really was, whereas women inflated their performance by half that. Overall, a series of related studies suggested men are naturally and subconsciously inclined to overstate their past accomplishments compared to women.
Few people strive to toot their own horn, yet this act is especially unseemly and uncharacteristic of women. The same collaborative work style many women exhibit with a sense of pride can cause difficulty when it comes to accepting praise, taking credit or highlighting their accomplishments at an individual level.
"Women tend to be about teams and advocating for their team versus advocating for themselves," said the vice president of research for an 820-bed teaching hospital on the East Coast. Studies have indeed found women who work on mixed-gender teams tend to fall into the "we" trap, meaning they are more likely to credit success to the team versus acknowledging their own contributions or role unless it was explicitly clear.
Battling perfectionism
Perfect is the enemy of good, as the saying goes. Yet despite the ubiquity of this phrase, many women struggle with perfectionism from the classroom throughout their professional lives. Several women in the room detailed their own struggles with perfectionism and the need to constantly prove and outperform oneself. Women's need to have 100 percent of the qualifications to apply for a job is one example, but there are smaller illustrations of it, too.
Until they are absolutely certain of an outcome with little risk of failure, those battling perfectionism are less likely to answer the question raised in a meeting, ask for a raise, submit the report or sign up for the marathon. Perfectionism is even evident among young girls, who are more likely to spend time perfecting their handwriting while boys in the class room are prone to "just scribbling it down," as a 2013 qualitative study out of the U.K. education system found.
The lifelong quest for perfection and 100 percent costs women time and opportunities compared to their male counterparts who see 60 percent as worth taking a shot.
"I do feel at times I have to be 100 percent, because I will be challenged consistently," said the chief information privacy and security officer with a 10-hospital system in the Midwest, who is also African American. "I have to be top-notch and even better than that, and continuously prove my expertise in this space. You overly have to convince people and then sustain it."
Bringing others up
The need to mentor and advocate for other women emerged and reemerged consistently throughout the 120-minute discussion. Interestingly, many women emphasized their instinct to seek out up-and-coming leaders who may not think of themselves as seasoned enough for a certain title, responsibility or salary. They specifically look for professionals who may still consider themselves "green" at their job.
Given their remarks about the gendered confidence gap they've experienced and observed in the C-suite, these female executives want to tap young women on the shoulder and put them in leadership roles — "even when they're not quite sure they're ready for it," said the president and CEO of two hospitals within a seven-hospital system. "Seeing bright eyes and intrinsic talent — it's all about taking that risk and saying, 'I'll be there to back you up.'"
It's important to advocate for young talent to assume high-level roles, but equally as crucial is standing by an up-and-comer once she lands the job. Several executives looked back on their own careers and credited a seasoned leader who trusted them with responsibility and decisions, and most importantly, patiently waited throughout their fits and starts. Since many women battle with perfectionism and veer away from risk-taking, an advocate who stands by a woman through her mistakes reinforces her sense of security and authenticity.
Speaking of authenticity: It's a must-have for anyone so lucky to call him or herself a leader. People respond to others who are genuinely themselves, shortcomings and all, opposed to those who try to emulate another person's leadership style. It often takes time for rising stars to feel comfortable in their own skin, but roundtable participants said counsel from trusted female executives can further them on this journey.
"I tell women to not believe that emulating male behavior in a presentation is going to mean success for you," said the SVP and COO with a large integrated health system in Kentucky. "You have to be authentic. Authenticity is how you inspire. If you believe you need to behave in a manner that you've witnessed, that will be a mismatch for you. Be you in a confident but humble way."
Seeing beyond the glass ceiling
The roundtable discussion included a number of female trailblazers in the healthcare field, each of whom cracked if not broke the glass ceiling in her own right. One woman was the first-ever female president of her large academic medical center. Another was the fifth female in 112 years to serve as chair of the American Hospital Association. There are other milestones to note, but striking was their shared insistence to downplay the glass ceiling — especially when mentoring younger women.
"If I've had a glass ceiling, I chose to ignore it," said the former AHA chair and CEO of a 170-bed woman's hospital in the South. "I advise women to go into denial about that. Don't use it as an excuse or a crutch. If you let that be the reason you're not going where you want, maybe it's time to go to another organization."
This sentiment was shared early on in the discussion, and throughout the two hours that followed it was brought up and affirmed time again. Some women naturally find themselves oblivious to the glass ceiling, only experiencing the occasional flash of awareness about their gender from time to time in the workplace.
"I’ve been always focused on my work; I think we should not let barriers like the glass ceiling get in our way," said Sabine Luik, MD, MBA senior vice president of medicine and regulatory affairs with Boehringer Ingelheim Pharmaceuticals. "Growing up in Germany, I was encouraged by my parents to always do my best and succeed, gender was never an issue. As long as our society perpetuates gender stereotypes, we continue to unconsciously promote gender bias rather than gender partnership."
Other women described shunning the glass ceiling as an intentional and deliberate act, not only for their own professional health but also when raising children. These women described ignoring the glass ceiling as one way to reframe reality and not impose limitations on themselves, subconsciously or otherwise.
The power of networking
Who you know in business is incredibly important and often influences one's next career move or hiring decision. There is a saying that job opportunities don't fall from the sky — most of the time, they are attached to people you know.
Several executives noted the power of networking, and they have felt the highs and lows of it firsthand. The CEO of a 150-bed hospital in Virginia said she was talking to a male colleague one day when she learned about an unfamiliar culture of collegial bonding in the hospital's administration. She learned that more causal social outings occur, which help build relationships, but there is not always a comfort level between men and women to engage in social outings together unless they are part of a larger group.
While missing an invitation for a social event may seem like a minor limitation in the moment, these missed opportunities add up and can hinder a woman's personal network over time. Professionals who have an open, diverse personal network are better positioned to learn about new ideas, opinions and opportunities. In fact, multiple, peer-reviewed studies have found an open network is the best predictor of career success — even more than grit and talent.
Networking events are not yet seen as gender-neutral, but many female executives said this setback makes them even more conscious and deliberate about how they connect with colleagues and other professionals. One shared piece of advice from many executives in the discussion? Women need to surround themselves with a network of strong, open-minded individuals. As women's networks continue to grow larger and more diverse, their rise to the top is inevitable, said one executive.
C-suites are rather small communities, so it is important for women to develop networks of people who are aware of their experiences. The history of knowledge is vital and can guide future advancement and opportunities.
Treating patients as partners
The roundtable discussion came to a close with the leaders' knowledge and observations about the most important people they serve: patients. Overwhelmingly, executives said their organizations are treating patients not only as recipients of care, but as trusted sources of feedback and input. The same collaborative style that was discussed early on remerged as the leaders talked about contemporary care delivery.
Leaders referred to the patient experience in terms both large and small. Sometimes patient input can change something so granular but critical as packaging for a certain medication or treatment device.
Through patient communication and engagement efforts, the Boehringer Ingelheim team found patients involved in clinical development of a product experienced difficulty opening blister cards of pills. "We needed to change that to bottles that they can actually open," Karen Iannella, executive director patient advocacy and stakeholder relations for Boehringer Ingelheim. The team has also collected valuable input about something broader and highly consequential: clinical trials.
"We are focused on patient engagement in order to help us build better products and services that better address patient needs," said Ms. Iannella. "We are asking patients for input into clinical trial design. We're learning a lot from them and, in some cases, even changing our protocols, based on the input we have received, which is helping us to run better trials."
Leaving the hospital or medical office to engage patients in the surrounding neighborhoods was another core tenet that emerged in the conversation. Several leaders cited examples of improved medical outcomes achieved through unconventional means.
For instance, one leader said her Midwestern health system partnered with a church based in a community where diabetes metrics were especially poor, as identified in a community health assessment. Under the new partnership, clinicians traveled to the church to aid patients with diabetes care. The system saw a noticeable improvement in patient compliance and outcomes. "They started taking better care of themselves, all through better access," she said.
Women value collaboration in the C-suite, and this virtue is growing more evident and palpable in the patient-provider or patient-pharmacist relationship. Another idea that came full circle was the need to demonstrate and take ownership of value. When making hiring decisions, the vice president and chief development officer with a 150-bed hospital in a major city said she looks for someone who can become a vocal advocate and speak up for him or herself. "I want them to be doing the same on behalf of our organization — speaking up," she said.
The same can be said for the provider-patient relationship, and how well providers speak up for patients. As healthcare goes from a transactional experience to one deeply invested in human relationships, the same skills and traits women credit to their professional gains may very well reappear as the most vital to engaging patients, including them in their healthcare and helping them obtain the confidence that they can positively influence their behaviors and health outcomes.