Women account for only 18 percent of hospital CEOs and only 4 percent of healthcare company CEOs, according to a report from Rock Health. However, they face the same challenges of reimbursement, hospital-physician alignment and population health management. How are today's female hospital and health system leaders managing these challenges? Here, nine top female healthcare leaders tackle questions about gender in healthcare leadership.
Question: What are the greatest challenges female hospital and health system leaders face today, and are these different from the challenges male leaders face?
Cathy Barr, MBA, RN, President of Bethesda Hospital (St. Paul, Minn.): I honestly believe the greatest challenge any leader faces today is the opportunity to have the most talented and best people on their team. Regardless whether male or female, we are only successful if we have a really talented team of individuals who work with us. Getting great leaders on your team is not only the biggest challenge, but it's also the biggest opportunity and probably the most rewarding.
Denise Brooks-Williams, President and CEO of Bronson Battle Creek (Mich.): A major challenge for working mothers is work-life balance. It is not unique to women, though, as more men are taking larger roles in the home. There may also be challenges around the perception of women in the workplace. While it has improved, sometimes women are not taken as seriously as men; some workers are not as inclined to follow women. There are still disparities in compensation.
Bonnie Phipps, President and CEO of Saint Agnes Hospital (Baltimore): The challenges that are based on the economy and the uncertainty of sequestration and payment cuts, staff shortages and, at this time, drug shortages and the other healthcare-related issues are the same for all leaders today unless you are lucky enough to be a sole community provider and one with significant market share.
I believe that men and women do equally well in dealing with medical staff and boards and with volunteer work in our communities. The personal challenges that impact time management can be a little more challenging for female leaders as they tend to be the "caretakers." So, taking care of medical or social needs of family members, even entertaining can be demanding on time and talent. It is easier for men to go to formal events too! I have threatened to buy a tuxedo!
Sylvia Smith Johnson, President and CEO of Maryland General Hospital (Baltimore): Male and female hospital and health system leaders face the same challenge: How do I recruit and develop a team that will enable my organization to provide the highest quality of care in the most economical manner and generate a bottom line that provides enough capital to keep facilities and equipment current.
Q: How might female hospital and health system leaders approach healthcare reform challenges differently than male leaders?
Laura Irvine, President of Methodist Dallas Medical Center: Leaders' styles are all different regardless of differences in gender. When I'm hiring, especially for leaders, I look for characteristics of visionary leadership, and strategic skills to navigate the change in environment we're going to have for at least the next decade. The characteristics are relationship building with our clinicians and our medical staff to help us all come together as a team, to work on quality, compassionate care for our patient — it takes all of those for any leader regardless of gender.
Barbara Martin, President and CEO of Vista Health System (Waukegan, Ill.): I don't think [men and women] approach them any differently. The key as a leader is you have to be very strategic — build physician relationships, look at growth, bottom line, building market share — all those things are the same. We think we know what healthcare reform is going to do; we know that reimbursement will decline, and we have to work with whatever means [we have] and improve care and continue to grow. Whether male or female, you have to stay focused on a very strategic mission and outcomes. Outcomes are everything.
Mimi Roberson, CEO of Presbyterian/St. Luke's Medical Center & Rocky Mountain Hospital for Children at P/SL (Denver): I think females have a natural holistic approach to healthcare and clearly align with the continuum of services, most importantly preventative care and health maintenance. Data shows that females are often the "healthcare decision-makers of the family" so this trait is one that supports developing business plans and entering into clinical relationships quite naturally.
Margaret Sabin, President and CEO of Penrose-St. Francis Health Services (Colorado Springs, Colo.): A female leader might initially be more collaborative, might in fact reach out to a previous competitor in an environment and say "Let's lay down the sword; this is an area of the population we need to care for, let's do it together." So a female might be quicker to have a collaborative discussion, even if [the partner] was previously viewed as a competitor in the market. Once you begin to look at population health, you have to pull together. You have to pull community collaborators in to help with the effort.
Sylvia Smith Johnson: In my opinion, neither male nor female hospital leaders have an innate advantage in dealing with this changing environment. Those leaders that are skilled in creative thinking and in facilitation will be able to partner with other providers/entities to complement inpatient care. Those who are energized by change and passionate about community health will be successful.
Q: What is the biggest misunderstanding or myth about women's leadership in healthcare today, and how can this misunderstanding be avoided?
Barbara Martin: The myth may be that women are aggressive per se, and really what they are is assertive. There may be a myth that women are more emotional, but if you're a strong business person, you keep the emotions out and make strong business decisions based on facts.
Patricia Maryland, DrPH, President and CEO of St. John Providence Health System (Warren, Mich.) and Michigan Market Leader for Ascension Health (St. Louis): Although much has changed in the last 30 years since I joined the healthcare industry, there's still a misunderstanding that in order to be a female executive, you have to sacrifice your family to make it happen. I know many successful female leaders in healthcare and other industries, me included, that have supportive spouses who help with family unity and keep us grounded about work-life balance.
Bonnie Phipps: I think the biggest myth is that women can be "nurturing" and not strategic. In an environment like we find ourselves in today, strategy is really one of the most important roles a leader must assume. And, developing strategy while on a burning platform can be a real challenge. To avoid this misunderstanding, women leaders need to demonstrate to all constituencies that they understand the current environment, the impact of external factors, the best path forward and that they have the courage to take the first step off the cliff without a net.
Mimi Roberson: Unfortunately, I think that sometimes females have been thought to work less hard than men by virtue of their responsibility for childbirth. There is also a myth that we are too sensitive to handle complex situations or conversations which can be construed to become controversial. I have never found that to be true. We have always demonstrated our professionalism and focus to our jobs. Fortunately, I think those myths are resolving themselves by the increase of women executives in the healthcare workforce.
Margaret Sabin: I think when women are tough, they might be perceived more negatively than when men are equally tough. It's absolutely a gender norm that women are expected to be kinder and gentler. For example, I sometimes hear the word stress applied to strong women leaders, and I think they're not stressed, they're passionate about what they're doing.
Q: How are healthcare reform and other market pressures changing women's leadership in healthcare?
Denise Brooks-Williams: Some reform, which is targeting groups that have been underrepresented in the workforce, is focused on initiatives that support appropriate representation. Our leaders are very balanced, with backgrounds in administration, public health and finance. Legislation is very clear about wanting to have an inclusive, strong, diverse workforce, which includes women. It may not immediately lead to executive roles, but it will create a pipeline, which is a positive outcome.
Laura Irvine: I don't think [healthcare reform] is affecting male or female leaders differently. I think it brings more attention to the strength of skills that are going to be needed — visionary leadership, strategy, compassionate team building with staff and clinicians to build care teams going forward. That's more of what [healthcare] is going to look for and healthcare reform, with its transparency, is going to bring that skill set to the forefront regardless of gender.
Barbara Martin: It may put a higher demand on female leaders who have the business, clinical and hospital operations background for CEO roles. Having that highest level of knowledge base and intelligence — business background and clinical background — helps to facilitate success and outcomes in leading a healthcare institution.
Patricia Maryland: Leadership in healthcare is changing, but the difference is not between males and females. The real differentiator is between the status quo and those willing to take risk during this transformational time in the healthcare industry.
Margaret Sabin: It's a wonderful time, and I embrace it. With healthcare reform, you bring in population health. Instead of thinking episodes of care, we need to think [of the care of a community], and women tend to think in that direction. We are sometimes in that role of the nurturers, the gatherers, so to think of the broader application of health in a community comes very naturally to women. It's a great opportunity to balance out skill sets, because that's what we need. We need a gatherer approach, a collaborator. Lay down the swords of competition; it's time to take the limited resources and pull together for the best of the community.
Q: What advice do you have for other current or aspiring female healthcare leaders?
Cathy Barr: Great leaders have a vision and a true understanding of what their own values are, and the ability to inspire others so they will come along with you. [To be] able to pick the very best people you can surround yourself with and get the job done and achieve desired results — that's a skill that everyone should cultivate.
I'm passionate about mentoring; it's a way to give back. The advice I would give to young leaders today is to find a mentor or coach they trust, who they believe has strong values and the ability to create a vision and inspire others. When you learn from them, give back to others in the organization or local community.
Laura Irvine: Seek mentors. I've had the privilege of having great male and female mentors. Take advantage of opportunities; never be scared if you've never done [something] before, you will learn a lot from it. The leadership skill set is being aware of people around you and people you're leading — what perceptions they have, how they view things. Be aware but don't be dictated by them. Seek win-win solutions for every challenge that [you're] part of.
Patricia Maryland: My own advice to aspiring female leaders is to listen to the stories of others. Notice what others are saying and doing. Watch for role models. You will recognize them when you see them. They are the people whose behaviors you admire, whose attitude and temperament you want to imitate, and who have the values you identify with. At decision points in your life, you will think: "How would so-and-so handle this? What would she do in this situation?" And you will know what path to follow. Choose your role models wisely and for the right reasons. Look for substance and integrity. And remember your role models don't have to be exactly like you. Some of the most influential role models in my life have been white males.
Bonnie Phipps: First, be certain that you have the educational credentials that you need. Generally that means at least a masters degree in a related field. Also, I encourage participation in professional organizations where you can demonstrate your knowledge and capabilities to a wide range of colleagues who could potentially suggest you for a leadership role. Finding a mentor is very helpful too. If you are already in a mid-level role, make yourself visible, not only to the CEO, but also to the board. Ask for help from the most unlikely people for guidance. People from other industries can sometimes offer real assistance in developing the right leadership style. And, finally, don't be afraid to take a chance, to move to another town if necessary. The biggest key I have found to success is courage.
Mimi Roberson: My advice is quite simple. Always enjoy what you are doing and keep your moral and professional compass. Be honest and ethical in everything you do, and appreciate the multitude of relationships you develop throughout your career. Those professional and personal relationships become the foundation for your success, and you should always extend that same courtesy to the next generation of healthcare leaders.
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Question: What are the greatest challenges female hospital and health system leaders face today, and are these different from the challenges male leaders face?
Cathy Barr, MBA, RN, President of Bethesda Hospital (St. Paul, Minn.): I honestly believe the greatest challenge any leader faces today is the opportunity to have the most talented and best people on their team. Regardless whether male or female, we are only successful if we have a really talented team of individuals who work with us. Getting great leaders on your team is not only the biggest challenge, but it's also the biggest opportunity and probably the most rewarding.Denise Brooks-Williams, President and CEO of Bronson Battle Creek (Mich.): A major challenge for working mothers is work-life balance. It is not unique to women, though, as more men are taking larger roles in the home. There may also be challenges around the perception of women in the workplace. While it has improved, sometimes women are not taken as seriously as men; some workers are not as inclined to follow women. There are still disparities in compensation.Bonnie Phipps, President and CEO of Saint Agnes Hospital (Baltimore): The challenges that are based on the economy and the uncertainty of sequestration and payment cuts, staff shortages and, at this time, drug shortages and the other healthcare-related issues are the same for all leaders today unless you are lucky enough to be a sole community provider and one with significant market share. I believe that men and women do equally well in dealing with medical staff and boards and with volunteer work in our communities. The personal challenges that impact time management can be a little more challenging for female leaders as they tend to be the "caretakers." So, taking care of medical or social needs of family members, even entertaining can be demanding on time and talent. It is easier for men to go to formal events too! I have threatened to buy a tuxedo!
Sylvia Smith Johnson, President and CEO of Maryland General Hospital (Baltimore): Male and female hospital and health system leaders face the same challenge: How do I recruit and develop a team that will enable my organization to provide the highest quality of care in the most economical manner and generate a bottom line that provides enough capital to keep facilities and equipment current.Q: How might female hospital and health system leaders approach healthcare reform challenges differently than male leaders?
Laura Irvine, President of Methodist Dallas Medical Center: Leaders' styles are all different regardless of differences in gender. When I'm hiring, especially for leaders, I look for characteristics of visionary leadership, and strategic skills to navigate the change in environment we're going to have for at least the next decade. The characteristics are relationship building with our clinicians and our medical staff to help us all come together as a team, to work on quality, compassionate care for our patient — it takes all of those for any leader regardless of gender. Barbara Martin, President and CEO of Vista Health System (Waukegan, Ill.): I don't think [men and women] approach them any differently. The key as a leader is you have to be very strategic — build physician relationships, look at growth, bottom line, building market share — all those things are the same. We think we know what healthcare reform is going to do; we know that reimbursement will decline, and we have to work with whatever means [we have] and improve care and continue to grow. Whether male or female, you have to stay focused on a very strategic mission and outcomes. Outcomes are everything.Mimi Roberson, CEO of Presbyterian/St. Luke's Medical Center & Rocky Mountain Hospital for Children at P/SL (Denver): I think females have a natural holistic approach to healthcare and clearly align with the continuum of services, most importantly preventative care and health maintenance. Data shows that females are often the "healthcare decision-makers of the family" so this trait is one that supports developing business plans and entering into clinical relationships quite naturally.Margaret Sabin, President and CEO of Penrose-St. Francis Health Services (Colorado Springs, Colo.): A female leader might initially be more collaborative, might in fact reach out to a previous competitor in an environment and say "Let's lay down the sword; this is an area of the population we need to care for, let's do it together." So a female might be quicker to have a collaborative discussion, even if [the partner] was previously viewed as a competitor in the market. Once you begin to look at population health, you have to pull together. You have to pull community collaborators in to help with the effort. Sylvia Smith Johnson: In my opinion, neither male nor female hospital leaders have an innate advantage in dealing with this changing environment. Those leaders that are skilled in creative thinking and in facilitation will be able to partner with other providers/entities to complement inpatient care. Those who are energized by change and passionate about community health will be successful.
Q: What is the biggest misunderstanding or myth about women's leadership in healthcare today, and how can this misunderstanding be avoided?
Barbara Martin: The myth may be that women are aggressive per se, and really what they are is assertive. There may be a myth that women are more emotional, but if you're a strong business person, you keep the emotions out and make strong business decisions based on facts.
Patricia Maryland, DrPH, President and CEO of St. John Providence Health System (Warren, Mich.) and Michigan Market Leader for Ascension Health (St. Louis): Although much has changed in the last 30 years since I joined the healthcare industry, there's still a misunderstanding that in order to be a female executive, you have to sacrifice your family to make it happen. I know many successful female leaders in healthcare and other industries, me included, that have supportive spouses who help with family unity and keep us grounded about work-life balance.Bonnie Phipps: I think the biggest myth is that women can be "nurturing" and not strategic. In an environment like we find ourselves in today, strategy is really one of the most important roles a leader must assume. And, developing strategy while on a burning platform can be a real challenge. To avoid this misunderstanding, women leaders need to demonstrate to all constituencies that they understand the current environment, the impact of external factors, the best path forward and that they have the courage to take the first step off the cliff without a net.
Mimi Roberson: Unfortunately, I think that sometimes females have been thought to work less hard than men by virtue of their responsibility for childbirth. There is also a myth that we are too sensitive to handle complex situations or conversations which can be construed to become controversial. I have never found that to be true. We have always demonstrated our professionalism and focus to our jobs. Fortunately, I think those myths are resolving themselves by the increase of women executives in the healthcare workforce.
Margaret Sabin: I think when women are tough, they might be perceived more negatively than when men are equally tough. It's absolutely a gender norm that women are expected to be kinder and gentler. For example, I sometimes hear the word stress applied to strong women leaders, and I think they're not stressed, they're passionate about what they're doing.
Q: How are healthcare reform and other market pressures changing women's leadership in healthcare?
Denise Brooks-Williams: Some reform, which is targeting groups that have been underrepresented in the workforce, is focused on initiatives that support appropriate representation. Our leaders are very balanced, with backgrounds in administration, public health and finance. Legislation is very clear about wanting to have an inclusive, strong, diverse workforce, which includes women. It may not immediately lead to executive roles, but it will create a pipeline, which is a positive outcome.
Laura Irvine: I don't think [healthcare reform] is affecting male or female leaders differently. I think it brings more attention to the strength of skills that are going to be needed — visionary leadership, strategy, compassionate team building with staff and clinicians to build care teams going forward. That's more of what [healthcare] is going to look for and healthcare reform, with its transparency, is going to bring that skill set to the forefront regardless of gender.
Barbara Martin: It may put a higher demand on female leaders who have the business, clinical and hospital operations background for CEO roles. Having that highest level of knowledge base and intelligence — business background and clinical background — helps to facilitate success and outcomes in leading a healthcare institution.
Patricia Maryland: Leadership in healthcare is changing, but the difference is not between males and females. The real differentiator is between the status quo and those willing to take risk during this transformational time in the healthcare industry.
Margaret Sabin: It's a wonderful time, and I embrace it. With healthcare reform, you bring in population health. Instead of thinking episodes of care, we need to think [of the care of a community], and women tend to think in that direction. We are sometimes in that role of the nurturers, the gatherers, so to think of the broader application of health in a community comes very naturally to women. It's a great opportunity to balance out skill sets, because that's what we need. We need a gatherer approach, a collaborator. Lay down the swords of competition; it's time to take the limited resources and pull together for the best of the community.
Q: What advice do you have for other current or aspiring female healthcare leaders?
Cathy Barr: Great leaders have a vision and a true understanding of what their own values are, and the ability to inspire others so they will come along with you. [To be] able to pick the very best people you can surround yourself with and get the job done and achieve desired results — that's a skill that everyone should cultivate.
I'm passionate about mentoring; it's a way to give back. The advice I would give to young leaders today is to find a mentor or coach they trust, who they believe has strong values and the ability to create a vision and inspire others. When you learn from them, give back to others in the organization or local community.
Laura Irvine: Seek mentors. I've had the privilege of having great male and female mentors. Take advantage of opportunities; never be scared if you've never done [something] before, you will learn a lot from it. The leadership skill set is being aware of people around you and people you're leading — what perceptions they have, how they view things. Be aware but don't be dictated by them. Seek win-win solutions for every challenge that [you're] part of.
Patricia Maryland: My own advice to aspiring female leaders is to listen to the stories of others. Notice what others are saying and doing. Watch for role models. You will recognize them when you see them. They are the people whose behaviors you admire, whose attitude and temperament you want to imitate, and who have the values you identify with. At decision points in your life, you will think: "How would so-and-so handle this? What would she do in this situation?" And you will know what path to follow. Choose your role models wisely and for the right reasons. Look for substance and integrity. And remember your role models don't have to be exactly like you. Some of the most influential role models in my life have been white males.
Bonnie Phipps: First, be certain that you have the educational credentials that you need. Generally that means at least a masters degree in a related field. Also, I encourage participation in professional organizations where you can demonstrate your knowledge and capabilities to a wide range of colleagues who could potentially suggest you for a leadership role. Finding a mentor is very helpful too. If you are already in a mid-level role, make yourself visible, not only to the CEO, but also to the board. Ask for help from the most unlikely people for guidance. People from other industries can sometimes offer real assistance in developing the right leadership style. And, finally, don't be afraid to take a chance, to move to another town if necessary. The biggest key I have found to success is courage.
Mimi Roberson: My advice is quite simple. Always enjoy what you are doing and keep your moral and professional compass. Be honest and ethical in everything you do, and appreciate the multitude of relationships you develop throughout your career. Those professional and personal relationships become the foundation for your success, and you should always extend that same courtesy to the next generation of healthcare leaders.
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