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Authors:Danielle Simpson (Canada), Lucy Clements (UK), Natalia Allué Orduña (Spain), Salwa Al Ubaidani (Oman), Shatha Bahutair (UAE).
Reviewers (YEL Alumni): Hiba Al Naabi (Oman) and Samar Almuntaser (UAE).
Women are at the centre of the global health workforce, caring for billions of patients each and every day. Women comprise almost 70% of health and social care workers globally and nearly 90% of the nursing and midwifery workforce (1,2). Despite women’s active involvement in the workforce, their numbers are not represented in the leadership levels. It is estimated that women hold only around 25% of leadership roles in health globally (1). Only 23% of national delegations to the World Health Assembly in 2020 were headed by women and fewer than 5% of chief executive officers of Fortune 500 health care companies are female (1). In 2014, only 24% of directors of global health centres at the top 50 US medical schools were women (2). COVID-19 has had a significant impact on women in the workforce and threatens to widen the leadership gap for women in healthcare (1).
Young Executive Leaders’ women in healthcare leadership survey results
The Young Executive Leaders (YEL) programme 2022 is comprised of leaders from 26 different countries. In a survey to this diverse group (n=32), it was found that 43% of participants’ CEOs were women, which is higher than in much of the reported literature. However, 43% of respondents indicated that their hospital senior leadership team was made up of less than 40% of women.
Findings from the survey were also consistent with the research when examining the lack of women in medical leadership positions. Sixty-five percent of respondents indicated that women held less than 40% medical leadership positions, with 21% of respondents indicating this number was less than 20% of positions. The lack of women in medical leadership is particularly troubling given that in many countries, women now make up the majority of medical students (3). For example, in Canada, a national study found that only 32% of department chiefs, 29% of divisional heads, and 23% of those with prestigious research positions were women (4). Not only are there fewer women in leadership positions, research from Canada also found that female surgeons earn 24$ less per hour spent operating than male surgeons (5).
Recommendations to support women in healthcare leadership
This gender equity gap in leadership positions is well known, not only in healthcare. There are a variety of ways to help fill the leadership pipeline and ultimately promote women into leadership positions. While many historical and social factors have contributed to the fact that less women are in leadership roles than men, this paper seeks to outline various recommendations that have been demonstrated in the literature, through the authors’ lived experience in their respective countries, to be effective in helping women advance in healthcare leadership positions.
1 Creating learning and support networks
One way of supporting women in leadership roles is developing shared spaces, such as a women’s networks, where women can come together and share experiences, support each other, and create change. Many healthcare organizations in the United Kingdom are creating women’s networks as part of their Equity, Diversity, and Inclusion agenda. These networks facilitate connections and relationships between a diverse range of women across the organization who all experience similar challenges and who otherwise may never have met or formed relationships. These networks have provided a number of practical opportunities to members such as coaching and mentoring; access to resources which otherwise might be hard to acquire; hearing from inspirational speakers about their career journey and challenges; lobbying change around particular topics, such as the gender pay gap; and providing shared experiences to help people connect and unite (6).
Organizations and individuals may face barriers in setting up these networks specifically due to a lack of information, understanding, lack of time or resources. It is important that senior leaders recognize the importance and value that can be gained from supporting staff in this way so that they can invest appropriately and unlock barriers. Sharing case studies, feedback, and research on the topic are all methods to help facilitate this improvement in understanding.
By combining activities which support confidence, connections, and professional or personal development, women’s networks can have a lasting impact in supporting gender equity in the healthcare workspace. From the survey of the YEL mentioned above, only 40% of respondents stated their organization had initiatives or priorities which related to gender equality; therefore, we recommend more healthcare organizations develop and support these types of initiatives.
2 Developing an organizational equity plan
With the aim of promoting equality in both genders and promoting the role of women in healthcare leadership, it is essential to carry out actions relating to organizational processes (7,9). One of the strategies that has shown evidence of success is for organizations to have an equality plan.
The first step to creating such a plan is to perform an analysis of the organization that aims at evaluating its current situation and developing the plan’s indicators. The plan aims to achieve equal treatment and opportunities for women and men alike and eliminate discrimination based on gender. The plan is overseen by a committee (Equality Commission) that monitors the progress and outcomes related to the plan.
In the Catalan hospitals of the Unió Catalana d’Hospitals in Spain, such as the Fundació Sanitària Mollet, plans such as these are mandatory. As an example, at the Mollet Hospital (Fundacio Sanitària Mollet), after carrying out an analysis of the workforce, it was identified that there was no discrimination against women in the types of contracts or level of studies. However, it was identified that women, in a greater proportion, requested flexible work arrangements or reductions in working hours to care for relatives. The organization has responded by allowing teleworking for some positions and the flexibility of schedules for others. Over time, these policies will be analyzed to determine if they had an impact on the number of flexible work arrangement requests by gender. The equity plan also measures the number of women in positions of responsibility, taking into account skills and development.
3 Recruitment and retention practices
Recruitment and retention strategies that focus on addressing structural issues and changing workplace norms is a step forward to helping retain women in healthcare leadership. Examples in the research where this has been shown to be beneficial include promoting policies, operations, and salaries that support gender equity (7). This may come in the form of reviewing hiring practices for unconscious bias or analyzing salary data to ensure pay equity. For example, in the NHS in the UK, salaries are compared across genders to ensure equal pay.
Incorporating succession planning conversations with high potential women, including giving them high visibility stretch assignments, is an important way to increase retention and build leadership capacity (7). Formal leadership programs for women can also be an important component of helping women broaden their networks, build their leadership skills, and ability to persist and excel in their career (8).
4 Work–life integration and family-friendly policies
The research is clear that women take on the greater proportion of childcare and domestic care responsibilities which can play a role in the opportunities for advancement in their career and their desire for them. In the YEL survey mentioned above, 40% of YEL respondents had asked for a workload adjustment in order to balance their work and family life at some point in their career, with 70% of these requests being approved. Although the YEL cohort is gender balanced as a cohort, only 21% of male YEL respondents reported having asked for a workload adjustment, whereas 55% of the women in the YEL cohort reported having asked for a workload adjustment.
Policies that enable flexibility are likely to enable more women to enter into senior leadership roles (1). Flexible work arrangements help promote work-life balance by creating an equilibrium between the needs of the employee and those of the organization. For this to be successful, the organization needs to have in place a flexible workplace policy, including the option to work flexible hours, and the technology in order to be able to accommodate the request if a remote work option is requested.
Family-friendly policies are crucial to achieving a working schedule that balances work with life and helps support both women and men to take an active role in their families. It can help employees reduce their stress and improve their job focus. These family-friendly policies include parental leave, childcare compensation, elder care compensation, remote work, family medical leave, and family health care coverage (10). A total of 13 countries around the world offer 100% equivalent pay for maternity leave and at least 3 months equivalent pay (11). European countries offer a paternity leave with full payment ranging from 2-12 weeks (11). Japan offers a paternity leave of 52 weeks at an average payment rate of 60.3% (11). Only a few countries allot time to fathers in their parental leave policies, meaning that childcare and domestic work can become unequally shared. Providing a portion of the parental leave to fathers is essential as childcare and domestic duties can be shared and the woman can take opportunities for career advancement.
5 Awareness and organizational role-modelling
Research has shown that organizational role modelling is one way that organizations can highlight and promote the visibility of women in leadership positions (7). By promoting the work of female leaders and allowing for open discussion about the challenges that women face as leaders, it role models to more junior women in the organization that what they want to achieve is possible, and promotes informal mentoring and networking relationships.
An excellent example of this is a podcast started by a YEL member at a large tertiary hospital in Oman entitled “Female leaders in the healthcare sector” (12). The podcast hosts conversations with female leaders in healthcare professions. The aim is to highlight their personal and professional journey, and to showcase their resilience to overcome continuous challenges they have encountered throughout their personal and professional life. Throughout the interviews, common themes of challenges were observed such as maintaining life-work balance, the accessibility of formal structured training, succession planning programs, and an awareness and engagement culture. Podcast guests spoke about the importance of establishing an effective mentorship scheme for women in the workplace, enhancing networking opportunities, the need to equip women with essential leadership skills and education, building self-confidence, effective time management, and resilience. Also, the need for more policies to promote work-life integration, and maximize the value added of the female workforce. By hearing from female leaders in their field, it can inspire women who are at earlier stages in their career.
This initiative is a great example of organizational role modeling practice, improving perceptions of women’s leadership competencies and reinforcing a supportive culture of advancing women in leadership. Senior leaders in the organization should continue to support, publicize and promote such initiatives which can be in return helpful in building a culture of awareness, workforce engagement, opportunity, and motivation among female employees.
Conclusion and next steps
Women are a crucial component of the healthcare workforce and should be equally represented in senior leadership roles across the globe. This article outlined some of the ways that organizations and governments can support women advancing in healthcare leadership. Although women have made significant advances in the workplace, everyone has a role to play in ensuring that organizations reach gender equity in the leadership ranks.
To this end, the IHF has established the Women in Leadership Forum to assist senior female executives in sharing experiences, build professional relationships, and expand the voices of women in the workplace. The forum regularly hosts events to elevate the voices of women in healthcare leadership. The Forum also aims to support female leaders in achieving their highest potential by offering them practical solutions to overcome issues and challenges that women are facing in the workplace. The Forum is another great example of how to elevate and upskill women to help them continue on their careers.
- World Health Organization. Closing the Leadership Gap: Gender Equity and Leadership in the Global Health and Care Workforce. June 2021.
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- Boniol M, McIsaac M, Xu L, Wuliji T, Diallo K, Campbell J. Gender equity in the health workforce: analysis of 104 countries. Working paper 1. Geneva : World Health organization. 2019.
- Doolittle R, Wang C. How Medicine’s Gender Power Gap Sets Up Women For Unequal Pay and Less Prestigious JObs. s.l. : The Globe and Mail. 2021.
- Dossa F, Simpson AN, Sutradhar R. Sex-Based Disparities in the Hourly Earnings of Surgeons in the Fee-for-Service System in Ontario, Canada. JAMA Surg. 2019, Vol. 154, pp. 1134-1142.
- Clements L. 2022. Women leaders in health. Available at: www.womenleadersinhealth.co.uk
- Mousa M, Boyle J, Skouteris H, Mullins AK, Currie G, Riach K, Teede HJ. Advancing women in healthcare leadership: A systematic review and meta-synthesis of multi-sector evidence on organizational interventions. EClinicalMedicine. 2021 Aug 12; 39:101084.
- Tsoh JY, Kuo AK, Barr JW, Whitcanack L, Merry I, Allredge BK, Azzam AN. Developing faculty leadership from ‘within’: a 12-year reflection from an internal faculty leadership development program of an academic health sciences center. Medical Education Online, 2019, Vol. 24.
- Moyer CA, Abedini NC, Youngblood J, et al. Advancing women leaders in global health: getting to solutions. Ann Glob Health 2018; 84(4):743–52.
- Indeed Editorial Team. Family Friendly Policies: Definition and Examples. 2021. Available at: https://www.indeed.com/career-advice/career-development/family-friendly-policy
- World population review 2022. Maternity Leave by country. 2022. Available at: https://worldpopulationreview.com/country-rankings/maternity-leave-by-country
- Al Ubaidani S, Al Fannah J. Female leaders in the healthcare sector. 2022. Available at: https://podcasts.apple.com/om/podcast/%D9%82%D9%8A%D8%A7%D8%AF%D9%8A%D8%A7%D8%AA-%D9%81%D9%8A-%D8%A7%D9%84%D9%82%D8%B7%D8%A7%D8%B9-%D8%A7%D9%84%D8%B5%D8%AD%D9%8A/id1616429700?i=1000555615333