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The call for increased female leadership within healthcare may appear self-evident, yet the intricate tapestry of this multifaceted issue reveals the need for a succinct and clear articulation of the fundamental rationale behind the pursuit of gender equity. In 2023, healthcare is undergoing significant changes, facing financial pressures, and dealing with a shortage of skilled professionals. There are also unique challenges in different regions, like limited access to care in remote areas and the need for cost-effective supplies and a skilled workforce. These complexities have made healthcare systems more intricate and interconnected than ever, requiring exceptionally strong transformative leadership.
Transformative leadership involves intuitive decision -making and high emotional intelligence. Empowering women in leadership is imperative as they combine intuition and emotional intelligence to address healthcare challenges.
Scientifically, differences exist between male and female brain connectivity, optimizing specific skill sets. Women’s ability to connect logical thinking with emotion explains their reliance on intuition leadership, resulting in more accurate decision-making. Women also have heightened social sensitivity, fostering innovative solutions in terms. In teams where women constitute a substantial portion, innovative solutions and creative decisions tend to flourish.
Despite the compelling case for promoting women to leadership positions, a disconcerting gender inequity persists within healthcare. While the workforce predominantly comprises women, with estimates ranging from 80% to 90%, the upper echelons of leadership starkly lag, with only 11% to 13% of healthcare system CEOs being women.
In a quest to unravel the root causes of gender inequity in healthcare leadership, we interviewed 25 female healthcare leaders holding director-level positions or higher. Pre-prepared questions were discussed with the leaders and their answers were summarized. These interviews unearthed culture as a profound and elusive root cause of inequity. Culture encompasses a complex tapestry, spanning national, regional, social, and organizational facets. It embodies the very essence of humanity, shaping our worldviews, beliefs, social interactions, and personal relations.
Culture as root cause
Numerous indicators within the healthcare industry point to culture as the most potent and elusive root cause of inequity, a sentiment echoed by interview participants who shared their experiences. Culture encompasses the way healthcare professionals live and work, their worldviews, beliefs, social and personal relationships within the industry. It is the medium through which we express our humanity as healthcare providers and recipients. Virtually every facet of healthcare delivery, from patient interactions to treatment decisions, is profoundly affected by the cultures in which it is practised.
Culture molds expectations regarding women’s roles, contributions, communications, and interactions. These expectations often manifest as a set of practices characterizing a woman’s role within a particular culture. For instance, in some national cultures, women may find themselves relegated to secondary positions, their voices stifled, and their self-confidence eroded from childhood. This assigned role undermines their ability to question or challenge male counterparts, even when equipped with similar training and experience as noted from one of the interview participants from Ghana. In Uzbekistan, for instance, education for women stops at the level of the ninth grade and excludes critical thinking skills.
Gwendolyn Mikell (1997) said, “Contemporary African women referred to women as walking a leadership and gender tight rope.” This extends beyond African women to women worldwide based on the traditional role of women in the family. Traditional norms describe women as the primary caregiver for their children and ‘carer’ of the home and thus, must balance their familial responsibilities of caring for children and household with their career aspirations. The term ‘double shift work’ defines this delicate balance. Leadership roles are demanding and require long hours which impacts the ability to serve as the caregiver for children. During the interview with one of the women leaders of Asian origin she stressed one of her biggest challenges was balancing her work, her children, and her specialization. Her culture demands more from her compared to her spouse who is also a doctor. She had to hold back doing her Masters until her children were older as there was no one else to help oversee them at home.
Even when women do get the necessary education to qualify for leadership positions in the hospital the question remains are they able to manage the long demanding hours as well as juggle their household responsibilities and deliver successfully on both fronts.
Better-educated women are more empowered women. When girls go to school, they develop into women who have more say over their lives, an increased sense of self-worth, analytical skills, and an ability navigate the world around them. Research demonstrates that women with higher levels of education are less likely to accept domestic violence, have greater control over household resource decisions, and have greater freedom of movement. World Bank researcher Jeni Klugman concludes that “education is particularly powerful in helping women overcome unequal and oppressive social limits and expectations so they can make choices about their lives.” Personally, as a well- educated woman, working in a hospital setting I feel confident in my decision-making capacity at work and at home. The root cause of this would be my educational foundation and bring raised in an environment where women and men were treated equally. The women we interviewed had one characteristic in common: they had parents who were educated, again demonstrating that education promotes critical thinking and encourages women to develop confidence to break societal barriers.
Culture also assigns roles and expectations for communication. Traditional, patriarchal culture associates’ power with bold, assertive styles of communication that are typically more characteristic of men whereas women are often viewed as the ‘softer’ gender, more nurturing because of their familial roles. In many cultures, this stereotype shifts the focus from performance outcomes to expectations for gender roles. When women communicate aggressively, they are perceived negatively for their contributions based on the style of delivery rather than the outcomes they produce and the competencies they demonstrate.
In the healthcare industry, job responsibilities have frequently aligned with stereotypes. The number of male physicians is far greater than that of female physicians and the number of female nurses is far greater than that of male nurses. The relationship between physician and nurse is often hierarchical since physicians’ function as decision-makers and nurses execute the decisions rather than leading them. This power gradient is exaggerated by the historical underrepresentation of female physicians. Only in the last 10 to 20 years have women pursued careers as physicians.
As clearly demonstrated, culture is a root cause for systemic gender inequity in healthcare leadership. Culture also strongly shapes self-confidence and women’s ability to visualize their potential in a professional environment. Self-confidence for women is another significant factor in this multifaceted issue, which necessitates further discussion.
Nurturing self-confidence for women in leadership
Overwhelmingly, female leaders have a distinctive trajectory of self-confidence that underlies their journey. As we delve into the interplay between individual experiences and cultural influences, a compelling narrative emerges – fostering self-confidence among women in leadership is critical to their success.
Research reveals that self-confidence is a key factor in how women progress throughout their professional careers. Interviewees ranked their own self-confidence trajectories, confirming the research that women start with lower self-confidence than men, but gain equal footing and ultimately surpass men’s levels of self-confidence somewhere beyond forty years of age. Many of the interviewees embarked on their careers with low self-confidence, a trend exacerbated by unsupportive work environments where resistance to female leadership was common. One interviewee highlighted: “I lead projects where there are men on my team. They do not accept a woman leading them and giving them advice. My self-confidence wavers because of this constant resistance.”
Despite such challenges, these women’s journeys are marked by resilience and determination to overcome adversity. It is their self-confidence that remains a potent force in propelling them forward.
Another leader shared that her “Self-confidence goes through a rollercoaster”. She has learned that every time she steps into a new environment, her self-confidence struggles. As a young, black female, she has a difficult time discerning which factor may be causing colleagues not to acknowledge her; the lack of acknowledgment reinforces her lack of self-confidence.
Several key elements emerge as essential building blocks to nurturing and sustaining self-confidence.
First and ideally, establish a clear development pathway and provide exposure to different areas in leadership to create and sustain strong female leaders. This provides the skills and perspectives needed to navigate the complexities of leadership.
Secondly, understand that traditional mindsets often undermine self-confidence and empowerment. Self-confidence is rooted in early family life, where values, worldviews, and self-image are initially shaped. Men may discourage their daughters and wives from seeking leadership roles and developing themselves. Simply encouraging women that they are capable of leading plays a pivotal role in nurturing self-confidence.
Exposure to other female leaders, cultures and systems broadens horizons and allows women to visualize a path to leadership and support one another in achieving success. As one interviewee shared, “Women supporting women hasn’t been part of the culture. Women must be in positions of influence to support other women upwards”. Acknowledging and celebrating achievements, no matter how small, instills a sense of pride and fuels determination to reach new heights.
One such example is from Oman, where three female ministers promoted the narrative that all genders are equal in government. These women led the way to more inclusive and diverse leadership that ultimately encouraged and empowered more women to pursue their careers.
Self-confidence is both a catalyst and an outcome of a multifaceted process that is somewhat circular. Exposure and experience serve as invaluable guides, shaping a woman’s drive to aspire to and achieve more. These experiences nurture her ability to identify opportunities, develop resourcefulness, and master the art of forging meaningful connections with peers. Empowerment is the cornerstone for women to chart their paths forward, gain a deeper understanding of opportunities, and hone essential skills.
Leveraging problem-solving skills and a proactive approach bolsters personal confidence and contributes to the growth of an entire team. Women, often less self-assured than their male counterparts, can promote empowerment initiatives focused on education and development of professional knowledge and skills.
Optimism and the expression of confidence in one’s competency are potent drivers of self-assuredness. Leaders who exude optimism can instill a similar mindset in their followers, catalysing increased confidence levels. Sometimes, all it takes is a modicum of confidence to enhance one’s competency, ultimately contributing to both individual and collective success.
Resilience is also closely connected to self-confidence that grows in facing challenges. An interviewee shared her experience as a mountain climber and how it impacted her ability to navigate in leadership: “I have done a lot of climbs and saw death in the face multiple times. Once you have faced death, no challenge, at work, scares you anymore – you just deal with it calmly and take it step by step”.
In the mosaic of self-confidence development, genetics may play a role, but the overwhelming evidence suggests that confidence is a trait that can be learned and fortified through a combination of experiences, support networks, education, and a proactive attitude. As women continue to ascend in leadership, these holistic approaches will serve as beacons guiding their path to self-assurance and, consequently, to greater heights in their careers.
Recommendations on empowering women
Addressing the cultural influences and self-confidence trajectories for women in healthcare leadership is not just a moral imperative but a strategic necessity. It requires a holistic approach that recognizes culture as a root cause, fosters education and exposure, challenges norms, and actively supports women’s progression. With a systematic approach, organizations can contribute to a more equitable, empowered, and innovative future for women leaders in healthcare, ultimately benefiting the industry and society as a whole. The time for change is now, and the benefits will be felt for generations to come. The World Hospital Congress is an incredible opportunity for us to put this wish into practice as we connect with leaders who truly believe in taking the right steps towards a better world.
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Young Executive Leaders 2023
IHF Member: Cedars-Sinai, USA. Supports efforts in building collaborations and partnerships with governments and leading healthcare institutions around the world.
Royal Hospital, Oman
Fahima Al Harthy
Head of Maternity Unit
Young Executive Leaders 2023
IHF Member: Ministry of Health, Oman. A staff nurse/midwife by training, she leads the maternity department as a unit nurse.
Centra Health, USA
Senior Director, Service Line Strategy
Young Executive Leaders 2023
IHF Member: Vizient, USA. Service line strategic planning, and building inspired environments to develop teams to provide care for patients and communities.
MP Shah Hospital, Kenya
Dr Nikita Ajay Raval
Head of Accident and Emergency
Young Executive Leaders 2023
IHF Member: MP Shah Hospital, Kenya. Clinical and administrative responsibilities for the unit and also in charge of the Mass Casualty Incidence Committee.
Evex Medical Corporation, Georgia
Head of procurement and logistics unit
Young Executive Leaders 2023
IHF Member: Evex Medical Corporation, Georgia. Responsible for the purchase of products, supplies, equipment related services, as well as building relationships with suppliers and partners.
Reviewers: Rizza Jean Rivera (YEL 2022, Philippines), J. Antônio Cirino (YEL 2021, Brazil), Dr Yosra Rashed Alsalami (YEL 2022, UAE)