Leadership / Liderança

Advancing Women’s Leadership in Academic Healthcare –

Why is it important? What is the benefit?

What is the way forward?

Page Morahan, February 2014

Current status:

In most countries, women have been accepted into the professional ranks of academic medicine, dentistry, nursing and other health professions. However, Kilminster and colleagues [1] have recently reported that, although changes in the gender composition of medicine have been reported from the UK, Netherlands, Norway, Sweden, Finland, Russia, Australia, Canada and the US, “all still show horizontal (women concentrated in certain areas of work) and vertical (women under represented at higher levels of the profession) segregation” despite their different health care systems and social contexts. [italics added for emphasis]

Much evidence documents the persistent vertical segregation, sometimes referred to as the glass ceiling or the sticky floor, in traditionally male-dominated organizations. A recent issue of Nature devoted to advancing women in science commented about why progress has stalled, “Childcare is one major factor…but that is a practical issue…Even the most enlightened childcare policies will not fix a second, more insidious major problem: overt or unconscious gender bias. It can be detected even in female scientists, and even…in those who actively promote women within science.”[2]

In a recent study, we found that there were only 38 women deans of U.S. medical schools between 1980 and 2006, compared with 496 men. (http://journals.lww.com/academicmedicine/Fulltext/2012/08000/Gender_Related_Differences_in_the_Pathway_to_and.12.aspx). Although their representation now is at about 15%, this is still far below the critical mass theory that says that 25-30% of a minority is necessary to effect qualitative cultural improvements in a system (see Discussion in the paper).  

Gender inequity extends to all of higher education, to most healthcare practicitioners [3], and to corporate America.  Kunin [4] has recently noted, “The academic world has been seen as a green space where life is fair…But, academia and science stand out as two professional fields where women continue to lag behind men.” The Alliance for Board Diversity has recently analyzed 2010 data from Fortune 500 companies and found that women lost ground between 2004 and 2010. “White men still overwhelmingly dominate corporate boards …Women…did not see an appreciable increase in their share of board seats.”  (http://theabd.org/Missing_Pieces_Women_and_Minorities_on_Fortune_500_Boards.pdf) Among the high tech “hottest new companies – Facebook, Twitter…none...has a female director on its board” (http://www.newyorker.com/reporting/2011/07/11/110711fa_fact_auletta#ixzzIU4TTINCK). Commenting on this, Kunin[5] notes: “What are these young men thinking? Despite being on the cutting edge of modern technology, they are in a time warp when it comes to women in leadership, not unlike their fathers and grandfathers.”

What is academic healthcare losing without women’s leadership perspective?

Over 10 years ago, Janet Bickel and I wrote about the need to capitalize on women’s intellectual capital in academic medical leadership. (http://journals.lww.com/academicmedicine/Fulltext/2002/02000/Capitalizing_on_Women_s_Intellectual_Capital_in.3.aspx) Unfortunately, although considerable evidence has continued to emerge in the past decade about the benefits brought by gender diversity in leadership, it has yet to become manifest in academic health centers.

What’s the benefit – why worry about women in leadership? Organizations with women in leadership have increased revenues, reduced costs, greater innovation, and increased employee engagement, productivity, and commitment (http://www.catalyst.org/knowledge/topics/business-case).  The National Center for Women and Information Technology reports that mixed-sex teams produce the most highly cited patents. (https://www.ncwit.org/sites/default/files/resources/2012whoinventsit_web_1.pdf). There’s better governance on corporate boards when women are about 25-30% of the membership. http://www.wcwonline.org/pdf/CriticalMassExecSummary.pdf) The numbers of women faculty are increased in association with the presence of women in academic leadership and on university boards (http://www.ilr.cornell.edu/cheri/upload/cheri_wp127.pdf). These are a small sample of the large literature documenting the positive impact of women in leadership.

In healthcare and medical research, the first major initiatives on women’s health research started under a woman NIH director.  Senator Susan Collins (R-ME) has said, ‘‘Women…bring different perspectives than men do to public policy issues…I don’t think it’s a coincidence that federal funding for women’s health care research went up once more women were elected to the House and Senate. We ensure that concerns that affect women disproportionately are brought to the table.’’  I don’t believe it was a coincidence that it took a woman president at Princeton, Shirley Tilghman, before a faculty benefit was destigmatized; delaying the tenure clock to allow faculty more time to achieve tenure after birth of a child was made mandatory for both men and women faculty.

Even the financial guru, Warren Buffet has become a believer in the benefits of gender diversity, saying “…an even greater enemy of change may well be the ingrained attitudes of those who simply cannot imagine a world different from the one they’ve lived in…So, my fellow males…get onboard. The closer that America comes to fully employing the talents of all its citizens, the greater its output of goods and services will be. We’ve seen what can be accomplished when we use 50% of our human capacity. If you visualize what 100% can do, you’ll join me as an unbridled optimist about America’s future.” (http://money.cnn.com/2013/05/02/leadership/warren-buffett-women.pr.fortune/)

Finally, we are at a unique period in human development. Sally Helgeson [6] has recently stated, “…men, women and children all increasingly use the same technologies to perform most of their routine tasks. It is startling to consider that this is actually the first time in human history that men and women have used the same primary tools in their work…Now that we all employ the same devices, our daily experiences have become more similar. This has the effect of freeing both men and women from generic expectations linked to gender.”

Why are we still living with the historical artifact of workplaces that were designed by wealthy EuroAmerican men for EuroAmerican men, given all this evidence about the benefits of gender diversity in leadership?  Kunin writes, “…many women who have careers…are still flummoxed by the most age-old problem: how to have a job and take care of the children, the elderly, the sick, and the disabled. Until we find a way to sort out how to share these responsibilities – between spouses, partners, employers, and governments – gender equality will remain an elusive goal.”[7] Isn’t it time to move beyond the outdated sociocultural norms to those more suited for our current century and embrace diversity in leadership – diversity in gender being one important element?

Achieving  gender diversity in academic healthcare leadership – The way forward

I propose several approaches. The first is an organizational development approach we call the leadership continuum,[8] combining the framework of Ely and Myerson[9] with career stages. Organizations can assess their status and decide where to strategically focus their efforts – at early or mid-to-senior career stages – and in equipping women with needed skills, creating equal opportunities, valuing relational skills and increasing visibility of women, or assessing and revising the work culture. Ely and Myerson [9] emphasize that while the first three areas are necessary, they are not sufficient unless the work culture and entrenched sociocultural norms are addressed. Our conceptual model for leadership development for women emphasizes this point.[10] For example, the U.S. National Science Foundation (http://www.nsf.gov/crssprgm/advance/) has sponsored institutional culture transformation grants (ADVANCE) for advancing women in STEM fields since 2001, and significant incremental changes in individual universities have been achieved. We have studied the outcomes of our national ELAM program to advance senior women faculty in medical, dental and public health schools; our results show significant advances when graduates are compared with matched women who have not attended (http://journals.lww.com/academicmedicine/Fulltext/2008/05000/Evaluating_a_Leadership_Program__A_Comparative,.13.aspx) , and deans of medical (http://journals.lww.com/academicmedicine/Fulltext/2009/01000/Medical_School_Deans__Perceptions_of.23.aspx) and dental [11] schools see positive impact on their organizations. [12]  However, neither of these initiatives nor others have yet produced a substantial national change in the sociocultural norms.

Additional strategies, often moving beyond organizational development, are needed. The emerging relational gender theory[13] can inform these; this theory states that gender is a multi-dimensional social structure, linking economic, power, affective and symbolic relations. The research has highlighted processes by which social worlds come into being and change through time, such as evolving meanings (e.g., woman, wife, man) and gendered meanings and power dynamics of voice and authority in the health workforce.

One approach involves women developing true collaborations and social activism with ALL women, not just well educated white women.  This requires moving from competition to cooperation to build trust-based coalitions among white women and women of color – and between upper and lower income women – and between women with young children and single and elder women. Women need to realize that they are on the women’s team. As Madeline Albright has famously said, "I think there is a special place in hell for women who don't help other women." Women in leadership are particularly visible, and thus have increased vulnerability when they navigate inevitable missteps. I have long recommended that each woman leader get an external executive coach or trusted mentor(s) for confidential, unbiased listening and advice.

Engaging men in advancing women is equally important. Examples include Catalyst’s MARC program (Men Advocating for Real Change) (http://onthemarc.org/home) and the National Center for Women and Information Technology’s resources to assist men in becoming advocates (https://www.ncwit.org/resources/read-online-maleadvocate).  One particular role men can play is sponsoring women; research is showing the importance of men in sponsorship, in addition to mentorship, in advancing women.

Reframing the feminist political agenda to focus on family and economics is perhaps the most far ranging approach to shifting outdated sociocultural norms. Kunin[14] advocates developing broad based political coalitions to advocate that investment in family/work policies fosters economic growth for now and future generations. In our work, we emphasize that advancing women is an organizational investment and changes benefit both men and women faculty. It’s no longer just a ‘woman’s issue’ with the demographic shifts occurring globally.

In sum, advancing women’s leadership in academic medicine requires a coordinated strategy in interrelated approaches – and at the individual, organizational and national levels. Do we have the will to start?

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[1] Kilminster S, Downes J, Gough B, Murdoch-Eaton D, Roberts T. Women in medicine – is there a problem? A literature review of the changing gender composition, structures and occupational cultures in medicine. Med. Educ. 2007; 41:39-49.

[2] Editorial. Science for all. Nature. 2013; 495 (7 March): 5

[3] Seabury SA, Chandra A, Jena AB.Trends in the Earnings of Male and Female Health Care Professionals in the United States, 1987 to 2010. JAMA Internal Medicine. 2013; Sept. 2: E1-3.

[4] Kunin MM. Revolution for women, work and family.White River Junction, VT; Chelsea Green Publishing. 2012: Chapter 10.

[5] Ibid. Kunin. Chapter 9.

[6] Helgesen S. Leading in 24/7: what is required? Leader to Leader. 2012; Summer:38-43.

[7] Ibid. Kunin. Chapter 1.

[8] Morahan PS, Rosen SE, Richman RC, Gleason KC. The Leadership Continuum: A Framework for Organizational

and Individual Assessment Relative to the Advancement of Women Physicians and Scientists. J. Women’s Health. 2011; 20: 1-10.

[9] Ely RJ, Meyerson DE. Theories of gender in organizations: A new approach to organizational analysis and change. Boston:

Center for Gender in Organizations, Simmons School of Management, 2000.

[10] Magrane M, Helitzer D, Morahan PS, Chang S, Gleason KA, Cardinali G, Wu C-C. Systems of Career Influences: A Conceptual Model for Evaluating the Professional Development of Women in Academic Medicine. J. Women’s Health. 2012; 12: 1-8.
[11] Dannels SA, McLaughlin JM, Gleason KA, Dolan TA, McDade SA, Richman RC, Morahan PS. Dental School Deans' Perceptions of the Organizational Culture and Impact of the ELAM Program on the Culture and Advancement of Women Faculty. J. Dental Education. 2009; 73: 676-688.

[12] Morahan PS, Gleason KA, Richman RC, Dannels S, McDade SA. Advancing Women Faculty to Senior Leadership in U.S. Academic Health Centers: Fifteen Years of History in the Making. J. About Women in Higher Education. 2010; 3: 137-162.

[13] Connell R. Gender, health and theory: conceptualizing the issue, in local and world perspective. Social Science & Medicine. 2012; 74:1675-1683.

[14] Ibid. Kunin. Chapter 2.