23 Mar Transforming Healthcare
Women leaders are uniquely positioned to drive change
By Heather Boerner
When Christine Candio started as a bedside nurse 33 years ago, the roles were clear—and segregated by gender. Most physicians were men and most nurses were women. And the hierarchy between the two was strict.
“If a physician came into your department, you got out of your chair so the physician could sit down,” she says. Then she adds, “We’ve come a long way.”
Candio, especially, has come a long way. In 2015, she became the president and chief executive officer of St. Luke’s Hospital in Chesterfield, Missouri. And she’s not alone. It used to be that the C-suite of just about all hospitals and health-care organizations were occupied by men, despite the fact that the vast majority of the health-care workforce was female. Today, about 41 percent of health-care executives worldwide are women, according to a 2015 report by the consulting firm Grant Thornton. That’s second only to education and social services as an industry with high representation of women at the top.
While women’s representation in health-care leadership still lags behind their representation in other industry positions as a whole, experts say the future looks bright. A combination of research and organizations fostering women leaders’ development, along with the rapidly changing skill set required to navigate a more team- and patient-centered health-care approach, means women are poised to make even more gains in coming decades.
“There’s still a ways to go in women in leadership,” says Deborah Bowen, president and CEO of the American College of Healthcare Executives (ACHE), which counts 48,000 C-suite or aspiring C-suite executives among its members. “No one works alone in this [health-care] environment today. We’re all accountable to upstream and downstream stakeholders to work with other people. So the nature of women as collaborators means that the outlook is optimistic for women leaders.”
Moving on from the bad old days
Women still have considerable ground to make up for in health-care leadership. According to a 2016 report on health-care gender diversity by health start-up Rock Health, women represented only 20 percent of Fortune 500 health-care leadership teams. In none of them did women account for more than half of C-suite positions, and none of the CEOs of companies in the health-care industry Fortune 500 were women. Data from the American Hospital Association shows that only 28 percent of hospital systems nationwide are run by women.
“So are women making progress?” asks Bowen. “Yes they are, in the breadth and depth of roles they are playing in organizations. But it’s a little more sluggish in CEO roles.”
But in the last few decades, several things happened at once. First, the age of the American population and the diversity of that population were changing. The average patient was no longer a Caucasian man or his family. Women were caring for both their aging parents and their children, and those women increasingly were brown or black and immigrants.
At the same time, health-care organi-zations began to focus their recruitment and retention efforts on diversifying their executive leadership. Programs ensured that women were involved in decision making and were groomed for leadership, and that diversity initiatives built into the core of business helped move women from traditional support roles into leadership—and those already in leadership toward the C-suite. All this is according to an ACHE white paper on gender diversity, which found that such programs have been around since at least 2006.
Perhaps because of these two trends, a third thing happened: all these changes began to bubble to the surface. ACHE began to track gender issues in promotion and leadership, for instance, and report them publicly every five years.
Then came a leadership change in another industry—media—which redirected the public conversation again. In 2001, Fawn Lopez began working at Modern Healthcare, a well-respected health-care business publication. In 2005, she became its publisher. Right away, Lopez says, she saw the gender disparity in health care. Often, she said, she was the only woman in any room of health-care executives.
“It became my personal goal, through the magazine, that I wanted to help women, both senior executives and up-and-coming female leaders, to improve by providing a platform, a venue, a spotlight, and recognizing the work and efforts of women and minorities,” she says. “It’s not just the demographic base of our health-care industry—the patient base has changed. It’s more diverse. And not just the patient population but also the employment pool. And women are the decision makers for health care. So we need women in positions where the important, critical decisions are being made.”
So 13 years ago, Modern Healthcare launched a biennial Top 25 Women in Healthcare list. The goal, says Lopez, was to “put the spotlight on and recognize the great work that women in leadership were doing.”
That was followed a few years later by the launch of Modern Healthcare’s Women Leaders in Healthcare Conference. With themes like “Shaping the Future of Healthcare” and “On the Front Lines of Transformation,” the two-day conference is a networking and leadership training opportunity for women (and a few “brave men,” Lopez says) designed to foster mentorship and women’s leadership pipeline.
Acknowledging women’s power
Part of the appeal of the conference, Lopez says, is recognizing the central role women play in the health-care decisions of their families.
“People tell us that they learned so much from the conference that can help them better understand the issues, and how women deal with issues,” she says. “We make decisions differently; we process information differently. So our conference is not a conference where people complain about their spot in life, but is a venue where people can share, collaborate, and learn from one another about the issues they face, operationally and managerially and in terms of leadership issues, too.”
This speaks directly to the power of women in health-care leadership, say Lopez and others. Because of how women are socialized to value relationships and collaboration above all, they are uniquely suited to tackle the other major shift in the health-care industry in the last decade: the Affordable Care Act and a shift in how health-care organizations are compensated for their care.
The shift, says ACHE’s Bowen, is from fee for service—that is, a hospital is paid a specific amount for a specific procedure—to value- and population-based reimbursement per episode. In this new system, health-care organizations are increasingly asked to center on the patient experience and shape services around patients so they don’t become readmitted to the hospital.
“When you’re paid on cost and quality, you’re forced to reorganize the way health care is delivered,” says Bowen. “That means personnel like advance-practice nurses are going to be playing an increasingly influential role in understanding how to redesign those systems to help patients. Those closest to the patient are the most knowledgeable, and this is an enormous opportunity for women.”
That opportunity seems to be showing up in the statistics. In 1990, very few of ACHE’s members were women. By 2000, they made up one in four. A decade later, about one in three ACHE members were women.
Today? New members are about half women and half men, Bowen says.
“If we were to project 10 to 20 years in the future,” she says, “it’s likely that males would be the new minority. It’s interesting to think about.”
This year, Modern Healthcare’s Women Leaders in Healthcare Conference sold out.
Leveraging women’s strengths
The increasing importance of women’s decision-making power in the health-care lives of their families has certainly impacted Pam Kehaly’s rise. Kehaly, president of Anthem’s west region, needs to understand health-care consumers in order to make sure the company’s insurance products will hit the mark. Being a woman, she says, can give her a leg up.
“When I sit down and look at market research, or talk about how to position a product from a marketing or sales perspective, I can see it from the vantage point of most of our buyers,” she says. “And look—your input is either right or wrong. But I think because I’ve got that vantage point, I’m probably more right than wrong.”
There’s another advantage to women’s leadership style, at least in the general sense, says Kehaly and Candio: an emphasis on value. Now that she’s reached her current level, Kehaly says, she’s not as focused on reaching the next level. The focus has shifted to how she can provide the most value to the company and to the customer. The question now, she says, is “Where can I make a contribution?”
Candio sums up this mind-set simply: “One of my purposes in life is to serve others.”
“I’m a true believer in servant leadership,” she says. “Health care today is in an exciting and challenging time. But I always say to folks we need to stop looking at this as [regulations] being imposed upon us. This is like anything in life, especially being a woman. We know the incline for us could be a little steeper. We need not look at it as steep, though, and instead see it as a rewarding challenge.” DW
Heather Boerner, a health-care and science writer based, is the author of Postively Negative: Love, Pregnancy, and Science’s Surprising Victory Over HIV.