Beyond the glass ceiling

As the country ushers in new ways of delivering and financing healthcare, many of the industry's thought leaders, policymakers and watchdogs will be remarkable not just for their expertise, but also because they represent a group of visionary female leaders.

The ranks of women executives are growing at a time when a national conversation has refocused on how to get more women to aim for the highest ranks of their professions. In healthcare, women are moving up in the industry at a time when significant change and even upheaval are taking place.

Key government healthcare agencies—including HHS, the CMS and the Food and Drug Administration—have women at the highest administrative levels, and several are included in the 2013 roster of Modern Healthcare's Top 25 Women in Healthcare.

Among those names are HHS Secretary Kathleen Sebelius and Marilyn Tavenner, who has served as acting CMS administrator since late 2011.

A confirmation hearing for Tavenner is set for this week before the Senate Finance Committee. If confirmed, she would be the first Senate-approved CMS leader in more than six years.

Before moving into government, Tavenner had a 25-year career at for-profit health system HCA—first as a nurse, then hospital CEO, before running the Central Atlantic division and finally serving as group president of outpatient services.

“I've always been a pretty optimistic person,” she says, recalling why she moved from nursing into management. “So I was always like, 'I think if I could be the manager, I could make this work better for people.' ”

Tavenner points to three challenges facing women healthcare executives. She notes that women tend to be drawn to clinician roles, but emphasizes that they need to be comfortable understanding the financial workings of healthcare delivery.

“Really learn finance and how finance works,” she says.

Women also need to take risks, she adds. “You can't just work in your comfort zone,” she says. “Maybe be willing to take the job that everyone else isn't migrating to and make it work for you.”

Finally, women and men need to be comfortable working together. “You've got to make sure you have diversity represented in your management team,” she says.

Industry reports and government data show women still remain significantly underrepresented in executive suites across healthcare. A study last year from Rock Health, a group that supports digital health startups, found that women make up only 18% of hospital CEOs and 4% of healthcare company CEOs.

Citing 2011 data from the Bureau of Labor Statistics as well as industry reports, the study found that while women accounted for 73% of medical and health services managers and 47% of recent medical school graduates, the numbers fell off further up the ranks.

“The needle is moving, but it's moving slowly,” says Deborah Bowen, incoming president and CEO at the American College of Healthcare Executives. Hospital boardrooms don't reflect the communities they serve, and “we know that diversity in leadership is one of our challenges.”

But women who have broken through the barriers attest to an industry that's more welcoming of female leaders and to more female voices being added to the discussion about the future of healthcare.

When several of this year's Top 25 Women honorees were asked what guidance they would give to young women in their field, two pieces of advice stood out: find a mentor who believes in you and don't be afraid to take risks.

Leah Binder did exactly that at the start of her career at the National League for Nursing, where she handled policy and communications. “I was mentored by two extremely fabulous women,” she says, naming Pamela Maraldo, the organization's former CEO, and Claire Fagin, the first female dean of the University of Pennsylvania's School of Nursing.

Binder is president and CEO of the Leapfrog Group, a self-described industry watchdog, particularly in the area of patient safety. It is best known for its hospital quality and safety survey, and recently introduced an updated hospital safety score, which grades facilities on how well they prevent medical errors, accidents, injuries and infections.

The group is now focused on outcomes in maternity care, Binder says, and its most recent focus has been on early elective deliveries, or those that occur before 39 weeks without a medical reason. In February, it released data showing that the number of reporting hospitals with an elective delivery rate of less than 5% had increased to 46% from 39% in 2011.

“We're going to advocate for transparency because that's the secret sauce,” Binder said.

Binder notes that her early years at the National League for Nursing helped shape how she views healthcare delivery. “I see the healthcare world from the nursing model of care,” she says, citing patient centeredness, care coordination and whole-patient care as its key attributes.

Dr. Risa Lavizzo-Mourey, who heads the Robert Wood Johnson Foundation, cited an African proverb when asked about her advice to young female health professionals: “If you want to go fast, go alone; if you want to go far, go together.”

It's also the way she confronts some of the country's most pressing public health issues as president and CEO of the RWJF, a philanthropic organization that tackles issues such as childhood obesity and healthcare accessibility.

Lavizzo-Mourey, who practiced medicine as a geriatrician before serving in Washington as deputy administrator for what is now the Agency for Healthcare Research and Quality, notes that changing behavior requires collaboration among many different stakeholders.

“If we all work across those sectors and keep (our) primary concerns about the patient … we have a chance of improving the healthcare system,” she says.

The foundation, for instance, is currently working to understand the policy changes that help decrease obesity rates—whether it's taking junk food out of school cafeterias and vending machines or increasing the percentage of kids who get regular physical activity.

“Seeing the childhood obesity rates begin to turn down was a very proud moment,” she says. “To me, that culture of health and creating a culture of health is a very exciting opportunity.”

Maureen Bisognano, president and CEO of the Institute for Healthcare Improvement, has also seen the importance of breaking down some of the silos that exist in medicine, even among different healthcare practitioners. While working on a maternal health project, for instance, she discovered that doctors and nurses even learn different terminology to describe a woman in labor.

“We're educated in different ways,” she says. “We're finding different parts of the system don't speak the same language.”

The IHI currently offers a virtual school for healthcare professionals that has seen 130,000 students enroll in just a few years. “It's an inspiring project,” Bisognano says.

She also remembers the moment that upended everything she thought about healthcare. It was supposed to be a routine checkup for her 4-month-old nephew, when he was due to receive the next dose of the DPT vaccine.

Her sister tried to warn the pediatrician about what had happened after the first DPT dose two months earlier—when the shot sparked an allergic reaction so severe that the baby had to be hospitalized. The pediatrician, considering and then dismissing a possible link between the vaccine and the illness, decided to administer half a dose.

The baby died 24 hours later.

For Bisognano's sister, three questions remained: Why didn't the doctor have the correct information? Why did he give half a dose? Why didn't he listen to me?

“The pull to healthcare improvement came quite early in my career,” says Bisognano, who initially trained to be a nurse.

Bisognano eventually joined the leadership team at IHI, and in 2010 she took the reins from Dr. Donald Berwick after he became CMS administrator. She has spent almost two decades at the not-for-profit organization, which works with providers, government agencies and other entities to improve healthcare safety and quality on a global scale.

“We're working on what we call the 'triple aim,' ” she says, citing population health, the patient experience and cost per capita. “I think we need to shift from 'what's the matter?' medicine to what matters to you. If we're going to create health, we're going to have to create a specific culture in our community.”

Debra Osteen, a senior vice president at Universal Health Services, sees a changing culture for behavioral health—a growing acceptance and awareness of behavioral health disorders.

As the head of the publicly traded hospital giant's behavioral healthcare division, Osteen has helped grow the number of psychiatric hospitals it operates from 23 to 197, with revenue swelling from $200 million to $1.4 billion.

“We've always looked at each acquisition on its own,” she says. “Sellers often come to us, and I think they saw our strong track record.”

Osteen was instrumental in UHS' $3.3 billion acquisition of Psychiatric Solutions and its 71 behavioral-health hospitals and other facilities in 2010, and the $517 million takeover last year of nine-hospital Ascend Health Corp.

She also expects mental health to continue to be a growing area, as the stigma attached to treatment lessens and there's more attention to access to and funding of care.

But while the company is results driven, it is also mission-oriented, Osteen says, noting that she is proud of services it provides, for instance, to military servicemen and women trying to overcome combat stress or chemical dependency.

Dr. Ardis Hoven, president-elect of the American Medical Association, knew from the age of 7 that she wanted to be a doctor. The daughter of a minister and missionary, she told her father that she wanted to go into missionary medicine.

“And he promptly told me,” she recalls, “there are a lot of mission fields here in the U.S.”

Indeed, as an infectious-disease specialist treating patients with HIV in the early 1980s, she saw firsthand how young men would often lose their jobs and health insurance after their diagnosis. And it impressed upon her, she says, “the role of advocacy and what physician voices can do.”

When she steps into the president's role in June, she plans to tackle a host of issues, including physician education, medical liability reform, the controversial Medicare sustainable growth-rate formula and more efficient healthcare delivery.

“We need to have physician-led, team-based care,” she says.

Women are natural caregivers, Hoven notes, but as their numbers in medicine grow, they need to come to the table ready to offer new ideas for healthcare delivery. She says more women are starting their own practices and more female practitioner voices are being heard.

“Physician leadership is probably the most difficult on the local level,” she says. “Don't be afraid to push the envelope.”

Bowen, of ACHE, similarly encourages women to pursue more post-graduate education and volunteer for assignments and new experiences—which she also describes as something she plans to focus on in her new role, effective next month. “The success of any leader is connected to lifelong learning,” she says. “This is a business, but it's a business with a calling.”

One of the biggest changes Lavizzo-Mourey says she's seen in the healthcare industry is simply the number of women who now enter the field. “That has meant a couple of things in the practical sense,” she says.

Women not only have a “cohort of women they can turn to,” but increasingly more women are mentoring other women. “I think there's a lot of glass ceilings around, but they've been shattered so many times,” she says.

Tavenner notes that as the world is “changing and improving,” it may be only a matter of time before more women are in the C-suite. “I think we all tend to migrate to people who think like us, act like us, sometimes look like us, but you need that diversity,” she says. “And that diversity brings a lot of experience and brings new opportunities.”

She adds, “And I always tell people: Keep your sense of humor. Make fun of yourself. Be able to apologize.”

—with Jessica Zigmond

TAKEAWAY: High-profile women in healthcare cite mentoring, risk-taking and collaboration as key to advancement in leadership roles.