The Top 25 Women in Healthcare: Gender diversity a work in progress

Dr. Lynn Simon returned to school for a master's degree in business a decade after entering practice as a neurologist.

She put both degrees to work as she was repeatedly promoted, including in her most recent role as chief quality officer and president of clinical services for Community Health Systems, a large hospital chain.

Simon, one of Modern Healthcare's Top 25 Women in Healthcare for 2015, accepted the challenges and accompanying anxieties of new opportunities.

That's the advice she gives to people seeking to advance their careers. “It's a matter of getting outside your comfort zone,” she said. “Take on risk.” She did that again in March when she assumed responsibility for Community's physician practices.

But for women who aspire to healthcare's executive-level roles, advanced education and the willingness to take risks may not be enough. Surveys of corporate leadership and healthcare management point to a continued, though narrowing, disparity of women to men in leadership roles. That's part of a broader lack of diversity in corporate leadership by gender, race and socio-economic status, experts say.

In 2012, an American College of Healthcare Executives membership survey found the ratio of women to men among healthcare CEOs was lopsided even after adjusting for tenure. Twenty-two percent of male executives surveyed were CEOs, while only 11% of female executives surveyed were CEOs. Women also earned less than men with the same education and experience. The median salary for men, $166,900, was 20% greater than for women.

“There remain tremendous inequalities,” said Lawrence Prybil, professor of health management and policy at the University of Kentucky. “It has to change.”

There is no scarcity in the pipeline for talented female executives. Women account for nearly half of law school and medical school graduates, and they make up one-third of all graduates in MBA programs. “Education level is not the problem,” said Paula Bobrowski, associate dean for research and faculty development at Auburn University.

In addition, women dominate the healthcare workforce by a ratio of 3-to-1.

But organizations need to develop and expand efforts that promote opportunity for women at the top levels of management. “Most of the healthcare workforce is women, (but) the rate at which they're rising is the stumbling block,” said Deborah Bowen, CEO of the American College of Healthcare Executives. She's also one of this year's Top 25 Women in Healthcare.

Mentoring and career-development programs can give women exposure to new opportunities as well as visibility within an organization. “There are a lot of women in middle management and they get stuck there,” said Bobrowski, who earned degrees in nursing and business administration but left healthcare for academia where she saw more opportunity for advancement.

Progress in recent years has increased the number of women in the healthcare C-suite.

“The (healthcare) sector, in my experience, is ahead of general commercial sector,” said Michael Peregrine, a corporate governance attorney with McDermott, Will & Emery. Yet more progress is needed, he said.

The women's advocacy organization Catalyst reported that women accounted for 14.6% of all executive officers at Fortune 500 companies in 2014, not much different than the 13.5% five years earlier. “It is incumbent on the board to be sensitive to issues of gender diversity at every level,” Peregrine said. The board that ignores or rejects diversity “will be an outlier.”

Healthcare organizations have made investments in recent years to boost diversity among executives, thanks in part to governing boards that increasingly have focused on the diversity of their organizations' leadership teams. Susan O'Hare, senior vice president for Integrated Healthcare Strategies, who consults with healthcare companies on leadership and governance, said boards are taking notice when their organization's C-suite gets “heavily gender-weighted toward the gender of the CEO.” Boards also face growing pressure to diversify their membership.

“Boards have become increasingly aware of diversity at all levels,” said Dr. John Combes, president and chief operating officer of the Center for Healthcare Governance and a senior vice president at the American Hospital Association. But there are steps that boards can take to address the need for more women at the top.

Boards hire and evaluate CEOs, who select other members of the C-suite. Some governing boards include upper-management diversity in their evaluation of CEOs, Combes said. When recruiting CEOs, some boards instruct executive search firms to seek a more diverse candidate pool.

Healthcare organizations have adopted other policies to address diversity of the management and executive workforce. The 2012 ACHE survey found that a zero-tolerance policy for sexual harassment was the most widespread practice adopted by organizations to promote gender diversity.

Half of respondents said their organizations offered career-development programs. One-quarter reported that the board or senior executives reviewed the diversity of individuals promoted within the company; the same percentage reported formal mentoring programs. Another 28% targeted healthcare management training to clinicians, including nurses. The nursing profession, the largest occupation in healthcare, is often overlooked when recruiting for leadership or governance.

Organizations that lack gender diversity miss valuable insights in their decisionmaking processes. “If you believe in the importance of adding new insights and new perspectives to the dialogue, then you start thinking, 'Why not have gender mix?” Prybil said. Diversity more broadly can contribute positively to decisionmaking, according to research, he said.

Even with stronger diversity efforts, women who want to advance to the top ranks have to boldly take initiative.

Patricia Maryland, president of healthcare operations and COO of Ascension Health, said “the willingness to risk and be willing to work in a more difficult and challenging environment helps you to grow. You learn new skills and it allows you to build your portfolio of capabilities and competencies that you need to take on more responsibility.”

She was promoted to COO of Ascension from her role as CEO of St. John Providence Health System, Warren, Mich., and head of all of Ascension's Michigan operations.

Mentoring is critical, too. “There is a natural tendency to say, 'Wow, that could be me,' ” said the ACHE's Bowen. She looked to female leaders at her organization for advice when she was hired as COO in 2003.

Maryland said she also benefited from mentors throughout her career, has served as a mentor and has urged more executives to act as mentors. Maryland recruited a former mentor, Gwen MacKenzie, to step in as head of Ascension's Michigan market when she got promoted. “I know her and we support each other,” Maryland said.

For healthcare organizations, Maryland said, the value of greater diversity in upper management is “not only the right thing to do” but a necessity. That diversity, she added, can improve leadership's understanding of what investments to make “as we look at health of people and how we deliver what they need.”