Female leaders aim to reshape healthcare, despite the C-suite's gender gap

NASHVILLE—The numbers paint a pretty stark picture: Despite making progress, healthcare still has a tremendous gender gap in the C-suite.

White women accounted for 27% of executive positions at healthcare companies in 2017. Black women made up just 3%. And women in healthcare are 25% less likely than men to be promoted to senior manager or director even though they ask for promotions as often as men, according to data from Mc-
Kinsey & Co. “The case for gender diversity has to be made, and it has to be made compellingly,” Jennifer Stanley, expert partner at McKinsey, told the nearly 300 executive attendees at Modern Healthcare's Women Leaders in Healthcare event this month in Nashville.

Companies must set targets to promote diversity and hold someone accountable for meeting those goals, she said, adding that there's strong evidence that companies perform better financially when their leadership positions reflect gender and ethnic diversity. Frontline managers should be trained to be aware of unconscious bias and call out behavior that's not inclusive.

During the event, Providence St. Joseph Health announced its new #NotHere campaign to give female employees in the system a voice if they are sexually harassed.

But more importantly, the system's leadership is committed to creating a workforce where that behavior is not tolerated. The campaign encourages anyone who sees threatening or inappropriate actions to come forward and make formal complaints.

Debra Canales, the system's executive vice president and chief administrative officer who is leading the #NotHere campaign, said that every caregiver knows sexual harassment has no place at Providence St. Joseph Health.

The makeup of the system should make it a little easier to implement more stringent policies. About 75% of the entire Providence St. Joseph workforce and more than 50% of senior executives are female.

Christine Malcolm, executive director of the Carol Emmott Fellowship for Women Leaders in Healthcare, urged the audience to include men in the fight against sexual harassment.

Malcolm recalled that during the women's movement of the 1970s, women activists unwittingly alienated men who were sympathetic to their cause by signaling that “we had it handled; that we didn't need them,” though enlisting men's help could have driven change further and faster.

She said inviting men to join women in the #MeToo and #TimesUp fights against sexual harassment and assault is critical.

Keynote speaker Dr. Claire Pomeroy, president of the Albert and Mary Lasker Foundation, said overhauling the healthcare system requires the full participation of women leaders.

“Improving our ability to compete with the boys does help in the immediate, but I don't think it's the right answer,” Pomeroy said. “We must change our culture to truly value and celebrate women and embrace diverse skills.”

Speakers also urged executives to take charge in creating a healthcare system that keeps people healthy by looking beyond clinical processes to factors like education, access to nutritious foods, safe housing and jobs.

Dr. Karen DeSalvo, former chief of the Office of the National Coordinator for Health Information Technology, spoke of her experience taking care of New Orleans residents in makeshift clinics after the flooding following Hurricane Katrina devastated the city in August 2005. That informed her vision to remake the city's healthcare system into one that meets patients out in the community and focuses not only on physical health, but also mental health and social needs.

DeSalvo, who was a professor at Tulane University School of Medicine when the storm hit—and years later would become New Orleans' health commissioner—led efforts to set up clinics on the streets once it was clear that the city's Charity Hospital, which long served as an anchor facility for the low-income uninsured, wouldn't reopen because of flooding.

Doctors, medical students, volunteer nurses and social workers rushed to care for the residents who stayed—the seniors with multiple medical conditions and the poor. She witnessed best practices outlined in literature come to life: they were working in teams and thinking about people and populations holistically while seeking to understand the context of their lives.

“There wasn't a lot of forcing and what was exciting at the time was to think, how do you capture the best of this … the humanity, the team component, the really thinking about the context of people's lives and how we could address those inputs to their health and not just their chronic disease?”

They started building prototypes of primary-care medical homes in neighborhoods, taking the emphasis off hospitals and ERs. They also developed a financing model based on capitation and a team-based workforce. What the team built was state-of-the-art then, DeSalvo said, and could be used as a starting point for innovation today. “We are beginning as a health community to understand that our job is more than just clinical excellence,” she said. “Our job is to build health and that doesn't just happen on admission or at discharge, it has to be all the time.”

Dr. Mandy Cohen, secretary of the North Carolina Department of Health and Human Services, echoed that sentiment while speaking about her mission to remake the state's Medicaid program to focus on the social and environmental factors that influence people's health.

To that end, North Carolina's Medicaid managed-care organizations will be required to screen every beneficiary for access to food, stable housing and transportation once the state transitions from fee-for-service to managed care in 2019, depending on regulatory approval.

The department also plans to run regional pilots to test which food, housing, transportation and violence interventions would best improve beneficiaries' health outcomes and reduce costs.

She stressed that the endeavor she's undertaking in North Carolina isn't especially innovative, as the importance of social determinants to a patient's outcomes has been widely accepted. But the actions Cohen is taking are the result of leadership and deliberate choices to improve the health of the population.

“Social determinants will remain a buzzword, with isolated pilots—very successful, but isolated pilots—interesting fodder for conferences until the people here in this room today decide to exercise the leadership to make change happen,” Cohen said.