Workplace harassment often ignored say women healthcare leaders

“I don’t think the older men in leadership positions respect me at first glance ... Several other women warned me never to be alone with this person ... I was ultimately fired because the harassment came from the COO ... I quit my job. I knew rape would be next.”

These are the experiences of women healthcare leaders who have been harassed or discriminated against in the workplace at some point in their careers. Their feedback was part of a Modern Healthcare survey that found 26% of the nearly 1,000 participants experienced workplace sexual harassment and about 32% have experienced gender discrimination. 

The survey also found many organizations ignore the problem. Of the respondents who experienced harassment or discrimination, 35% said no action was taken when they reported it to their employer.  

The survey, released at the 9th annual Women Leaders in Healthcare conference, included responses from 911 workers in leadership positions across the industry. About 75% of the respondents were women and 45% said they worked in a hospital setting.

While research on the prevalence of harassment in healthcare is sparse, it’s a well-known issue that hasn’t been adequately addressed by leadership, said Dr. Timothy Johnson, a professor of women studies at the University of Michigan who has researched sexual harassment in academic medical centers.

“One of the biggest issues is that people don’t recognize the degree of the problem and the fact that it has a real impact on women,” he said. “It hasn’t been on the radar of CEOs and hospital administrators.”

Johnson said he wasn’t surprised by Modern Healthcare’s findings and actually expected the numbers to be slightly higher, suggesting that underreporting is likely at play. There is a clear power structure in healthcare that allows harassment and assault to breed, he said, adding, “You have a hierarchical power differential where senior people prey on junior people.”

Even so, there are signs the culture is improving, albeit slightly. Younger women who responded to the survey were less likely to report experiencing sexual harassment than older woman. Nearly 19% of women ages 18 to 34 said they’ve been subjected to sexual harassment, which is lower than the 26% of women ages 35 and older who said they were harassed.

Several factors likely contribute to this contrast including changing cultural norms, the rise of women in medicine and growing awareness about the importance of diversity and inclusion.

“Maybe it’s a sign of progress,” said Candice Saunders, CEO of WellStar Health System, during a panel at the Women Leaders in Healthcare conference. She recalled that at the beginning of her 40-year career a man asked her to get him a cup of coffee before she was supposed to present at a management meeting.

The #MeToo movement raised more awareness about the issue as well. Kety Duron, chief human resources officer at cancer center City of Hope, said she sent out a mass email to staff soon after the hashtag began gaining ground saying the institution supported the movement.

Although blatant acts of sexual harassment or gender discrimination may have abated modestly, microaggressions against women or minority populations are still a problem, said Dr. Janis Orlowski, chief healthcare officer at the Association of American Medical Colleges.

“It’s not just when someone is forcing you to engage in an activity you don’t want to be involved in,” she said. “There can be harassment when you’re not mentored or given opportunities to progress.”

In fact, Modern Healthcare’s survey found nearly 19% of participants said promotions at their organizations are based on favoritism instead of merit. One respondent said she missed out on opportunities for career advancement because networking or client events included only men. “As the years go on, it’s much more subtle, but continues,” she added.

The AAMC held a forum for academic medical center leaders in June about workplace harassment. Orlowski said the meeting focused on raising awareness about behaviors that may be hard to detect as exclusionary.

Since then, the AAMC board has made a commitment to work with its members on fixing the problem. So far, it has offered academic medical centers a worksheet with employee survey questions that are targeted at specific instances of inappropriate behavior so the organization can get a better sense of problems.

“Victims of harassment often will not define it as such when asked,” Orlowski said.

Although because issues of harassment and discrimination have stayed under the radar for so long, the industry doesn’t yet have a good understanding of interventions that work, Johnson at the University of Michigan said.

“We don’t have the evidence of what is the best way to change culture,” Johnson said. “CEOs and nurse managers, they need to use their best judgment and figure out how they are going to do this.”

Many leaders make the mistake of trying to solve the problem with “one-off” solutions, he said. For instance, sexual harassment training isn’t effective when only web-based or done just once a year. Instead, it has to be ongoing and part of a “broader culture change,” he said.

WellStar makes its priorities around harassment and discrimination clear from the get-go, which Saunders said has helped improve the culture.

When WellStar is looking for new hires, the system’s policy on harassment and inclusivity is part of company information materials. Saunders said recruiters get a lot of questions about it from applicants. Once hired, harassment training is part of orientation as well as ongoing training activities. All managers are routinely trained on harassment and inclusivity.

“You have to be intentional about it,” Saunders said.

WellStar employees can also report any discrimination or harassment concerns anonymously through a hotline or with human resources. Those tools aren’t universally available across the industry, according to Modern Healthcare’s survey. Just 19% of respondents said their organizations had a formalized process for reporting discrimination and harassment with consequences for offenders.

Saunders said that percentage is quite low considering “that is only the beginning of getting people to speak up and to know their voices matter … that is just table stakes.” WellStar is working on how to best address problems with offenders, which is also key to changing the culture.

“If leaders hear it and don’t address it, people don’t speak up, you have fatigued them,” said Johnese Spisso, CEO of UCLA Health.

Spisso holds open forums, surveys staff on issues of harassment and rounds on clinical units to get a sense of the different cultures and issues.

“When you talk about speaking up, people feel comfortable speaking up,” she said.

And soon after Spisso was appointed CEO of the system in 2016, leaders were retrained on diversity and inclusivity. There are now five female clinical chairs at the organization, up from just one when Spisso started.

Duron at City of Hope said all harassment and discrimination complaints are taken seriously and thoroughly investigated.

“There is no tolerance for that behavior,” she said, adding that people have been fired or demoted for discrimination and harassment.

But even when institutions are intentional about trying to change the culture, it’s still hard. At New York-Presbyterian Hospital, leaders have been trained on implicit bias but Chief Operating Officer Dr. Laura Forese admitted she and her colleagues caught themselves factoring in a woman’s recent pregnancy when it was time for her promotion.

“You see how it’s easy to do that,” she said. “Even though we are working on that implicit bias it’s just there unless you are constantly as a team saying well, ‘Did we miss something? How do we think about this different?’ ”