Recommendations for How Hospitals and Health Systems Can Support More Women in Leadership Roles

This is the fifth in a series of posts from our study of career inflection points of women leaders. We would like to thank Hospira for their continued support of this research topic.

This blog will focus on activities that will support the careers of women in healthcare leadership.

The gender disparity in hospital CEO positions has changed very little over the past few decades and short of some unanticipated development, this disparity is likely to continue. We encourage the use of evidence-based practices and provide the following from our interviews with successful women CEOs.

First, hospital and system leaders should directly cultivate career aspirations of women associates and encourage early careerists to proactively manage their careers, regardless of functional background. This can be achieved by developing career plans and discussing a range of potential future positions with emerging leaders of both genders.

Second, organizations can develop formal mentoring programs to enhance career management activities and encourage a wide range of senior leaders to get involved in the development of future leadership talent. We specifically found that administrative fellowship programs were instrumental in the eventual career success of women leaders and encourage the development of new fellowships and the continued support for fellowship programs in hospitals.

In addition to fellowship programs, hospitals and health systems can provide training opportunities in a variety of settings (e.g., cross-division) and expand membership in high-visibility projects. Chief learning officers and talent directors can encourage and recommend junior women and men for projects that will support this critical type of inflection; further, leaders can proactively sponsor talented employees with opportunities for growth, such as advanced education, on-the-job training, or executive coaching.

Finally, systems and hospitals can work with leaders at all levels to support (financially and structurally) the development of women’s groups or other networking events for women.   This includes supporting the participation of women in community women’s groups as well as programs that occur within the hospital or health system itself.

Do you have any stories from your own career path that you can share? What inflections, whether good or bad, have impacted your ability to move up the career ladder? How can healthcare foster the attainment of leadership roles for more women?

Women CEOs Describe How Organization’s Supported Their Career Trajectories

This is the fourth in a series of posts from a recent study was to analyze the career trajectories of women who successfully achieved the hospital CEO position executives to determine the factors that generated inflections in their careers. The study was conducted by NCHL with investigators from the University of Michigan and supported by a grant from Hospira.

We will now turn our attention to the executives’ perception of the organizational supports that helped them ascend to the CEO position.

We all know that leaders and organizational culture can have an impact on job satisfaction, organizational commitment and tenure. Over half of the executives in our study stated that they worked in hospitals with positive work environments and cultures of growth and opportunity. On the other hand, nine of the executives described working in biased work environments. The majority of these CEOs began their career in clinical roles (nurse, physician).

Other studies have shown that the gender composition of the governing board may impact the gender diversity in the CEO position. The findings of our study, however, were inconclusive. For instance, half of the executives in our study stated they were hired by a governing board that was comprised of both men and women. Conversely, four of the interviewed CEOs were selected by all male governing boards— in some cases comprised of many physicians. In addition, two of the executives were selected by another female CEO and four executives were selected to be CEO by the system CEO or the division president, all of whom were men.

Besides leadership and governing boards, the CEOs in the study mentioned that they felt supported by organizational programs designed to promote diversity in the workforce. A few CEOs mentioned that there was an organizational diversity strategy. The more formal diversity initiatives included long-term strategies, goals, and incentives for diversifying the workforce, while less formal ones focused on diversity training. In this study, nine of the executives reported being hired as a CEO in a hospital with a formal diversity strategy, but only two of these said the diversity strategy included specific goals and incentives.

Women CEOs in this study mentioned the importance of succession planning. Half of the executives stated they were involved in a succession plan when they were selected into the CEO position. Several of them stated this type of program was important for their career development and retention. Of interest, most of the organizations with a diversity strategy also had succession planning.

Family and work responsibilities often negatively impact the careers of female executives. A common solution to the issue is to have family-centered work practices to help reduce the stress of managing family and work responsibilities. In this study, only eight of the CEOs said they were aware of family-centered work practices in their organization. The most commonly mentioned practices were flexible work schedules, extended paternity leave, and onsite daycare.   Half of the interviewed CEOs stated that family-centered programs were more recently developed in their hospital and were not available earlier in their careers. In addition, one of the CEOs noted that family-centered programs were not designed or utilized by those in executive positions.

Let us know what you think. How has your organization hampered or helped your career? Are organizational supports different for male versus female employees? Which organizational supports are most helpful to have in place?

“Health Leads Loves the NCHL Leadership Competency Model”

At NCHL’s Human Capital Investment Conference last November, Health Leads CEO Rebecca Onie discussed the necessity of addressing patients’ social needs and how Health Leads has provided a way for physicians and nurses to do this, by “prescribing” patients to them. Last year, Health Advocates, the student employees of Health Leads, touched 11,500 patients. These Health Advocates are the next generation of healthcare leaders described as “disruptive innovators” because of how they are working to transform the healthcare industry. Addressing the challenges currently facing healthcare, Rebecca describes how Health Leads is confronting these challenges. Assessing patients’ basic resource needs allows clinicians to better understand obstacles those patients face in leading healthy lives.  
Rebecca calls on healthcare leadership to “deliver healthcare that is accountable to patients’ lives” and make patient-centered care a reality. Using NCHL’s Leadership Competency Model, she provides examples of how Health Leads is working in each of the three areas – people, execution, and transformation. Looking towards the future of healthcare, Rebecca acknowledges its uncertainty but also the unchanging complexity of patients’ lives. She believes leaders will be evaluated on how well they understood and addressed these complexities.

Career Inflection Points Differ by Functional Background

This is the third in a series of posts providing insights from a recent study conducted by NCHL with investigators from the University of Michigan. The study analyzed the career trajectories of women who successfully achieved the hospital CEO position to determine the factors that generated inflections in their careers.

This blog highlights the differences in career inflection points for women who began their careers in healthcare management.

In our study of 20 successful women hospital CEOs, we identified different inflection points for those who began their career in healthcare management versus those who began their career in a clinical or administrative support area (for example, accounting). We describe some of the differences here and also note how these differences appear to converge at the COO position.

With a few exceptions, most of the women we interviewed described how their work experiences fell within their primary functional area until they entered the senior-executive ranks. For example, most of the healthcare management executives started as associate administrators or the equivalent and one started as a healthcare consultant. All of them had follow-on administration positions within the core business areas of a hospital. As they ascended in the leadership hierarchy, most reached the director or vice president of operations position on a trajectory that ultimately led to COO and then CEO.

As for education, those starting in healthcare management graduated with a master’s degree in healthcare administration or public health and then immediately completed an administrative residency or fellowship. During this training, they were closely mentored and sponsored by senior executives and their experiences gave them a broad understanding of hospital operations. These early career inflections were described as creating major differences for them throughout their careers.

On the other hand, the CEOs who began in clinical or administrative support positions followed different career trajectories. All started as professional staff members and moved into management positions within their functional area later in their career (e.g., nursing, accounting). Several mentioned taking risks by moving into positions outside of their primary functional area in order to expand their knowledge and experience of operations. A number of them also indicated how mentors and sponsors helped them move into these types of career developing positions.

For the most part, the mentors and sponsors were within the executive’s primary functional area.  For example, nurses were most often mentored by senior nurses or the CNO. These executives appeared to be ascending towards the senior-executive position within their functional area.

In terms of education, this group of executives obtained graduate education later in their career in order to advance in management. They revealed that sponsors directly supported their effort to going back to school and some said the hospital provided scholarships for them. A few mentioned they received on-the-job training and mentorship from the COO or CEO in lieu of completing an administrative residency or fellowship.

An interesting finding was that almost all of the women had been COOs before being CEOs, even those who had previously been CNOs. Although the trajectories started to converge at the COO position, there was still a difference in terms of mentoring and sponsoring relationships. For instance, nearly all of the executives mentioned the hospital CEO mentored and sponsored them when they became the COO. The clinical and administrative support executives, however, mentioned they were mentored or sponsored by the COO or other senior executives until they were ready to move to the COO or CEO role. Thus, it was harder for them to move into COO or CEO positions. Some mentioned how this type of bias influenced them to move to another organization in order to become a CEO.

What do these various paths/inflection points mean for current and future clinicians who want to lead an organization? What skills do clinical and support service leaders need to ascend to the C-suite?

2014 resolutions for healthcare leaders

Dissatisfied with your “must do” resolution list this year? Here are a few “nice to do” suggestions from NCHL, to help round that list out with a to-do or two that are hopefully at least a bit more inspiring and fun. (Public commitment is optional, but worth considering.)

Goal #1.  Work on bending the sick curve.  Earlier this fall, the Robert Wood Johnson Foundation published the first health-related “good news” infographic I have seen in years. The graphics depict CDC data indicating that from 2008-2011, childhood obesity rates among young children dropped in 18 U.S. states.

How about setting a goal to be a part of that good news when the next report comes out? You can find suggestions on the Health Care Providers page of the Let’s Move website.

Goal #2. Work on bending the stress curve.  Getting the sense that healthcare management has become a lot more stressful these days? You’re not alone – and it’s not just healthcare management. Research by Harris Interactive has been tracking an upward trend in stress levels among working adults for over a decade.

Interested in getting stress management taken seriously in your organization?  The American Psychological Association’s “Stress in America” study provides a good overview of the current state, as well as the ways healthcare systems could take a more active role to the benefit of our patients. What about leading by example? The current issue of Frontiers in Health Services Management is all about strategies for personal and professional resilience in the age of healthcare reform.

Goal #3. Work on transcending “bending the cost curve.”  Recognized as problematic almost from its inception, the problems with the very well-traveled “bending the cost curve” metaphor are by now well documented in forums as diverse as the New York Times, Health Affairs, and IHI COO Jeffrey Selberg’s remarks at NCHL’s 2012 Annual Conference.

How might we best help the national dialog move past an obsession with near-term cost, and toward the aspirations represented by the triple aim?

Yes it’s a tough question, which is why I’m giving you a year.

Looking forward to seeing what you come up with.  And wishing you a healthy, prosperous 2014, from all of us at NCHL.




What were the Career Inflection Points of Women Hospital CEOs?

This second in a series of posts on women healthcare leaders, a study conducted with investigators from the University of Michigan, specifically focuses on the career inflection points we discovered and provides several highlights for each theme.

In our study of 20 women CEOs, we identified 25 career inflection points that fall into six themes: (1) education and training, (2) work experience, (3) career management, (4) work/life balance, (5) social support and networking, and (6) mentorship and sponsorship.

First, women CEOs described inflections related to education and training. All of the women obtained a graduate degree in early or mid-career. As one of them stated, a master’s degree in healthcare administration or the equivalent “was a requirement of the job.” Other inflections in this area included completing an administrative residency or fellowship, attending leadership training, and receiving executive coaching.

Second, the majority of women CEOs held the position of COO before moving into the CEO role—even if they had previously been in the CNO or CMO roles. Other work experience inflections were related to obtaining broad work experience, such as getting hospital or system-wide assignments. There were also several specific types of experiences that created inflections, such as obtaining clinical experience (i.e., later sought out for their clinical acumen and rapport with clinicians) and working with the hospital’s governing board.

Third, we found several inflections related to career management. Proactive actions included risk-taking through assignments or specific roles (e.g., moving from the ICU to an outpatient clinic) and voicing interest in higher level leadership work. Several women discussed moving to another organization in order to ascend into a CEO position because the odds of becoming CEO in their current organization were low. Most women did not develop formal career plans and did not aspire to be a CEO until the time they were working in the C-suite themselves.

Fourth, issues of work/life balance were described by nearly all the executives. They consistently described the importance of support from their significant other. They also described inflection points associated with having to move due to a spouse’s career or turning down positions they were offered because of family constraints. Several mentioned commuting in their job (across states or regions) so that children would not be moved.

Fifth, the women in our study discussed important social support and networking inflection points. In fact, this was the largest group of inflections mentioned, possibly reflecting the importance of workplace relationships. This included taking on high visibility positions, participating in professional associations and women’s groups, serving on community boards, and working with executive recruiters.

Finally, we observed inflection points related to mentorship and sponsorship.  We found clear evidence of sponsorship among the women interviewed—that is, someone with power and influence within their own organization or outside who advocated on her behalf.  While mentorship was also mentioned, sponsorship was clearly more important for career inflections in this study of women hospital CEOs. Mentoring and sponsorship were the only inflection points mentioned consistently at all career stages for these executives.

Tell us what you think: Can you identify with these inflection categories or themes?  Have you had a sponsor in your career? How did that relationship differ from your mentors? Finally, how might you and your organization support women in advancing their careers?

In future posts, we will outline more of our findings.

Assessing high-potentials and senior executives: Healthcare vs. Top Companies

Of all the areas known to contribute to the effectiveness leadership development systems, there is none for which the evidence base is stronger than the use of high-quality assessments. But it is also well-known that management practices, like clinical practices, often take quite a while to catch up to science.

What is the current state of assessment in practice? Recently two industrial psychologists, Allan Church and Christopher Rotolo, conducted a study to find out. Both work for Pepsico, a company well-known for its sophisticated leadership development practices, and are well-connected to other companies that emphasizing leadership development as a core competency. (Most had received national recognition for their leadership development programs.)  From the 84 companies responding to their survey, insights included:

  • The most frequently cited populations the organizations used assessments with were senior executives (90%), followed by middle managers (81%) and high-potentials (75%).
  • The most frequently used assessments were 360-degree feedback (60% for senior executives; 66% for high-potentials), followed by personality inventories (57% for senior executives, 66% for high-potentials).
  • The most frequently cited purposes of assessments were to identify development needs (74% for senior executives; 82% for high-potentials) followed by identification of potential (30% for senior executives, 50% for high-potentials).  The least frequently cited purpose was external recruitment / selection (25% for senior executives, 14% for high-potentials).

At NCHL’s annual conference on November 19th in Chicago, we will be taking a look at how Allan and Christopher’s results compare to the 104 leading U.S. health systems who participated in NCHL’s 2013 survey of leadership development practices.  (A quick preview: although the use of high-quality assessments in healthcare leadership development is growing, we still clearly lag behind the best-in-class companies from other industries.)

Several organizations presenting at the annual conference have particularly strong assessment programs as part of their work. We look forward to hearing more about them very soon, and hope many of you will be able to join us.  For those who can’t, we will be providing a white-paper on our findings.  Look for it this winter.


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