Although women make up a large portion of the U.S. health care workforce, men still hold most leadership positions in health care organizations, according to a new study published in JAMA Network Open.

Radio Advisory episode: Your organization likely doesn't have enough women leaders—here's how to fix that

Study details

For the study, researchers from Ohio State University collected data from 161 U.S. health systems with at least five affiliated hospitals and 108 health insurance groups with at least 0.09% of the national market, along with each organization's board of directors (BOD), between April 1 and May 31.

Using information from the organizations' websites, the researchers determined the binary genders of the organizations' boards, as well as their top eight executives:

6 Advisory Board resources for recruitment, retention, and the workforce landscape

• Chief executive officer
• Chief financial officer
• Chief medical officer
• Chief operating officer
• Chief information officer
• Chief strategy officer
• Marketing/communications officer
• Human resources officer

In total, the researchers identified the genders of 3,911 top executives in health systems, 1,303 in health insurance groups, and 3,462 board members. They also identified the genders of the 31 individuals holding leadership positions at HHS.

Key findings

Overall, researchers found that around 20% to 50% of the leadership among BODs and senior executive teams in both health systems and health insurance groups were women.

It's notable that women were represented more in the lower leadership positions than the highest. In particular, 17.5% of board chairs in health systems and 21.3% in insurance groups were women. In health systems, 15.3% of CEOs were women, while in insurance groups, 15.8% of CEOs were women.

In both health systems and insurance groups, the proportion of women in most executive positions, such as CMO, CFO, and chief information technology officer, was around 20% to 25%. The percentage of female COOs was higher, however—more than 30% in health systems and around 40% in insurance groups.

3 ways executives can build a culture that supports diversity and inclusion

The story was different for marketing/communications and human resources, where women held more than half of the executive positions. Most notably, women made up 70% of human resource officers at insurance groups.

The researchers also found that female CEOs in health systems were associated with a higher proportion of women on their BODs or in senior leadership positions. Similarly, a higher proportion of women on senior executive teams in health insurance groups was associated with increased representation of female CEOs.

In comparison, in the majority of leadership roles at HHS, 58.1%, were held by women. However, the researchers noted that there were only 31 leadership positions at the agency compared with more than 5,000 in the health systems and insurance groups they examined.

Thoughts moving forward—act now

The fact that only about 15% of health systems and insurance groups are led by women is particularly dismal because health care is a women-dominated industry. It's also worth noting that there is an even deeper discrepancy in representation for women of color.

As the study notes, having a more gender diverse board and senior leadership team is critical in boosting chances for a woman CEO. But since there is much more at play here, we’ve detailed four key ways (with immediate action items) to reduce the gap.

Four ways to fix the health care leadership gender-gap

1. Dive into your data—and get specific about where there are gender gaps.

People often point out that health care is an industry dominated by women, and it’s true that 76% of all health care jobs are held by women—but don’t use this as an easy out.

Resource library: Build diversity, equity, and inclusion among your staff and leaders

Immediate action item: We challenge every organization to dive into their own data and be specific about where there are gaps in gender representation. This is what I recommend:

• Utilize your human resource data to measure baseline gender ratios for the whole organization, as well as key departments and contrast with ratios of leadership bodies (the board, medical executive committee, clinical consensus groups, etc.).
• Segment your annual employee engagement survey results to identify gender-based differences in engagement. If possible, segment this further by clinical/non-clinical roles, tenure, age, facility, and department to identify specific areas with largest gender gap.
• Utilize payroll data to assess gender pay gap and rank-order roles with the largest gaps.

You will almost certainly find disparities—acknowledging these shortcomings is a crucial starting point. Be intentional about building pipelines where there are gaps. Pay attention to which ranks see the most drop off in women—if few women are making it to the Director level, for example, focus on identifying the key barriers and biases behind this “cliff.”

Also notice which departments lack women representation across their ranks—if most women are concentrated in a few departments, this reduces the chances for women to reach senior leadership positions. For example, frontline nursing tends to be heavily women dominated, but there can only be one CNO. To increase leadership opportunities for women, we need more women making it into management and mid-level leadership in other departments and functions as well. This may require supporting lateral movement or exposure to move women talent around the organization.

2. Reconsider what it takes to be a “leader” at your organization.

Be aware of gender-based stereotypes that are likely to show up in talent reviews. We are all prone to gender-based stereotypes when evaluating talent, especially on subjective traits related to leadership potential (e.g., ambition, assertiveness, and strategic thinking). This pigeonholes women in certain roles or prevent them from being considered for certain leadership positions. Oftentimes, women are expected to take on more administrative or support work, and they may be punished for displaying the same behaviors as their male peers (for example, being viewed as “bossy” where men are viewed as decisive). As always, acknowledging these harmful stereotypes is the first step towards a more equitable situation.

The executive’s role in fostering resilient, adaptive leaders

Executives must challenge these stereotypes when they come up, especially during performance reviews and promotion conversations. Rather than relying on personal (and often biased) opinions, some organizations use external evidence-based talent assessments to measure leadership ability.

Finally, to limit room for misinterpretation, ensure you are basing performance on objective, outcomes-based performance criteria.

3. Design flexible work models and benefits to retain women across their careers and into leadership.

Women are often forced to choose between work and home—inadvertently being punished for outside of work roles, taking maternity leave, or having caregiving responsibilities. Women have always taken on more work and caregiving responsibilities at home, and this became exacerbated by the Covid-19 pandemic. In September 2020, nearly 900,000 women left the U.S. workforce—four times more than men. And despite movement on division of labor in the home, women are still taking on the brunt of home responsibilities while working during the pandemic.

Emerging idea: Informal caregiver flexible working arrangement

Create flexible work policies that women can leverage across their career as their needs and priorities evolve, and view these models just as productive as traditional arrangements. Consider work models that allow flexibility in where, when, and how people work. And ensure that you have robust benefits for women, such as maternity leave, childcare subsidies, and onsite childcare services. We've developed resources to help guide you.

Immediate action item: Connect with existing women employee resource groups or launch focus groups to get input from women employees who make up the majority of your workforce on what work models, benefits, and support they feel they need to stay at your organization and advance.

4. Prepare women for leadership roles—and be proactive about it.

Data shows women are less likely than men to apply for positions that demand more "qualifications" than they have. Organizations should not assume that women will apply for open positions, given the history of socialized and structural inequities. You need to do the leg work to establish leadership as a legitimate path or women, invest in preparing them for these roles, and encourage them to apply. Better yet, promote women and suggest them for the candidate slate without them having to ask.

Immediate action item: I challenge you to include two women on your slate of successors for the CEO role—immediately. Why two? Because if there's only one woman in your candidate pool, there's statistically no chance she will be hired. Again, this action is not enough on its own. Work to actively connect women to opportunities that can grow their leadership skills and relationships.