Why It Matters
Women make up 65 to 70 percent of the workforce in US health care, yet only 13 percent of health care CEOs are women.
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Why Health Care Needs More Women and Nurse Leaders

By Maureen Bisognano | Tuesday, August 6, 2019
Why Health Care Needs More Women and Nurse Leaders

In 1995, IHI President Emerita and Senior Fellow Maureen Bisognano facilitated a roundtable discussion about “The Glass Ceiling in Health Care.” In the following interview, she reflects on how much has changed for women in health care since then and how far there still is to go.

You started working in health care in 1973. What roles did women have then compared to now?

I started as a nurse and, basically, that was the option at that time ― almost every executive was a man. I started in health care thinking that I would be a nurse forever, and I never expected to take a role outside of nursing. Today, we are seeing a focus on women at all levels of leadership. When I began, I just had fun at what I was doing, and I think being technically skilled, and being happy to give to patients made people aware that perhaps I could do something else. When you love your work, it opens opportunities as people see your impact.

Women make up 65 to 70 percent of the workforce in US health care, yet only 13 percent of health care CEOs are women. Why is this?

I think women are victims of bias that people don’t recognize, especially women of my age and my generation. There were some moments in my career where people without bias trusted me, and I think that made all the difference in the world. People like Don Berwick [IHI President Emeritus], Paul Batalden [IHI founder], and Tom F. Frist Sr. [former President of Hospital Corporation of America], look at people’s assets and expertise and not necessarily at their age or gender. But I think some of the older people in health care leadership positions still have biases unknowingly.

What are your thoughts on the differences between how men and women lead?

I think the differences are shrinking today. In my time, I think women tended more to the joy of the workforce. When it came to patient care, there was a lot of attention to not just the clinical side but also the question of “What is this person going through?” I think more and more, men are realizing that asking, “What matters to you?” is an important way for us to think, not only for caring for patients but also for staff.

We’re in a place where 93 percent of new nurses have no intention of staying in their jobs beyond a year or two. So, they need development. I strongly support “stay interviews” in addition to “exit interviews.” The young need someone to call them in and say, “In this past year, you’ve become incredible in working in neonatal intensive care. What do you want to do next?” It’s that mentoring that becomes very important.

I think another difference might be compassion. Empathy is the ability to understand what another is going through. But compassion is: “I understand, and I’ll act on it.” Men certainly see the pain that people are going through, but women are more likely to act, to reach out.

Do you have any advice for women who face gender-related obstacles?

When I would walk into an executive room in my early years, I was almost always the only woman. The first time I walked into an executive meeting with all CEOs, one of the men turned around and he said, “Honey, get me coffee.” And I said to him, “I’d be happy to get you coffee. How do you take it? And this afternoon, you can get me mine, and I take it black.” And then I laughed, and everybody in the room broke out laughing. It both raised my profile and told them who I was. I think humor is important, but standing your ground is important, too. If there is injustice, calling it out is our job because we’re in this place where the numbers aren’t moving as quickly as we think they should.

Influence is also critical. Understand that everybody’s got different priorities. How do you engage and influence a diverse group of people? Techniques such as story, extrapolation, and discussing human cost and financial cost have helped me demonstrate that, as a woman, I’m not afraid to tell you that I feel very passionately about patient care. As a woman, I understand what the workforce is going through and I’ll stand up for them. And as a woman, I speak with financial literacy and strategy design.

What do you think can be done to move women in health care ahead more quickly?

  • Data and stories ― We need the data to highlight the gaps and the stories to say, “Don’t be afraid. Women do succeed.” We’ve got people like Nancy Howell Agee [CEO of Carilion Clinic], Susan DeVore [CEO of Premier Inc.], and Andrea Walsh [CEO of Health Partners]. Those organizations are thriving, and those women are making huge differences, not only for the patients that they serve, but for the staff that they work with. Recent studies show that organizations with women CEOs tend to lead to more profitable outcomes. I think that is little known.
  • Build leadership strengths in young women ― We’ve got to deliberately build leadership skills in the younger generation. If we have this attitude that says, “You have to wait until you are 40 or 50 or 60 to lead,” we’re going to lose the next generation in health care. We need deliberate action to mentor and lead with this group of young women.
  • Organizational culture ― We need to have a very deliberate approach to working on the culture of organizations, which recognizes and celebrates women leaders, especially in health care. I have seen informal mentor networks working well at some of the boards that I serve on. Many of the boards are comprised of 50 percent women, and the women will often go out and have dinner just to talk about what it’s like to be a woman in a world that’s still predominantly male. There are also sponsorships that reach out to young people with potential and give them tuition to go to college, or to get an advanced degree, or to go to a leadership program. I think those kinds of formal sponsorships help as well.
  • Can you see any change happening?

I see positive change on the horizon, but I do think we have to be active about it. I’m serving on the advisory board of a new organization called Nursing Now ― a global organization with the aim to try and raise the status of nursing in every country in the world. What we’re doing is working on building leadership and governance capabilities in nurses around the world, trying to get more nurses on boards and in CEO positions because that will raise the profile.

We also just launched a new project called the Nightingale Challenge to celebrate Florence Nightingale’s 200th birthday next year in 2020 ― which the World Health Assembly has declared to the “Year of the Nurse.” We aim to get organizations around the world to identify 20 young nurses or midwives and develop their leadership skills so that we’re opening the pathway for those young people to take on more responsibilities.

We’re looking at how can we bring more nurses to the IHI National Forum and then once they’re there, how can we assure that they’re mentored by women leaders so that they start to see the long-term possibilities in their future?

Editor’s note: This interview, conducted by Multimedia Intern Nadine Gelmar, has been edited for length and clarity. 


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The Equity track of the IHI National Forum on Quality Improvement in Health Care

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