The numbers are woefully familiar to women who work in healthcare. Women comprise 65% of the healthcare workforce, yet just 30% of C-suite roles in the industry.a And while 13% of healthcare CEOs are women — more than double the percentage of women CEOs in other industries (5%)b — the gap between the number of women who help keep healthcare running, operationally, and those who make decisions about their organization’s future remains wide.
In this executive roundtable, sponsored by Bank of America, six women executives discuss the challenges that women face in reaching the C-suite, especially in healthcare, and they offer strategies for breaking down barriers to advancement.
What are some of the challenges women face in attaining healthcare leadership positions?
Elizabeth (Liz) Foshage, CPA, Executive Vice President and CFO, Ascension: One of the challenges we bring upon ourselves is not picturing ourselves in a top leadership position. We don’t have many role models for this, especially in the area of finance, and for so long, we haven’t seen people in the top chair who look like us. However, now that more women are beginning to assume leadership positions, there are a lot more role models for younger women.
Carol A. Friesen, FHFMA, Northern Region CEO, OSF HealthCare: One of the biggest difficulties, initially, lies in finding the right opportunities. Some of the roles women naturally excel at and achieve initial success in — such as project management and operations — end up holding them back from advancement because senior executives are content with the value they provide in their current roles. Also, it can be challenging to step away from a role they are successful at when they feel personally stretched outside of the office and to open themselves up to something new, even if it would position them for more broad responsibility and opportunities down the road.
To that end, it is critical to have a strategy for building a robust leadership skill set, including diverse experiences to become attractive for future leadership positions. Some examples include intentionally considering what teams or projects to be involved in or lead — as well as whom to learn from — to prepare to tell a compelling leadership story when the time is right for advancement.
Suja Chandrasekaran, Chief Information Officer and Digital Officer, CommonSpirit Health: In health IT, just 18% of chief information officers and digital officers are women. That’s a really poor showing. Throughout the industry, there has been a lot of analysis around this. Today, diversity and inclusion initiatives and gender equity programs are helping women to build network connection and affiliation. Such programs also position organizations to more effectively identify women who are candidates for leadership to ensure that women don’t get left behind.
Carol A. Lovin, MHSA, MN, Executive Vice President, Chief Integration Officer & System Chief of Staff, Atrium Health: Sometimes, it’s self-limiting: Women look at the C-suite — not just in healthcare, but also in other industries — and see the lack of female representation and wonder, “Is it too hard to get there?” Additionally, research shows 65% of the C-suite roles filled by women are those that require specific technical expertise.c Some women are not interested in those very technical roles.
It’s also a tremendous amount of work when you get to the C-suite. Anyone who takes on a senior leadership position understands that there are sacrifices you make. There is the elusiveness of balance. The reality is there are trade-offs.
What difficulties do women encounter once they have the job?
Dana Alligood, West Market Executive, Healthcare, Education, and Not-for-Profit, Bank of America: Women in leadership positions face higher scrutiny even before they begin their leadership position. Typically, when a man has been promoted into a leadership role, many people will assume he is going to be a great leader, whereas for women, the attitude tends to be, “We’ll see how she does.” That’s why it’s important that women have the self-awareness to know what their strengths and weaknesses are and ensure they have the right team around them. Specifically, they should have supporters that have followership among the team. These leaders can help credentialize women in leadership roles.
Friesen: It can also be lonely at the top. You really have to be mindful about who you are at the core and build a support system and team that works for you.
Always be confident that your ‘good enough’ is good enough every day — at work, at home, in relationships, in the boardroom, and more. There is not an exact formula for success. Success is what you make of it.
Kathy Lancaster, Executive Vice President and CFO, Kaiser Permanente: The main challenge facing women in leadership is developing their individual leadership style and having the confidence to stay true to that style even when confronting adversity. The balance between work and family can also be challenging. However, I think it is important to never shy away from letting people know your family is a priority. Speaking up about what is important in your life helps keep the workplace and family priorities in balance.
How fragile is the glass ceiling in this industry?
Alligood: I can’t say that it’s very fragile if only one in five hospital CEOs are women and only 4% of all healthcare companies are led by women, but the majority of the healthcare workforce is female. That makes me think it’s not so easy to break, but I’m hopeful we’ll see more women in leadership positions soon.
Foshage: I think the glass ceiling is definitely starting to show some cracks. As I go to finance and CFO conferences and look around the room, I’m not the only woman; in fact, I’d say the percentage of women in attendance is 20% to 25%, and that’s very different from earlier in my career. And the women at the conferences gravitate toward each other. They support each other and network.
Lovin: It’s as fragile as you believe it to be. I never wanted that to limit me, so I don’t think of it in terms of fragility.
How should organizations seek to elevate and better support women in healthcare leadership?
Alligood: Organizations need to be intentional about their efforts to support women in healthcare leadership. It starts with recruiting the talent and then investing in women and helping them learn their potential and what their strengths are. At Bank of America, we have a women’s executive development program, and we host a global women’s conference where senior leaders discuss the challenges that women face as leaders and the best practices that can help position women for senior leadership roles. We also have a next-level leadership program designed for middle-tier women who may be facing multiple demands — such as raising a family or caring for elderly parents — to offer support in navigating these challenges and to show them how they can still progress in their leadership journey.
One interesting initiative is the “Power of 10.” This was started in 2012 by a female executive and a group of 10 women who each chose to pay it forward to 10 other women by serving as mentors and providing advice and networking opportunities. Today, over 400 women across the globe have taken part in this program. We like to say it’s led by us, for us.
Lancaster: At Kaiser Permanente, we identified a need for women to connect with each other across geographic locations. Our organization created WE@KP, a business resource group where women within the organization can connect virtually. This gives our women in the workforce the opportunity to network, learn from others across the country and develop leadership skills that enhance their work and life experiences. Additionally, our Finance & Shared Services Women in Leadership (WIL) program provides curriculum focused on key hurdles and challenges unique to women as they seek to reach their full leadership potential. We also host an annual event within our physician groups that encourages female physicians to pursue leadership roles in medicine. I find these types of networking and educational programs give women in the workforce opportunities to stretch and test their boundaries of expertise.
Chandrasekaran: One of the things I’ve done is to create an online forum for women in healthcare tech called T200. It’s a not-for-profit forum that currently includes about 130 women, all of whom are C-suite leaders in healthcare IT. It’s a wonderful way for us to ask each other questions such as, “How would you approach this situation?” or to ask for recommendations around products or talent. Each day, I’m able to have a dialogue with 129 other women. It’s an amazing support system. When I started the forum three years ago, this type of camaraderie did not exist among women leaders in health IT. Now, when we get together at conferences, it’s like a party.
What are some strategies for improving networking opportunities among women?
Chandrasekaran: I’m an immigrant, and I’m a woman of color. I don’t speak about sports, and I’m a vegetarian. At every IT retreat, I would look around the room, and I would be like, “Oh my goodness, I am so different from everyone else.” That attitude can be limiting, especially for women in leadership. I realized I needed to do something about it. I began to very intentionally connect with people at conferences and follow-up with them afterward. I found that for every 100 people I meet, 30 will connect with me afterward; maybe 10 will become acquaintances, and one could become a mentor or sponsor — or I could become theirs.
Start with 100 people and work on building those connections. Seek to give them something of value — by sharing a resource, for example — without expecting anything back.
Friesen: Make time once a week to have coffee with someone, such as a colleague or physician. Ask how they are doing, what interesting projects or work they are involved in and the types of things that are most challenging or rewarding for them right now. This creates connection and an experience of refreshment. End by asking, “Do you have any advice for me?” I usually finish every conversation of this nature with that question because I’ve found that you can receive amazing feedback when you let someone know that you value their opinion and expertise.
What strategies would you recommend to women who are early in their careers about how to position themselves for advancement?
Lancaster: Early in your career, I think the guiding force needs to be grounding yourself in who you are as a person and letting that serve as the foundation for your leadership style. We all have different strengths and opportunities for growth but remaining authentic to who you are is what creates a strong leader.
Lovin: There is a credibility that needs to be established early on that you can do the analytical and strategic work and that you’re not just good at the corporate softer skills. Differentiate yourself by developing expertise, particularly in some of the STEM areas like science, math and technology or engineering. Look for ways to provide value by putting in extra hours, bringing a unique perspective to your work and excelling in your role. When you do this, people will be more likely to think of you for a promotion later.
Foshage: Understand that you are your own best advocate. Volunteer for the hardest challenges as a team is being called together. If your organization is launching a new initiative, try to be part of it. The quality of your work and your work ethic are your calling card, and they will get you noticed.
HFMA Roundtable Participants
Elizabeth (Liz) Foshage, CPA
Executive Vice President & CFO
Carol A. Friesen, FHFMA
Northern Region CEO
Chief Information Officer & Digital Officer
Carol A. Lovin, MHSA, MN
Executive Vice President, Chief Integration Officer & System Chief of Staff
West Market Executive, Healthcare, Education & Not-for-Profit
Bank of America
Executive Vice President & CFO
About Bank of America
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a. “Women in Healthcare Leadership 2019,” press release, Oliver Wyman, 2019.
b. White, M.C., “Female CEOs Gained Ground in 2018 but Still Trail Their Male Peers,” NBC News, Jan. 25, 2019.
c. “Women in Healthcare Leadership 2019,” press release, Oliver Wyman, 2019.