Women make up half of the U.S. workforce and more than 75 percent of all workers in health care. Women also are the major consumers of health care services in this country. Yet, in all sectors, few hold executive or governing board positions. Only 12 percent of health care CEOs are women, a statistic that has not changed much in more than a decade, according to a 2008 report in the Journal of Healthcare Management.

Why aren't women among the top ranks of health care leadership? No one would argue that diverse skill sets and collaborative styles of leadership, which experience and research demonstrate that women possess, are urgently needed in this time of transformational change. However, as women face obstacles to career advancement, the traditional glass ceiling is giving way to a different metaphor to explain inequity.

In Through the Labyrinth: The Truth about How Women Become Leaders, Alice H. Eagly and Linda L. Carli suggest that women face myriad overt and subtle challenges that are difficult to negotiate — or even understand — on their journey to the top. Leadership stereotyping (men are assertive and confident; women are harsh and shrill), lack of gender parity in positions and income, and less access to leadership roles are just a few of the ongoing challenges facing women in the workplace that have been amply documented by numerous research studies as well.

Shared Experience

In January 2010, a group of experienced health care executives who had been or are in top leadership roles convened in Chicago to explore these issues and discuss why the barriers to advancement for women seemed to be increasing. These leaders cited significant numbers of women leaving the C-suite as well as a dearth of younger women being prepared for upper management positions. They also shared personal stories that testified to the challenges that can derail or discourage women in their journey up the career ladder.

One female CEO recounted numerous high-risk turnarounds she had successfully accomplished, only to be perceived negatively for making difficult but necessary decisions compared with men who were viewed more positively in the same situations. Another female executive said reading Through the Labyrinth was a painful reminder of her rise through the C-suite, where she was frequently the token woman. She acknowledged that a critical success factor is how women respond to their situations. She recalled how taking on challenges, being willing to make difficult decisions and being a change agent helped her to become a CEO.

Several non-nursing executives expressed feeling isolated when working among their predominantly male colleagues. Their experience contrasted with that of female nurse executives who established connections through shared clinical experiences. They suggested that female nurses may have one fewer barrier to overcome compared with women in other careers who seek leadership or governance roles. Many of the female executives also had been perceived as lacking sufficient quantitative skills or not being smart enough to lead. These were myths they had to dispel as they advanced, often feeling the need to outperform their male counterparts to be viewed as equally capable.

More than one female executive recounted childhood lessons that prepared her for career success. Examples included understanding how to balance demands for high achievement with the expectation to maintain a pleasing, feminine personality. Another was to function as "the son her father never had."

Attendees also observed that as health care grows and becomes more business-oriented, values associated with the spirit of healing seem to be waning. Some suggested that younger generations are hungry for a new health care model and that women have an important role in creating a system centered on helping others.

They also expressed concern that younger generations of leaders may think gender barriers no longer exist in the workplace and that young women who encounter them may decide not to seek leadership positions because of the personal toll. The good news, participants observed, is that women often have taken a more circuitous route to the top, compared with the more traditional linear path. Women's paths to career advancement fortunately are consistent with the habits of Generation X and the Millennials, who often change positions and follow different paths to gain new experiences.

Strategies for Success

Women can take several steps to help eliminate barriers and better prepare themselves for becoming executives and board members:

  • Understand the labyrinth and its impact on career advancement.
  • Seek mentoring experiences to better navigate the labyrinth and optimize career advancement potential.
  • Leverage the strengths of collaborative leadership styles to enhance the effectiveness and flexibility organizations need to thrive during the stress and change that delivery system transformation brings.
  • Educate yourself to assume executive and governance roles. This is especially true when it comes to governance, as on-the-job learning should be preceded and supplemented by formal preparation and ongoing education to maintain effectiveness.

Since the initial gathering, participants have continued to educate others about women in leadership and have broadened the discussion to include women in other lines of business through publishing and speaking engagements. This informal group has chosen to take a grassroots approach to mentoring the next generation of female leaders.

Executives and board members who already have traveled the labyrinth also must educate and mentor future female leaders to ensure they are fully engaged in health care's evolution. Now is the time to offer the guidance and support women need to maximize the contributions they can make as leaders and throughout the health care enterprise. Encouraging women to aspire to executive and board positions and helping them achieve these goals will benefit not only the majority of the health care workforce, but also patients and other stakeholders of health care, a critical and essential community resource.

Kathryn J. McDonagh, R.N., Ph.D., (kathryn.mcdonagh@hospira.com), is vice president for executive relations at Hospira Inc., Lake Forest, Ill., and serves on several national boards. Ninfa Saunders, R.N., M.B.A., Ph.D., (nsaunders@virtua.org), is president and chief operating officer of Virtua Health in Marlton, N.J., and serves on several boards.