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Analysed: Results of HSJ's women in healthcare survey for mobile

The findings of the HSJ survey on female health leaders, run in association with The King’s Fund, are a cause for both optimisim and concern. Analysis by Claire Read

The more than 1,000 people who responded to the HSJ survey on female healthcare leaders did so during a period of intense focus on the issue of workplace equality.

In recent months, Ernst and Young, the Women’s Business Council, Cranfield University School of Management and the Commons business, innovation and skills committee have all investigated whether women have achieved equal levels of representation in leadership positions. Questions regarding the barriers women face − obstacles that might not be encountered by their male counterparts − have also come to the fore.

‘Women need to earn authority and trust, which is more naturally granted to men’

In both the public and private sectors, the general theme seems to be one of simultaneous optimism and concern. While senior female managers are no longer the rarity they once were − and while progress in this regard has been particularly strong in the UK − they are still not as common as they should be.

True, the UK has the third highest percentage of female public sector leaders among the G20 countries. But it is also true that 66 per cent of public sector employees in the UK are female, yet only 35 per cent hold leadership positions.

Almost three-quarters of FTSE 250 companies now have women in their boardrooms, but the percentage of women in those same boardrooms is just 13.3 per cent. Yes, the majority of entrants to medical school are now female − “Clever girls used to be nurses, now clever girls become doctors,” Professor Jane Dacre of the Royal College of Physicians told the Commons business, innovation and skills committee. Even so, only 32 per cent of consultants are women.

Mixed outlook

The results of the HSJ survey on female health leaders, which was run in association with The King’s Fund, show a similarly mixed picture. In some ways, the responses are outstandingly positive. Particularly encouraging is the 75 per cent of respondents who said they would recommend a career in healthcare management to other women.

Positive too is the 60 per cent who reported they felt female healthcare leaders had the same level of authority as men, and the similar percentage who reported that their experience was that men and women were paid equally for similar jobs in the sector.

‘Women leaders purposefully adopt a more dominant leadership style to be taken more seriously, it seems’

Alongside these hopeful statistics were some that were anything but. Asked if they had experienced sexual discrimination during their careers in healthcare, a worrying 37 per cent of women said they had. A clear majority said that they felt female healthcare leaders were under greater pressure to prove themselves than their male counterparts.

Many respondents returned to this issue when asked whether female leaders in the health service led differently to men. A common thread in the hundreds of answers to this question was the notion that women have to make a much greater effort to establish their authority than men in equivalent roles.

“Women need to earn authority and trust, which is more naturally granted to men,” suggested one female respondent. “As a woman, you need to establish your authority, you can’t assume it,” agreed another. “Developing an authoritative style when needed without being stereotyped is more difficult,” added a third.

It seems that many women in healthcare are finding the only way to develop that authoritative style is to mirror the leadership styles more commonly associated with men. “Women leaders purposefully adopt a more dominant leadership style to be taken more seriously, it seems,” one respondent suggested. “Women do feel pressure to act in a ‘macho’ way,” echoed another. “I know women who feel that they need to match the macho style in order to be considered part of the group.”

Bullying among women leaders

Sadly, the result of that is, in some instances, extremely negative. Both men and women responding to our survey said they felt bullying behaviour was more common in female leaders. “They are more ‘political’ and can be more manipulative than men,” said one woman. “I have been bullied by a female line manager and the bullying took the form of ignoring me, sidelining me and working through others to discredit me and my achievements.”

‘We have to manage the impression that we have to be power hungry ballbreakers to be successful’

Such an experience was far from isolated. “The bullying I experienced was from a female director,” said another woman respondent. “I have met some real female bullies,” reported another. One put it simpler still when asked about the differences between male and female leadership styles: “Women use more of a bullying style.”

A male respondent agreed: “There is more bullying under female leaders. They collude with bullies and appear to foster top-down bullying.” Another man offered the following observation: “In a male dominated managerial environment, I find the rule that the oppressed often exhibit the behaviours of the oppressor, and because of their gender they often do so more aggressively than their male equivalents.”

The survey results suggest the perceived need to become dictatorial and bullying is one many women leaders are rallying against, however. “We have to manage the impression that we have to be power hungry ballbreakers to be successful,” said one respondent. Another said: “I’m currently managed by a ‘crazed, power hungry’ woman. The perception might be that I’m the same as her, when really I’m very different in style.”

Different leadership styles

So where there are positive differences between male and female leadership styles, what are they?

‘The really visionary and inspiring female leaders manage to be strong and kind’

Some themes cropped up again and again in responses. Well over 100 comments mentioned women being more empathetic, collaborative, compassionate, communicative or inclusive. Many pointed to female leaders demonstrating a much higher degree of emotional intelligence than men. The idea of women being better listeners who are more in touch with their workforces was also frequently raised. These characteristics should be more willingly embraced, many suggested.

“I find it more difficult to find strong women leaders because many try to adopt male traits,” explained one woman surveyed. “The most inspiring female leaders I’ve met don’t try to adopt these traits and actually embrace their own skills and values.”

“The really visionary and inspiring female leaders manage to be strong and kind,” concurred another respondent. “It’s something women have a more natural ability for, but a value I rate as highly in the men I aspire to be like as in the women.”

Children a disadvantage

So what does the NHS need to do to encourage and create more of these visionary, inspiring female leaders? Acknowledging childcare issues would be a good start: 61 per cent of the women who answered our survey had children but, revealingly, nearly half of all respondents felt that being a parent had or would put their career in healthcare at a disadvantage.

‘I had a family, stayed at home and came back to a workforce where the goalposts had moved’

The reasons for that are complex. First, of course, is the simple fact that becoming a mother necessitates a career break. “I have had to work twice as hard as my childless colleagues to get back to where I was before my maternity leave,” said one woman. “I would say it set me back at least two years.”

“I had a family, stayed at home and came back to a workforce where the goalposts had moved,” reported another respondent. “I obtained a senior position but never really made up the ground lost. However,” she concluded, “I have no regrets.”

Even if it is possible to manage the challenges of maternity leave, childcare presents its own issues. The solution commonly suggested to this has been flexible working. Half of all of those who answered our survey said they had requested flexible hours at some point. Encouragingly, the vast majority said the request had been granted either willingly or as a matter of course.

Flexible working

Flexibility over working hours may make childcare easier to manage, but it seems unlikely it entirely removes its status as a barrier to women’s career progression. Many respondents to our questionnaire pointed out that attendance at early morning meetings, conferences across the country and informal evening networking are crucial to gaining and maintaining leadership positions in the NHS. All are difficult when faced with the school run, the need to get children to bed or the simple desire to balance work and home life.

‘I would rather spend time with my children after work than go to an “informal” meeting and I hate going away to conferences’

When asked what the barriers were in her current role, one respondent replied: “Not wanting to go to the pub at the end of the day because of family commitments.” Another answered that the need to be away from home and to travel was a barrier to her taking the next step of working at a national level.

A third saw the main barrier as: “The lack of the networking opportunities that men have. I would rather spend time with my children after work than go to an ‘informal’ meeting and I hate going away to conferences for more than a day. Both my husband and I work, but I do the bulk of the domestic chores.”

Some respondents expressed concern that commitments to caring for children and/or elderly relatives meant women had been disproportionately affected by the Health and Social Care Act. “Changes in location of job and hours are more difficult for those with more carer responsibilities for either children or parents,” noted one.

Jobs for the boys

The way in which female leaders with children are regarded by some men appears to be another issue. “I have four children. No one sees beyond that, despite the fact I achieve more than my male counterparts,” reported one respondent. “Gender stereotyping is alive and well in the ‘old boys’ network.’”

‘In my experience it has been other women rather than men who are most threatened by talented female managers’

She was far from the only one to report the continuing existence of an “old boys’ club” in the health service. “The ‘jobs for the boys’ culture remains within the NHS,” said another. “This is gradually changing but not quickly enough.”

Views on the attitudes of men towards women leaders was perhaps predictable. Less so was the suggestion that other women could be a problem. “Jealously of other senior women is a huge barrier,” said one respondent. “It is something of a taboo subject, but in my experience it has been other women rather than men who are most threatened by talented female managers.”

Another answered: “One barrier is other women who pulled the ladder up behind them when they got into senior management.” One respondent reported: “Occasionally people, usually other women, will question my credibility for a new role… This sometimes leads me to hold back from taking risks.”

Lack of self-confidence

It was an answer that touched on another interesting theme in the survey results − the idea that what is sometimes stopping a potential woman leader progressing is that potential leader herself. “The main barriers are often self-inflicted due to lack of confidence,” said one woman.

She was far from alone: “A main barrier is my own self-confidence. I don’t think it’s because I am female per se, but certainly my male colleagues seem to be more relaxed about entering senior management at a younger age.” “Lack of confidence in getting my view heard, especially in male dominated meetings,” was an issue another woman raised.

‘Women tend to underestimate their abilities, men sometimes overestimate theirs’

It was not just women who had noticed this. One male respondent to the survey said: “I feel women should be more confident in their abilities and be more ambitious as they deserve positions at the top, rather than adhering to the socially unacceptable glass ceilings.”

Of all the barriers mentioned, this lack of confidence seems likely to be the most easily addressable. One female respondent posed a thought provoking question: “What would you attempt to do if you knew you could not fail? Barriers are often imagined. Women tend to underestimate their abilities, men sometimes overestimate theirs.”

Finding self-belief

How can potential female leaders find that self-belief? Mentoring, coaching, leadership development programmes, networks and local secondment opportunities were all mentioned by those who responded to our survey. Asked to name enablers in her current role, one person replied: “Specific mentoring and coaching for women in leadership and assertiveness.”

The importance of supportive colleagues was also a commonly cited enabler, as was the need for inspirational female role models. “Working for a female chief executive is a real enabler,” said one respondent. “Enablers − the predominantly female management team above me,” replied another.

The sheer number of enablers cited by the hundreds of women who responded to this HSJ survey is an encouraging sign that female healthcare leaders are getting the support they need to progress. Encouraging too was the − admittedly small − number of women who said they felt their gender had no bearing on their career. “Complete acceptance of gender equality by colleagues,” said one.

“I find being female largely irrelevant,” reported another. The challenge now, perhaps, is to create an NHS in which that statement is universally applicable.

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