When only one woman was named among the 25 chief executives to run Scotland's reconfigured system of hospital and primary care trusts, the alarm bells began to ring.
Three posts remained vacant in that first round, and two of those jobs have now been filled by women. But the paucity of women at the top of the NHS in Scotland is a continuing cause for concern - and action.
Last week, five women just starting out on their NHS careers launched a Women in Healthcare Management initiative, holding their inaugural conference in Kilmarnock.
Safia Qureshi, who joined the NHS management training scheme in 1996 and now works as a project officer at Ninewells Hospital, Dundee, told 90-plus women delegates that her experiences and those of her colleagues had prompted the setting up of WHM.
'As trainees we were privileged,' said Ms Qureshi. 'We had mentors, we had access to powerful people within the NHS and we had a good trainee network.
'We knew that we would miss all this and that as we began to plan our NHS careers we would probably face different problems from the male trainees, not necessarily because of overt sexism.
'We believe a practical, supportive, productive network might help us and other women progress up the career ladder.'
The WHM initiative has been encouraged by the support of Scottish health minister Sam Galbraith and NHS in Scotland chief executive Geoff Scaife.
Janet McGregor, deputy human resources director at the NHS Management Executive, said the track record of women reaching the highest levels of management was 'patchy' - and this in a service dominated, in numbers, by women.
But she believed there would be opportunities to redress this imbalance through the new NHS human resources strategy and she encouraged delegates to contribute to the workings of its equal opportunities group.
Wai-Yin Hatton, general manager of Ayrshire and Arran health board, said she did not believe there was a glass ceiling in the NHS, but those who wanted to succeed had to push their limits beyond their own 'comfort zone' and build up their competences. Proactive career planning was essential, she said.
'It took me 20 years in the NHS to get my first chief executive post but I was always preparing for the next job, keeping my eye on the job market so I knew what to prepare myself for, and expanding my portfolio.'
Women should have aspirations and be competitive, added Ms Hatton.
'What is wrong with wanting your organisation to be leading edge?'
Powerful, mutually supportive networks of people 'who are there when you need them' were also important, she said.
Neil Campbell, general manager of Dumfries and Galloway health board, said it was 'not good enough for an organisation like the NHS' to have so few women chief executives.
In the past week alone he had travelled 900 miles on business and made three overnight stays. 'This is totally incompatible with my being able to provide the level of support my wife needs so that she can get on in her career,' said Mr Campbell.
But he said the Scottish health white paper Designed to Care was 'a wonderful opportunity' for women in the NHS.
'Chapter two, in particular, is all about partnership, collaboration and taking down barriers, rather than macho things like building empires and competition,' he said.
'There are opportunities for women to make a greater impact in this new environment.'
A range of practical steps to help women make progress in their careers were identified, including regional jobshare registers and a register of returners, local WHM networks, flexibility in working hours and succession planning, with appropriate support through family breaks.
It was especially important for WHM to get these messages across to trust chairs, the delegates felt.
They also wanted to see more shadowing, pairing and mentoring in the NHS.