Advancing women in healthcare
Dame Carol Black DBE FRCP FMedSci
keynote given at the Ludwig Boltzmann Forum on women’s development and leadership, Tokyo, Monday 16 May 2016
by Dame Carol Black DBE FRCP FMedSci, Principal of Newnham College, Cambridge University, and Expert Adviser on Health and Work, Department of Health and Public Health England
(Summary of Dame Carol Black’s keynote written by Gerhard Fasol)
Dame Carol Black DBE FRCP FMedSci
Principal of Newnham College, Cambridge University.
Dame Carol Black has held top positions in medicine and now holds high-level policy advisory positions on health and work in the United Kingdom.
- Dame Carol Black: Profile on the website of Cambridge University
- Dame Carol Black, Principal of Newnham College, Cambridge
- Wikipedia: https://en.wikipedia.org/wiki/Carol_M._Black
Women in healthcare – Women in the British National Health Service
The gender imbalance in the National Health Service is reflected by the facts that 77% of the total workforce is female, while only 7% of female staff are doctors or dentists, ie only 5.4% of total workforce are female doctors or dentists.
41% of Chief Executives are women.
81% of non-medical staff are women.
Alison Wolf and the XX Factor
Alison Margaret Wolf, Baroness Wolf of Dulwich CBE, is a British economist, and the Sir Roy Griffiths Professor of Public Sector Management at King’s College London, see:
- King’s College, London: Alison Wolf, Baroness Wolf of Dulwich, Sir Roy Griffiths Professor of Public Sector Management
- Alison Wolf, Baroness Wolf of Dulwich: https://en.wikipedia.org/wiki/Alison_Wolf,_Baroness_Wolf_of_Dulwich
In her book “The XX Factor: How Working Women Are Creating A New Society” (Profile Books 2013), Alison Wolf writes that women are split into two groups: one group sacrificing family for rapid professional advancements, while the other group of women opts for having children at a young age, and remain in low level positions. As a result, inequality is growing faster among women than among men, and low status and low paid jobs are predominantly done by women:
- 97% of secretaries are female
- 92% of registered nurses are female
- 89% of nursing, psychiatric and home health aides are female
- 90% of maids and housekeeping cleaners are female
The fundamentals: what are the essential characteristics of “good employment”?
- Good work: is stable and safe, allows individual control, is flexible, gives opportunities, promotes wellbeing, reintegrates sick or disabled people if possible.
- Good workplaces: have visible senior leadership and well trained managers, enable staff engagement, empower employees to care for their own health
Good news for medicine, less good news for academic medicine
Generally we have achieved a good situation regarding gender equality in medicine. We have achieved meritocracy, and their are no reports providing evidence for systematic barriers against women’s professional advancement. Both intake and retention for women in medicine is high, and the pay scales are the same.
A study (Royal College of Physicians (RCP) Working Party 2009), investigated the female share of Consultants (= established Senior Medical Professionals in the UK), and showed the ratio of women is highest (38% – 49%) in “more plan-able” and “more people oriented” specializations such as general practice or paediatrics, while women’s share is lowest (8% – 23%) in “more technology oriented” and “more unpredictable” specializations such as anaesthetics or surgical specializations.
There is far less progress in academic medicine, and cultural stereotypes and bias remain, see:
- Carol A. Isaac, Anna Kaatz, Molly Carnes: Deconstructing the Glass Ceiling
- Molly Carnes, MD, MS, Christie M. Bartels, MD, MS, CAROL ISAAC, PhD, Anna Kaatz, MPH, PhD, and Christine Kolehmainen, MD, MS: Why is John More Likely to Become Department Chair Than Jennifer?
Women’s advance into top leadership positions suffers from “cultural” prejudices, e.g. prejudices that women too kind, too caring, not logical or strong enough, or otherwise unsuited to lead.
Prominent leadership roles for women, Prominent medical leadership
Prominent leadership roles need investment in the “extras”, leads leadership dimension in each speciality, and requires career single-mindedness.
Prominent medical leadership requires investment of time “over and above” the ordinary duties, requires professional “stewardship contributions”.
The top 200 leadership positions will naturally go to those who pursue their career goals with a high degree of single-mindedness.
Women choosing the route towards prominent leadership roles need encouragement and support, they need:
- role models
- mentors, and
Role models: Prominent women leaders in UK medicine
- Una O’Brien, Permanent Secretary, Department of Health
- Professor Dame Sally Davies, Chief Medical Officer
- Dame Julie Moore, CEO, University Hospitals Birmingham, NHS FT
- Claire Murdoch, CEO, Central and NW London NHS Foundation Trust
- Professor Jane Dacre, PRC Physicans
- Clare Marx CBE, PRC Surgeons
- Dr Suzy Lishman, PRC Pathologists
- Dr Maureen Baker, Chair, RC General Practitioners
Need to debunk leadership myths
Its important not to fall into the traps of common leadership myths, e.g. that leadership is inborn, that leadership is that of a lone genius, that they must inspire others to follow their vision, the leadership requires formal authority, or that all leaders have common personality features.
We need to avoid similar leadership myths in medicine, e.g. that men naturally make better leaders.
Dame Carol Black: From a shoe-making village in decline to Government Advisor
Dame Carol Black is born in the shoe-making village of Barwell, Leicestershire, went to Grammar School in Market Bosworth, were she became Head Girl, despite her working class background.
Dame Carol Black studied first History, then Medical Social Work and finally Medicine at the University of Bristol, specialized in Rheumatology research, focusing on Scleroderma. Later advanced to Medical Director, Royal Free Hospital, President of the Royal College of Physicians, Chairman of the Academy of Medical Royal Colleges, Chair of the Nuffield Trust on Health Policy, then advising Government as National Director for Health and Work, and now Principal of Newnham College, Cambridge.
A major step was Dame Carol Black’s advancement to Medical Director of the Royal Free Hospital, since this meant not just responsibility for an institution or a group or a department, but also responsibility for the health of a population.
Leading the Royal College of Physicians
The Royal College of Physicians was founded by Royal Charter by Henry VIII on 23 September 1518 with the aim to promote the highest standards in medicine.
The skills required were: understanding a wide landscape, consensual leadership, standing ground when necessary, negotiating with Whitehall (= British Government) and building trust.
Chairing all the Medical Royal Colleges – The Academy, 2006-2009
Dame Carol Black from 2006-2009 chaired this group of 21 independent organizations. As Chair, Dame Carol Black had no executive powers, needed to lead by persuasion and with consensus.
Dame Carol Black shared several of her experiences advising Government and highest ranking Government officials and Ministers.
Key was to become valuable in the eyes of Government officials by giving independent advice based on scientific evidence, in combination with remaining totally unpolitical.
Dame Carol Black became a champion for the “cause” of health and work, and kept totally out of politics, never revealing any political views or opinion, and wrote three major reports.
The Confidence Code – forget perfection…Striving for perfection can waste women’s time, and hold back the best from reaching the top
Perfectionism and lack of confidence is large a female issue, see Katty Kay and Claire Shipman: The Confidence Code – the science and art of self-assurance, and what women should know.
Women tend to be held back by striving for perfection, while men tend to take more risks. Striving for perfection can waste women’s time, and hold back the best from reaching the top.
Women in healthcare, Women and careers, women in scientific careers
The issue of Women in Scientific Careers was examined in the “Science and Technology Committee – Sixth Report – Women in scientific careers” by the British House of Commons Science and Technology Committee in February 2014, which can be downloaded here as a pdf file:
This UK House of Commons report finds some common traits which hold women back from reaching top leadership positions, including that women may perceive promotions as undesirable, wait until they meet all perceived criteria for promotion while men often take higher risks and may behave more speculatively, and women may think that “political” skills are required to reach the top.
Finally, to reach top leadership positions, we need:
- self confidence
- risk taking
- speaking out
- staying motivated after failure
- mentors, sponsors, role models
- personal values aligned to organisational values
Summary of Dame Carol Black’s keynote written by Gerhard Fasol
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