Fast forward to 2014 and the announcement of the HSJ's ‘Inspirational women in health’ list. Two colleagues from The King’s Fund and I were included in this list, and at least one third of the women named have been coached by, or attended development programmes run by, me or my colleagues. This prompted me to revisit in my head the tale of Judith Shakespeare and to relate it to my 16 years’ experience of working with women in health.
When I moved from developing and coaching individuals in the commercial sector to the world of the NHS, women made up 77 per cent of the workforce – they still do, and hold only 37 per cent of board positions, and just over 30 per cent of NHS chief executive roles. In this context, the NHS Confederation has set the goal of having 50 per cent more women on all NHS boards by 2018 – an unambitious target given the benefits attributed to having greater diversity in leadership.
Leaders across health and care agree that much more needs to be done to address the low representation of women in senior medical leadership roles. It has taken 214 years for the Royal College of Surgeons to elect a female president, for example (Miss Clare Marx took over this role on 10 July). And of course, it is not only in terms of gender that there is a mismatch between the composition of those at the top of organisations compared to staff and the patient population: the black and minority ethnic population is largely excluded from senior positions, both as NHS managers and as NHS trust board members.
In the late ‘90s some suggestions were made for women’s lack of success at achieving senior leadership roles, including:
- ‘women have a lower sense of motivation’
- ‘they fear success’
- ‘they have a low sense of competence’
- ’they tend to attribute failure to themselves and successes to external factors’.
These suggestions have their origin in traditional motivation theory – mostly written by men.
Against this, when I review the many achievements of women on HSJ’s ‘Inspirational women’ list, I and colleagues at the Fund who have in one way or other touched the careers of these women noticed that many strive to overcome the many obstacles to career progression – balancing working lives with their responsibilities as carers or parents, undertaking extra study at night and/or second jobs. Many women in health today seem able to adapt, to negotiate and renegotiate their job role. However, there are three areas that continue to act as individual or collective barriers to progression for women.
First, gender stereotyping, which some women feel has been with them from school age, affects their inner dialogue when making choices about their working lives and certainly contributes to ‘wobbles’ in their confidence and self-belief.
Second, the cultural expectations (as in Judith Shakespeare’s time) women have of themselves and that others have of women still act as a significant barrier to progression.
And finally, many organisations have either inadequate or absent career planning and talent spotting as part of an overall strategy.
One powerful element in any culture is the stories that are told. A list such as the HSJ’s can offer evidence that women in health can achieve their potential and also presents positive role models. And the celebration of those successes in itself contributes to creating a culture of an expectation of achieving potential. Here at the Fund we recognise the need to continue to support the successes of the many women we have worked with over the years – both as part of our women-only Athena programme and through our wider work developing individuals and organisations. Indeed, we hope that this leads to a recognition of the success of all the women who make up 77 per cent of the NHS workforce.