Advancing women in healthcare leadership: A systematic review and meta-synthesis of multi-sector evidence on organisational interventions

The representation of women on Australian clinical practice guideline panels, 2010-2020

OBJECTIVES

To assess the composition by gender of Australian clinical practice guideline development panels; to explore guideline development-related factors that influence the composition of panels.

DESIGN, SETTING, PARTICIPANTS

Survey of clinical guidelines published in Australia during 2010-2020 that observed the 2016 NHMRC Standards for Guidelines, identified (June 2021) in the NHMRC Clinical Practice Guideline Portal or by searching the Guideline International Network guidelines library, the Trip medical database, and PubMed. The gender of contributors to guideline development was inferred from gendered titles (guideline documents) or pronouns (online biographies).

MAIN OUTCOME MEASURES

The overall proportion of guideline panel members - the guideline contributors who formally considered evidence and formulated recommendations (ie, guideline panel chairs and members) - who were women.

RESULTS

Of 406 eligible guidelines, 335 listed the names of people who contributed to their development (82%). Of 7472 named contributors (including 511 guideline panel chairs [6.8%] and 5039 guideline panel members [67.4%]), 3514 were men (47.0%), 3345 were women (44.8%), and gender could not be determined for 612 (8.2%). A total of 215 guideline panel chairs were women (42.1%), 280 were men (54.8%); 2566 guideline panel members were men (50.9%), 2071 were women (41.1%). The proportion of female guideline panel members was smaller than 40% for 179 guidelines (53%) and larger than 60% for 71 guidelines (21%). The median guideline proportion of female panel members was smaller than 50% for all but two years (2017, 2018).

CONCLUSIONS

The representation of women in health leadership roles in Australia does not reflect their level of participation in the health care workforce. In particular, clinical guideline development bodies should develop transparent policies for increasing the participation of women in guideline development panels.

Leading practices for men to support women's health leadership: A toolkit of resources to initiate change

Men have a critically important role to play in supporting women from different backgrounds to move into leadership roles. Indeed, it is necessary work for those in positions of privilege to challenge processes that result in inequitable gender outcomes in health leadership. We present the resources that have been compiled into a toolkit for men to support more inclusive health leadership and transformative systemic change. A three-step process was undertaken to search, select, and curate leading evidence-informed practices. Three key clusters of resources in the toolkit address why men's actions are necessary, what leading actions entail, and the importance of mentorship and sponsorship. Change will require more than shaping the individual attitudes and behaviours of men in leadership positions. Attention to gender and other forms of inequity need to be embedded into the structures, processes and outcomes of teams, organizations, and systems and evaluated for process.

Trends in female first-author abstracts at the Society for Academic Emergency Medicine Annual Meeting, 1990-2020

OBJECTIVES

To describe first author gender differences and characteristics in 1) Society for Academic Emergency Medicine (SAEM) Annual Meeting abstracts and 2) resulting manuscript publications.

METHODS

We performed cross-sectional evaluation of SAEM abstracts from 1990, 1995, 2000, 2005, 2010, 2015, and 2020, compiling and reviewing a random sample of 100 abstracts for each year (total n = 700 abstracts). We documented abstract characteristics, including first author gender, and used the 2020 SAEM scoring rubric. We then searched PubMed to identify manuscript publications resulting from abstracts from 1990 to 2015 (n = 600). Finally, among abstracts that resulted in manuscript publication, we identified first and last author gender on both the abstracts and the resulting publication.

RESULTS

Overall, 29% (202/695; n = 5 missing gender) of abstracts had female first authors. Female first authors increased over time (e.g., 17% in 1990 to 35% in 2020). Abstract quality scores were similar (both median [interquartile range] of 11 ([9-12]). Overall, 42% (n = 254/600) of abstracts resulted in a manuscript publication, 39% (n = 65/202) with female and 44% (n = 189/493) with male first authors (p = 0.26). The median time (IQR) from abstract to manuscript publication was longer for abstracts with female first authors vs. those with male first authors (2 [1-3] years and 1 [1, 2] years, p < 0.02); 77% and 78% of publications resulting from abstracts with female and male first authors, respectively, had the same first author. Female first author abstracts more often converted to a male first author manuscript publication (18%, n = 12/65) compared to male first author abstracts converting to female first author publications (7%, n = 14/189).

CONCLUSIONS

A minority of SAEM abstracts, and manuscript publications resulting from them, had female first authors. Abstracts with female first authors took longer to achieve manuscript publication, and almost a fifth of female first author abstracts resulted in male first author manuscript publication.

Learning Through Diversity: Creating a Virtuous Cycle of Health Equity in Health Care Organizations

In the US, a growing number of organizations and industries are seeking to affirm their commitment to and efforts around diversity, equity, and inclusion (DEI) as recent events have increased attention to social inequities. As health care organizations are considering new ways to incorporate DEI initiatives within their workforce, the anticipated result of these efforts is a reduction in health inequities that have plagued our country for centuries. Unfortunately, there are few frameworks to guide these efforts because few successfully link organizational DEI initiatives with health equity outcomes. The purpose of this chapter is to review existing scholarship and evidence using an organizational lens to examine how health care organizations can advance DEI initiatives in the pursuit of reducing or eliminating health inequities. First, this chapter defines important terms of DEI and health equity in health care. Next, we describe the methods for our narrative review. We propose a model for understanding health care organizational activity and its impact on health inequities based in organizational learning that includes four interrelated parts: intention, action, outcomes, and learning. We summarize the existing scholarship in each of these areas and provide recommendations for enhancing future research. Across the body of knowledge in these areas, disciplinary and other silos may be the biggest barrier to knowledge creation and knowledge transfer. Moving forward, scholars and practitioners should seek to collaborate further in their respective efforts to achieve health equity by creating formalized initiatives with linkages between practice and research communities.

Association of women leaders in the C-suite with hospital performance

BACKGROUND

Women comprise 50% of the healthcare workforce, but only about 25% of senior leadership positions in the USA. No studies to our knowledge have investigated the performance of hospitals led by women versus those led by men to evaluate the potential explanation that the inequity reflects appropriate selection due to skill or performance differences.

METHODS

We conducted a descriptive analysis of the gender composition of hospital senior leadership (C-suite) teams and cross-sectional, regression-based analyses of the relationship between gender composition, hospital characteristics (eg, location, size, ownership), and financial, clinical, safety, patient experience and innovation performance metrics using 2018 data for US adult medical/surgical hospitals with >200 beds. C-suite positions examined included chief executive officer (CEO), chief financial officer (CFO) and chief operating officer (COO). Gender was obtained from hospital web pages and LinkedIn. Hospital characteristics and performance were obtained from American Hospital Directory, American Hospital Association Annual Hospital Survey, Healthcare Cost Report Information System and Hospital Consumer Assessment of Healthcare Providers and Systems surveys.

RESULTS

Of the 526 hospitals studied, 22% had a woman CEO, 26% a woman CFO and 36% a woman COO. While 55% had at least one woman in the C-suite, only 15.6% had more than one. Of the 1362 individuals who held one of the three C-suite positions, 378 were women (27%). Hospital performance on 27 of 28 measures (p>0.05) was similar between women and men-led hospitals. Hospitals with a woman CEO performed significantly better than men-led hospitals on one financial metric, days in accounts receivable (p=0.04).

CONCLUSION

Hospitals with women in the C-suite have comparable performance to those without, yet inequity in the gender distribution of leaders remains. Barriers to women's advancement should be recognised and efforts made to rectify this inequity, rather than underusing an equally skilled pool of potential women leaders.

Using a Modified Delphi Approach and Nominal Group Technique for Organisational Priority Setting of Evidence-Based Interventions That Advance Women in Healthcare Leadership

BACKGROUND

Few studies address how to prioritise organisational interventions that advance women in leadership. We report on the relevance, feasibility and importance of evidence-based interventions for a large healthcare organisation. This study supports the first stage of implementation in a large National Health and Medical Research Council funded initiative seeking to advance women in healthcare leadership.

METHODS

An expert multi-disciplinary panel comprised of health professionals and leaders from a large healthcare network in Australia participated. The initial Delphi survey was administered online and results were presented in a Nominal Group Technique workshop. Here, the group made sense of the survey results, then evaluated findings against a framework on implementation criteria. Two further consensus surveys were conducted during the workshop.

RESULTS

Five priority areas were identified. These included: 1. A committed and supportive leadership team; 2. Improved governance structures; 3. Mentoring opportunities; 4. Leadership training and development; and 5. Flexibility in working. We describe the overall priority setting process in the context of our findings.

CONCLUSIONS

With evidence and expert input, we established priorities for advancing women in healthcare leadership with a partnering healthcare organisation. This approach can be adapted in other settings, seeking to advance women in leadership.

Factors that influence the implementation of organisational interventions for advancing women in healthcare leadership: A meta-ethnographic study

BACKGROUND

Gender inequity in healthcare leadership persists and progress is slow, with the focus firmly on problems, barriers and on requiring women themselves to adapt and compete in a system not designed for them. Women are individually burdened to advance their careers, with little effort given to addressing systemic barriers in the health sector. A recent systematic review prioritised organisational-level approaches and demonstrated effective interventions. In this meta-ethnographic study, we further this work by examining factors in implementation of organisational interventions for advancing women in leadership.

METHODS

The meta-ethnographic framework applied here follows the Noblit and Hare approach for synthesising findings and applying interpretive analysis to original research. We generated a new line-of-argument with insights for the healthcare sector. The protocol is registered (CRD42020162115) on the International Prospective Register of Systematic Reviews. Three academic databases (MEDLINE, PsycINFO, SCOPUS) were searched systematically between 2000 and 2021. Studies were analysed if they included organisational-level interventions that sought to measurably advance women in leadership. Study characteristics were extracted using a standard template for intervention details. Quality appraisal was conducted using the Critical Appraisal Skills Program tool. Data synthesis was conducted across 19 criteria of the Meta-Ethnography Reporting Guide (eMERGe).

FINDINGS

Fifteen qualitative studies were included. Analysis revealed three meta-themes that are central to successful implementation of organisational interventions that advance women in healthcare leadership: (1) leadership commitment and accountability, influenced by internal and external organisational settings, salient for long term outcomes and for developing an inclusive leadership culture; (2) intervention fit with individuals with consideration given to personal beliefs, preferences, experiences, capabilities or life circumstances, including capacity for leadership roles in their broader life context; balanced against maintaining interventional fidelity, and (3) cultural climate and organisational readiness for change, addressing traditional, conservative and constrictive perspectives on gender and leadership in health, highlighting the facilitating role of male colleagues.

INTERPRETATION

This meta-ethnographic research extends past work by integrating empirical evidence from a systematic literature review of effective organisational level interventions, with the identification of pragmatic themes to generate, implement, evaluate and embed evidence-based organisational interventions to advance women in healthcare leadership. This work can inform initiatives and policymakers to generate and implement new knowledge to advance women in healthcare leadership.

FUNDING

Epworth Health and Monash University provided scholarships for MM. HT is funded by an NHMRC / MRFF Practitioner Fellowship, JB by an NHMRC fellowship and HS by a Monash Warwick University Professorship.

Gender equality in the 21st century: Overcoming barriers to women's leadership in global health

PURPOSE

The purpose of this manuscript is to provide an overview of the significant role that women play in providing global health care, barriers encountered to achieving gender equality in global health leadership, and to propose key recommendations for advancing gender equality in global health decision-making through the integration of gender mainstreaming, gender-based analysis, and gender transformative leadership (GTL) approaches.

METHOD

Data were evaluated to determine the participation rate of women in global health care and social sector roles in comparison to men. Gender equality data from the United Nations, World Health Organization, Organization for Economic Co-operation and Development, International Labour Organization, and other resources were analyzed to assess the impact of the coronavirus disease 2019 pandemic on gender equality with an emphasis on women in global health leadership positions, the health care and social sector, and gender equality measures for girls and women throughout the world. The literature was examined to identify persistent barriers to gender equality in global health leadership positions. Additionally, a review of the literature was conducted to identify key strategies and recommendations for achieving gender equality in global health decision-making; integrating gender mainstreaming; conducting gender-based analysis; and adopting GTL programs, incentives, and policies to advance gender equality in global health organizations.

FINDINGS

Women represent 70% of the health and social care sector global workforce but only 25% of senior global health leadership roles. Since 2018, there has been a lack of meaningful change in the gender equality policy arenas at global health organizations that has led to significant increases in women serving in global leadership decision-making senior positions. During the pandemic in 2020, there were nearly 100 open vacancies-one-quarter of CEO and board chair positions-at global health organizations, but none were filled by women. Women disproportionately provide caregiving and unpaid care work, and the pandemic has increased this burden with women spending 15 hours a week more on domestic labor than men. A lack of uniform, state-sponsored paid parental leave and support for childcare, eldercare, and caregiving, which is overwhelmingly assumed by women, serve as major barriers to gender parity in global health leadership and the career advancement of women.

CONCLUSION

The pandemic has adversely impacted women in global health care and social sector roles. During the pandemic, there has been a widening of the gender pay gap, a lack of gains for women in global health leadership positions, an increase in caregiving responsibilities for women, and more women and girls have been pushed back into extreme poverty than men and boys. Globally, there is still resistance to women serving in senior leadership roles, and social and cultural norms, gender stereotypes, and restrictions on women's rights are deeply intertwined with barriers that reinforce gender inequality in global health leadership. To ensure comprehensive human rights and that equitable workforce opportunities are available, the concept of gender equality must be expanded within the global health community to consistently include not only women and girls and men and boys, but also persons who identify as nonbinary and gender nonconforming. Efforts to eliminate remnants of systemic and structural gender discrimination must also incorporate gender mainstreaming, gender-based analysis, and gender transformative approaches to achieve gender equality throughout global health systems and organizations.

Exploring the opportunities and challenges of female health leaders in three regional states of Ethiopia: a phenomenological study

Background

Gender equity involves fairness in all aspects of life for women and men and is usually determined by social, political, economic, and cultural contexts. The proportion of female leaders in healthcare within the health sector is low. The aim of this study was to explore and describe the experiences, opportunities, and challenges faced by women in their path towards becoming leaders within the health sector.

Methods

This study was conducted using the phenomenological method of qualitative inquiry. The approach was chosen for its merits to narratively explore and describe the lived stories and shared experiences of women leaders in the healthcare system. A purposive sampling technique was used to identify six women leaders. Semi-structured interviews were conducted through telephone by the investigators. The qualitative data analysis was conducted parallel with data collection, using steps of thematic analysis.

Results

This study identified individual, societal, and organizational level opportunities and challenges that had an influence on the career paths of female health leaders in Ethiopia. The leadership positions were an opportunity in the career development of women who had long-term goals, were known for their empathy, and exercised wise use of resources. In addition, women who had the support of close family members and their peers are more likely to compete and rise to leadership positions. Furthermore, women who received organizational support in the form of affirmative action, training, development, and recognition also tended to rise to leadership positions. However, women who assumed leadership positions but whose day-to-day decision-making was influenced by their supervisors, those who had experienced sexual harassment, and those under the influence of societal norms were less likely to attain leadership positions.

Conclusion

The opinions and experiences of female health leaders revealed that individual behaiour whileassumming a leadership positon, empathy, and wise resource management positivey influence their career development. In addition, female health workers who had support form close family members and peers strived for growth to leadership positions. Furthermore, the presence of organizational support, in the form of affirmative actions, and succession planning were another opportunity for females in their career paths. Conversely, some social norms were found to deter female health workers from advanicing to leadership positions. Therefore, enhancing the leadership capacity of women and improving social and organizational support is recommended. In addition, addressing the low level of self-image among women and patriarchal societal norms at the community level is recommended.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13871-w.

Does global health governance walk the talk? Gender representation in World Health Assemblies, 1948-2021

BACKGROUND

While an estimated 70%-75% of the health workforce are women, this is not reflected in the leadership roles of most health organisations-including global decision-making bodies such as the World Health Assembly (WHA).

METHODS

We analysed gender representation in WHA delegations of Member States, Associate Members and Observers (country/territory), using data from 10 944 WHA delegations and 75 815 delegation members over 1948-2021. Delegates' information was extracted from WHO documentation. Likely gender was inferred based on prefixes, pronouns and other gendered language. A gender-to-name algorithm was used as a last resort (4.6%). Time series of 5-year rolling averages of the percentage of women across WHO region, income group and delegate roles are presented. We estimated (%) change ±SE of inferred women delegation members at the WHA per year, and estimated years±SE until gender parity from 2010 to 2019 across regions, income groups, delegate roles and countries. Correlations with these measures were assessed with countries' gender inequality index and two Worldwide Governance indicators.

RESULTS

While upwards trends could be observed in the percentage of women delegates over the past 74 years, men remained over-represented in most WHA delegations. Over 1948-2021, 82.9% of delegations were composed of a majority of men, and no WHA had more than 30% of women Chief Delegates (ranging from 0% to 30%). Wide variation in trends over time could be observed across different geographical regions, income groups and countries. Some countries may take over 100 years to reach gender parity in their WHA delegations, if current estimated trends continue.

CONCLUSION

Despite commitments to gender equality in leadership, women remain gravely under-represented in global health governance. An intersectional approach to representation in global health governance, which prioritises equity in participation beyond gender, can enable transformative policymaking that fosters transparent, accountable and just health systems.

Development, Implementation, and Evaluation of a New Course on Essential Skills for Women's Leadership in Global Health

While many calls have been made to support the development of women leaders in global health, few resources have been developed and evaluated to meet this goal. We developed and evaluated a one week online short course on the essential skills for women’s leadership in global health, offered in June 2021 to 22 students from 4 countries (Australia, Ethiopia, Thailand, and the United States). The course covered the state of women’s leadership in global health and influencing factors; leadership theories models and frameworks; self-awareness and self-assessments; organizations and enabling environments; communication; and negotiation, and was designed to promote skills via practice, discussion, and debrief. Students rated the course highly and enjoyed the skills-building components, diversity of voices presented throughout the course, and embedded networking opportunities. Future iterations of the course, particularly those held in low-and middle-income countries, should contextualize materials, co-create with local instructors and amplify local voices, and consider incorporating shadowing, coaching, mentorship, and communities of practice.

Ten actions to achieve gender equity among intensivists: the French Society of Intensive Care (FICS) model

In our recent survey, we aimed to collect information on perceived inequity as well as professional and personal fulfillment among women intensivists in France. For the 371 respondents out of the 732 persons who received the survey, the findings were unequivocal: for one-third of the respondents, being a woman was considered as an obstacle to careers or academic advancement, and for two thirds, pregnancy was viewed as a barrier to their career advancement. Gender discrimination had been experienced by 55% of the respondents. In 2019, to promote and achieve gender equity in the French Intensive Care Society (FICS), ten actions were initiated and are detailed in the present manuscript together with supporting data: (1) creation of a working group: the FEMMIR group; (2) promotion of mentorship; (3) implementation of concrete sponsorship; (4) transparency and public reporting of gender ratios in editorial boards; (5) workshops dedicated to unconscious gender bias; (6) workshops dedicated to improved women assertiveness; (7) role models; (8) creation of educational/information programs for young intensivists; (9) development of research on gender inequity and, as a perspective; and (10) development of a wide-ranging program. This review is aimed at providing a toolbox of organizational best practices designed to achieve gender equity. It is particularly important to share promising practical action engaged in our FEMMIR group with other concerned professionals around the world.

Assessing barriers to the career ladder and professional development for ethnic minority genetic counselors in the United States

Ethnic diversity is not reflected within healthcare professions, including genetic counseling, where lack of growth and membership among minority colleagues extends to upper-level and executive roles. While diversity and inclusion-based topics have been emphasized, studies on potential barriers to career advancement in the field of genetic counseling have not received the same attention. Our study examined the current state of mentorship and sponsorship programs, the presence of diversity and inclusion initiatives, and opportunities for career advancement through the lens of a minority genetic counselor. Practicing genetic counselors in the United States identifying as part of any racial group, other than non-Hispanic White alone, were recruited through the Minority Genetics Professionals Network for survey participation. A 31-item survey was fully completed by 19 practicing genetic counselors from a variety of ethnic backgrounds. Data were analyzed using descriptive statistics and thematic analysis, allowing for individual stories and accounts to be amplified. Results showed 16 of 19 participants had never been promoted in their current employment setting. Additionally, 7 out of 19 respondents disagreed or strongly disagreed that their company had a commitment to an ethnically diverse workforce within upper-level positions. Prominent themes identified from open-ended responses included lack of social connection with supervisors and the cross-race effect, a term referencing a tendency for individuals to better recognize members of their own race or ethnicity than others. Additional themes revealed feelings of isolation, need for support from White colleagues, as well as desired emphasis on sponsorship tailored toward professional growth. These findings demonstrate a need for proactive involvement in reaching ethnic and racial minority genetic counselors through companywide policy efforts, support and advocacy from White colleagues, and modification of cultural perception frameworks. Further focus and emphasis on these distinct but critical topics may be important in promoting increased diversity in upper-level positions in the field of genetic counseling.

Advancing gender equity in the academy

Implementation science offers a rigorous set of tools to help mitigate long-standing and worsening gender disparities in academia.

The feminization of medicine in Latin America: 'More-the-merrier' will not beget gender equity or strengthen health systems

This viewpoint addresses the lack of gender diversity in medical leadership in Latin America and the gap in evidence on gender dimensions of the health workforce. While Latin America has experienced a dramatic change in the gender demographic of the medical field, the health sector employment pipeline is rife with entrenched and systemic gender inequities that continue to perpetuate a devaluation of women; ultimately resulting in an under-representation of women in medical leadership. Using data available in the public domain, we describe and critique the trajectory of women in medicine and characterize the magnitude of gender inequity in health system leadership over time and across the region, drawing on historical data from Mexico as an illustrative case. We propose recommendations that stand to disrupt the status quo to more appropriately value women and their representation at the highest levels of decision making for health. We call for adequate measurement of equity in medical leadership as a matter of national, regional, and global priority and propose the establishment of a regional observatory to monitor and evaluate meaningful progress towards gender parity in the health sector as well as in medical leadership.

"I may be essential but someone has to look after my kids": women physicians and COVID-19

OBJECTIVES

This paper analyzes results from focus groups held with women physicians in British Columbia which explored questions around how gender norms and roles influenced their experiences during COVID-19.

METHODS

Four virtual focus groups were organized between July and September 2020. Participants (n = 27) were voluntarily recruited. Data were analyzed using applied thematic analysis.

RESULTS

In addition to the COVID-19-related changes experienced across the profession, women physicians faced distinct challenges related to an increase in unpaid care responsibilities, and often felt excluded from, and occasionally dismissed by, leadership. Women leaders often felt their contributions were unrecognized and undervalued. Participants drew strength from other women leaders, peer networks, and professional support, but these strategies were limited by unpaid care and emotional labour demands, which were identified as increasing risk of burnout.

DISCUSSION

Even though women physicians hold a degree of relative privilege, unpaid care work and gender norms contribute to distinct secondary effects of COVID-19. Women physicians link these to pre-pandemic assumptions (within families and communities) that women would absorb care deficits at their own cost. Health system leadership continues to reflect a masculine normative experience wherein the personal and professional are separated, and which devalues the emotional labour often associated with feminine leadership. The strategies participants employed to address negative impacts, while demonstrating resourcefulness and peer support, reflect individualistic responses to social-structural challenges. There is a need for greater recognition of women's contributions at home and work, increased representation in decision-making, and practical supports such as childcare and counselling.

Using an employee resource group to develop GRIT in female healthcare leaders: a case study

PURPOSE

This case study aims to demonstrate how the Greater Leadership Opportunities for Women (GLOW) Mayo Clinic Employee Resource Groups (MERG) has positively impacted leadership development focusing on growth, resilience, inspiration and tenacity (GRIT) and increased advancement for female leaders at Mayo Clinic. It will also establish how the innovative utilization of employee resource groups can positively impact the development of leaders within an institution in general and specially can enhance behaviors related to GRIT.

DESIGN/METHODOLOGY/APPROACH

This case study design was used to measure the impact of the GLOW MERG's interventions through qualitative and quantitative approaches that highlight both process and outcome to increase study validity through complementarity, which "seeks elaboration, enhancement, illustration, clarification of the results from one method with the results from another" (Greene, et al., 1989, p. 259) as well as completeness and context (Onghena et al., 2019; Schoonenboom and Johnson, 2017; Bryman, 2006). Learning outcomes (knowledge), skill accomplishments and attitude development were evaluated within two weeks after each session and annually through standardized surveys sent to participants via email. The surveys were designed to capture key information about the sessions, including the impact of the session content, the willingness and ability of attendees to apply the learning and identification of opportunities for improvement in session design and delivery, as well as measure satisfaction with the activities offered, the frequency and method(s) of communication, barriers to session attendance and particular topics or speakers of interest to members (Appendix 1). Response options included dichotomous scales, Likert-type scales, multi-select and free text. This provided a voluntary response sampling, as post-session surveys were sent to all session attendees and annual surveys were sent to all GLOW MERG members, which allowed individuals to choose if they would respond to the surveys (Creswell and Creswell, 2018). To foster an environment of continuous improvement, plan-do-study-act (PDSA) cycles (Langley et al., 2009) were conducted after every survey by the event planning team and the GLOW MERG Board. Interventions were tested, reviewed and discussed during monthly board meetings and event planning. Improvements were made and results were shared with key stakeholders through regular communication channels. Additionally, 30 past and present GLOW MERG leaders were surveyed to measure their perceived impact of participation in the GLOW MERG interventions using dichotomous scales, multi-select and free text responses (Appendix 2). This targeted purposive sample was selected because of their high level of engagement with the MERG to provide a retrospective evaluation of the success of the GLOW MERG, and its interventions for career advancement related to the development of GRIT attributes, knowledge and skills resulting in career advancement for those who are/have been highly engaged with the MERG.

FINDINGS

The results spanning the past few years of GLOW MERG interventions has shown that the GLOW MERG has been successful in providing targeted educational events that address the GRIT knowledge, skills and attributes, needed for female health-care leaders to be successful in developing GRIT capabilities. By staying true to its mission and vision, the GLOW MERG has been able to promote, educate and empower female leaders at Mayo Clinic while actively breaking down the barriers that can prevent women from obtaining leadership positions.

RESEARCH LIMITATIONS/IMPLICATIONS

There are several limitations with this case study's data collection and sampling methods. First, the post-session and annual survey sampling was based mainly on ease of access, with responses obtained from respondents who are more likely to volunteer or those with the strongest opinions. This allowed for potential bias as responses may not be representative of all GLOW MERG member opinions. Furthermore, the purposive sample of present and past GLOW MERG leaders was also subject to volunteer bias and may not have be representative of the GLOW MERG population. Additionally, the case study examined the practices of only one site and MERG group and may not be representative of all sites or employee resources groups.

PRACTICAL IMPLICATIONS

The interventions implemented by the GLOW MERG to assist women with developing GRIT knowledge, skills and attributes - barriers women often face in leadership roles - were tested, reviewed and discussed during monthly board meetings and event planning. PDSA cycles were conducted, improvements were made and results were shared with key stakeholders through regular communication channels (Langley et al., 2009). Key lessons learned from these assessments include: One size does not fit all for leadership development. GLOW members have a wide variety of backgrounds, skills and experiences. Repetition is important in the development of GRIT knowledge, skills and attributes associated with GRIT. A one-time event provides attendees with an information overview and the steps to start developing a new skill but no dedicated time to practice and implement that skill.

ORIGINALITY/VALUE

The innovative utilization of employee resource groups can positively impact the development of leaders within an institution in general and specially can enhance behaviors related to GRIT.

Female Representation: Australian Diabetes and Endocrinology Societies

BACKGROUND

Endocrinology has one of the highest proportions of female specialists and trainees, however females have traditionally been underrepresented in leadership positions and as speakers at scientific meetings.

HYPOTHESIS

Females would represent less than half of invited speakers (plenary, symposium sessions) at endocrinology conferences and in leadership positions of endocrinology societies.

METHOD

An audit of Australian diabetes and endocrinology societies and their respective annual scientific meetings between 2016 - 2020. Analysis of the gender of conference speakers across oral, symposium and plenary sessions, session chairs, program organising committees and society committees.

RESULTS

A total of 1638 speakers (females 856, 52.3%) across 550.4 hours (females 273.6, 49.7%) of presentations at the conferences were identified. Among plenary sessions of all 3 societies there were more male (61%) than female speakers. A total of 608 session chairs were identified, with 313 (51.5%) females. The majority of organising committee members (n=116) were female (56%), however the representation across each organising committee varied. There was a low proportion of society female council members (39% female).

CONCLUSION

There was an equal representation of females and males as conference speakers and session chairs. However, there was an underrepresentation of women in more prestigious roles of plenary speakers and society council members. We implore conscious efforts to address this disparity.

Gender equity in emergency medicine: Five years on, where are we headed?

The challenge of addressing gender inequality was highlighted in the 2016 Trainee Focus of Emergency Medicine Australasia. Despite increasing numbers of female medical graduates, including increasing female trainees in emergency medicine (EM), this has not yet translated to equal representation in formal leadership roles. Five years later, as the Australasian College for Emergency Medicine (ACEM) welcomes the second female college president, this article explores the gendered leadership gap in EM from an organisational and intersectional feminist perspective and recommends high-level strategies for change. Notably, ACEM has demonstrated committed engagement with gender equity, such as the establishment of the Advancing Women in Emergency Section. It has also achieved gender parity in provisional trainees and improved women's representation on the ACEM Board. However, broader organisational processes that ensure work-life integration, transparent leadership development pathways and equitable recruitment, promotion, retention and evaluation remain critical. Creating a local evidence-base to support diversity in leadership development remains a priority.