Carol Emmott Fellows share their insights on the glass ceiling, isolation vs. integration in addressing gender equity, helping rural minority populations, motivating front-line managers and providing support functions with a fresh perspective.
It’s not the ceiling, It’s the floor
Author: Carol Emmott Fellow Thomasine Gorry, MD, MGA, University of Pennsylvania
We have newly designed office space at work. The conference rooms are now elegant glass enclosures with subtle glass doors at their center. One day I sat in a meeting and watched a female colleague approach the doors at full speed, coffee in one hand, papers in the other. She was running late but had arrived at the right room. She was where she was meant to be. I glanced back at the table, preparing to present my work, when I heard the loud thud. I looked up just in time to see the woman collide into the glass door. Papers flew into the air and coffee fell to the floor. She looked stunned, as did everyone in the conference room. We looked down politely as though it never happened. The woman laughed nervously, made the appropriate expression of self-deprecation (from behind the glass) and then retreated. We proceeded with the meeting. No one noticed or acknowledged that she did not return.
That is how most women understand the glass ceiling: as a witness to others’ mishaps. Most women in medicine know the ceiling exists but never get high enough to swing at it. A few women at the top collide into an invisible barrier and go no further. The majority of women simply find themselves on uneven footing, as though always standing in mud. For most women (though not all), it is not the ceiling that holds them back; it’s the floor that sinks beneath them.
Why do women work so hard just to stay above the surface? Why aren’t women positioned on a crisp dance floor on which to show off their talents and from which to advance to the next level? How is it that women often churn without advancing?
It is the cumulative effect of reticent negotiations. Women are reluctant negotiators for a variety of reasons: First, we are uncomfortable asking for our worth − even elevating it (as negotiation requires). This best strategy for men is unseemly for women. Second, we rightly fear retribution for asking for or receiving a pay increase. Women seeking raises may face resentment. One pay increase may halt career progression and even end professional relationships. “Who does she think she is?” The fear of advocating for themselves is not completely unfounded so the pay gap in medicine endures. The opportunity cost of each failed (or avoided) negotiation accumulates over a woman’s career at great expense. The floor slips beneath them.
Women often assume (or are expected to assume) supportive roles even if they are not in support positions. Even in medicine, female physicians, are more likely to generate referrals than to be the sub-specialist who thrives on them. If women work hard to prevent bad outcomes and care for the team, that work is not quantified and, therefore, not rewarded. High performance at supportive roles is simply not recognized. In the healthcare and most industries, everyone rewards the high scorer. No one counts the assists. The floor gives in again.
Women inhibit themselves in the belief that they are protecting their children. That is, women fear that every professional step up is a personal step away from our children. This may indeed be true. (The floor slips again.) Our world still orients around the same rigid lines: Are you full time or part time? Do you stay at home or do you work? When women are seen as standing on one side of a given line, they are necessarily absent from the other side. If they perceive that their children sit on the opposite side of that line, women stand down. The cost is too high. The workplace must evolve so that these rigid lines become false choices. Lines should be replaced with creative work design that rewards the contributions of talented, strong, women with fair pay, equal promotion, and earnest dedication to family. The overall culture must shift so that children of talented, strong, professional women are also entitled to their mother’s gifts. Can we find a solution that makes these both true? Can we change the workplace structure for women, not the structure of women’s lives?
Finally, and most importantly, the unconscious is hard at work in healthcare. Everyone − men, women, minorities − have some pre-existing identity in our minds. This is commonly referred to as “implicit bias.” Within this bias, women are not seen as strong leaders. The result: women must first work to undo that assumption and then work to execute the basic tasks of leadership. Worse, women may even carry an implicit bias against themselves. “I’m just not that person.” (Again, the floor sinks when it should rise.) The responsibility to change the implicit, “I just don’t see her that way,” bias should not fall on the individual. Organizations should actively seek to place women in leadership positions and begin the slow process of normalizing women as leaders. Eventually, organizational work will erode the bias that individual women now work to undo.
How do we keep women from churning in place? It requires a willingness to disrupt culture from the bottom up. We must normalize the identity of women as leaders, make it possible to succeed as a professional and as a mother − neither one at the expense of the other − and allow women to take the calculated risk of professional negotiations. Women themselves must believe (without fear) that they are entitled to their own best shot. Make the floor beneath women an unyielding foundation and they will advance under their own power.
Then we’ll discuss the ceiling…
Thomasine Gorry, MD, MGA, is Vice Chair for Quality at Scheie Eye Institute; Associate Professor of Clinical Ophthalmology and Cataract Surgery at Perelman School of Medicine at the University of Pennsylvania; Medical Chair for Quality in Clinical Operations for Clinical Practices at the University of Pennsylvania.
Integration vs. isolation: Walking the fine line to gender equity
Author: Carol Emmott Fellow Barbara Fonte Ronda, MHSA, University of Miami Health System
The healthcare landscape has been undergoing a period of unprecedented transformation and the evolution has confronted the status quo. Change can be perceived positively or negatively but in either instance, transformation is generally accompanied by opportunity. It appears that with each swing of the pendulum, the newly dressed landscape offers a broad and inspirational bouquet of prospects that tests an individual’s commitment to the health administration and delivery renaissance through the reinvention of roles and positioning.
For the female executive, embracing opportunistic change often represents a notable challenge. Studies show that men will raise their hand to a new job before a woman. Once in leadership roles, men will secure much healthier employment terms and salaries, when comparing apples to apples. These and other causes have led to a significant disparity between the numbers of women who enter the health services administration career path to those that ascend into a senior leadership capacity. Those very disparities have contributed to the rampant gender and wage equity issues that plague the health industry today.
Women are rising in response to this widespread crisis. We are learning of these differences and are focused on finding solutions. The past decade has brought increased awareness to women’s issues and a number of platforms have emerged as a result. Women must accept their role and responsibility in leading change if progress is to be made in our lifetimes. Additionally, the disparity crisis has given way to formidable “for women by women” advocacy groups such as the MomUp Campaign, Women in Health Care Leadership Project, and The American Medical Women’s Association; all of which fervently challenge equity issues.
Evidently, we the afflicted, are rightfully answering a call to action. However, success in the form of significant change is slow to come. There is an inherent flaw in the “for women by women” philosophy. Action must be measured and mindful. The homogeny of such groups can lead to a one-sided viewpoint. A one-dimensional perspective may lack a competitive perspective, and the narrow gate of entry only allows for like-minded philosophical beliefs and attitudes to squeeze through. This platforming also walls out differing ideology which promulgates stagnation. Creative solutions to the gender and wage gap will require an integrated approach. The solution cannot exclude our male counterparts.
Aren’t we seeking integration and equality? Then I submit that it is unrealistic to bridge the gap without engaging the “other side.” Let’s work together, men and women of all race and ethnic backgrounds, to create integrated groups reflective of the communities we serve and to create the change we wish to see.
Barbara Ronda, M.H.S.A., associate vice president and chief administrative officer for UHealth – the University of Miami Health System. She serves as a Board Member for The Health Foundation of South Florida and was recently recognized as a 2017 Public School Alumni Achievement Award Honoree.
The time is now: Addressing health inequities in rural minority populations
Author: Carol Emmott Fellow Marva Williams-Lowe, PharmD, M.H.A., Dartmouth-Hitchcock Health System
In 1966 Dr. Martin Luther King Jr. gave a speech to the Medical Committee for Human Rights and said “of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.” In 2017 inequality in healthcare still exists and the consequences are striking.
Health inequities or disparities in urban communities are well known and in some cases more resources may be available to address them than in a rural community. In rural previously homogenous communities these issues are even more significant as the minority community begins to grow but the healthcare systems have not changed or are not moving fast enough to keep pace with diversity.
Ethnic disparities in healthcare cost the U.S. billions of dollars. African Americans, Hispanics, and Native American Indians experience higher rates of chronic diseases like diabetes and hypertension than other populations. In many cases, these increased costs and reduced quality of life and mortality are preventable with wellness programs or disease state management that takes into account the specific population needs.
A May 2017 data summary from the Centers for Disease Control and Prevention (CDC) shows African Americans ages 18-49 are twice as likely to die from heart disease than whites and African Americans ages 35-64 years are 50 percent more likely to have high blood pressure than whites. The data shows that African Americans are dying younger from diseases like cancer, diabetes and heart disease than whites.
The US spends trillions of dollars on healthcare each year yet not everyone can afford to access healthcare when they need it and some populations are more challenged than others in accessing care. If you are able to seek care when you need it, you may or may not be able to afford your medications. If given the choice between paying rent, buying food, or getting medication for a chronic illness, some patients will choose not to fill their prescriptions. If the prescriptions are filled, in some cases they will not take them consistently if they believe they can save money in the short term. Drug prices and the impact on patients when they cannot afford medications is a significant issue for our country and contributes to the long term increasing health costs and poor health outcomes. This adds an additional complexity to the rural locations, poverty, race, and issues that contribute to an unequal distribution of preventative care, disease management, and access to overall healthcare.
Our neighborhoods and communities affect how we live, our daily lives, and our well-being. In rural communities where the minority populations are growing and they are underrepresented in healthcare professional and provider positions, gaps are likely to exist. In these communities, healthcare providers are often not aware of the challenges that these minorities face to access healthcare or the challenges they face when they meet a provider who is not aware of their economic, environmental, social, or cultural challenges.
Consider the story of Janice, an African American who visited a healthcare provider in a rural community. Janice rarely accesses the healthcare system and when she does, her experiences have not given her confidence that the providers recognize the importance of her difference as a minority. On her last healthcare visit, the provider was not familiar with a rash that she had on her skin which she describes as commonly seen in the African American population. When Janice previously saw a provider in a city well populated with minorities, the provider was familiar with her skin condition, was able to assist and Janice had a positive outcome.
Roberta is an African American who was seen for the first time by a gynecologist in a rural community. After the visit, Roberta reviewed her chart and noticed that the provider incorrectly documented her as Caucasian. Roberta wondered if this was a default setting in the electronic medical record since she lives in a community that was primarily white but is now experiencing a growing population of minorities. Roberta wants her provider to “see” her and recognize her difference, as she knows that race can play an important role in how some disease are diagnosed and treated.
While these are not major examples of issues with healthcare interactions in a rural community they do provide an inside view of why minorities may be hesitant to visit a provider, may not be confident that they will be understood or that their differences will be recognized. Ethnic and racial differences have a significant impact on health outcome. The challenges faced by minorities in seeking care can negatively affect their ability to lead healthy lifestyles.
To begin to address these issues we need to create equal opportunities for health at the community level as it affects the overall health status and costs for our nation. Community engagement and partnership with key stakeholders will be a necessary element to create and sustain change. Understanding specific populations, individual culture, and barriers are necessary components to establish healthy communities to reduce and one day eliminate inequities in health.
The journey to health equity in the rural locations will require community partnership with healthcare organizations and the development of programs and policies to address access to services for minority populations. Community discussions, assessments, and the development of cultural competencies will be key elements for this journey in rural populations. It will require the creation of equal opportunities for all races and populations to access and participate in healthcare and to experience no gaps in health outcomes. It will be a worthwhile journey to a worthwhile goal.
Marva Williams-Lowe, PharmD, M.H.A., is the regional pharmacy director for the Dartmouth-Hitchcock Health System. She has responsibility for hospital pharmacy practice and operations including purchasing and inventory management, budget, personnel, medication-related policies and procedures and regulatory compliance.
 (2017, May 2). National Center from Chronic Disease Prevention and Health Promotion. African American Health. Retrieved from https://www.cdc.gov/vitalsigns/aahealth/index.html
Sparking inspiration in front-line leaders
Author: Carol Emmott Fellow Chantel Johnson, PhD, RN, Palo Alto Medical Foundation—Sutter Health
As an operation leader in ambulatory healthcare, my days are filled with “fire-fighting”— staffing the clinics, managing physician schedules, moving improvement work forward, etc. Little time is spent on individual leadership development. Let me be more honest − no part of my day is usually spent thinking about leadership. Yet, it is absolutely essential for all of us to carve out time to further develop ourselves as leaders.
Over the years, I have benefited from various forms of leadership development. Whether from structured classes, coaching, or making tough mistakes, these experiences have shaped me as a leader. This year my organization sponsored me to be an inaugural member of the Carol Emmott Fellowship (CEF). While sitting amongst the other fellows in our first session, I was struck by the deep learning that I was experiencing. The rich discussions with my colleagues gave me new perspectives on leadership and stretched my thinking.
I went back to work after the first CEF convergence session inspired! I wanted the leaders under me to be similarly stimulated. I searched within my company for existing leadership offerings. Yes, the fundamentals of management were covered well in new manager orientation classes. How to hire the best, how to use project management skills, how to give presentations were covered nicely by existing programs. On the other hand, I didn’t see anything like the content I was exposed to at CEF. I abandoned the idea and felt disappointed for my managers.
A lightbulb went on for me a few weeks later while I was having a 1-1 with one of my managers. I brought up issues of gender in leadership from what I learned in CEF. I asked her what she has noticed about women leaders in our organization. I explored her observations on how women leaders behave, how others behave around them. Interestingly, she hadn’t really thought about it before. We talked well past our meeting time. When I was leaving she said that she’d love to have another leadership discussion in our next 1-1.
This was the lightbulb moment. I can bring my managers together and have inspired discussions. What had held me back was thinking that I needed to be some type of leadership guru. I thought I needed a degree in leadership or to be an expert on the topics. I am none of those things. I am not a leadership development expert or professional coach. However, I have learned some things over my years in leadership. I am an expert in my own life and experience and that’s enough.
I decided to host a lunch with my managers to talk about gender and leadership. Gender is a hot topic that most people avoid, either intentionally or because they think gender doesn’t matter anymore. I invited my managers to this one-hour Leadership Lunch and Learn session. I sent out a couple of quick homework items before the session. I asked them to read a short article and watch a TED Talk video to prime their thinking.
During the session, I gave a 20-minute overview on the gender, women in leadership, and why the topic was important. We spent the rest of the time in discussion. I prepared several conversation starters based on the homework and my overview. I asked them about how gender differences show up in their leadership teams. I shared my own struggles with being a woman leader with the assumptions and double standards sometimes put on us. My team came alive with such a dynamic discussion!
One of my managers shared strategies she uses to command more of a leadership presence in meetings. She does small things like standing up straight and avoiding inflections in her voice. Another manager jumped in and said she has been struggling with the same issue and wants to try those ideas. They weren’t just talking to me. They were talking to each other. They were inspiring each other!
For the second offering, I chose the topics of power and influence. I talked about different forms of power and why influence is such an important leadership quality. In preparation for the session, I reached out to our executive team. I gathered their tips for how to: 1) gain influence and 2) how they have effectively used power or seen others misuse it. My executives appreciated the chance to have their ideas shared with the front-line leaders. My managers loved these tips. They started guessing which senior leader had given each tip, as a way of connecting to them and matching their impression of them with their words. I have the third Leadership Lunch and Learn scheduled to talk about our personal leadership philosophies.
The feedback about my sessions have been overwhelmingly positive. My managers have extended these meeting invitations to their colleagues and supervisors so they can benefit from the content. My managers shared that they feel valued because I have taken time to offer the sessions. They said they can tell I really care about them and want to support their growth.
Even more inspiring is that I have noticed my managers are putting their learning into action. I notice subtle changes in how they present themselves in group, utilizing strategies that increase their presence. Another example great example of the impact of this type of learning was seen when a manager was recruiting for a supervisor. She was surprised that one of her star employees hadn’t applied for the position. From our Lunch and Learn session, my manager understood that frequently women do not apply for promotions when their qualifications are not a perfect match for the position. She used that information to directly reach out to her star employee and have a discussion with her, ultimately encouraging her to apply. These are just a few examples of the ripples from the Lunch and Learn sessions.
I have learned so much in this process! I learned to give myself permission to own my expertise and share it with others. I learned that I don’t have to wait for someone else to give me “permission” to mentor and coach people. I don’t have to be a world-renowned expert on a topic to still provide meaningful information and spark enlightened conversation. My team learn more from each other than they do from me. My role is to help facilitate and guide, prime the pump with some reading and ideas. I also learned that I don’t have to make it complicated. No, the Lunch and Learns are not a comprehensive leadership development course. Grassroots leadership development can be small and still create a huge difference.
I suggest other leaders to give this a try. Ask your team to join you for lunch. Pick a leadership topic and dive in.
Chantel Johnson is the Pediatric Service Line Director at the Palo Alto Medical Foundation in the San Francisco Bay Area, overseeing operations at all pediatric primary care across 24 clinics. Additionally, she is the committee chair in the Association of California Nurse Leaders.
Saving a life through health IT
Author: Carol Emmott Fellow Jeri Koester, BBA, PMP, Marshfield Clinic Information Services, Inc.
I recently watched Jimmy Kimmel share a personal story about his new son on live television. His son, Billy Kimmel, was born with an undetected heart defect that required immediate surgery. Because of the great healthcare his son received, Billy lives to see his future. While my heart ached as I listened to Jimmy’s emotional message, I was overcome with appreciation for all the work medical professionals do within healthcare.
I think of the compassion and care that clinicians provide every day for patient-centered care – within our own healthcare system and beyond. These prestigious professionals have humanity as their foundation. This also represents my passion within healthcare IT leadership and what drives me to support top-notch patient care.
I witness the daily operations of my colleagues who are responsible for providing IT solutions and services to our healthcare system. These vary from electronic health record (EHR) adoption, medication dispensing solution, enterprise data strategies, cyber security and much more. But above all, we create, implement, and improve technology that may help save patient lives.
The solution we create flags a medication that could cause an allergic reaction for a patient. This may save a life.
A reminder system that notifies patients of needed preventive screenings or tests for disease development instead of waiting until the symptoms appear. This may save a life.
A risk model that shows patients most at risk of a heart attack based on algorithms allows clinicians to intervene and engage with the patient before a life-threatening situation occurs. This may save a life.
A completely redundant infrastructure with zero unexpected downtime so a patient waiting for a discussion with their clinician regarding a cancer diagnosis does not have to hear, “We need to reschedule your appointment because our system is down.” This may save a life.
Healthcare IT leadership has never been more important. Technology is no longer just a tool, ut a part of the strategic initiative in moving organizations forward in the ever-evolving healthcare field. In conversations regarding EHR, interoperability, blockchain, cloud-based applications, and more, care and compassion need to remain at the center. We need to advocate for the safety of our patients when introducing technology.
This can be accomplished in many ways. We can start by talking about it openly. Our organization is moving forward with strategic initiatives that includes implementing hospital systems, re-platforming legacy applications and supporting shared services efficiencies. In one of our recent meetings, the project manager highlighted our project purpose and objectives to the number of applications we need to retire. This alone sounds arduous; however, shifting the intent of the meeting to how this is important to our patients restored vision and determination. The engagement from employees on the project increased significantly when our conversation focused implementing a system safely for our patients.
Additionally, our operational services can benefit from this shift in thinking as well. We are in the process of implementing lean techniques to how we work. When discussing the value stream, we place the patient in the center of our “True north” and have established measures to track success as it relates to our customers and patients. This concept creates a meaning as to why our decisions are important because we can help save lives.
Within our organization, we are expected to deliver solutions for provider efficiency and patient safety. In doing so, we share the same mission and vision of our health system, which is to enrich patient lives. And at the center of our days are patients who need care and compassion. We work to safely implement systems and ensure important data is present when it’s needed most. Healthcare IT leaders should openly discuss the effect technology has on patient care, to support the humanity of healthcare.
As healthcare leaders are continuously asked to control costs and deliver more, I have found that focusing on the very thing that keeps our hearts warm is a way to move mountains. And as the amazing providers and staff worked their miracle to save Billy Kimmel, we were all there. Ensuring the programs ran, the information was available, and doing what we can to help save lives.
Jeri Koester is vice president of IT business management at Marshfield Clinic Information Services, Inc. and has been instrumental in leading Marshfield Clinic’s transition of the IT department into a for-profit subsidiary of the health system.