Despina Kotis, Pharm.D., FASHP Women in Leadership Despina Kotis, Pharm.D., FASHP

“We need a new generation of leaders – men and women – who willingly embrace their opposites.” Tony Shwartz, blogs.hbr.org October 30, 2012

Satya Nadella CEO, Microsoft "It's not really about asking for the raise but knowing and having faith that the system will actually give you the right raises as you go along…Because that’s good karma, It’ll come back. Because somebody’s going to know: That’s the kind of person that I want to trust. That’s the kind of person that I want to really give more responsibility to. And in the long-term efficiency, things catch up.” Grace Hopper Celebration of Women in Computing Conference October 9, 2014 2

Executive Leadership CEOs ranked top issues facing hospitals: Financial challenges Healthcare reform implementation Governmental mandates Patient safety and quality Care for the uninsured Patient satisfaction Physician-hospital relations Population health management Technology Personnel shortages Creating an accountable care organization CEOs surveyed by ACHE in 2013 listed their concerns in order of importance. Succession planning and leadership were not at the top of their list. Take Away: The list reflects leaders’ pre-occupation with the daily pressures of operating an organization. As a result, healthcare organizations too often aren’t focusing sufficiently on building “bench strength”. Source: Top Issues Confronting CEOs: 2013. American College of Healthcare Executives. Retrieved February 2014. www.ache.org/pus/research/ceoissues.cfm 4

Gender and Healthcare Leadership Women continue to be under-represented at top levels of leadership. Perhaps the largest talent pool we are not fully leveraging: women. 74% of healthcare workforce (Bureau of Labor Statistics, 2012) Source: http://www.bls.gov/cps/wlf-databook-2012.pdf 71% of mid-level officer and management positions (EEOC Employer Information Report for Hospitals, 2011) 54% of executive and senior officer positions (EEOC Employer Information Report for Hospitals, 2011) 24% of senior executives (AHA, 2010) 18% of hospital CEOs (ACHE) Collective Source: Changing Healthcare by Design: Critical Career Inflection Points for Women Healthcare Executives. ACHE 2013 Congress on Healthcare Leadership. Take Away: Women are not making it to the top. Why? Sources: Bureau of Labor Statistics (2011), EEOC Employer Information Report for Hospitals (2011), American Hospital Association (2010), American College of Healthcare Executives (2013).

Gender and Healthcare Leadership Study conducted in partnership with the Women’s Leadership Center at Kennesaw State University Coles College of Business 282 quantitative responses to online survey 157 women, 125 men in leadership levels from Director to CEO 58% secular non-profits, 21% religious non-profits, 9% government, 7% for-profits, 5% other 38% > 10,000 employees; 22% between 5,000 and 9,999 employees; 32% between 1,000 and 4,999 employees; 8% fewer than 999 employees 52% urban, 36% suburban, 12% rural The purpose of the research was to examine gender differences in the career experiences of healthcare leaders including Chief Executive Officers and other C-suite positions, Vice Presidents and Director Levels. The survey was conducted jointly by Diversified and the Women’s Leadership Center through the Coles College of Business at Kennesaw State University. Analysis was conducted by the Women’s Leadership Center Research Director Samantha Paustian-Underdahl, PhD. Participants included 157 female leaders and 125 males working for healthcare systems, hospitals, medical centers and other types of facilities in a broad range of sizes throughout the U.S.

Career Paths Educational Background: All Leaders Men Women MBA (25.4%) Women and men in leadership positions have different work histories and educational backgrounds. Educational Background: All Leaders Men Women MBA (25.4%) MBA (19.1%) MD (25.5%) MHA (14.6%) MHA (12.7%) MSN (12.7%) Bachelors (5.6%) Bachelors (10.8%) Functional Background: All Leaders Men Women Medicine (35.7%) Nursing (43.9%) Finance (16.7%) Medicine (9.6%) Administration (14.3%) Finance, HR, Admin (6.4% each) Our survey found: MBAs more commonly held than MHAs by healthcare leaders. While women constitute nearly 50% of medical school graduates, they do not move into leadership roles at the same rate as their male counterparts. (9.6% for women vs 35.7% for men). Women leaders often come from nursing, suggesting a clinical background benefits women wanting to move into higher leadership roles. Among CEOs in the survey: 53% of women CEOs have nursing backgrounds. 43% of men CEOs come from general administration.

Career Paths Women are more likely to be promoted internally than hired externally. A significantly greater number of women than men in Diversified’s research were promoted from within their organizations than hired externally, Men reported the opposite. Possible Explanations: Survey showed men are more willing to relocate for jobs than women--perhaps because women, if married, are more likely to have spouses with full time jobs; women reluctant to uproot children. Literature consistently suggests subtle bias in hiring process—women judged by performance, work she’s done while men are judged by potential. Take Away: This mentality (a) makes it more likely that a woman will be promoted within her organization where her work is known and (b) suggests it is easier for men to be hired into other organizations. This internal versus external dynamic has financial implications for individuals and the organization. In Diversified research study, external hires earn $389,500 on average, while internal hires make $364,567 on average. These are not statistically significant differences, but do reflect the impact of internal versus external hiring on a person’s salary. The average cost of replacing one leader with an external candidate, at minimum, is approximately $50,000 — a cost that could reach as high as $1.5 million for a CEO. Source: Hospitals & Health Networks magazine, https://www.besmith.com/thought-leadership/white-papers/10-questions-comprehensive-succession-planning Take Away: External hires cost significantly more and are paid significantly more. Meanwhile, research by Wharton School of Management shows senior leaders hired from the outside have less tenure in their roles and perform lower when compared to internal promotions. Other research by Booz & Co. showed 35 percent of the externally hired CEOs were let go versus 19 percent who were promoted from within.

Career Paths Women tend to stay at an organization longer than their male peers. Years in the workforce, in healthcare and in their current positions were very similar within the survey sample. The difference in data points came when asked about years with their current organization. Women averaged 15.15 years versus men who averaged 11.52 years for an average difference of 3.63 years. This is despite the fact that the data show being willing to relocate is significantly more helpful for women’s career advancement than mens’. This may be because women are more reluctant to make lateral moves or hold out for opportunities that are extremely beneficial. It could also indicate that because fewer women than men relocate, when women do, they are rewarded.

Leadership Competencies Zenger/Folkman

Factors Valuable to Career Success Women cited specific factors as more helpful to their careers than men did, including: Leadership abilities Involvement in professional or community organizations Networking within their organizations Having sponsors to endorse them Access to flexible work practices Support from family members In order to do a better job of tapping into women as potential leaders, we have to better understand factors impacting their success in the workplace. Diversified’s research ask men and women healthcare leaders to indicate factors they believe have either helped or challenged their career advancement. Responses clearly differed by gender. Women in all cohorts surveyed—all healthcare leaders, C-suite executives, and CEOs—rated access to flexible work practices significantly higher than their male peers. In fact, men at all levels of leadership consistently rated access to flexible work practices at the bottom of their list. That said, when asked to report how much family life impacts their work, men reported much higher rates of conflict than women. Perhaps this is due to the fact that women not only value access to flexible work practice but are also more likely to leverage them

Challenges to Career Advancement Women identified challenges to career advancement: Lack of supportive supervisors Exclusion from informal networks Lack of senior role models “like me” Inhospitable culture/biased attitudes Failure of senior leadership to help advance someone “like me” The need to prioritize family over work Men identified different challenges to career advancement: Women rated these 6 factors as more significant obstacles to career advancement than their male counterparts. Men rated only these 3 factors higher than the women did in terms of their impact on career advancement. Diversified research also showed men perceived their willingness to relocate throughout their careers as more beneficial than their female counterparts; yet the same research shows relocation is significantly more helpful for women’s career advancement than men’s . Possible explanations: perhaps women who are willing to relocate get “rewarded” with promotions to a great extent than men because it is less likely to happen; Perhaps it takes a major promotion to entice women to relocate whereas men may be willing to relocate for lateral job opportunities. Take Away: Women identify external challenges to their career advancement, while men identified internal limitations as the most significant challenges to advancement Unwillingness to change organizations / companies Having an ineffective leadership style Lack of significant general or line management experience

Diablo Cody Academy Award Winner for Best Screenplay, - Juno “I’d say that it’s natural to be scared, and that can fuel a lot of your adventures in life. [And] there will always be people who find a strong woman off-putting. You can’t allow them to determine your fate. You have to tune out that kind of static and just be bold, be true to who you are. I do my best work under pressure, when I’m a little bit frightened—plus it just makes life more fun! You know, there’s something to be said for adrenaline when you’re tackling the unknown” Vanity Fair, September 2014 2

Christine Lagarde Managing Director of the International Monetary Fund First female Finance Minister of France 2007-2011 First female Chairman of a major global law firm “Although I think the fact that I was a woman helped to get this job,” she admits. “It would have been hard [after the scandal] to give it to another French man.” She now feels growing responsibility to embrace women’s issues. “I am so often the only woman in the room and I feel I should talk about it.” She said when she got to the IMF she found silo-thinkers,” she explains. “They thought that things like women’s contribution to the economy, or climate change, or income inequality, didn’t matter. But it does.” Financial Times September 12, 2014 3