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

Abstract

Background: Women are underrepresented in healthcare leadership, yet evidence on impactful organisational strategies, practices and policies that advance women's careers are limited. We aimed to explore these across sectors to gain insight into measurably advancing women in leadership in healthcare. Methods: A systematic review was performed across Medline via OVID; Medline in-process and other nonindexed citations via OVID; PsycINFO and SCOPUS from January 2000 to March 2021. Methods are outlined in a published protocol registered a priori on PROSPERO (CRD42020162115). Eligible studies reported on organisational interventions for advancing women in leadership with at least one measurable outcome. Studies were assessed independently by two reviewers. Identified interventions were organised into categories and meta-synthesis was completed following the 'ENhancing Transparency in REporting the synthesis of Qualitative research' (ENTREQ) statement. Findings: There were 91 eligible studies from 6 continents with 40 quantitative, 38 qualitative and 13 mixed methods studies. These spanned academia, health, government, sports, hospitality, finance and information technology sectors, with around half of studies in health and academia. Sample size, career stage and outcomes ranged broadly. Potentially effective interventions consistently reported that organisational leadership, commitment and accountability were key drivers of organisational change. Organisational intervention categories included i) organisational processes; ii) awareness and engagement; iii) mentoring and networking; iv) leadership development; and v) support tools. A descriptive meta-synthesis of detailed strategies, policies and practices within these categories was completed. Interpretation: This review provides an evidence base on organisational interventions for advancing women in leadership across diverse settings, with lessons for healthcare. It transcends the focus on the individual to target organisational change, capturing measurable change across intervention categories. This work directly informs a national initiative with international links, to enable women to achieve their career goals in healthcare and moves beyond the focus on barriers to solutions.

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

“…The gender gap in leadership representation in EM, and healthcare organisations more broadly, mirrors the leadership participation gap in other traditionally male-dominated industries. 3,4 Understanding and addressing the complex drivers behind this gap has arguably been stymied by historic domination of organisational and leadership research conducted by and representative of male perspectives. As gender researchers Eagly and Carli have observed, referring to the scarcity of women in senior leadership, 'If one has misdiagnosed a problem, then one is unlikely to prescribe an effective cure'.…”

“…This is especially limiting because organisational-level strategies are typically more successful, sustainable and, beyond the health sector, are better resourced and underpinned by organisational theory and practices. 3 A challenge for EM is the multiple loci of organisations. ACEM is a binational organisation.…”

“…A major organisational process to consider for gender equity is work-life integration, particularly through tangible access to supports like parental and carer leave, on-site childcare and flexible work policies. 3 Ensuring safety and support during pregnancy and the postpartum period for EM requires policies that consider rostering and night shifts, allocation of non-clinical work (especially important during the pandemic) and enabling ongoing lactation following return to work. Parenting responsibilities remain disproportionately borne by women, 1 but ensuring meaningful and accessible paid parental leave for men and other non-gestational parents is equally important for normalising carer roles and supporting well-being across genders.…”

Female Representation: Australian Diabetes and Endocrinology Societies

“…Despite this, there is underrepresentation of women at endocrinology conferences, on society boards, in authorship of endocrinology guidelines and editorial positions of scientific journals (1,6,(8)(9)(10). The reasons for this are not entirely understood but barriers to females advancing through academia and into leadership positions are well documented in healthcare and require multi-faceted organisational intervention to address such disparities (11). There is no publicly available data on the rates of academic versus clinical endocrinologists in Australia and the female representation among academic endocrinologists (physician with university appointment) in Australia.…”

Building an evidence base on organisational interventions to advance women in healthcare leadership

“…While women remain underrepresented in healthcare leadership, an evidence base on organisational interventions that can help to accelerate their advancement to leadership positions is limited and scattered across different sectors. In an article published in EClinical-Medicine, Helena Teede and colleagues contribute to building such an evidence base by identifying and synthesising organisational interventions that have been shown to measurably advance women in leadership [1].…”