Taking action toward gender diversity and equity in medical leadership
Lina Abouzaid, Ann Brown, Lyne Filiatrault, MD, Neli Remo, Lynn Straatman, MD
https://doi.org/10.37964/cr24720
In fall 2018, senior women physician leaders at Vancouver Coastal Health sounded the alarm on the lack of gender diversity among physician leaders. An appreciative inquiry was undertaken to look into the barriers women physicians were facing in assuming formal leadership roles. As women physicians, we could wait for the change or make it happen; we chose the latter option. Although our journey is not over, we wish to share our experience in the hope that it will assist others who may be tackling the same challenges.
KEY WORDS: gender diversity, equity, inclusion, physician leadership, appreciative inquiry, engagement
CITATION: Abouzaid L, Brown A, Filiatrault L, Remo N, Straatman L. Taking action toward gender diversity and equity in medical leadership. Can J Physician Leadersh 2020;7(1):4-9.
In British Columbia, the means to strengthen relations and improve collaboration between health authorities and their affiliated physicians were described in a tripartite agreement signed in 2014 by the BC Ministry of Health, Doctors of BC, and the CEOs of six health authorities. Funding for engagement initiatives was provided through the provincial Physician Master Agreement. Top
One support mechanism for physician engagement was to create or strengthen pre-existing medical staff associations. In our location, the Vancouver Coastal Health Authority (VCH), the Vancouver Physician Staff Association (VPSA) was created in 2016. It includes physicians from three Vancouver hospitals and affiliated community locations, representing approximately 1900 physicians.
Improving gender diversity, equity, and inclusion has been identified as a means to broaden physician engagement. In the past few years, the gender imbalance in medical organization leadership has been called out. In VCH and many health care organizations in Canada,1-4 women physicians are being left behind when it comes to leadership positions. Top
In mid-October 2018, an associate medical director within VCH asked the VPSA to look into the barriers women physicians face in assuming formal leadership roles. The request was prompted by a joint meeting where senior women physician leaders sounded the alarm on the lack of gender diversity among physician leaders. At the time, three of the authors (LA, LF, LS) were involved with the VPSA’s Facility Engagement Initiative and needed little convincing to take on this challenge. As women physicians, we could wait for change to happen or make it happen; we chose the latter option. Although our journey is not over, we wish to share our experience in the hope that it will assist others who may be tackling the same challenges.
Methods
In November 2018, the VPSA held an exploratory meeting to gauge interest and determine the opinions of physicians about gender diversity in physician leadership in our organization. Attendees included 12 physicians (11 women and one man) representing a broad range of specialties, various career stages, and a mix of formal and informal leadership roles. One of the participants had dedicated their research to documenting gender diversity (or lack thereof) across specialties in medical academia, and two others were members of the Equity Committee of the University of British Columbia (UBC) Department of Medicine. The participants shared knowledge, experiences, and personal stories to demonstrate some of the existing barriers and potential facilitators to enhancing gender diversity and inclusion in physician leadership in our organization and society at large. Some of the comments included:
I am in the department of orthopedics surgery. My entire career, I have attended meetings where I was the only woman in the room.
If you walk into a meeting of department heads with 90% women, people will stop and notice. Having 90% of men, however, is the norm.
My department head once said at a departmental meeting: “When you have a baby, you must realize the burden it puts on your colleagues.” Top
This last quote, unfortunately, resonated with many of the participants. Along with other comments made throughout the meeting, common themes emerged, such as lack of appreciation for the value of gender diversity in clinical departments and physician leadership teams as well as unconscious bias against pregnant physicians. Several physicians’ personal experiences were validated, prompting the realization that “it’s not just me.” This meeting galvanized the attendees to strive to close the gender gap in physician leadership ranks. It also highlighted the need for objective baseline demographic data on physician leaders. To create change, an appreciative inquiry (AI) approach was selected, rather than the more familiar problem-solving method.
We hired an AI coach and assembled a core team of nine women physicians and two members of the VCH Physician Relations and Compensation Department. The team led an AI process to identify diversity goals and objectives among physicians and administrative leaders at VCH. Top
Two AI sessions were held. The first, in January 2019, focused on “discovery” and “dream.” The VCH board chair, Dr. Penny Ballem opened the session by sharing her own experiences from 30 years earlier. She offered her support and hope that we would not be discussing the same issues in ten years. This first session was attended by 20 physicians, 17 women and three men, representing a diverse range of departments and divisions.
In preparation for the second session, the core team reviewed, revised, and affirmed the possibility statement and its essential elements. It then identified some of the work and actions the organization needed to initiate (or strengthen) and the stakeholders who should be involved.
This information seeded the second AI session in April 2019, which was attended by a growing number of participants. More than 40 physicians, including physician leaders from VCH and UBC Faculty of Medicine, as well as senior executives (including CEOs) from VCH and Providence Health Care, all came together to “design,” defining the components of each of the essential elements and identifying strategies and actions required for the next stage: “delivery.”
The design session provided additional material to leverage and incorporate into our final report and action plan. This report, Using All Our Talents: Meaningful Leadership Opportunities for Women Physicians at Vancouver Coastal Health, was shared with our core team and all AI participants and is accessible on our VPSA website, under resources.6 It has also been distributed to other organizations actively focusing on diversity, equity, and inclusion, such as Doctors of BC, UBC Faculty of Medicine, and the Canadian Medical Association.
On 26 September 2019, Using All Our Talents was presented to the VCH board. The action plan was endorsed, with “diversity” expanded beyond gender to include the many other important facets of diversity, both visible and invisible. The VCH Diversity, Equity and Inclusion Committee was created as a collaboration between VCH administrative staff and physicians. The committee is accountable to the VCH senior executive team and is responsible for implementation and operationalization of the actions and recommendations made in the final AI report. Top
Results
Demographics
To move to where you want to be, you need to know where you stand at present. “Numbers? Why would you want numbers?” came the response to our request for data. Nonetheless, thanks to our colleagues in the VCH Physician Relations and Compensation Department, the physician credentialing database was mined. It revealed that, in 2018, women held only 36 of 186 physician leadership positions. Whereas 43% of physicians at VCH were women, only 19% of the medical leadership roles were held by women. This ratio has been stable for the past three years, with an increase of only 1% a year. At this rate, gender parity in our physician leadership ranks will be achieved in 31 years.
Appreciative inquiry
Define: The affirmative topic selected to guide the direction of the AI was “Meaningful leadership experiences and opportunities for women physicians: women and men physicians participating together and equally in strong leadership roles at Vancouver Coastal Health.”
Discovery and dream: Through paired interviews and table discussions, the January session produced a description of a positive future also known as a possibility statement.
We are an organization that values women, in all their diversity, as leaders. There is a supportive corporate culture at VCH for empowered woman physician leadership.
At all stages of their careers, women are actively supported to develop leadership skills and knowledge by a culture that provides learning and experiences, including opportunities to collaborate, network, and lead.
We actively sponsor and mentor women to ensure equal representation in leadership.
Women always have a seat at the table.
Success begets success!
To support VCH in becoming this organization, four essential elements were identified:
- culture and environment — grow a culture that visibly values women physicians in leadership
- talent management and succession planning — make this part of standard practice and include diversity, equity, and inclusion principles
- meaningful metrics — capture the diversity of those in leadership roles and in the leadership pipeline; track the outcomes associated with more diverse physician leaders
- leadership skills — women and men physicians confident and prepared to lead Top
Design: The conversations around design emphasized the need for organizational culture change with a move away from what is perceived as more “male” attributes, setting the standards for leadership excellence.
There was discussion about how to un-bias the hiring process for physician leaders, from posting, shortlisting, interviewing, through to selection. This was viewed as necessary to ensure transparency and that hiring is truly based on established predetermined criteria rather than proverbial “fit.” When recruiting into an existing leadership team, “hiring for diversity” would make sense.
VCH needs to embrace ALL of its physicians and will benefit greatly from improving engagement with the nearly half of their workforce that is currently culturally excluded from leadership.
Additional participants’ comments included addressing the “boys’ club” environment, “unconscious bias in current leadership succession” and “implicit bias — assuming women are busy and not interested.” Top
Many participants felt that the organization must value physician leadership more by providing protected time, administrative support, and better compensation. As well, it was noted that too often leaders’ activities and meetings are scheduled as bookends to busy clinical days, thus creating logistical issues for those with family responsibilities. Participants’ suggestions included:
Consider co-leadership roles to increase flexibility.
Fund more positions to create smaller roles that can be taken without a 14-hour day.
Participants recommended early identification and development of future physician leaders. This would avoid the issue of physicians stepping into leadership roles with too little preparation and needing to learn on the job.
When asked what they valued most about the two AI sessions, the attendees consistently mentioned meeting other physicians and the opportunity to interact with leaders, “hearing other’s ideas,” and “generating ideas for change together.” This flies in the face of the common belief that women do not like to “network”; perhaps it’s all in the framing.
Deliver:Top
The main goal of the Culture and Environment Working Group is to propose processes and structures to grow a culture that visibly values diversity in physician leadership. The Leadership Skills, Talent Management and Succession Planning Working Group is tasked with developing leadership pathways that identify physician leaders early while applying diversity, equity, and inclusion principles, with the ultimate goal of developing confident and competent leaders. The leadership pathways will include both workshops and experiential learning. Physician leaders will be supported through mentorship and sponsorship.
Diversity, equity, and inclusion in medicine and in medical leadership benefit everyone. Ensuring those qualities is everyone’s responsibility.
Discussion
Our appreciative inquiry came at an opportune time. For some time now, there has been a clamour for gender diversity in the executive suite and on boards of companies. On 31 December 2014, the Ontario Securities Commission introduced a mandatory disclosure requirement for gender diversity on boards and executive teams of Toronto Stock Exchange listed companies. As of 1 January 2020, all corporations falling under the Canada Business Corporations Act are subject to new diversity disclosure rules, including the representation of women, Indigenous peoples, people with disabilities, and members of visible minorities on boards of directors and in senior management.
It was only a matter of time before attention turned to the “house of medicine.” Scrutiny came in 2018, thanks to Ontario physicians sounding the alarm on longstanding discriminatory hiring practices of an emergency department chief.8,9 The conversation continued with the Federation of Medical Women of Canada and the Canadian Medical Association, which jointly published Addressing Gender Equity and Diversity in Canada’s Medical Profession: A Review.10 In December 2019, the Canadian Medical Association released its Equity and Diversity in Medicine policy.11 Top
In the fall of 2019, the BC medical association released its own Diversity and Inclusion Barrier Assessment Report.12
All this momentum gives us hope for a more diverse, equitable, and inclusive future in the profession of medicine.
Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.
— Margaret Meade
References
1. Roth VR, Gartke K, Parai J, Khoury L. Unlocking the leadership potential of women in medicine. Can J Physician Leadersh 2018;5(1):27-32.
2. Roth VR, Theriault A, Clement C, Worthington J. Women physicians as healthcare leaders: a qualitative study. J Health Organ Manag 2016;30(4):648-65.
https://doi.org/10.1108/JHOM-09-2014-0164
3. Female physician leaders in Alberta Health Services. Edmonton: Alberta Health Services; 2018.
4. Frangou C. Alberta Health Services removed proposal for discrimination investigator from report on women in medical leadership. Globe and Mail 2019;17 June.
5. Cooperrider DL, Whitney D, Stavros JM. Appreciative inquiry handbook (2nd ed.). San Francisco: Berrett-Koehler; 2008, p. 101.
6. Resources. Vancouver: Vancouver Physician Staff Association; 2019. Available: https://ourvancouvermsa.ca/resources/
7. IAP2 spectrum. Denver, Colo.: International Association for Public Participation; n.d. https://tinyurl.com/y33mkk84
8. Glauser W. Scrubbed: Ontario emergency room chief faces questions about failing to hire any female doctors in 16 years. Globe and Mail 2018;16 Dec.
9. Glauser W. Ontario emergency room chief who hired no women for 16 years resigns amid discrimination probe. Globe and Mail 2019;31 Jan.
10. Addressing gender equity and diversity in Canada’s medical profession: a review. Ottawa: Canadian Medical Association and Federation of Medical Women of Canada; 2018. Available: https://tinyurl.com/y6hm7vvu
11. Equity and diversity in medicine. Ottawa: Canadian Medical Association; 2019. Available:
https://policybase.cma.ca/en/permalink/policy14127
12. Doctors of BC diversity and inclusion barrier assessment. Vancouver: Doctors of BC; 2019.
Acknowledgements
Our inquiry benefited from the funding and staff support provided by the Vancouver Physician Staff Association Facility Engagement Initiative.
We would also like to thank our core AI team for their unwavering support in this journey. Top
Authors
Lina Abouzaid is project manager for the Vancouver Physician Staff Association.
Ann Brown is an organizational change consultant and appreciative inquiry coach.
Lyne Filiatrault, MD, is past co-chair of the Vancouver Physician Staff Association’s Facility Engagement Initiative.
Neli Remo is manager of Vancouver Coastal Health Physician Engagement and Contract Strategies.
Lynn Straatman, MD is past chair of the Vancouver Physician Staff Association’s Collaboration and Advocacy Committee.
Author attestation
All authors contributed substantively to the article and approved the final version.
Correspondence to:
This article has been peer reviewed.