What's missing from the debate about women leaders in the NHS? Men

Dean Royles

15 / 1 / 2014 11.57am

There seems to be a lot around at the moment about women in leadership in the NHS. Good. But rather strangely nearly always written about by women. It can perhaps seem odd to have a man speak or write about women in leadership – how can men understand the issues and challenges? But it is an issue far greater than one of fairness or equality and needs men to engage in the debate.

I was recently asked to give a speech on Women in Leadership - The Opportunities and Challenges for Men. I was surprised that there was only one male delegate – despite the efforts of the organisers. Yet the context we face in the NHS is about ensuring a more visibly compassionate NHS. This will take the leadership of both men and women.

Michael West, Professor of Organisational Psychology at Lancaster University, recently wrote that “leadership is the embodiment of culture”. And that is important because it tells us that having more women leading is more than just an issue of equality. Equality is important. That is why the debate about women leaders is often framed as one of fairness. And it’s not just the NHS where this is an issue. In fact the NHS does better than most.

The Equality and Human Rights Commission report, Sex & Power 2011, measured the number of women in positions of power and influence. The report calculated that at the current rate of change it would take around 70 years to reach an equal number of men and women directors of FTSE 100 companies.

Figures from the report reveal that, while women are graduating from university in increasing numbers and achieve better degree results than men.  

In business women represent:

  • 13 per cent of directors of FTSE 100 companies

In the public and voluntary sector women represent:

  • 23 per cent of local authority chief executives
  • 14 per cent of university vice chancellors
  • 33 per cent of health trust chief executives

'The Peter Principle' posits that people get promoted until they reach a point where they are no longer good at their job. But 'The Paula Principle' argues that most women work below their level of competence. 'The Paula Principle', argues there are five elements holding women back. These are: discrimination; childcare and elder care; psychology - women are often averse to putting themselves forward; a lack of vertical networks - men tend to know people higher up the ladder; and women choosing - for one reason or another - to stay where they are rather than move up to the next level.

So the equality evidence remains centre stage – but it’s not the most important issue. And not the biggest opportunity or the biggest challenge for men.

It is largely accepted that men and women as leaders exhibit or excel at or rely on certain traits – for women these are often defined as traits like collaboration, conviction, inclusiveness, creation and mentorship. And that is why having women in leadership is far more important than simple equality. We know that more women on boards leads to better services. Now, it can be argued that it’s not women per se but the benefit of better gender balance, but the benefits include:

  • Better governance: apparently linked to women’s ability to better manage and control risk. Resulting in a different type of boardroom discussion
  • Improved collaboration: linked to women’s tendency to be more open and inclusive
  • Values led decision making: linked to women’s tendency to operate on common agreed principles.

So the big opportunity for men is that if we have more women in leadership we get better services. Better for patients, better for our families and better for us. Of all the changes we need to NHS culture, this one, on paper at least, should be easier to address.

So if that’s the biggest opportunity, what is the biggest challenge?  

The biggest challenge for men – is that we stop seeing the ‘problem’ as a problem in women’s leadership or education. It is us, the NHS culture that needs to change. 

Unconscious bias is the predisposition in all of us to tend to favour certain groups and certain individuals because they are more “like us” – and therefore less threatening / challenging. This is an increasingly important business issue and I’m sure better understanding will shape a different discussion about leadership and gender.

It is really important that we as a sector continue to ensure increased participation of women in leadership programmes, training and development. And for that matter increased participation in BME where the gap is even starker. But more importantly we must look our predisposition and prejudice in the face and change our attitudes and understanding. Without that we have culture getting in the way of better patient care. This must change.

You can listen to Dean’s podcast of his King’s Fund speech.

By Dean Royles, chief executive of the NHS Employers organisation as featured in The Guardian on 8 January 2014.

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