By JULIE MINDA
Patricia Maryland had been in senior management at the Cleveland Clinic for about 15 years when, around 1997, Kevin Lofton — who was then the head of a university health network — told her, "With your experience and capabilities, you should really be running a health system."
Patricia Maryland, then-president of St. John Providence Health System in Warren, Mich., participates in a 2012 physician celebration event hosted by St. John. Maryland now is president of health care operations and chief operating officer of St. Louis' Ascension Health, St. John's parent company.
Maryland recalled, "He expressed the confidence in me to make the next move when I hadn't envisioned that for myself. His encouragement helped me and gave me the confidence to leave a safe environment and move up." She has since served in top executive positions at nearly half a dozen health care organizations, including as president and chief executive of St. John Providence Health System in Warren, Mich., prior to her promotion to her current position as president of health care operations and chief operating officer of St. Louis-based Ascension Health. Lofton is chief executive of Englewood, Colo.-based Catholic Health Initiatives.
Maryland and other female top executives in Catholic health care told Catholic Health World that they've seen an increasing number of women on executive teams both at the facility and system level in the ministry during the course of their careers, but there is room for improvement, particularly when it comes to the number of women on system-level leadership teams, in chief executive roles and on boards in the ministry.
Slow climb
Sr. Rita Thomas, CBS, is a retired administrator who helped to establish Bon Secours St. Mary's Hospital in Richmond, Va., in 1966 and then headed the facility for about four years before accepting a leadership position in her congregation. Her replacement at the hospital was a lay man. She said that until about the 1960s it was common for women religious with a clinical background to lead the health care facilities their congregations had founded. But as the number of women religious declined in the U.S., many congregations redirected the sister administrators to congregation leadership roles or allowed them to pursue their preference to work directly with the poor. Also, in the wake of the 1946 Hill–Burton Act that provided federal dollars for hospital construction and improvement, and with the implementation of Medicare and Medicaid, government regulation increased. "So, it wasn't as simple as it used to be (to run a hospital), and it took a lot more experience, and a
lot of education. Health care was becoming big business — not a ministry," she said.
Sr. Maureen McGuire, DC, Ascension executive vice president of mission integration, said "there was a need for business acumen for a changing health care environment, and sisters looked to their boards" and their lay leaders for executive candidates with operational and financial backgrounds. In the 1960s and 1970s, most people with such experience were men, and so men were recruited to those executive positions. Sr. McGuire said in the ensuing decades, as more women have pursued careers in health care operations and finance, more women have taken on those jobs in the ministry as well.
Women aren't breaking through to the topmost posts in the ministry or in corporate America in numbers that reflect their representation in the workforce overall. According to information from Catalyst, a nonprofit that provides research, programs and events geared toward increasing women's participation in leadership roles in business, female chief executives currently head 23 Fortune 500 companies, or 4.3 percent of that group. In those companies, women fill fewer than
20 percent of board seats and posts at the vice presidents in charge of a principle business unit level and above.
In a study published in December 2012, the American College of Healthcare Executives found "a slight decrease in the proportion of women relative to men who achieved CEO status" among the group of 1,588 responders to its survey earlier that year, as compared with 2006, when 837 health care executives participated in the executive survey.
A query of the CHA database, which contains information on almost all of the Catholic hospitals and health systems in the U.S., indicates how the ministry is faring when it comes to placing women in "c-suite" leadership positions. Based on the CHA database, about 18.5 percent of Catholic health system chief executives and about 27.8 percent of Catholic hospital chief executives are women. When chief operating officers, chief financial officers, chief information officers, chief medical officers and chief nursing officers are counted as a group, women executives hold 39 percent of those system-level jobs and 49 percent of hospital-level posts. When chief nursing officers are removed from the data set, women make up
22 percent of Catholic health system and 29.6 percent of Catholic hospital c-suite executives.
Ready to advance
It is difficult to pinpoint why there are not more women in chief executive posts in a ministry once dominated by women religious administrators, said the executives who spoke to Catholic Health World.
"I would assume it's not overt — that it's unintentional," said Ruth Brinkley, president and chief executive of Louisville, Ky.-based KentuckyOne Health. "I want to believe it's because people get comfortable" in selecting chief executive candidates who are like them. Brinkley said in some cases men who are making hiring decisions "need to get out of their comfort zones" and be willing to consider more candidates who are different from them.
Deborah Proctor, president and chief executive of Irvine, Calif.-based St. Joseph Health and immediate past chair of CHA, said her perspective on the subject has changed over time: "Early in my career I thought there was no gender bias. I didn't believe in the concept of a glass ceiling. I've always said to women, 'The only glass ceiling there is, is the one in your head.' However, the older I've gotten the more I see some of the biases that still remain. … It's perhaps about the lens used" by people making hiring decisions. She explained that she has heard of a search committee that subtly minimized the experience of a female candidate for a top executive position while inflating the experience of a male candidate.
She noted that a few decades ago, there often were not strong female candidates for executive positions. "Largely there weren't a lot of women in my generation seeking those positions because they hadn't been provided the opportunities for leadership experience and growth. But women now in their 40s and 50s will seek them." She said, too, that many of the career tracks men have traditionally been encouraged to pursue in health care — the financial and operational tracks — lead more smoothly to the chief executive post than the chief nursing officer track many women take.
Toni Ardabell, chief executive of Bon Secours St. Mary's Hospital in Richmond, added that gaps in a woman's resume could be a hindrance in achieving a top executive post, if she has taken time out of her career to care for a child or parent. "How are people interpreting those gaps in a resume?" Ardabell asked.
Taking the reins
Maryland of Ascension Health said "we need women who are willing to embrace opportunities to move up." She explained that there is a "natural fear of change" that comes with a jump to an executive position. American College of Healthcare Executives research bears out that far fewer female than male health care executives aspire to the chief executive post (37 percent, versus 66 percent) according to the 2012 survey.
Brinkley noted that qualified women may not be as assertive as men in climbing the career ladder. "Sometimes as women we have trouble saying what we want. Men are not as reticent as women. Women often wait for people to offer positions to them."
Ardabell agreed, noting, "Women may not ask for what they need because they may see it as a sign of weakness to ask."
Brinkley said some women may not pursue top positions because they want to have time for their family. "But, really we all have limits — whether it's sick parents or sick kids — we just have to say we'll succeed despite those limits."
Network of support
The female executives who spoke to Catholic Health World said they were aided by male and female mentors, and they now watch for promising executives who they can mentor and coach. Maryland has built up a team of female executives who have followed her from one organization to the next. Proctor introduces up-and-coming female executives to her colleagues and encourages the women to pursue board positions, so the women's leadership capabilities can be seen. Ardabell mentors women internally and in her community.
The women also said their organizations have strong leadership formation programs and succession planning initiatives, and the organizations ensure that women are groomed and ready for executive advancement. "You have to be intentional and courageous in seeking out diverse perspectives if you want to see adequate diversity," said Maryland.
Said Brinkley: "We need to better reflect what the community looks like. And, it makes the team stronger when there's a diversity of thought" that comes with a diverse leadership team.
"It's dangerous to all think the same way," Brinkley said.
Sr. McGuire cautioned, though, that an overemphasis on gender balance in the executive ranks can be dangerous as well. "We need a continually available group of men and women who are committed to this ministry — we need their gifts. We need to focus on getting the right people with the right skills" in the right positions, regardless of their gender.
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