The Feminization of Health Care

Amy Compton-Phillips, MD

Historically, health care providers and health care leaders have been selected for and nurtured traits that are traditionally seen as “masculine” – traits such as heroism, independence, and competition. Yet it is clear that as people live longer with more complex conditions, the more traditionally “feminine” traits of interdependence, empathy, and networking become more important. Even in the most technically challenging health care event, the outcome for the patient is determined by a team.

A successful outcome for surgery on a brain tumor requires the heroic hands of a neurosurgeon, along with the primary care diagnostician, the radiologist, nurses, physical and occupational therapists, oncologists, radiation oncologists, the spouse, children, home health aides, friends, neighbors, and the list goes on. It truly takes a village to create a healing environment around individuals with complex conditions.

A lone hero is a lonely voice. A highly coordinated, synchronized team of participants working in concert with the goals, desires, and wishes of the patient and family create the symphony.

A New Approach to Care
This is what I mean by the feminization of health care – delivering care in more team-based ways characterized by collaboration and the use of social networks. This approach is in sharp contrast to the patriarchal, hierarchical model that is traditionally masculine.

When doctors, nurses, medical assistants, and other valuable team members work in collaborative, interdisciplinary teams organized around a common goal we unleash the power of the group. We get a kind of infectious excitement to innovate and create change. The team-based care that is becoming the norm in the United States operates with outcomes in mind but is supported by a network – and a more balanced management style.

Observation and experience during my more than 20 years as a physician reveal some well-defined patterns and trends. The traditional masculine, top-down hierarchical style of management is certainly employed by some women and, on the other side of the ledger, there are men who possess a team-based leadership approach. Yet in general, it has been my experience that the management styles of men and women as a whole are different.

I have found that organizations with a hierarchical approach feel much more focused on compliance, and on the idea that people do things because they have to (because it’s what they are paid for) rather than because they want to (which connects with their sense of purpose). Despite the fact that a large majority of workers in health care are women, most mainstream health care organizations – like most large corporations – operate with this patriarchal mindset.

Alignment with ACOs
The feminization of health care is well-aligned with the trend toward Accountable Care Organizations and other team-based approaches. Creating an ACO, by definition, requires building an effective inter-professional, interdisciplinary team. And the team must be capable of caring for the patient from the clinic to rehabilitation to home – with all of the actors working together around the individual patient. The “lone-wolf” leadership style is counterproductive in this sort of setting.

When doctors, nurses, medical assistants, and other valuable team members work in collaborative, interdisciplinary teams organized around a common goal we unleash the power of the group.

The feminization trend is particularly evident in middle layers of management where there is rapid growth of a management style that is team-based, collaborative, interdependent, and helps people develop and perform as highly as possible. This has been happening throughout Kaiser Permanente where there are more women in leadership as chiefs of service, as physicians in chief, assistant physicians in chief, and hospital leaders.

In addition, there are active social networks among interregional teams, using network-based learning to accelerate making care better for our members. In this model people come together as peers, organized around a common purpose rather than under a hierarchy.

Glass Ceiling in Health Care
While this trend is pervasive within middle management the news is less encouraging at the top. According to a report by Rock Health, women represent only 21 percent of executives and 21 percent of board members at Fortune 500 health care companies despite making up more than half the health care workforce.

At senior management levels and in board rooms, leaders-as-heroes and leaders who drive results top-down remain highly valued. At these levels there is clearly greater comfort with authoritative rather than collaborative, servant leaders.

I believe that greater balance in leadership and management styles can accelerate capitalizing on the benefits of the feminization of health care. If we are to transform health care in the United States we need to get “unstuck” from our reliance on the traditional models of leadership in our industry.

Hierarchical models have moved us toward greater accountability for results. However, we are not going to manage our way out of our current health care crisis. We need to learn our way out, enabling disruptive thinking from a much larger set of contributors.

We need to evolve our health care leadership both because the traditional hierarchical approach excludes many women and because, quite honestly, the method has not gotten us where we need to be. Adding in the “yin” to complement the “yang,” the feminine to the masculine can bring the benefits of balance, inclusion, and diversity to help transform the industry.

Amy Compton-Phillips, MD, is the chief quality officer of The Permanente Federation. Follow her on Twitter at @amyleecp3.


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6 replies »

  1. I’m concerned there are some massive generalizations going on with the argument that healthcare needs to be “feminized,” assuming, arguendo, that healthcare is presently now too “masculine??” And even if so, we need to determine if this is a bad thing or a good thing. Last time I looked, BTW, almost everyone in healthcare is FEMALE, from at least half the doctors now, to 90% of the nurses, to a majority of the ancillary personnel, to maybe 35-50% of the administration. So where is all this “masculinization” of healthcare coming in???

    Let’s analyze a few of these generalizations: Boys grow up playing sports. Girls grow up playing with dolls. Sports (outside of golf, or maybe tennis) are TEAM endeavors. Little boys learn that even if someone is NOT my friend, I can work with him to help the team win, i.e., succeed. “I’m going to intentionally throw a bad pass so that little Joey can’t catch it, because he is soooo pompous and I hate him!! I don’t even care if we lose!!!” – SAID NO MALE QB EVER!

    LIttle girls (outside of the ubiquitous soccer, I guess) do not grow up playing team sports. Their competition is among each other. Most girls would be fine with the team losing as long as her hated rival doesn’t get the glory of scoring the winning run/goal/points. (yeah gonna get phone calls and emails about that one!) Girls become skilled at manipulation, boys become skilled at motivation. Girls become skilled at reading complex social cues, boys become skilled at using pool cues. There is no crying in baseball, per Tom Hanks.

    So, while all the above are clearly broad generalizations (which the author has apparently endorsed) if we are to assume that healthcare is male-centric, Neanderthal, paternalistic, “hero-driven,” and “top down,” it’s because boys are not good at playing on teams? I’m not buying it. I have played on teams all my life. Winning teams, losing teams, pickup teams, mediocre teams, teams with stupid coaches, teams with great coaches, teams with prima donna players, teams with heart, teams that had no talent whatsoever, and teams (at times) with male and female players. I know how to play on a team.

    But teams need coaches and quarterbacks. They need leaders, and they need role players. They do not need committees. The NFL, which is arguably the most successful sports endeavor ever known to this planet, is NOT run by some sort of consensus. 53 players on a team, and 11 players on the field, and if just ONE doesn’t do his job correctly, the whole thing falls apart. The QB does not ask for player’s ideas in the huddle. The coach doesn’t hold a practice and ask everyone’s ideas on how to beat Green Bay this week. The placekicker doesn’t ask the linebacker how fast the wind might be blowing.

    Thus, a good approach to improving healthcare might be:
    1) to make sure that EVERYONE on the team knows his/her job
    2) to make sure EVERYONE feels valued
    3) to make sure EVERYONE performs up to expectations
    4) to make sure ANYONE with a question or problem feels it’s ok to speak up
    5) to make sure EVERYONE is accountable to each other, and to the patient.
    6) to make sure everyone works hard, and practices hard, and works together.

    this is not feminization, or masculinization, it is Leadership. It is Accountability. In the NFL, you do your job right, or they will find someone else. If you are talented, but a screw-up, then sorry, good luck elsewhere (like the Dallas Cowboys!)

    Maybe we just need to hire football coaches as the CEO’s of our hospitals, and not former RN’s . . .?

  2. Dike you make an important pt: That top down, command and control “doctor gives orders, staff obeys and patient complies” comes from med education. But Amy’s point about the collaborative nature of women leaders in health care is compelling. I read her pt about the feminization of health care as being, at its core, about balance. While there is an increasing level of balance in middle management, there is anything but at the upper echelons.

  3. I agree a battle of the sexes would be disruptive, hence my logic that it would be ideal to learn from our historically divergent approaches. The value of diversity and inclusion is we can blend what works to continue to evolve.

  4. To make this a “battle of the sexes” discussion does everyone a disservice. Great headline to an article and a fabulous way to alienate your male colleagues at a time when you could really use their help changing the culture of healthcare. Please don’t feminize me … especially in the wake of the whole Bruce Jenner transformation. And I am not just kidding.

    The top down, command and control. “doctor gives orders, staff obeys and patient complies” leadership style is a result of our medical education. All doctors absorb it automatically regardless of gender.

    And unless you are running a code, it is not the best way to lead a team or collaborate on a complicated patient or a project whether the leader is a man or a woman.

    Dike Drummond MD

  5. Everyone seems to be a mix of at least several dozen traits that might impinge upon our professional competence–from our complex genomic ancestral mosaic. When we put people into categories based upon only a few of these–like genes determining sex or race or weight–we sort people in a superficial way, almost like hair color. When we think of the whole task and try to get people who are the fittest for that total task, we are probably doing a more efficient and profound selection. And this may require that we even forget the sex determining genes, although it may include them. We need to try things and measure outcomes.

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