27 June 2024
The changes needed for achieving gender equality among health professionals in leading positions are deep. So it's no coincidence if the annual Nursing Conference, which recently took place at the Champalimaud Foundation, in Lisbon, included a roundtable on this topic.
Given that nursing is mostly a female profession, why are management positions mostly held by men?
The question was asked by Carla Martins, director of nursing at the Local Health Unit of Santa Maria Hospital, in Lisbon, during a recent debate at the Champalimaud Foundation (CF) on gender equality and, more specifically, on female leadership in healthcare.
The topic made perfect sense in the context of the CF's annual Nursing Conference, which this year centred on change, the ability of health professionals to adapt to change, emerging realities and the need for nursing professionals to play an active role in this change.
The panel, moderated by Leonor Beleza, CF’s President, also included contributions from André Valente, a neuroscientist at the Foundation; Fátima Cardoso, oncologist and director of the Breast Unit; and Rita Sá Machado, Portugal’s Director-General of Health.
"The issue of female leadership in the health area is a very interesting personal experience for me," said Leonor Beleza. "It has enormous relevance in all areas – and we know that for a long time, it hasn't always been given its due importance," she added, "But since we’re discussing health issues here, it's natural that we talk about it concerning health matters."
It was Fátima Cardoso who raised the issue of the recent decline in gender equality and female leadership in Western societies. "In recent years, we seem to be moving backwards rather than forwards," she emphasised.
She provided some data that confirms this regression in oncology and medicine. "Today, more than 80 per cent of medical students in Portugal are women," she said. "However, not even 20 per cent of senior positions are held by women." Very few women try to apply for this type of position “because they think it's not worth it, as they won't be chosen," she said. In the area of research, the situation is no better.
"So what can we do to rectify this situation?" asked Fátima Cardoso. "I think that from now on we have to choose among the candidates for these positions with a conscious bias. Merit has to be the first criterium, but when two people have equal or very similar merits, the decision-makers have to consciously choose women. They have to."
Fátima Cardoso believes that we will never achieve gender balance if we choose to alternate between men and women in senior positions. According to data from the World Health Organisation, she said, at the speed at which we are trying to achieve gender equality in medicine, the process will take almost three centuries. "I think we need to move faster," she concluded.
The first speaker of the roundtable was André Valente, who mentioned the problems of gender equality in research, but focussed mainly on another issue: the fact that, for a long time, the sex of laboratory animals used in experiments was not given due importance. "The growth of science and the way we deal with gender is not a happy story," he said.
He gave the example of thalidomide, a sedative used for nausea that pregnant women used during the 1950s and 1960s. This drug had never been tested on female animals during gestation, nor on pregnant women. "The result was absolutely devastating: many of the foetuses didn't survive and those that did were born without limbs," explained André Valente. "If there had been pregnant animals among the experimental animals, we would probably have known about the effect of thalidomide in time. But there weren't," he lamented.
Today we know that animals of different sexes can have very different responses to drugs and that this needs to be taken into account in research. "But it's not something that has been done automatically in the scientific field," concluded André Valente.
Rita Sá Machado spoke about female leadership, analising "the characteristics of leadership". For her, leaders, both men and women, are a "mix" of attributes, some more masculine and others more feminine.
"Why are there still so few women in leadership positions?" she asked. "Is it a lack of competence? That's certainly not the reason. Is it that women have less availability? Maybe." Are they less willing to accept this kind of positions? Can they cope with the difficulties of top leadership jobs?
"We need to empower women to make decisions," emphasised Rita Machado de Sá. "Decision-making is a difficult process, it's a lonely process," she added, speaking of her personal case. "I hope that the change in culture needed to achieve gender balance in health doesn't take three hundred years," she vowed.
The last speaker was Carla Martins. "We are currently witnessing a social transformation related to gender issues and it still makes sense to talk about female leadership," she said. "Despite the improvement in the number of women in leadership, progress is insufficient with the current measures alone."
According to the European Institute for Gender Equality, in 2023, only 6.7 per cent of executive management positions in top Portuguese companies were held by women, she stressed. The European Union average is not much better: 8.3 per cent. On the other hand, a very recent McKinsey study points out that the number of women in leadership positions in Portugal is falling.
It's the same in nursing. "We have a profession with a majority of women, but the nurses in management positions, are mostly men. Why?" asked Carla Martins.
She believes female leadership in health undoubtedly has added value. "As women, we have a stronger perspective on inclusion, communication and collaboration," she said. "We also manage crises better and don't panic as much as some men."
What's more, "all the studies show that whenever women are involved in management, they manage money better," added Carla Martins. And she emphasised that female leadership in health also has tangible benefits for the quality of care and the satisfaction of users and professionals.
But there are barriers "that don't allow us to move forward," she said. "And many of the factors that don't allow us to move forward are our own responsibility. I've had and continue to have countless women colleagues who tell me 'I don't know if I have the time, I don't know if I can do it, I don't know how I'm going to manage things'.”
"It's time for us to believe that we have the strength," concluded Carla Martins. "Every challenge we face brings us closer to a future in which leading with authenticity and courage will become the norm rather than the exception for women".
Panel Discussion: "Women's Leadership: A Reality, Not a Novelty"
