Vale Helen Reddy and her passion for the strength of femininity: I am Woman hear me roar and in numbers too big to ignore. Nearly 50 years on from this momentous song, the numbers are still ignored at the upper echelon levels of business. So if our numbers are waiting in the wings – then could this be something to do with the roar itself? Perhaps.

Between 2017 and 2020 the number of women in line management or operational roles at ASX 200 has been stuck at 12% and over the past year the number of female CEOs fell from 12 to 10 so that women make up 5% of CEOs (same as 2017). There is some progress to appoint women in functional roles such as a HR and legal but less likely to get roles with P&L accountability.

In healthcare the situation is less encouraging. The healthcare workforce in Australia is predominately female at 70-80% – yet according to the 2019 Chief Executive Women (CEW) consensus, women in line roles (CEO, Operations) account for 10% which has declined from 15% over the last three years.

women leaders in healthcare

This is not dissimilar to the issues found in numerous studies carried out in the US trying to answer the mystery of where are the women leaders in healthcare. After all women are the primary purchase decision makers in health and 77% of the workforce (US Bureau of Labor) yet they make up approximately 30% of C-suite yet only 13% of CEOs. This BCG graph highlights the drop off amongst women in health sectors from entry level to CEO – if a picture paints a thousand words- this is a pretty alarming one. The Medical Journal of Australia (MJA) recently conducted a poll where 57% of survey respondents strongly agreed that gender inequity is alive and well in medical leadership.

So why is the roar not being heard? Especially in a sector like healthcare with so many women in the industry? After all, what you can see is more likely to lead to what you can be – so how can we get greater visibility?

diversity scores

Moreover, diversity is so important for strong results and for innovation (my sweet spot). Coming out of COVID there has never been a need for greater levels of innovation to respond to challenges and environments never before faced. BCG found that companies with above average diversity scores reported an increase of 19% from innovation revenues versus companies with below average diversity.

Similarly, a WGEA report commissioned with Bankwest Curtin Economics Centre offers definitive proof that gender equity drives better performance, greater productivity and greater profitability. They found that in Australian ASX-listed companies, having a female CEO led to a five per cent increase in their market value. This is worth the equivalent of AUD$79.6 million on average.

We see that two of the big banks, have come under scrutiny for reverting to a ‘Blokes are best’ strategy. Namely CBA and Westpac have had gender diversity in the executive leadership team fall to 31% and 21% in 2020 from 46% and 33% in 2017 respectively. This is a different story at ANZ, which has lifted gender diversity in its top executive team from 33% in 2017 to 50%.

It’s little surprise then that simultaneous increases in cultural employee engagement of the teams at ANZ is going from strength to strength up to 77% in FY19 whilst CBA and Westpac have been going the other way dropping to 68% and 71% respectively. My point again – what people can see matters!

Speaking at the CEW panel, ANZ CEO Shayne Elliott said that men to revert to the old ways of doing things in time of crises… it’s normal human behaviour when confronted with a crisis to revert to what you know.

Shane said ‘good companies and good cultures and good leaders actually look for new solutions to those problems rather than relying on things of the past’

So that’s all fine and well I hear you say.. we know there are improvements needed and there is focus on interventions such as targets, quotas, pay gap, reducing the old boys club and golf games, educating on unconscious bias, improving childcare and parental leave.. amongst others.

However what if the answers were a little deeper and less visible…under the water line type issues? A light shining on the unintentional cultural differences between men and women (and no I am not suggesting it’s a confidence issue of women) but differences which require some change management in a similar way other adaptive challenges require in order to get to the less visible, more subtle issues.

Oliver Wyman (OW) in their report Women in Healthcare Leadership 2019 found that the answer is subtle and is centred around change management. Let’s look at what they found from developing profiles of thousands of executives across healthcare payers and providers to better understand differentiation in female leadership. The findings are similar to what I have seen myself from over a decade in health leadership roles.

Cultural and behavioural reasons which have largely arisen from years of systemic challenge in the workplace, for example women have a greater delivery and results focus than on self-promotion. They focus on proof through merit. Throughout the Oliver Wyman interviews, many women strongly believe “results speak for themselves.” However, when women over-rely on results, it unintentionally causes women to be less top-of-mind for promotions.

Many women admitted that men are better at self-promoting and although they want the work to speak for itself and acknowledged it felt arrogant to do so – it was acknowledged that self-promotion is needed.

Lately I’ve heard women leaders ask themselves ‘what would a man do?’ this isn’t about wanting to emulate or be a man but rather a filter question to help with an internal struggle with being uncomfortable in these unfamiliar spaces.

This results focus can lead to men thinking that women only talk about problems – because women get good at execution, often as they get brought into solve problems or to be the frontline warriors of change initiatives.

As one Female Executive said in the OW interviews; “I was brought in to work on the hard stuff. It was as if they said, ‘We have a clean-up on aisle seven, bring her in’

Oliver Wyman also found differences in the way men and women communicate – a skill clearly very valuable at the executive table. I’m not inferring Men are from Mars type differences but rather women are more context laden ‘why’ talkers and men more action oriented ‘what talkers’.

In the boardroom, men communicate in three-word sentences. They won’t want to hear my paragraph explanations. Women communicate in longer sentences because we feel we need to better explain concepts.” Said one Female Chief Strategy Officer

It was found that men and women in senior leadership positions recognised that to succeed in the industry, women often need to communicate more like men. However, this can lead to a double standard – an expectation of a leader, but not an expectation of a woman who’s called “aggressive” instead”.

Is it any wonder that the roar isn’t being heard – given the composition of leadership in healthcare, the burden of adapting is more on women than men, as OW points out- the added effort just to be heard is often invisible to those who think, listen and speak like the majority.

Thirdly there is a difference in views on competence required for a role. This could be where the confidence myth originates – i.e. that women don’t feel confident enough and therefore the solution to all gender inequity is that women simply need to focus on building confidence. If only this were true, we would all have Tony Robbins style coaches in every corner. Women have confidence but perhaps value competence more highly men, we have all heard about the Hewlett Packard review which showed that women need to meet 100% of the job listed qualifications whilst men were happy with meeting 60%. Just like the above-mentioned challenges – this too comes from learned behaviours, perhaps wanting to have the stats to back ourselves.

Many of these behavioural differences mean that many women can plateau even after initial progression, you get pegged, or mental files opened on you. Although your work is good, perhaps too good to move you on, some women find the only way up is to leave a large organisation for a bigger role at a smaller organisation – ultimately aiming to return to a bigger organisation.

Promotion is common within healthcare and the OW survey showed that 63% showed that organisations promote Chief Executives from within. Limited opportunities may mean the need to move locations which is more challenging for women than men. As Annabel Crabb points out in The Wife Drought – to succeed you often need a wife at home, men have them in spades compared to women. One Harvard Business School study showed that majority of male executive spouses were at home not working full time compared with 10% of women. It’s just much harder for women to up and move for career reasons.

technical problems vs adaptive challenges

So what can be done to break the cycles which continue to disadvantage women at the executive table? Given the subtle and adaptive nature of these cultural nuances which have evolved over time, a laser sharp focus on understanding the issues is the first step. A commitment to going deep below the water line to fish for the subtle and surface the treasure which exists here is important. Change management is critical. I think about Ronald Heifetz (et al.) work on leadership as he describes two types of challenges in change – technical and adaptive.  Gender equity is most definitely an adaptive challenge which can only be addressed through changes in people’s priorities, beliefs, habits and loyalties and it requires ongoing learning – for the organisation and people within. Adaptive issues such as gender equity require a holding environment for lasting system change.

OW advise that evening the playing field through creation of ways for men and women to develop connections that build trust (through affinity) and improve sponsorship opportunities. Women like to have fun, socialise and connect – moving this away from golf, pub nights etc. and creating unstructured opportunities such as volunteering or other community focused events, in the new world – Zoom virtual coffees or trivia can work.

Targets are important- but especially focused on moving women out of functional roles only and in line for CEO promotion is very important. Pipelines need to be genuine and sustainable and not just for show. OW suggests that organisations should challenge themselves on selection criteria and what is really a necessary skill and what is enough experience to get hands raised and cast the net wide.

The benefits exist for business, innovation, men, women and society. We need to get onto the proverbial balcony and take a greater look at the cultural and behavioural change required to realise these benefits and more.

In the words of the wonderful Helen Reddy – I am woman, hear me roar, In numbers too big to ignore, And I know too much to go back an’ pretend, ‘Cause I’ve heard it all before… So let’s listen and learn for the differences and change the script.


10. The Practice of Adaptive Leadership, Ronald Heifetz, Alexander Grashow and Marty Linsky