The Time is NOW for Women in Healthcare Leadership

This transcript of their discussion has been edited for clarity and length.

Cheryl Toth: We're delighted to have with us today, Dr. Patricia Gabow. She's the former CEO of Denver Health and author of the new book, TIME'S NOW for Women Healthcare Leaders: A Guide for the Journey.

Dr. Gabow, this is the first time we've really focused an entire episode on women in healthcare leadership and how women can create a path to leadership, characteristics of women leaders, and why having women in leadership roles is important for an organization. And I really feel like we couldn't ask for a better guest to talk with about this topic. So, welcome to SoundPractice.

Dr. Patricia Gabow: Thank you for having me. I'm delighted to be here.

Toth: Let me tell listeners a bit more about your background. Dr. Gabow began her career as an academic practitioner and researcher in the area of renal disease. She was principal investigator on the largest clinical NIH program project grant in polycystic kidney disease for 15 years. And Dr. Gabow went on to serve in administrative roles, including Director of Medical Services and a Chief Medical Officer role of a healthcare system. Ultimately, she stepped into the position of CEO of Denver Health. And Denver Health is an integrated healthcare system that's been treating and healing the people of Denver for more than 150 years, so amazing legacy. And as CEO, Dr. Gabow led a system transformation where she shifted a struggling public hospital system into a successful model of an integrated high quality, fiscally stable system.

Dr. Gabow is now retired. Her new book was published in April. It's her second book by Productivity Press. And Dr. Gabow, you've said your hope for this book is not only to be helpful for women, but also for addressing healthcare's myriad of problems in improving health and society overall. I think this conversation's just going to be really interesting. So, let's start by framing this issue. How many women are in healthcare leadership roles today, and why do you think it's the right time to change these numbers?

Gabow: Well, before I answer, let me explain to the listeners, my voice. I have a condition called spastic dysphonia, which is a long way of saying I have a twitch in my vocal cords. The treatment for it is Botox; it does nothing for my wrinkles, but I hope I have beautiful vocal cords.

Toth: Yes. Excellent. Thank you for that.

Gabow: You're welcome. Women make up 51% of the United States and healthcare is the largest employer in America and women make up 80% of the frontline healthcare workers, but only 30% of executives of healthcare organizations. And even in that executive suite, they often are not the most influential position. They're not usually the CFO or the COO. And then, when you look at CEOs, they are less than 15% and this needs to change for three reasons.

The first is that American healthcare has many issues and I'm sure you've covered them in other podcasts. I won’t dwell on those. The second issue is just out of plain simple fairness that there should be gender equality. And the third reason why we need women in leadership is we have unique perspectives and skills that we can bring to the table. I don't blame the problems of American healthcare on men, but the fact is that it has been men and mostly white men who have been sitting at all the tables of leadership in healthcare for decades. And if we keep the same people at the same table, we will get the same outcomes.

So, I think it's time to say, we need men and women. We need white people and people of color. We need seniors and young people. And if we start to have different people at the tables of healthcare leadership, we will get different outcomes, hopefully better outcomes for all Americans.

Toth: That's so well put. It's the strength in diversity and difference in bringing all those perspectives together, so important. What are the two, let's just pick two, changes you think need to occur in order to turn the tide, and raise the number of women in healthcare leadership? Are there some big overarching things?

Gabow: I think there are overarching things but let me step back just a tiny bit and say Dick Lamm, who was our Governor of Colorado many years ago, said there are four stages to problem solving. The first is no talk, no do, where we don't even think about the issue. The second is talk, no do, where we start to raise the issues into public consciousness. And the third is no talk and do, where we start to solve the problem. And the final stage is back to no talk, no do, and we've solved it.

And I would say right now on the issue of women assuming leadership roles, we're somewhere between Step 2 and Step 3. So, I think we're now talking about it and we're beginning to take some actions. So, as we're talking about it, what are the things that are important to change? I think there are two really big barriers to women achieving leadership bias, which is often implicit, and sexual harassment, and these two overlap. A place that has a lot of bias is fertile grounds for sexual harassment. And these two contribute to a culture which doesn't welcome women into leadership roles.

The second thing that we're going to have to do if we are going to have women in leadership is level the playing field. Now, a lot of times people say that equality and equity are the same, but they're really quite different and the difference matters to women. So, in equality, everybody gets the same thing. It's like giving women, children, and men all the same bicycle and think they'll all be able to ride it, which they can't. Equity means giving people what they need to succeed. So, with the bicycle image, you'd give the children a little bike, the women would be a little bigger, the men would be bigger, and a disabled person would have a bicycle that they could use in a different way.

So, how do you get equity for women? How do you level a playing field? Well, you acknowledge that they're the mothers, so you have maternity leave. You acknowledge that they do most of the child rearing, so you have affordable, accessible childcare. You acknowledge that they are most of the caregivers for adults or you have paid family leave. And then you have pay equality, so that they have the resources to do these other things that they need level of playing field. So, I think we got to think about the barriers, and we have to level the playing field.

Toth: And you have lived this in thinking about how this would work because of, I think, your leadership roles that you've held. And so, let's talk about that path that you were on and how you got to CEO at Denver Health. How did you navigate some of these things that the bias and the sexual harassment or any of these other, and I hate to say women's issues, but that's what's coming to my mind because they are unique to women. Tell us about your path and how you dealt with those and some of the key factors that helped you overcome them.

Gabow: To give you a run through of my path, I started out, as you said, as an entry level physician at Denver Health. And I was right out of my training, and I started the kidney division at Denver Health and probably being young and naive when someone said, "Oh, can you start the division?" I said, "Sure," without really a lot of understanding of what it meant. I then became Chief of Medicine and CMO, Chief Medical Officer and finally, CEO.

And I think there were a number of factors that enabled me to follow this leadership path. The first one was value alignment with the institution. And I always counsel other young women and men, who are looking at any job, but especially at a leadership position that you have to have value alignment with the institution that you're working in, otherwise, every day is an ethical conflict. And for me, Denver Health, which was committed to caring for the most vulnerable, was a perfect fit and I would not have been as successful in another type of institution.

The other thing which really helped me with barriers that exist were great mentors and sponsors. And again, this is something I advise all my mentees is you really need mentors and sponsors if you're going to go on a leadership journey. And I think probably the last thing was I was willing to take risks and step up. Just to give you a lighthearted version of that, when I became CEO, my son, who was then a teenager said, "Mom, how exactly are you taking a job for which you've had absolutely no training?" No, I happen to think being a clinician is very good training for leadership, but I was willing to step into a role that was rather intimidating in many ways.

Toth: Well, to have the confidence to step into that and take the reins is amazing. And I think sometimes women, I know I work with they don't feel that confidence. There's something about being a woman in business that we don't all have that inherent confidence. How did you have that? How did you decide you would step all the way to the top? Was there something in particular that drove you?

Gabow: I think, if you're lucky enough to have a family that's supportive and I was from very early in my life and my grandfather was a great influence. My father was killed at World War II when I was a baby, so I grew up in a household with my mother, my grandparents, and an uncle. And my grandfather had a saying for every event in life and one of his was, if you have a gift and you don't use it, no confessor on earth can absolve you. And over the years, I've come to believe that leadership is really about knowing the gifts you have, and we all have gifts. Maturing those gifts. Being committed to grow and finally, to use those gifts in the service of others. And I think that really helped me.

The other thing that I think gave me confidence was I went to a Catholic girls’ school for college. And my major professor was a nun, and she took me with her every summer to Woods Hole Biologic Laboratory, where she was the only woman on the board. And watching this nun hike up her habits, which they wore back then and wade into the water with the men scientists to collect specimens, showed me that you didn't have to change who you are to be successful even in a man's world. And in fact, the best way to be successful was to be authentic. And I think that lessons from my grandfather and my professor early on in life really helped me.

Toth: Those are terrific stories because they were mentors and guideposts and these inspirations for you, and I do think that's so important. As you've mentioned the mentoring, and we're going to talk about that a little bit later, is a critical component for success. Is there anything on your path, career path that you would've done differently that's memorable for you? A lesson that you learned.

Gabow: I don't think there's anything I would have done differently. I feel I'd been really blessed with a great family, a great career, and a great institution to work at. I think all of us women, who had leadership, always wish we'd have spent more time with our children if we have them. But other than that, I would say everything is great and I wouldn't change anything.

Toth: That's terrific. So, when you were CEO, you were involved in leading some really transformational projects. Some of those were you turned the financial picture back into the black, you moved the whole IDS from a government department to an independent one. You implemented a whole host of operational innovations. Before we started recording, we were talking a little bit about your use of lean. What were some of the leadership success factors that you think helped you achieve these things? What did you bring to the table that you feel like worked well in leading those initiatives?

Gabow: I will reemphasize having value alignment with the institution, it is really important. I had a great team who were all on the same page and that's really essential. You can't lead by yourself. It takes a team, and the team really has to be of one mind and the way to be of one mind is to spend time together. I know a lot of times in management training, they say minimize meetings. But the Kellogg Foundation used to have a say that relationships are primary and everything else is derivative. And I spent a lot of time with a great team of people and the team really helped us achieve what we did.

The other is to know where you want to go and to gather relevant data and to define the steps that are going to be necessary for an initiative or a change that you're going to institute and communicate effectively and broadly.

And finally, persistence. Leadership is a long game. It's not a sprint and you have to persist. If something's important to do, you have to stick to it. So, you mentioned taking Denver Health out of a city government into an independent entity, and that took four years. So, imagine going to a mayor and saying, "I've been thinking that your second largest department of city government would be better off away from you." They don't jump at this.

Toth: No, it's a big change.

Gabow: And for four years, every time I saw Mayor Webb, that's what I was talking about. And at one point he said to me, "Patty, are you ever going to get off this issue?" And I said, "Yes, as soon as you say yes." And that's one little story, but it really shows that you have to persist in leadership.

Toth: That shows such tenacity that you would just keep after it. And I think so often we're expecting things to change quickly, because our world moves so quickly. But sometimes you just got to, well, you said four years? Sometimes good things come to those who wait and who are persistent. It takes time.

From your perspective as a former CEO, what would you say women can bring to the executive table? What are some of the strengths and talents you've seen from your CEOs, Chairs, with the success of women around you and what they bring on?

Gabow: First of all, let me describe my executive team because when I describe it, you'll see why I know a lot about what women bring to the table. So, while I was CEO, my chief operating officer, my chief financial officer, my chief nursing officer, my chief communications officer, my chief government officer, the general council, the head of the health plan and head of the foundation were all women. This is quite extraordinary for healthcare. And what I saw from this extraordinary group of women has been confirmed by other formal studies.

One is that women really are committed to a set of values, particularly integrity. In fact, studies have shown that women will not sacrifice their integrity for promotion. And integrity is foundational in creating trust and trust is foundational in leadership, so I think women display this. The other is women are mission-driven, I believe. And I interviewed 12 senior women for my book and their comments about why they went into leadership were about wanting to do good using their talents to improve the healthcare system, doing more than they could one patient at a time.

And this isn't to say, men don't have those feelings, but I think they're much more common as a motivator in men. Women are relationship builders. And again, that's been well-shown in studies and while they're good about building relationships, they're also very good about holding people accountable. People will say women don't like to discipline people because they want to be liked. But in my 40 years’ experience, women were much more willing to call out when something wasn't right and had to be fixed. And the last thing I would mention is women really do dig into details and want to know what's really happening. Oftentimes men like to deal at the 30,000, sometimes even 50,000-foot level. And what my CFO pointed out is those details can really matter.

And so, I think those are some of the things that I think characterize the skills. The other thing that women bring to the table is the perspective in of having made the healthcare decisions for the family, having cared for children, having cared for the adults in the family. We understand the gaps in the healthcare system, and we see what needs to be fixed, perhaps with greater clarity and sharpness than men might see.

Toth: Yes, I do agree with that, and I've seen it over and over in myself and the women around me. And it is true that we are the ones carrying that load and so, we have the experience and do understand it. There are a lot of women out there that would like to cover a path like yours and whether it's a female physician or a woman in another clinical or administrative role. Where would you start? What guidance do you have for them as they look down the road?

Gabow: I will reiterate just briefly what I said about knowing your gifts, and maturing them, and then using them. I also think mentors and sponsors are critical and they're different. And I think we'll talk more about that later, but very few people can travel the leadership journey without a guide. And it's our Yoda. We need our mentors and sponsors.

I think one of the strongest things that you can do if you aspire to leadership is lead from where you stand. Lead from where you are right now. And what does that entail? Showing up, not just physically, but emotionally. Learning and approach to seeing problems and solving them. For us, as you alluded to, that was lean. And you can't deal with everything, so identify your passion and become an expert in that area. And then go to where the action is and raise your hand. I always tell people; it doesn't do any good to become an expert and to go to where the issues are being discussed and then sit silently. You have to raise your hand. And if you lead from where you stand, you'll become a thought leader and you can be influential and you can bring about change. It can lead to positional leadership, but not every woman wants a positional leadership role and we all can't be the CEO, but we all can lead from where we stand. And in doing so, we could all be thought leaders and influencers and change makers, and that's really important.

The other thing that I would say is if you are coming to leadership from a clinical perspective, embrace and use what you've learned in your clinical practice. Clinical skills are really applicable to leadership. We've learned to put the patient's interest above our own, which I would posit should be the foundation of healthcare. We get much data when we're caring for patients, and you get a lot of data when you're in leadership and we've learned to sift out what's critical. We've learned to make decisions with incomplete data, and you almost never have every piece of data you would like in a leadership decision.

And we've learned to stay calm in a crisis. We don't fall apart at a cardiac arrest. And it teaches us not to fall apart when you get a call that they are conflicting gang members in the ED. And we've learned a structured approach to decision-making. So, I think my advice is have mentors, lead from where you stand and if you were a clinician, apply those clinical skills to your leadership role.

Toth: I really like how you tied together the things that you learn and do as a clinician to the administrative side, because I know a lot of physicians who want to make that switch and just aren't sure. But stringing together those threads is so true. They've already got a lot of the capabilities and the skills. They've just got to think of them differently in how they apply them. I love that.

Let's start at mentoring for a moment because we've brought it up a few times and I do want to talk about it. You talk about its importance. What are some of the ways to find a mentor? AAPL does have a mentoring program, I should say that. If members are listening, you can call AAPL, and they do have a service for you and they can match you. But what are the practicalities of finding one and working with one? And what if you can't find one?

For example, I took a new leadership role a couple of years ago in a company. And there was a woman, who's 15 years my senior, she was just amazingly successful, great relationship builder, all the qualities you're talking about. And I asked her if she would help mentor me and she said no. She was busy and everything and I get that. But what happens when you have trouble finding somebody? You got any advice?

Gabow: Let's start with how you approach finding a mentor and what do you do if you can't? I think, for women, you have to start with some general questions. Do you want a man or a woman as your mentor? Some women want someone who's walked the walk and can identify with some of the unique challenges that women have. That's the first decision. Then I think you have to decide, do you want someone at your institution, or can they be at another institution? Can they be even in another discipline? With today's video conferencing, a person can be at another country and still be your mentor.

I think then you have to say, does the person that you are thinking of, is that person someone you can work with? That you want to work with? Is it someone who, as you point out, has the time and is it someone who's going to really push you forward? And then you have to ask them, as I always tell people, don't think that you'll be sitting in your office and someone's going to knock on your door and say, "I've been thinking. I'd love to be your mentor." That just doesn't happen. You have to look, and you have to ask.

Now, sometimes as your experience-wise, you'll ask, and the person won't be able to do it. But you need to look around, widen your net. And if you can't find a senior person, which you should do. Most of the time, a mentor should be a senior person who can guide you. But if you can't find a senior person, peer mentoring is another option. And you can form a group yourself or as you are alluding to, you can get into a program where you have a team of people that you can become acquainted with, who can become a peer mentoring group for you. So, there are multiple ways to achieve this.

The other thing I want to emphasize is mentors are important, but the data has shown that a mentor alone is not sufficient to get you into a leadership role. You need a sponsor and they're different. It can, over time, a mentor can become a sponsor, but usually they're different people. And a sponsor is a senior person who's influential who will open doors for you. And so, while a mentor is a guide, a sponsor really is someone who opens the door for you to a leadership role and both are important. And I think the data is pretty clear that sponsorship is really important in obtaining leadership positions.

Toth: So, you need the door opener or a sponsor type person in an influential role, and then a mentor as well. And that person doesn't necessarily have to be, like I was looking for a senior person. It was a marketing role. And I really, I didn't know much about marketing, and I had hoped to find some guidance, but I could have gone also to peer as well. I wonder if you have, because I did ultimately, join a mastermind group. And I don't know if you have any experience with those or how you feel about that if people can't find a mentor and there were eight of us and we met every week for like three months and there was a check-in. And it was a mutually supportive group of people. And we really formed some great relationships from that.

Gabow: Well, the women that I interviewed for my book, the 12 senior women, they talked about both. And some women found that a peer mentoring group that came out of a specific leadership training was invaluable to them, and others found a person who was helpful. So, I think you can go either way. I think the important thing is to understand that leadership journeys are filled with challenging terrain and it's good to have others to help you navigate that terrain.

Toth: And that's something women are pretty good at is asking, I think. I would say that about myself and other women I've worked with is allowing other people to help you navigate that terrain. So, it should come somewhat naturally to many of us, I think.

We've been talking about what aspiring women leaders can do, could do. Anything you'd suggest that they not do? Anything you think women should try to avoid in their path?

Gabow: One thing, never forget the core healthcare values of putting the patient's interest above our own. That's above our own personal interest and those of the institution. We can never abandon that. The other thing I would say is many women ask the question, "Can I have it all?" And my answer is yes, but not all at the same time. So, don't think that I'm going to have everything that I want out of my personal life and out of my professional life all in this year.

I just recently told a group of younger women, "Remember you're probably going to live into your 80s. Your career is probably going to be 40 or 50 years long. It doesn't all have to happen in the same year." And we talk about work-life balance, but I think what women should not expect is that there is balance every hour of every day, every day of every week, every week, every month. It's more like a seesaw. Sometimes, your personal life is what you're focused on and sometimes, it's your professional life.

So, I think women shouldn't think that they have to be doing everything and achieving everything all at the same time. And the other thing they shouldn't do is think they can do it all by themselves. We need support and you need a support team around you, both at work and at home. And I know when I started and I thought I needed to scrub my kitchen floor because my mother scrubbed her kitchen floor. But I soon learned that hiring resources, if you have the luxury, women in leadership have luxury, unfortunately, a lot of women don't. But if you do, you're buying time and peace of mind. So, don't forget to have the resources you need for your support team.

Toth: Terrific. Let's talk to those women out there who've recently successfully stepped up or stepped into a new leadership role. Based on your experience and thinking, like a CEO in this case, what would you tell them to focus on in their first 100 days as a new leader?

Gabow: There’re three things. The first thing is communicate. Meet the people for whom you are responsible. It's not sending out an email saying, "Hello, I'm here." It's going and meeting face to face and seeing the people where they work, seeing what they actually do. And they can see you and get to know you. That's really important and you can't overdo it.

The second is to build your team and when you take any leadership role, you'll inherit some people in roles that report to you, and you'll be choosing some new people, but you need to build that team. Spend time with them, understand their skills, and really create a family out of your leadership team. And the third thing you have to do in the first 100 days is really understand what your organization is responsible for, whatever component you're leading, know what it is that that component needs to do. And then figure out the data that will let you know whether you're being successful.

And I would say one of the reasons leaders fail is they really don't know how to measure whether they're being successful or not. And that's lethal. And so, you really need to do those three things right away.

And then longer term is to think about the fact that leaders really have two jobs. They have to make the trains run on time and they need to lay new tracks. And making the trains run on time is about the here and now and improvement. And laying new tracks is really about the future and innovation. And depending on where you are in the organizational structure, you'll have a different balance of these two, but you always have some component of both. So, if you're in a patient-facing frontline area, you're going to spend much more time on making the trains run on time. Whereas if you are the CEO, you're going to spend substantial part of your effort on laying new tracks. And both of these require observation, and it requires data and careful monitoring and communication, but they have different emphasis.

Toth: How can men in these same organizations where women have stepped into a new leadership role, how can the men support this?

Gabow: It depends in part on what role the men have in the organization. So, if they're your boss, then they need to be a mentor and a sponsor for you and they need to work on creating a true culture of equality and respect for everyone. If they're your male colleague, they need to be your collaborator, not your competitor. And if they're a man reporting to you, they need to be a good team member. And I think we won't get to equality in leadership by the effort of women alone, so I think you're totally right in pointing out that men are going to play an important role in women achieving equality.

Toth: Last question, what would you like the men and women listening today to take away from this conversation?

Gabow: I think that I would say acknowledge that American healthcare has many problems and that women have important skills and perspective to bring to the table to help solve these problems and we need women at the table. But women have to also step up, take a risk and start leading right now from where you stand.

Toth: Great final words. Thank you, Dr. Gabow for joining us on SoundPractice today. We really appreciate your time.

Listen Now

TIME'S NOW for Women Healthcare Leaders: A Guide for the Journey

Order your print copy here:  https://www.routledge.com/TIMES-NOW-for-Women-Healthcare-Leaders-A-Guide-for-the-Journey/Gabow/p/book/9781138365582

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https://www.amazon.com/TIMES-NOW-Women-Healthcare-Leaders/dp/1138365580