| Abstract | The inception of this research into a glass ceiling (GC) in the English National Health Service (NHS), is derived from my own observations as a former NHS employee. Initially, most attendees at the meetings I went to were female managers. This contrasted with my first board meeting at which only one female Executive Director was present. This led me to question why, when women comprise 77% of the NHS workforce, do they constitute only 44% of leadership roles (NHS, 2016)?
The title of this research project is An Exploration of Women’s Representation in Senior Leadership Positions in the English National Health Service. This title is aligned to the following research question, ‘Does a Glass Ceiling Exist in the English National Health Service and, if so, what are the factors acting as barriers to women accessing senior leadership positions?’
A GC is ‘the unseen, yet unbreachable barrier that keeps minorities and women from rising to the upper rungs of the corporate ladder, regardless of their qualifications or achievements’ (FGCC, 1995, pp. 4). The literature suggests many explanations for GCs; however, the main justifications put forward in the literature are not entirely pertinent to the NHS, given most of the NHS workforce and consumers are female, and the NHS is a comparatively flexible employer, which supports female staff and their development.
Objectives
The objectives of the research were to:
1. Explore whether data on female representation on NHS boards indicate a GC.
2. Understand, if a GC is proven, why it exists.
3. Suggest recommendations to address any gender imbalance.
Methods
Mixed Methods were employed. Quantitative analysis reviewed data on gender composition across the NHS, including an analysis of Trusts’ boards and uptake of development programmes. The qualitative analysis consisted of twenty-six interviews with NHS managers. The main challenge was accessing interviewees, for example, one gatekeeper to a subset of interviewees delayed access for almost a year.
To analyse the interview data, narrative analysis was applied to each of the individual transcripts. This was achieved using a Labov proforma template. Once the narrative analysis had been completed, it was then possible to analyse the interview data across the different groups of interviewees using thematic analysis.
Grounded theory was found to be valuable. Although insights from the literature were used to inform the initial development of the interview schedule, the emphasis was on open discussion to allow examination of the reasons for the possible existence of a glass ceiling in the NHS and to enable theories to be based on the emerging data.
Findings and Conclusions
Much has been done across the NHS to promote female progression to the boardroom; however, the glass ceiling remains intact. The quantitative research evidenced that trust boards still have a deficit in female members, especially in key leadership positions such as the CEO, Director of Finance and Medical Director. An analysis of recruitment data evidenced that women are less likely to apply for board level positions than men, but when they do apply, they are equally likely to be appointed.
The qualitative research demonstrated that more must be done to address the main barriers to gender equality, which are the responsibility for childcare and overcoming the ‘old boys’ network.’ To ease the burden of childcare, organisations could implement job sharing and flexible working. The NHS advocates these measures for lower positions, but not at board level, due to the accountability and visibility required for executive positions. The main opportunity to breach the ‘old boys’ network’, is for women to create their own networks, and by supporting each other through mentoring and signposting of employment opportunities.
My research suggested the creation of the Healthcare Leadership Equality Model. This framework recognises that the means of breaking the glass ceiling are within the reach of female employees (such as seeking out training courses, networks, and role models). However, there is also the need to incorporate wider macro factors, including the role of government in driving forward initiatives, such as national frameworks for flexible working.
As this research project was conducted prior and during the 2020 Coronavirus pandemic, I was able to look beyond the primary research aims. It was possible, in real time, to evaluate how the unique demands of the pandemic impacted female career advancement. The pandemic presented situations in which women could build and display the skills which were viewed as necessary for board level leaders. Therefore, the acceleration caused by the pandemic enabled some women to rapidly build their careers, in line with the Healthcare Leadership Equality Model.
Stakeholder Impact
The purpose of my research was to identify the barriers to women reaching senior NHS positions and make recommendations on how to address these. Throughout, I engaged with NHS organisations, such as the NHS Leadership Academy, who have expressed an interest in the outputs of my research. |
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