European healthcare systems are in a crisis. They are “underprepared, understaffed and face underinvestment”, and a key component of that crisis not receiving enough attention, is gender: “[health workforce issues] have gender dimensions to them. There’s nothing as gender-neutral discussions about health workforce” said Roopa Dhatt, co-founder of Women in Global Health, at this year’s edition of the European Health Forum Gastein (EHFG), “they’re gender-blind, and therefore gender-harmful”.
COVID-19 has exacerbated the inequities that exist between men and women in the healthcare system. For example, there were higher number of COVID-19 infections among women as they were more exposed to the virus while caring for patients. Also, women had lower access to appropriate personal protection equipment; Women in Global Health did a survey concluding that many governments purchased personal protection equipment in the size ‘XL’ leading to 70% of the health workers not having well-fitting protection clothing.
Another example of inequity between women and men in healthcare is the gender pay gap; women earn approximately 20% less in the health and care system. [1] Moreover, there is both underpaid and unpaid work; six million women healthcare workers globally are doing unpaid work.1 While in high-income countries there are high rates of resignation in the healthcare system, as a response there’s increased migration from low- and middle-income countries to high-income countries destabilising health systems globally.
Finally, Dhatt said, “the taboo that no-one wants to talk about, is the amount of harassment, violence, and sexual harassment…that women face at higher numbers…and the health systems are NOT addressing it”. Indeed, as reported by the WHO in 2019, [2] workplace violence and sexual harassment in the health and social sector are widespread and often hidden. Moreover, it is mostly women who face sexual harassment by men – colleagues, patients and community members – but often it is not reported due to stigma and fear of retaliation.
Compassionate leadership
The answer? Leadership! That is at least part of the answer. Dhatt speaks about gender equal leadership. “Women make up 70% of the health workforce, [3] so they should be 70% of the leaders”, she said. However, looking for instance at data in Austria, reported by Sabina Ludwig from the Medical University of Innsbruck during the very first session of EHFG launching the Austrian chapter of Women in Global Health, women represented only 4,8% and 18,8%, respectively, for different levels of leadership positions. It’s not only a matter of fairness or justice, but there is also vital expertise that gets lost from women providing the care at the bedside in shaping and developing health systems. And, Dhatt added, … “more diverse teams make better policies”.
Micheal West, Professor of Organisational Psychology and Senior Visiting Fellow at the King’s Fund, London, takes it one step further and shared his 20 years’ research on compassionate leadership. [4] He explained how the current levels of stress and burnout in the workforce show that the system has failed to deliver the core human needs; staff is working in cultures of fear and blame, there’s no control over work-life balance, insufficient feeling of belonging, and not being valued, respected, cared for by their colleagues and leaders. And what exhausts people, is empathy without the ability to make the difference they want to make. So, he said, “we need to create cultures that reflect the core values of healthcare workers, which is the value of compassion. Afterall, compassion is the single most powerful intervention we have available.” And when leaders do show compassion and empathy, and facilitate strong relationships at work, staff satisfaction goes up. Moreover, it results in higher levels of patient satisfaction, increased staff retention, better quality of care, lower avoidable patient mortality, and better use of financial resources.
So, how do we get there, how do we do we shape cultures? West referred to hundred years of research on organisational culture telling us that leadership is the most important factor. And evidence shows that organisational cultures can change within just a few years. But it requires courage, to commit to introducing compassionate leadership, as Wales is doing, and gaining the support from the governing boards. However, he stressed, it should be part of a systemic approach, changing both the working conditions and paying people fairly; “the pay differential between males and women is just unacceptable”.