What are the right skills to lead?

All of the women described differing leadership styles, highlighting that as a leader, it is possible to have your own leadership style(s) and bring your full personality to the role. Common to them all were:

1. Collaboration and facilitation.

2. Developing trust and respect.

3. Compassionate leadership.

Celia Ingham Clark made it clear that leadership was often about having a flexible leadership style, adapting to the situation: ‘I was facilitative and collaborative but as a surgeon I can be directive’. Helen Stokes-Lampard built on this: ‘To be a good leader you just need to understand people… it comes down to influencing people and building relationships based on trust and respect. It begins with emotional intelligence’.

The value sets described by the women we interviewed reflected the inherent values of the NHS. Despite having different backgrounds and career journeys, all seven women retained a singular focus on providing high-quality care for patients. Celia Ingham Clark reflected on how she was always motivated by patients and creating positive change for patients: ‘I started life as a general surgeon and could help patients one at a time and then I realised people could change things in a bigger way (through becoming a clinical leader), looking after large groups of patients’.

It is clear that the mindset of the women we interviewed was positive, ambitious and open-minded. Clare Marx described herself as a ‘Huge optimist… Not many people want to follow people that are sad and grumpy’. Kathy McLean explained that this mindset enabled her to grasp opportunities and take on new responsibilities. ‘My philosophy has always been to say yes. I was willing to say yes and worry later about whether I had taken on too much’.

Wendy Reid highlighted that as a leader there can be a disconnect between how you are perceived and how you feel: ‘I am brave and I am passionate; I am prepared to admit I am wrong but not prepared to accept I can’t do that. I am seen as a strong leader but that isn’t always how it feels’. Many of the women emphasised the need for resilience when in senior roles and many reflected on difficult decisions that they had to take as senior leaders. Jane Dacre reported, “you often cannot change things without it upsetting people in the process, but it is about doing what is best for the organisation. The organisation is bigger than all of us. If something isn’t right you need to do something about it and sometimes it is hard to be nice to everyone”.

How do we design ‘the right roles’ in order to maximise the talent pool and improve access for women?

Throughout the interviews, there were reflections on the challenges of raising a family while undertaking a senior leadership role. This is a dominant theme when considering gender equality in the workplace in many industries, including healthcare.15 Several of the women interviewed referred to respective sacrifices they had to make for their career. Kathy McLean reflected that ‘while I had kids, I never had time off. That approach is not for everyone but I am not sure I could have had a national role otherwise’.

Flexibility and support through transitions, for example, returning from maternity leave, were clear enablers for the women we interviewed. Helen Stokes-Lampard discussed the importance of less than full-time training to enable women to achieve their potential. However, Helen Stokes-Lampard also questioned the design of the model: ‘How do we stop the less than full time training taking three times as long rather than twice as long?’ Wendy Reid discussed the importance of enabling a smooth ‘step out, step in’ process. If we want to develop a diverse talent pipeline, we must ensure those wanting to take time out, for any reason, are supported in this decision and enabled to transition back smoothly, without incurring unnecessary delay to career progression.

Celia Ingham Clark emphasised the need for women to feel supported by colleagues while they had young families. She explained how when she was a senior trainee with a new baby, her consultant showed understanding saying ‘we can work something out if there’s ever an emergency’. She went on to explain that “I never even had to use this offer but it made a big difference; it provided me with reassurance and I felt calmer and more secure about my job”. It is also important to recognise the importance of supporting men in taking paternity leave so that parental responsibility can be shared where this is feasible.16

This is further evidenced by the benefits of support networks, such as the ‘Emerging Women Leaders Programme’17 and mentors for those in leadership roles; feeling supported can engender greater self-belief and build resilience when facing challenges. Clare Marx furthered this by commenting on the issue of confidence for many women, ‘A lot of leadership is about mindset and women just don’t put themselves forward. For example, look at Obstetrics and Gynaecology as a specialty, 80% dominated by women and yet the Royal College of Obstetrics and Gynaecology only just elected their second female president. The crisis of confidence must change’.

One of the barriers the women who reached these senior leadership positions highlighted is the fact they did not relate to the leaders before them. Helen Stokes-Lampard explained that “the stereotypical leader is in many people’s minds a middle aged man with strong leadership” and went on to describe the importance of role models in demonstrating relatable leadership qualities through a personal example: “This woman was thoroughly lovely and brilliant …. She hadn’t shattered glass ceilings, she had walked quietly through them. Her style was reassuring but she had personal confidence… We need to give that ‘you can do it’ feeling to each other and to our colleagues.”

How do we ensure the right people have the opportunity to reach the roles?

All our interviewees described how important supportive women’s networks, undertaking training and both formal and informal mentorship are, to empower women to undertake leadership roles. This is a theme echoed throughout the literature in both healthcare and other sectors.18 Kathy McLean explained how she is a big believer in the ‘tap on the shoulder’ and explained how it is about seniors prompting those with potential: ‘Have you thought about this? I have seen you do this already… We have to encourage people that these roles are good to do and it is worth putting yourself out for it’.

This also linked into the concept of women’s networks. It was particularly interesting to hear from Clare Marx who admitted she ‘used to be very anti women-only networks because I always believed we need to work and develop together. However, when I tried to establish a 50:50 leadership programme, no women were putting themselves forward. So I established the emerging women leaders programme… It was an excellent example of a women-only network being a stepping stone’.

The statistic that men apply for a job when they meet only 60% of the qualifications, but women apply only if they meet 100% of them was brought up in a number of the interviews.18 It emphasised that one of the biggest challenges in creating balanced leadership in organisations is women putting themselves forward for leadership roles in the first place. Celia Ingham Clark explained “some of it is the imposter syndrome: women assume that they need all requirements”.

Strategies such as appropriate advertising, mixed interview panels and succession planning are important in achieving gender balance in senior leadership roles, particularly when embedded into organisational structures.1 2 Helen Stokes-Lampard further added that, “It is essential women do not fall into the humility trap…when it comes to salaries, bonuses and negotiations”. Jane Dacre described her proudest achievement in her post at the Royal College of Physicians as the progress she has made in changing the culture of the organisation: ‘the thing I’m particularly proud of is the increased equality and diversity’. Jane Dacre explained that she ‘had to be prepared to put in place changes to rules and governance. These included wider advertisement of roles, refreshing those in senior leadership to balance new ideas with experience and empowering the next generation of leaders’.

Clare Marx also reflected on organisational change to create an environment of inclusion. “Only 25 out of 560 of the Royal College of Surgeons examiners were female… I said to my Head of Exams, ‘what are we doing wrong if you are advertising and women aren’t applying?’ We concluded the need for targeted advertising and, with this, 40 women applied, all had the desired qualifications. If you have got a system that really wants to make sure it accesses certain groups, you have to make that group feel very welcome and wanted”. Neena Modi discussed the concept of having quotas for number of women in certain roles. She said “when quotas are for a set length of time with a clear objective, they can be necessary to create change but a quota should not be seen as an end in itself”.