Information technology (health IT) in healthcare delivery organizations, stemming from objectives such as meaningful use attestation as well as population health and data analytics initiatives, has resulted in a corresponding demand for a skilled health IT workforce. And it stands to reason that in order to attract and retain experienced and talented IT professionals, organizations need to offer competitive compensation and career pathways that can lead to senior and executive roles.
However, this past March, the Chicago-based Healthcare Information and Management Systems Society (HIMSS) published findings from its December 2015 Compensation Survey that pointed to a notable gender-based pay gap within health IT, which suggests women health IT professionals are being marginalized in this sector. Based on a survey of 1,900 respondents, the findings indicated that men had a higher average compensation at $126,000 compared to women at $101,000. When looking at the data from the perspective of full-time employment, according to the study findings, men earned an average of $124,000 annually, while their female counterparts earned $100,000.
“When analyzing the data by organization level and tenure, there are two sets of concerning findings. In nonexecutive and non-senior managerial roles, the first year compensation for females in non-executive and non-senior managerial roles tends to be 80 percent of what their male peers make. Over time, compensation tends to increase for both genders in this segment. However, females never reach parity,” wrote the authors of the HIMSS white paper, titled “Gender-Based IT Pay Inequity and the Impact of the Clinical IT Executive in the Health Sector.”
And, even more troubling, when examining the compensation data according to respondents in executive and senior managerial roles, the survey findings indicated that the first year compensation for women tends to be 63 percent of what their male peers earned.
“In this segment, it takes 15-plus years of women being in such roles to reach parity,” wrote the authors of the HIMSS white paper.
The HIMSS compensation survey also pointed to gender gaps in access to senior management and executive leadership roles within health IT. Of the respondents, only 10 percent of women represented senior managerial roles compared to 19 percent of men. And the findings indicate even greater disparity as it relates to executive management roles—only 3.6 percent of women reported being in such roles compared to almost 12 percent of men.
Beyond the compensation inequities, gender-based disparities in advancement can impact an organization’s ability to attract and retain the best health IT workforce. So, the question for health IT and healthcare delivery organization leaders is what can be done to address these inequities and drive positive action at the departmental and organizational levels?
“We need to be willing to be open about this problem,” says Sue Schade, interim CIO at University Hospitals in Cleveland, Ohio. Increasingly, published studies and surveys, such as the HIMSS compensation survey, help to cast light on these issues, which sparks conversations and, ultimately, more problem-solving discussions at individual organizations. Senior managers and executives at every healthcare delivery organization can begin to proactively address the issue by looking at their compensation practices, Schade says.
“If you are management within an organization and you make decisions around pay, you need to be looking very seriously at the gender equity in terms of your staff,” says Schade, who has more than 30 years of experience in healthcare IT management and is a founding advisor of Next Wave Health Advisors, a Huntsville, Texas-based consulting, coaching and interim management services company.
Susan Heichert, senior vice president and CIO of the Minneapolis-based Allina Hospitals and Clinics, agrees, noting that organizational leaders need to examine salary data and take corrective action. “You need to understand how you got there in the first place and work with your human resources (HR) team to employ strategies to make sure it’s not happening.”
Currently, there is not enough corrective action occurring at this foundational level to level the playing field for women both in current positions and promoting positions, according to Rebecca Quammen, founder and CEO of Quammen Health Care Consultants. “I have witnessed a situation recently in which a woman taking a management position through an internal promotion was not being offered equivalent pay to her predecessor male counterpart, who just left the position. When all variables except gender are the same, then the question of how much to pay should become mute.”
While there has been progress with women increasingly rising to prominent positions within the healthcare C-suite—CNO, CFO, COO, CIO and even CEO—the problem, Quammen notes, is that “these numbers are still too few for the industry to feel a shift in organizational cultures that promote female diversity in numbers reaching advancement and pay equality.”
“Workforce diversity continues to be a current debate; even today the balance of traditional Caucasian males holding positions to all other ethnicities and genders is significantly tilted,” she says.
The ongoing disparities also raise serious questions about current hiring, promotion and retention practices within the healthcare IT sector. Heichert asserts that the most effective executive teams are balanced, consisting of people representing a variety of leadership styles and opinions. “A balanced team results in a better product, better outcomes and better, healthier dialogue,” she says, noting that Allina Health has a balanced team with numerous “strong women role models on the executive team” who encourage other women leaders.
“You need to be conscious of how you’re structuring your teams and how you’re addressing balance on those teams,” Heichert says. “You obviously want to promote the best candidate for a position, but you also want to make sure that you have the best pool of candidates to choose from.”
It’s important, many industry leaders say, to ensure that managers and directors throughout an organization are developing all their team members and encouraging both men and women to “throw their hat in the ring” for a higher position.
Quammen says, “I recently participated in a presentation in which it was suggested that male managers are not grooming women for promotion in the same way they are grooming males. And, this is a more challenging area to correct as it happens at individual levels.” One way to address this issue, Quammen notes, is for organizations to engage third-party coaches who will apply the same rigor and focus on female candidates as male candidates for promotions and preparedness for larger assignments.
There are a number of studies that indicate there are also cultural issues underlying the underrepresentation of women in executive roles, and discussions with industry leaders seem to confirm these cultural differences. Schade believes men, in general, have done a better job over the years negotiating for higher salaries. “Women aren’t always the best at negotiating,” she says.
Several years ago, Hewlett-Packard conducted a survey of its executive employees with the aim of highlighting why more women weren’t in top management positions. The survey findings indicated that women were not applying for upper management positions, based on the job descriptions, as women only applied for promotions when they met 100 percent of the qualifications listed in the job posting. On the other hand, the survey found, men would apply for the promotion if they met 60 percent of the qualifications. In discussions about women in executive roles, this is often referred to as the “confidence gap.”
Schade believes that women and men are often evaluated differently when applying for management and executive positions. In general, she says, women are evaluated based on what they have accomplished, while men are evaluated based on their potential. “So, you take a female candidate and a male candidate and you look at their qualifications, and the woman has done x, y and z and the job requires x, y and z but the job also requires a, b and c and the woman hasn’t done a, b or c. Then you look at the male candidate, and he’s done x, y and z and he says he can do a, b and c, even though he never has, and that candidate is evaluated based on what he’s done as well as what the hiring manager thinks his potential might be.”
More objective practices during the hiring process, such as a candidate evaluation form where each candidate is given a score based on what he or she has demonstrated, could help address this issue. “That takes a lot of the subjectivity out. It’s important to have fair and balanced hiring practices,” Schade says.
Clinical IT at the Executive Level
As more organizations take on clinical IT-enabled initiatives, clinical IT leaders, such as chief nursing informatics officers (CNIO) and chief medical informatics officers (CMIO), are playing a more strategic, critical role within a hospital or health system’s executive team. Findings from the latest HIMSS Leadership Survey indicates that respondents working at an organization with a clinical IT executive tended to place a higher importance on health IT. And, 71 percent of organizations employing a CNIO, and 59 percent employing a CMIO reported the clinical IT executive was part of their organization’s executive team. In addition, according to research from Impact Advisors, the emerging role of the CNIO provides a path to “engage and empower nurses in IT initiatives at the senior executive level.”
About 90 percent of nurses are women, according to statistics from the American Nurses Association, so it’s possible the rising importance of clinical IT leaders could be a path forward for women to the C-suite. “It’s a way in and it’s an opportunity,” Heichert says, although she adds, “But I would hate to see women pigeonholed or labeled as that’s their only best leadership opportunity.” Women account for about 33 percent of physicians in the U.S., according to the Federation of State Medical Boards, and Heichert sees the CMIO role as a promising opportunity for women leaders as well.
Despite the ongoing challenges, Schade, Heichert and women health IT executive leaders acknowledge that there has been progress, especially with the advancement of the next generation of healthcare leaders.
“There is already much more equity, more equality and more awareness, and it’s a more supportive environment,” Schade says. “I’ve been in management since 1984 and when my children were younger, I was often the only woman on a leadership team and it was an all-boys network, but [now] it’s a different, better place.”
Increasingly, industry professional associations are casting more light on the issues, such as hosting roundtable discussions about gender-based pay gaps and hiring practices. And, industry organizations are making strides in developing resources and educational programming specifically for women.
Many industry leaders see mentorship—both having a mentor and being a mentor—as playing an important role for women’s advancement in health IT, as well as gaining the support of male colleagues in addressing these issues, especially pay disparity.