Creating a Climate of Gender Equity

This article is modified from Dr Browne’s talk at the ACEM Annual Scientific Meeting Hobart, November 2019. You can listen to the original audio on our podcast.

Creating a Climate of Gender Equity

There is a climate problem in healthcare. We work in a cultural climate of gender inequity, and it is harming our profession and our patients.

There is a climate of under-representation of women in senior leadership roles. There is a climate of discrimination, bullying and sexual harassment – and a climate of inadequate and ineffective responses to harassment. There is a climate of dealing with systemic inequality as though it is an individual level problem, driven by personal choices and inadequacies.

Why does Inequality Matter?

Equality isn’t about tokenism or including women for the sake of satisfying political correctness. Inequality in women’s participation means that the whole emergency medicine community is missing out on ideas, talent and contribution. In the business of healthcare, this impacts the care we provide to our patients and our communities - we need organisations that look more like the populations they serve.

How we change the climate

Fix the System, Not the Women

Gender inequality is a structural and systemic problem. It is time to move the conversation away from our assumptions about personal choices and characteristics, and to focus instead on the policies and ideas preventing women from achieving full equality and representation. There was a time when it seemed that the reason for women’s under-representation in leadership was a lack of eligible women in the pipeline – once more women entered the workforce, this issue would correct itself as talented women naturally rose to the top. Decades after women have entered the medical workforce, and even as we have become the numerical majority, it seems clear that this passive “trickle-down” approach is a myth. Equality for women and gender diverse people is an uphill battle. There is a power gradient operating against women and we need investment of energy and resources to overcome it. To achieve sustainable change, we need to adopt policies that actively address and reverse gendered disadvantage. It’s not enough to claim to “treat everyone the same” or have a “gender-blind” stance – nobody is gender-blind, we are all personally biased and our system is biased. If we don’t factor our bias into our policies we will never overcome it. By the same token, trying to solve inequality by fixing individual women, with leadership courses, mentoring and assertiveness training is not going to solve fundamental structural inequity.

Revise our definitions

Our cultural definitions of professional success, leadership and merit are based on traditionally masculine standards and traits. Women in leadership are caught in a double-bind, whereby they are critiqued as either “too aggressive” for failing to conform to expectations of feminine behaviour, or “too nice”, for failing to perform masculine styles of leadership behaviour. The social penalties for threatening gender stereotypes are significant. This also holds true for men who tend towards more empathetic, reflective and collaborative styles of practice and leadership. We need to broaden and diversify our definition of merit. Stop and reflect on the cultural expectations and gender stereotypes that you reinforce, especially in giving feedback to trainees and junior colleagues.

Formal targets and quotas on representation

It’s exciting to see that ACEM is leading the way with a proposed target of 40% female representation on the Board, COE and CAPP. Gender scorecards are another great initiative, but these need to have meaningful outcomes attached, and should be reported and attended to in general forums and the halls of power, not just in the feminist echo chamber.

Male Champions for Change

No minority group ever overcame its disadvantage alone – women need allies to shift the power balance. Men need to step up and take positive action to address the inequality that they benefit from. Conversations about gender inequity need to involve everyone, because gender inequity affects everyone.

Parenting is a normal human activity.

Image credit: Humphrey Muleba @good_citizen (unsplash.com)

Departments and training programmes need robust and consistent policies that deal fairly and realistically with the demands of raising children.

Firstly, let’s get the basics right and ensure that women are receiving the protections and entitlements that are their legal due. Asking about pregnancy plans in job interviews is completely unacceptable, and we need a mechanism for this to be confidentially reported. Women are often not paid their full entitlements while on parenting leave. Transparency is a first step towards ensuring that women get a fair go.

It’s great to see that AWE is developing guidelines that support pregnant and breastfeeding staff, as well as flexible work arrangements for carers. There is evidence-based data from across a range of industries that getting this right improves retention, wellbeing, and ultimately organisational performance. I hope that embedding appropriate standards and regulations for FACEMs and trainees has flow-on benefits for medical staff outside ED training and also our nursing colleagues, as an inclusive culture around parenting and caring is normalised.

Discussions around parenting often focus exclusively on birth mothers, failing to include fathers, partners, step-parents or adoptive and foster parents. Discriminatory parental leave policies perpetuate inequality, not just at the time of a new baby’s arrival, but also exerting long-term impacts on the distribution of domestic labour throughout the life cycle. How do our departments and our training programmes acknowledge the needs and responsibilities of fathers and other non-pregnant parents?

Keep Women Safe

Perhaps the most chilling area of inequality in Medicine in Australasia is the gender difference in experiences of Discrimination, Bullying and Sexual Harassment. Data collected in surveys from ASMOF and ACEM demonstrate shockingly high rates of sexual harassment, disproportionately affecting women and trainees in particular. “Every bit of energy we spend on feeling unsafe is energy we are not spending on creating value (Dr Rhonda Graves Acholonu)”. Until we devise safe, effective and reliable mechanisms for dealing with DBSH in our institutions, we will continue to waste women’s talent and energy.

ACEM has a unique contribution to make to improving women’s safety – similarly other professional organisations such as unions, the AMA, medical boards, and academic institutions. When DBSH is not adequately dealt with by a department or hospital, it is vitally important to have recourse to external bodies with authoritative influence – especially for trainees. ACEM’s role as the accreditor for Emergency Departments confers an opportunity and responsibility to set the cultural tone around workplace safety. We applaud ACEM’s DBSH Action Plan, released in 2018, and hope to see it effectively implemented.

Australian Human Rights Commission - “Face the Facts”, 2018

It is also important to recognise the burden of violence against women outside the workplace. Being an emergency physician, or any other professional within healthcare, does not render women immune from the threat of violence and harassment at home or in other aspects of our public lives.

How do our organisations respond to violence against women in other domains? How do we support our employees, trainees and colleagues when they are dealing with experiences of violence outside of work? Are we demonstrating that we take violence against women seriously, or do our organisational conversations and behaviours display attitudes of victim-blaming, disbelief of women, denial or downplaying the impact of violence? Survivors of violence within our workplaces are listening very carefully to these cues.

We need to change what we see to change our vision

Representation matters. The expectations and attitudes of the emerging generation are shaped by what we model to them. Every time we see a manel, or another male-dominated leadership structure, we reinforce the norm that expertise and leadership are the remit of men.

At NoWEM we believe that creating visibility for female leaders plants and nurtures the cultural seed that women can fill these roles and can do so with a unique excellence. By celebrating and giving a platform to female role-models, we hope to inspire the next generation of female leaders. We also aim to create opportunities that give women experience as speakers, writers, leaders and representatives, and imbue them with the support and confidence that is required to succeed in these roles.

If you’re a man invited to be on a manel or an all-male speaking line-up point the organisers in the direction of a female expert before accepting the gig yourself. If you organise events, stop and think about the representation of expertise and leadership that you are promoting, and make a conscious decision to model equity. What we represent on our stages, in our publications, on our leadership boards and in our honours and awards sends a powerful message to the community about the future we envisage.

Creating Connections – Standing Together

We believe that networks are a powerful structure for creating change at both personal and structural levels. Our network can advocate on behalf of our community, and absorb the backlash that individuals experience when they advocate for themselves. We have the collective knowledge, leverage and reach to achieve policy change, in arenas that may be inaccessible to our individual members. We can pool our limited resources of time, energy and expertise and scale up the impact of our activism. We help people make connections, to share stories, experience and resources. We encourage women to raise one another up. Most importantly, we are refreshed and recharged by one another’s company.

NoWEM is a grassroots organisation of ordinary people, who care about inclusion and equity, and about each other. You can get involved on social media, by visiting our website, checking out our blog or podcast and signing up for our newsletter. We host events in many parts of Australasia and we would love to have you along. If nobody has started a local NoWEM in your area we would love to support you in starting up a local group yourself. If you want to write for the blog, or record a podcast, or contribute your time and skills in some other way we would love to hear from you.

Climates are complex systems, and the climate of gender inequity in medicine is no different. But climate systems are dynamic, and cultures are created by the people within them. We have the power to effect change in the cultural climate. It will take deliberate and consistent effort – sometimes uncomfortable effort. But ultimately a culture that actively strives for equality, respect and inclusion is good for everyone, especially our patients.

Dr Rhiannon Browne, ASM 2019