At present while 40% of doctors are female, only 28% hold consultant posts and only 8% of all consultants are female surgeons (Elston, 2009). This raises interesting questions about the nature and future of clinical leadership in surgery.
Leadership styles are influenced by gender as highlighted by the research of Rosener (1990) who concluded that women have a preference for transformational leadership - a style of leadership where leaders engage with, motivate and empower others to perform by encouraging them to see a long term vision and to change their perception of reality. In contrast, men tend towards transactional leadership characterised by incentive based exchanges between leader and follower in return for enhanced performance.
Does surgical practice lend itself to a transactional male style of leadership? Certainly there is strong evidence to suggest that the quality and safety of surgical procedures can be optimized by encouraging surgical teams to work to a checklist before proceeding to the next phase (de Vries, Hubert, Rogier et al, 2010). This approach is inherently task-orientated and transactional. Or is the success of the checklist approach dependent upon a feminine style of leadership which promotes the flattening of hierarchies, team cohesion and the open expression of concerns? Edmundson et al (2001) suggest that the successful implementation of new micro-surgical techniques is dependent upon the ability of the leader to relinquish their authoritarianism in order to function as a collaborator in the operating team; this approach is entirely consistent with a feminine engaging style of leadership.
Is a transformational and feminine style of leadership of greater value than a transactional male style in the emerging NHS? One might argue so given that the future of our healthcare system may be dependent upon the proactive implementation of change and the ability to rapidly diffuse innovative practice. Do we underestimate the influence of gender and the value of feminine leadership in surgical specialities and in the wider NHS? Or do our current clinical leaders, male and female, have the flexibility to switch between styles as circumstances dictate?
References
de Vries EN, Hubert AP, Rogier MPHC et al (2010) Effect of a Comprehensive Surgical Safety System on Patient Outcomes. New England Journal of Medicine. 363:1928-1937
Edmundson AC, Bohner R, Pisano GP (2001) Speeding up team learning. Harvard Business Review. 79:9; pp125-32
Elston MA (2009) Women and medicine: the future. London: Royal College of Physicians
Rosener JB (1990) Ways women lead. Harvard Business Review. 68:6; pp119-25
women surgeons
As A surgeon and head of surgery I have no doubt that women can and do very effectively address leadership in differen ways >it has to depend on what you are trying to achieve and the audience. I alter my style depending on what i feel will be most effective. How many men think they have come up with a brilliant solution when the women in therelife have been slowly putting the idea into thier head for months. We don't need to take the glory as long as what we set out to do has been accomplished. though it is nice sometimes to get the credit.