International Women’s Day, 8th March 2022, is an opportunity to celebrate the role that women play at work and in the world. In healthcare systems around the world, women make up around 80% of the workforce. Women are doing 80% of the work, but not 80% of the decision making: women are not represented in leadership roles or in senior clinical roles in numbers that reflect their contribution. When other factors; ethnicity, socio-economic background, disability, sexual orientation and gender identity, are added, the system is even more unequal.

The women who work for the NHS in England, and in other health and care systems around the globe have been a pillar of strength and demonstrated enormous courage during the last two years of the pandemic both in their professional roles and the extra duties they have had in informal care and supporting and protecting their families. The time for tough, aggressive, self-assertive leadership is over. We need to create the conditions, platforms, and spaces for women to play their full role in shaping the future.

In the NHS system, a white male consultant in a major university teaching hospital earns 40% more on average than a black female consultant. Women make up 80% of the NHS workforce but are underrepresented at every level of leadership. It is a similar story in healthcare systems across the globe. There are challenges of gender inequality in every healthcare system and in other organisations with a predominantly female workforce.  For instance, reward systems that are supposed to be based on merit actually increase gender inequalities when it comes to performance evaluations, work allocation and rewards. It has been shown that social expectations for women to be nurturing place pressure on women clinicians to spend more time with patients and provide more emotional support than is expected of male counterparts. In addition, there may be complex social and psychological biases at work, such as the “power dead even rule”: stating that women’s positive relationships with each other at work are based on similar levels of power and self esteem and there may be invisible pressures for women not to threaten these.

Last year, 8^th March 2021, women in the NHS held the largest International Women’s Day event in health and care globally. 5800 women and allies signed up. We mobilised women through a virtual  ‘unconference’: – an event where the people taking part designed the programme and chose to have the conversations they wanted to have. Up to 3500 people were participating live in the 70 unconference sessions at a point during the day. More than 4,000 people also took part through Twitter, with 11,700 tweets sent. Hundreds of women made pledges for action as a result of the day. Following the event, there were more than 8,000 sessions of “courageous coffee”: where two women or allies that were randomly allocated to talk to each other met virtually for coffee.

What did we learn from this and what actions do we need to take for International Women’s Day 2022 and every day to promote women’s equality in health and care?

This process showed the key issues that women want to discuss and are shaping. The key themes included:

• Equality in its widest sense especially addressing health inequalities
• The positive impact of women’s leadership in a crisis
• Women pioneering breakthroughs in health and science
• Racial and social justice with a focus on intersectionality
• Raising awareness of menopause as a workplace issue and better support for the menopause
• Women caring for themselves, including putting their own oxygen mask on first
• Being more explicit and intentional about women’s careers and development
• Thinking about what flexibility means in its widest sense to support women at work
• The need for more evidence and data gathering to address gender bias both in the provision of health and care and in the workplace
• How we challenge inequities in access to treatments, clinical consultation, clinical research as well as gender bias in the workplace
• Being in our career prime when we are over 60 and having choice and flexibility in later stage careers

The conversations showed us what we know from our daily lived experience as women in health and care: we often sell ourselves short, we have to fight to be at the table, our ideas may not attributed to us. These inequalities are amplified for women of colour. Yet we have more power and influence than we realise or are led to believe by the context around us.

There are actions that those in leadership roles can take to help make our health and care organisations more flexible, supportive and equitable for women at work:

1. Women often do not communicate their needs at work – as can be seen by the number of discussions about encouraging women to speak up, sharing tools and encouragement to “step into their power”. Therefore, leaders should be aware of this reality, be active listeners and make structural interventions to ensure women can shape the team and work environment to be able to contribute.
2. Leaders should be explicit in their stance against discrimination, create space to be an active ally, and amplify women’s voices. Women expect their workplaces, their managers and their leaders to be strong allies in the fight for equity and inclusion.
3. The individual and heroic model of work and leadership is leading to burnout across genders but especially for women as they are still doing the lion’s share of caregiving in society. Leaders need to be able to identify when women are getting overwhelmed and need to take “no” from women, (especially relevant for health care)

So this International Women’s Day, let’s take action to celebrate and value the massive contribution that women make to health and care. Let’s also be aware of the bias, assumptions and discriminatory practices that stops women reaching their potential in our health and care system and identify actions that we can all take to help create a system that is fair, inclusive and helps everyone to reach their potential.

Dr Helen Bevan, OBE

Dr Helen Bevan, OBE, is Chief Transformation Officer with the Horizons team, a group of internal change agents within the English National Health Service. Helen has been a leader of large scale change, improvement activist, thought leader and innovator within the NHS for more than 30 years. She has led and facilitated many nationwide initiatives to improve care, including in cancer services, urgent and emergency care and services for people living with dementia, involving many thousands of NHS people and people who use services. She acts as an advisor and teacher to leaders of health and healthcare in many other countries.

Helen has an ability to connect directly with thousands of frontline staff and patient leaders. She is one of the top social influencers in healthcare globally, reaching more than a million people each month through her social media connections, virtual presentations, commentaries, and blogs.has thirty year’s practitioner experience as an internal change agent in the NHS and has worked on initiatives involving hundreds of thousands of patients and people who work for the NHS. She advises leaders of change in healthcare systems across the globe. Her team won the global HBR/McKinsey award for creating “Leaders Everywhere”. This was for their NHS Change Day initiative, that created hundreds of thousands of pledges for change in the NHS. The award was organised by Gary Hamel and the Management Lab. Helen is featured as a case study in Gary’s latest book with Michele Zanini, Humanocracy. Helen was the subject of an interview in HBR in 2018 on “making process changes stick”: https://hbr.org/2018/11/making-process-improvements-stick . Her work as a change practitioner using social movement change methods inside a large organisation was featured as a case study in New Power by Jeremy Heimans and Henry Timms in 2019.

Helen leads The School for Change Agents, an online programme on “how to rock the boat and stay in it”. This is currently offered as a MOOC on the FutureLearn platform. Nearly 100,000 people have taken part in the school since 2014. Helen is on the Thinkers50 radar class of 2020. She is one of the most socially influential people in healthcare globally (@HelenBevanTweets) reaching over a million people a month with her tweets, blogs, and commentaries.

Prerana Issar

Prerana Issar was previously Chief People Officer for the NHS in England. She has 25 years of leadership experience across multiple sectors:

• in the private sector- 16 years at consumer goods giant Unilever
• in the multilateral and development sector – 6 years in the executive team of the (Nobel Peace Prize winning) United Nations Program and the World Food Programme, where she travelled to more than 40 countries affected by conflict and famine to support frontline staff
• public sector: as the Chief People Officer of the NHS, one of the biggest people roles in human resources in any sector globally

Prerana’s TedX talk on The Power of Purpose is one of the most widely viewed in healthcare. Prerana features as a case study in a book by Nick Craig, (5 June 2018). Leading from Purpose: Clarity and the Confidence to Act When It Matters Most. Hachette Books.

Prerana interacted with over 100,000 people who work for the NHS during pandemic, in her role as the lead for the healthcare workforce response to Covid-19. This has involved person time with people in hospitals, clinics and vaccination centres, virtual listening and engagement events with staff, managers, and leaders, and she regularly speaks at national events in. She was the first leader from a minority ethnic background to be a national leader in the NHS.

Declaration of interests

We have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.