The Women’s Guide to Healthcare Leadership: The Why and The How

Description

You have what it takes to lead. This book shows you why you must lead and the way to get there.

Women make up 75%–80% of the healthcare workforce. They account for the majority of their families’ healthcare decisions. Research consistently shows that women leaders produce better clinical outcomes, stronger organizational performance, and more equitable workplaces.

Yet fewer than 15% of top healthcare leadership positions are held by women.

That gap is not desirable or inevitable. It can and must be addressable. The Women’s Guide to Healthcare Leadership: The Why and The How is the book that addresses it directly.

Written by Patricia A. Gabow, MD, MACP — physician scientist, 20-year CEO of Denver Health, and one of the most honored healthcare leaders of her generation — this is the practical, evidence-grounded, experience-tested guide that aspiring women healthcare leaders have been waiting for.

Dr. Gabow has made the journey. She has navigated the barriers, earned the credibility, and led one of the nation’s most respected health systems through decades of transformation. Now she shares everything she learned — the why and the how — so the next generation of women recognize the urgency to become leaders and see the path for the journey.

Why Women Must Lead — and Why Now

Americans spend nearly twice what other high-income countries spend on healthcare, yet Americans live shorter lives, face wider health disparities, and endure a system burdened by fragmentation, inequity, and runaway costs. The leaders who built this system have not been able to fix it. New voices — different perspectives, different priorities, different skills — are urgently needed at every leadership table.

Companies with more women in senior roles outperform their peers financially. Women physicians generate lower mortality rates, higher adherence to evidence-based guidelines, and reduced readmission rates. Women legislators sponsor more bills and pass more meaningful healthcare policy. The question is not whether women should lead — it is how to get more of them there faster.

Karen B. DeSalvo, MD, MPH, MSc, Google Chief Health Officer (Retired), writes in the Foreword, “Anyone who is a gatekeeper of talent, resources, or policy has a role to play because when we empower women to lead in healthcare, we enable transformative change that can positively impact the health of generations to come.”

Dr. Gabow is the perfect person to shape this advice given that she is an extraordinary leader admired by many — including me — as a model for principled and effective leadership.”

What This Book Delivers

• A rigorous, data-rich examination of why American healthcare needs women in leadership — and what women bring to the table that the system cannot afford to lose.
• An honest accounting of three of the biggest barriers women face — gender bias and the glass ceiling, the motherhood penalty and pay inequity, and work-life balance — with concrete approaches for navigating each one.
• Practical “thought exercises” in every chapter that help readers move from understanding to action, applying the book’s insights to their own careers, institutions, and goals.
• Real examples drawn from research, policy, and clinical practice that make the abstract concrete and the possible feel within reach.
• BONUS: A concluding chapter of candid reflections from 10 accomplished women healthcare leaders — physicians, nurses, scientists, administrators, and policymakers — who share what helped them, what challenged them, and what they would tell their younger selves.

Four Strengths That Set This Book Apart

First, it is written by someone who made the journey. Dr. Gabow spent two decades as CEO of Denver Health, a model safety-net institution that demonstrated high-quality care is possible for everyone regardless of ability to pay. She is not writing from theory. She is writing from experience.

Second, it is thoroughly documented. The book draws on an extensive body of peer-reviewed research on women’s leadership, healthcare system performance, clinical outcomes, and organizational effectiveness. Readers will find this a valuable reference long after they finish reading it.

Third, it is genuinely practical. Every chapter is built around “thought exercises” that engage readers directly, asking them to apply what they are learning to their own situations. This is a book designed to be used, not just read.

Fourth, it speaks in many voices. Through in-depth interviews with 10 women leaders who represent the full breadth of healthcare — different professions, different roles, different backgrounds, different paths — the book makes clear that there are many starting points and many places from which to lead.

This guide helps readers see their own potential and path to leadership.

Leadership is your road map. The journey starts here.

About the Author

Patricia A. Gabow, MD, MACP

Patricia A. Gabow, MD, MACP, is a national leader in delivery system innovation and the care of poor, uninsured, and vulnerable populations. She spent her career at Denver Health, a model healthcare safety-net institution, serving as CEO for the final 20 years before retiring in 2012. She is professor emerita of medicine at the University of Colorado School of Medicine and a Master of the American College of Physicians. Dr. Gabow has authored more than 140 articles and book chapters and three previous books: Lean The Prescription: Powerful Medicine for Our Ailing Healthcare System; TIME’S NOW for Women Healthcare Leaders: A Guide for the Journey; and The Catholic Church and Its Hospitals: A Marriage Made in Heaven? She was a founding member of the federal Medicaid and CHIP Payment and Access Commission and currently served for a decade on the Robert Wood Johnson Foundation Board. Her honors include the National Academy of Medicine’s Gustav O. Lienhard Award, the AMA Nathan Davis Award for Outstanding Public Servant, and the AAMC David E. Rogers Award. She is a member of the Colorado Women’s Hall of Fame.

Table of Contents

Acknowledgments

About the Author

Foreword by Karen B. DeSalvo, MD, MPH, MSc

Introduction

1. Why Should Women Lead?
   • Assessing Our Healthcare System
     • Healthcare and Cost
     • Healthcare Coverage and Access
     • Healthcare Quality, Disparity, and Equity
   • Digging Deeper into Determinants of Health
   • What Women Bring
     • Public Perceptions of Women in Leadership
     • Leadership in the Workplace
     • Organizational Benefits of Women in Leadership
   • Women in Healthcare
   • Women as Leaders of Healthcare Change
   • Women Making a Difference Globally
   • Concluding Thoughts
2. Lay of the Land for Women in Healthcare
   • Women Pioneers in Healthcare
     • Florence Sabin
     • Clara Barton
     • Mother Joseph
   • Women’s Caregiving and Health
     • Women’s Role in Family Health
     • Women’s Health
     • Women Healthcare Researchers
   • Women in Healthcare Professions
     • Women in the Nursing Profession
     • Women in the Medical Profession
     • Women in Other Healthcare Professions
   • Women in Healthcare Leadership
   • Gender and Pay
   • The Motherhood Penalty
   • Nursing Wages
   • Physician Wages
   • Concluding Thoughts
3. Obstacles and Opportunities
   • Confronting Bias
     • Bias in Language
     • Addressing Institutional Gender Bias
     • The Motherhood Penalty
   • Sexual Harassment
   • Recommendations for Action
   • The Imposter Phenomenon
   • Opportunities for Women
   • Changing the Culture
   • Improving Care
   • Concluding Thoughts
4. First Things First
   • Reflection on Values and Leadership
   • Living the Values
   • Aligning the Values
   • Choosing Leadership
   • Concluding Thoughts
5. You Can’t Parachute into Leadership
   • Leading from Where You Stand
   • Clinical Training in Leadership
   • Formal Leadership Training
   • Leadership Training for Clinicians
   • Leadership Training for the Administrator
   • Documenting Your Accomplishments
   • Applying for a Leadership Position
   • Battlefield Promotion
   • Role Models, Mentors, Sponsors, and Coaches
   • Concluding Thoughts
6. Now You Are a Leader
   • Introducing Yourself
   • Establishing Relationships
   • Building Your Team
   • Who Is on the Team
   • Recruiting and Hiring
   • Effective Evaluations
   • Role Modeling, Mentoring, Sponsoring, and Coaching
   • Supporting the Workforce
   • Changing Roles, Disciplinary Actions, and Terminations
   • The Importance of Communication
   • Concluding Thoughts
7. Even Leaders Have a Boss
   • The Boss on the Chart
   • Other “Bosses”
     • Your Peers
     • Your Team
     • The Board
     • The Community
     • Affiliated Organizations
   • Concluding Thoughts
8. Making the Trains Run on Time and Laying New Tracks
   • Data Is Your Friend
   • Research Is a Teacher
   • Making Decisions
   • Decision-Making Tools
   • Making the Trains Run on Time
   • Laying New Tracks
   • Changing Landscape
   • Concluding Thoughts
9. Sharing and Receiving Lessons Learned
   • Barriers to Sharing
   • How to Share
     • Sharing by Teaching
     • Sharing by Presenting
     • Sharing via Publication
     • Other Sharing Opportunities
   • Receiving Lessons Learned
   • Concluding Thoughts
10. Remember the Obvious
    • Creating and Maintaining Balance
      • Managing the Family and Household
      • Having and Raising Children
      • Caring for Our Parents
      • Finding Support
      • Well-Being
      • Can We Have It All
    • Burnout and Moral Distress
      • Burnout
      • Moral Distress
    • Behaviors
      • Past Behaviors
      • Online Behaviors
      • Behavior of Others
    • Professional Appearance
    • Concluding Thoughts
11. Reflections of Women Leaders

Appendix

References

Testimonials

• “Dr. Patty Gabow is an icon — someone I have looked up to throughout my career. Having spent part of my career at the safety net with Dr. Gabow as CEO, I absorbed many of her leadership lessons by watching her in action. The Women’s Guide to Healthcare Leadership reflects those transformative insights and offers practical wisdom for those seeking to lead with courage, integrity, and purpose. A must-read for anyone navigating the opportunities and challenges of leadership in healthcare.” — Marisha Burden, MD, MBA, Professor of Medicine, Division Head of Hospital Medicine, University of Colorado School of Medicine
• “As a nurse leader, I deeply resonate with Patricia Gabow’s message in The Women’s Guide to Healthcare Leadership. This book is practical, profound, and values-driven, reminding us that great leadership is forged not only through success, but also through perseverance, resilience, gratitude, humor, and the willingness to do what is right under pressure. At a time when healthcare faces extraordinary complexity and challenge, this book speaks powerfully to nurses and other healthcare professionals who are called to lead with courage, clarity, and compassion. It equips women across healthcare to lead with conviction, humanity, and purpose when their leadership is needed most.” — Jing Wang, PhD, MPH, RN, FAAN, Dean, Florida State University College of Nursing
• “Dr. Patricia Gabow has done the work — from the front lines of clinical medicine to healthcare system CEO — and this book reflects the hard-won lessons of that journey. She confronts honestly both the failures of American healthcare and the persistent barriers women face within it, then delivers the practical frameworks, mentorship wisdom, and leadership tools needed to overcome them. Grounded in data, enriched by the voices of 10 accomplished women leaders, and written with the clarity of a physician who has diagnosed the problem and knows the cure, this is the guide every woman in healthcare needs to stop waiting for a seat at the table and start leading from wherever she stands.” — Risa Lavizzo-Mourey, MD, MBA, President Emerita, Robert Wood Johnson Foundation, The Robert Wood Johnson Foundation University Professor Emerita of Health Policy and Equity at the University of Pennsylvania
• “In The Women’s Guide to Healthcare Leadership, Dr. Gabow provides an inspiring ‘call to action,’ arguing that the myriad problems in American healthcare, including high costs, fragmented care, difficult access, poor outcomes, and disparities, require the unique perspectives and skills that women can bring to the table. Gabow makes a compelling argument that women leaders are uniquely positioned to address many current healthcare system failures. The key strength of this book lies in its comprehensive, data-driven approach providing evidenced-based advocacy and a practical ‘how-to’ framework with a focus on values and ethics. Gabow emphasizes that true leadership must be anchored in personal and institutional values. She argues that courage, humility, and integrity are essential to drive the major transformation that is necessary to move the U.S. toward a more equitable and affordable healthcare system. By focusing on these moral foundations, she challenges women not just to seek equitable representation, but to utilize their unique skills and collaborative approaches to address the most critical shortcomings in American healthcare. The Women’s Guide provides a foundational roadmap for leadership, including practical advice on aligning personal values with institutional goals, emphasizing the importance of mentors and sponsors, and demonstrates the mechanics of leading a team. Gabow provides a deeply personal ‘guide’ that blends her 20-year journey as a CEO with the shared ‘reflections, advice, and insights’ of 10 diverse women leaders, offering a communal roadmap rather than a top-down administrative manual. The emphasis on ‘leading from where you stand’ and maintaining a ‘moral compass’ is critically important, now more than ever. By shifting the focus from simply ‘running a system’ to ‘transforming the system’ through uniquely female perspectives and collaborative skills, the book offers a more specialized, advocacy-based approach than typical healthcare leadership literature. Gabow provides important new insights for women in healthcare that will benefit current and future leaders. I encourage you to read it and share it with your colleagues. I am deeply grateful to Dr. Gabow for her leadership, mentorship and ongoing contributions to healthcare.” — Victoria Fraser, MD, Adolphus Busch Professor of Medicine, Chair of the Department of Medicine, Washington University School of Medicine (WashU Medicine)
• “No single person has made a greater contribution to healthcare policy and practice than Dr. Patricia Gabow. Her latest book offers significant insights regarding the women’s healthcare leadership imperative, as well as invaluable advice on the path forward.” — Sara Rosenbaum, JD, Emerita Professor, Health Law and Policy, Milken Institute School of Public Health, George Washington University
• “In a world where 69% of Americans believe having more women in leadership would improve their quality of life, why do we remain so shy of the mark? Dr. Gabow makes the case, as always using available evidence, that women’s leadership in healthcare matters and then shows us the steps we need to take to make it happen. But don’t take her word for it — be sure to read to the end so you can appreciate the wisdom of other women leaders who have risen to the highest positions of influence in our profession!” — Nanette Santoro, MD, E. Stewart Taylor Professor of OBGYN, University of Colorado School of Medicine
• “The Women’s Guide to Healthcare Leadership is a manifesto, user manual, and inspirational sourcebook for how women can aspire to and attain leadership in healthcare. This is a must-read for something that is a must-do. Almost everyone in healthcare knows that something is missing. Look around and you readily see that the ‘something’ is the absence of women in most roles where significant policy is made, decisions arrived at, budgets allocated, and visions of the future created. Patricia Gabow has written an important and actionable guidebook for changing that situation, to the benefit of healthcare and all those it serves. In concise and cogent prose, Gabow discusses why we need women in half the seats of decision power, and how women can best prepare themselves for and propel themselves into those seats. The Women’s Guide to Healthcare Leadership will galvanize women at every career stage. It offers specifics on how to become a leader of yourself — first and foremost — and then a leader of a team, an institution, and a profession. This is a book about creating empowerment with a purpose. The small investment of time spent reading The Women’s Guide to Healthcare Leadership will yield a large return personally and professionally.” — Azita Emami, PhD, RN, FAAN, Dean, Yale School of Nursing
• “Women dominate the healthcare workforce but are far less represented in the ranks of senior leadership. Yet contemporary healthcare challenges, including workforce capabilities and burnout, technological changes, financial pressures, and an increasingly diverse and older population, we need more women leaders. This book offers pragmatic advice for women aspiring to lead as well as those who have encountered obstacles to fulfilling ambitions to lead and collaborate at the highest levels from Dr. Patty Gabow, an early pioneer and superstar, whose dedication to guiding and elevating women leaders is unparalleled.” — Carolyn Clancy, MD, Former Director, AHRQ, and VA Senior Executive
• “Among a generation of aspiring female healthcare leaders in Denver, everyone wanted to be Patty Gabow, the visionary leader of one of America’s most storied safety net health systems. Now, Patty has given us the gift of her leadership philosophy — with a twist — to highlight the particular opportunities and challenges for female leaders. Her book is a comprehensive overview of healthcare leadership, a personal statement of her leadership values, and a call to women to take the reins and lead with eyes wide open. Her perspective is unique and rings true at a moment in U.S. healthcare that requires the most from our leaders, male and female.” — Heidi Wald, MD, MSPH, Chief Quality Officer, Denver Health
• “Dr. Patricia Gabow’s new book, The Women’s Guide to Healthcare Leadership: The Why and The How is an insightful and practical book that serves as a one-stop tour de force volume on the values, ideas, and skills required to have a successful career as a woman leader in healthcare. Dr. Gabow is a nephrologist, medical researcher, academic leader, and healthcare executive whose career spans five decades, well known for transforming Denver Health into one of the nation’s leading public healthcare systems. In the book, she has combined clinical medicine, research, health-system leadership, and public policy advocacy to provide a book focused on her career life lessons as well as the careers of other notable women leaders. Reading this book inspires, as it provides information about the obstacles to leadership for women as well as the stepwise ways to move forward. I recommend this book to aspirational women leaders everywhere.” — Judy Regensteiner, PhD, Distinguished Professor of Medicine, Judith and Joseph Chair in Women’s Health Research, Director, Ludeman Family Center for Women’s Health Research