Supporting diverse health leadership requires active listening, observing, learning and bystanding

• DOI: https://doi.org/10.1108/EDI-08-2021-0214
• Published date: 20 February 2023
• Date: 20 February 2023
• Pages: 346-363
• Subject Matter: HR & organizational behaviour,Employment law,Diversity,equality,inclusion
• Author: Ruth Decady Guijarro,Ivy Lynn Bourgeault

Supporting diverse health

leadership requires active

listening, observing, learning

and bystanding

Ruth Decady Guijarro

University of Ottawa, Ottawa, Canada, and

Ivy Lynn Bourgeault

School of Sociological and Anthropological Studies, University of Ottawa,

Ottawa, Canada

Abstract

Purpose –Fostering diversity in health leadership is imperative as that not only enhances the quality of health

care itself, but improves an organization’s effectiveness and responsiveness to address the needs of a diverse

population. Inequitable structures entrenched in health care such as sexism, racism and settler colonialism

undermine efforts made by women from diverse backgrounds to obtain leadership roles. This paper identifies

leading practices which support diverse health leadership.

Design/methodology/approach –A multi-methodological approach involving a targeted published and

gray literature search undertaken through both traditional means and a systematic social media search,

focused particularly on Twitter. A literature and social media extraction tool was developed to review and

curate more than 800 resources. Items chosen included those which best highlighted the barriers faced by

diverse women and those sharing tools of how allies can best support the diverse women.

Findings –Four core promising practices that help to disrupt the status-quo of health leadership include

(1) active listening to hear and amplify voices that have been marginalized, (2) active learning to respond to

translation exhaustion, (3) active observing and noticing microaggressions and their consequences and

(4) active bystanding and intervention.

Social implications –When implemented, these practices can help to dismantle racism, sexism, ableism and

otherwise challenge the status-quo in health leadership.

Originality/value –This paper provides an original and value-added review of the published literature and

social media analysis of heretofore disparate practices of allyship, all while amplifying the voices of health

leaders from marginalized communities.

Keywords Diversity, Healthcare, Toolkit, Inclusive leadership, Allyship, Promising practices

Paper type Research paper

Introduction

Fostering diversity in health leadership is imperative. Diverse leadership provides a broader

source of talent, which has been linked to enhanced quality of care, improved organizational

EDI

42,3

346

The authors would also like to recognize that this work was supported by theDepartment of Women and

Gender Equality Canada, specifically through the funding of the Empowering Women Leaders in Health

initiative which focused on women’s leadership in health care, health sciences and Indigenous health.

This funding has enabled the project to become a transformational initiative across a number of

organizations. Many sincere thanks to the Empowering Women Leaders in Health research team at the

University of Ottawa and Queen’s University, namely Jamie Lundine, Dr Karen Lawford, Billie Jane

Hermosura and Dr Yvonne James. The authors would also like to acknowledge the contributions made

to the overall project by its designated leaders in health care, Dr Gillian Kernaghan, health sciences, Dr

Nancy Edwards and Indigenous health, Dr Lisa Richards and the authors’project advisory committee.

Conflict of interest: The authors declare no potential conflicts of interest with respect to the research,

authorship and/or publication of this article.

The current issue and full text archive of this journal is available on Emerald Insight at:

https://www.emerald.com/insight/2040-7149.htm

Received 31 August 2021

Revised 7 June 2022

Accepted 29 September 2022

Equality, Diversity and Inclusion:

An International Journal

Vol. 42 No. 3, 2023

pp. 346-363

© Emerald Publishing Limited

2040-7149

DOI 10.1108/EDI-08-2021-0214

performance and responsiveness to the needs of a diverse population (Hunt et al., 2015).

Despite a burgeoning literature on leadership diversity (Yadav and Lenka, 2020;Haas, 2010;

Jonsen et al., 2010), this has not yet been studied extensively in health care contexts. Studies

that focus on diversity and leadership in health tend to focus on how health leaders can

manage diversity in staff and patient populations. Although important, leadership diversity

is not only about “upskilling”the diversity knowledge of existing leaders, but also about

having more diverse individuals in leadership positions. There are many skills and insights

that can uniquely come from a diverse group of leaders. Diverse leaders are more likely to

understand the communities they come from and make more meaningful decisions that serve

diverse communities and others.

In the case of gender diversity, it is well documented that women are disproportionately

absent from decision-making and leadership positions in health organizations (Betron et al.,

2019). Although women represent the bulk of front-line providers in health care (over 70%

globally and over 80% in Canada), very few of them are in leadership positions (Bourgeault

et al., 2018). Although efforts to recruit and promote more women are initiated, significant and

often invisible barriers (such as systemic sexism and unconscious bias) can interfere. Gender

bias is further compounded by other aspects of an individual’s identity such as race, gender,

ability and sexuality. For Indigenous women, Black women, women of color [1], gender-

diverse individuals or women living with disabilities, the pervasive and ever-present racism,

colonialism, ableism, homophobia and other systems of inequity act as a strong barrier to

attaining leadership positions. There are, however, growing calls for health care leaders in

senior management and on governing boards to more fully reflect the communities they serve

(Izenberg and Taylor, 2018). Nevertheless, the promotion and advancement of diverse

individuals into leadership roles is thwarted by bias, prejudice, lack of representation, lack of

mentorship and sponsorship and inade quate academic guidance as well as hos tile

institutional environments.

Finding an organization without a written statement outlining its commitment to

diversity is rare (Backhus et al.,2019). In Canada, despite legislation against the

aforementioned inequalities (e.g. the Canadian Human Rights Act, the Employment Equity

Act and the Canada Labor Code), they are as pervasive as ever. Even when individuals from

under-represented populations attain leadership positions, most are over-represented in less-

prestigious positions that serve their unique populations and earn lower salaries (Nair and

Adetayo, 2019). The lack of diversity in health care leadership not only has implications on

patient care, but also impacts the recruitment and retention of future health workers and

“contributes to a vicious cycle of underrepresentation”(Crown et al., 2021).

Against this backdrop, our research team began as an initiative focused on enabling

women’s leadership in health, with a specific earmarked focus on Indigenous women leaders,

informed by an intersectional lens (Crenshaw, 1989). As part of this initiative (titled

Empowering Women Leaders in Health), we organized various events aimed at developing

tools and resources that would support women’s leadership. During these events, we

experienced awkward conversations exemplifying microaggressions by some of the white,

settler participants. This revealed a need for an explicit set of resources beyond simply a

focus on gender. This prompted our research team to consult with advisors and create a

toolkit in which resources could be compiled for existing health leaders to begin to recognize

the unique health and health care needs of diverse communities and the importance of

actively supporting diversity in health leadership. Our search for these resources was

sparked by the following question: If someone has the desire to support diverse women and

gender-diverse individuals in their leadership journeys, what is it that they would need? The

resulting open-access toolkit (which can be found on the LEADS Canada platform) contains

numerous promising practices that, if implemented, supported and evaluated, could help to

foster more inclusive environments for individuals from various equity-deserving groups,

Supporting

diverse health

leadership

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