From Majority Workforce to Decision-Makers: Closing the Women’s Leadership Gap in Health Systems
Women make up the majority of the health care workforce, yet they remain underrepresented in executive leadership. For health systems, that gap is not simply a matter of representation. It is a leadership challenge with implications for performance, succession planning, and organizational decision-making.
That disconnect is a central focus of Harvard T.H. Chan School of Public Health’s Emerging Women Executives in Health Care program, which helps women leaders build the strategic capabilities, networks, and perspective needed to advance in complex organizations.
For Karen Curley, Program Director for Emerging Women Executives in Health Care, the issue is not a lack of talent.
“The most consistent pattern we see is what I’d call high-impact, low-visibility leadership,” Curley says. “Many women in healthcare are running critical operations—improving quality metrics, stabilizing teams, driving patient experience—but are not positioned in roles that carry enterprise-wide visibility or P&L accountability.”
Why The Leadership Gap Persists
Conversations about women’s advancement often focus on confidence, communication style, or readiness. Those factors can matter, but they do not fully explain why leadership gaps persist across organizations.
A more useful lens is structural. Leadership inequities are shaped by workplace culture, gender norms, and institutional systems that influence who gets visibility, sponsorship, advancement, and authority. In practice, that means organizations cannot rely on encouragement alone. They have to examine how readiness is defined, evaluated, and rewarded.
Curley sees this in the way high-performing leaders are often assessed. Strong execution earns trust, but not always expanded authority. Leaders may be known for solving problems and improving operations, yet still remain outside the forums where strategy is set, resources are allocated, and future executives are identified.
Why Performance Alone is Not Enough
One of the most persistent myths in leadership development, Curley says, is that excellent work will naturally lead to advancement.
“Performance is necessary but not sufficient,” she says. “Advancement requires strategic visibility, narrative control, and sponsorship.”
That distinction matters in health systems, where many women leaders hold roles defined by execution rather than enterprise authority. Their work may be essential, but it is not always framed in the terms senior leaders use to assess readiness for broader roles: strategic judgment, business value, financial impact, and organizational scope.
Another common mistake is waiting for complete readiness before pursuing the next role. Senior positions are rarely filled because someone has already done every part of the job. More often, leaders are evaluated based on visible range, perceived trajectory, and the ability to demonstrate next-level capacity.
The Capabilities That Shift Perception
In Curley’s view, advancement depends in part on building capabilities that organizations consistently associate with senior leadership.
Emerging Women Executives in Health Care emphasizes strategic framing, influence without authority, executive communication, negotiation and boundary-setting, and leading through complexity. Together, these capabilities shape whether a leader is seen as someone who can connect operational work to enterprise priorities, align stakeholders across functions, and make sound decisions under pressure.
One practical tool Curley highlights is the decision memo.
“The decision memo framework consistently creates the fastest shift,” she says. “Many participants move from ‘updating’ senior leaders to shaping decisions within weeks.”
Rather than simply reporting progress, leaders learn to define the issue, clarify trade-offs, present options, and recommend a course of action. That changes how their thinking is received. It signals not only competence, but strategic judgment.
Mentorship Helps, and Sponsorship Changes Outcomes
The program also draws a clear distinction between mentorship and sponsorship.
“Mentorship equals advice and guidance,” Curley says. “Sponsorship equals advocacy and access.”
A mentor can help a leader navigate challenges. A sponsor does something different: they speak on that leader’s behalf in promotion discussions, succession planning, compensation reviews, and stretch assignment decisions.
That distinction matters because advancement is shaped not only by development, but by who gets named for larger opportunities, backed for leadership roles, and connected to influential networks and decision-making forums.
What Health Systems Can Change Now
For organizations, the implication is clear: the solution cannot rest on individual development alone.
“Organizations often focus on confidence-building when the real barriers are structural,” Curley says.
She points to several changes health systems can make now: redesign promotion criteria so they reward enterprise thinking as well as operational excellence; formalize succession planning with transparent criteria and diverse slates; require calibrated talent reviews to reduce bias in readiness assessments; and create clearer pathways into roles with financial, strategic, and cross-functional scope.
If there is one place to start, Curley says, it is making advancement criteria explicit.
“When ‘what it takes to advance’ is ambiguous, bias fills the gap,” she says.
Transparent systems do not solve every problem, but they make barriers easier to identify—and harder to ignore.
A Playbook for 2026
For health systems, closing the leadership gap requires action at multiple levels.
At the individual level, leaders need to translate their work into enterprise value by connecting outcomes to strategy, cost, risk, growth, and performance.
At the manager level, the task is to actively sponsor high-potential women, not just support them. At the executive level, the priority is scope: women leaders need access to roles with budget ownership, strategic responsibility, and cross-functional accountability.
At the board level, leadership diversity should be treated as a governance issue tied to organizational performance, with visibility into promotion data, succession pipelines, and accountability for results.
For Curley, the broader shift is from development alone to power-building. Health care does not have a simple pipeline problem. It has a power-distribution problem. The workforce is there. The capability is there. The question is whether organizations are willing to make advancement pathways more visible, more measurable, and more structurally fair.
“That means access to forums, capital allocation, strategic projects, and influential networks,” she says. “Until those are equitably distributed, representation at the top will lag the workforce reality.”
