Kuhlmann Ellen, Ovseiko Pavel V, Kurmeyer Christine, Gutiérrez-Lobos Karin, Steinböck Sandra, von Knorring Mia, Buchan Alastair M, Brommels Mats
Medical Management Centre, LIME, Karolinska Institutet, Stockholm, Sweden.
Institute for Economics, Labour and Culture, Goethe-University Frankfurt, Frankfurt, Germany.
Hum Resour Health. 2017 Jan 6;15(1):2. doi: 10.1186/s12960-016-0175-y.
Women's participation in medicine and the need for gender equality in healthcare are increasingly recognised, yet little attention is paid to leadership and management positions in large publicly funded academic health centres. This study illustrates such a need, taking the case of four large European centres: Charité - Universitätsmedizin Berlin (Germany), Karolinska Institutet (Sweden), Medizinische Universität Wien (Austria), and Oxford Academic Health Science Centre (United Kingdom).
The percentage of female medical students and doctors in all four countries is now well within the 40-60% gender balance zone. Women are less well represented among specialists and remain significantly under-represented among senior doctors and full professors. All four centres have made progress in closing the gender leadership gap on boards and other top-level decision-making bodies, but a gender leadership gap remains relevant. The level of achieved gender balance varies significantly between the centres and largely mirrors country-specific welfare state models, with more equal gender relations in Sweden than in the other countries. Notably, there are also similar trends across countries and centres: gender inequality is stronger within academic enterprises than within hospital enterprises and stronger in middle management than at the top level. These novel findings reveal fissures in the 'glass ceiling' effects at top-level management, while the barriers for women shift to middle-level management and remain strong in academic positions. The uneven shifts in the leadership gap are highly relevant and have policy implications.
Setting gender balance objectives exclusively for top-level decision-making bodies may not effectively promote a wider goal of gender equality. Academic health centres should pay greater attention to gender equality as an issue of organisational performance and good leadership at all levels of management, with particular attention to academic enterprises and newly created management structures. Developing comprehensive gender-sensitive health workforce monitoring systems and comparing progress across academic health centres in Europe could help to identify the gender leadership gap and utilise health human resources more effectively.
女性参与医学领域以及医疗保健中性别平等的必要性日益受到认可，但大型公共资助的学术健康中心的领导和管理职位却很少受到关注。本研究以四个欧洲大型中心为例说明了这种需求：柏林夏里特大学医学中心（德国）、卡罗林斯卡学院（瑞典）、维也纳医科大学（奥地利）和牛津学术健康科学中心（英国）。
现在，这四个国家的女医学生和女医生的比例都处于40% - 60%的性别平衡区间内。在专科医生中，女性的占比更低，而在高级医生和正教授中，女性的占比仍然显著偏低。这四个中心在缩小董事会和其他高层决策机构中的性别领导差距方面都取得了进展，但性别领导差距仍然存在。各中心实现的性别平衡水平差异很大，在很大程度上反映了各国特定的福利国家模式，瑞典的性别关系比其他国家更为平等。值得注意的是，各国和各中心也存在类似趋势：学术机构中的性别不平等比医院机构中更为严重，中层管理中的性别不平等比高层更为严重。这些新发现揭示了高层管理中“玻璃天花板”效应的裂缝，而女性面临的障碍则转移到了中层管理，并且在学术职位中仍然很大。领导差距的不均衡变化具有高度相关性，并具有政策意义。
仅为高层决策机构设定性别平衡目标可能无法有效促进更广泛的性别平等目标。学术健康中心应更加关注性别平等，将其作为各级管理层面组织绩效和良好领导的一个问题，尤其要关注学术机构和新设立的管理结构。开发全面的对性别问题敏感的卫生人力监测系统，并比较欧洲各学术健康中心的进展情况，有助于识别性别领导差距，并更有效地利用卫生人力资源。
