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Secrets from the C-suite: women leaders on the bridging gap

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Content Secrets From the C-Suite: Women Leaders on Bridging the Gap
by
Anasia Obioha
Rossier School of Education
University of Southern California
A dissertation submitted to the faculty
in partial fulfillment of the requirements for the degree of
Doctor of Education
December 2023

© Copyright by Anasia Obioha 2023
All Rights Reserved

The Committee for Anasia Obioha certifies the approval of this Dissertation
Esther Kim
Marcus Pritchard
Monique Datta, Committee Chair
Rossier School of Education
University of Southern California
2023

iv
Abstract
Men continue to dominate leadership positions in healthcare. Despite women in the United States
accounting for 75% of entry-level positions in the healthcare field, they make up only 32% of
chief positions. That number decreases to 4% for women of color. This dissertation assessed the
personal, behavioral, and environmental factors that shape women in senior leadership positions
at healthcare organizations in the United States using the social role theory as a framework. The
impetus for the study centered on providing perspectives of organizational support for women
seeking healthcare C-suite positions and identifying factors and best practices that drive women
to executive roles despite barriers. The study applied a qualitative approach to data collection
through interviews with 12 women leaders at various U.S. healthcare organizations. The findings
support four recommendations for women seeking chief roles in healthcare: seeking stretch
assignments, establishing support systems to help mitigate professional challenges, selfadvocacy, and working for employers with systems that create a culture of inclusivity for women
in leadership with strategic goals and measurements to evaluate progress.
Keywords: healthcare, female leadership, C-suite, gender bias, social role theory, selfadvocacy, intersectionality.

v
Dedication
To my husband, I could not have achieved this without your love and support. To my children,
Alijah and Adaora, thank you for your patience and understanding. I love you more than words
can express. Being your mom inspires me to be great.
To my parents and grandmothers for empowering me to aim high.
To all the women in corporate America who feel unseen and unvalued, you are my inspiration for
doing this. Do not dim your light.

vi
Acknowledgements
This dissertation would not be possible without the support and patience of my chair, Dr.
Monique Datta. Your guidance is unmatched. Thank you for pushing me to be great. I am also
grateful for my amazing committee members, Dr. Marcus Pritchard and Dr. Esther Kim, who
encouraged me to go above and beyond. To my village, including all my professors, Cohort 20,
Dr. Scot Brown, Dr. Joan Marques, and my counselors, your encouragement and support carried
me through. To the brilliant and courageous women leaders who contributed to this study, I am
indebted to you. Sharing your stories and learning from you made this long journey worth it.
There are no conflicts of interest to disclose.
Correspondence concerning this dissertation can be addressed to Anasia Obioha at
aobioha@usc.edu

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Table of Contents
Abstract.......................................................................................................................................... iv
Dedication........................................................................................................................................v
Acknowledgements........................................................................................................................ vi
List of Tables ................................................................................................................................ vii
List of Figures..................................................................................................................................x
Chapter One: Overview of the Study...............................................................................................1
Background of the Problem .................................................................................................2
Statement of the Problem.....................................................................................................3
Purpose of the Study ............................................................................................................4
Significance of the Study .....................................................................................................4
Definition of Terms..............................................................................................................5
Organization of the Study ....................................................................................................7
Chapter Two: Review of the Literature ...........................................................................................8
Background on Women’s Progression in the Workplace ....................................................8
The Underrepresentation of Women Leaders in Health ....................................................15
Current Trends Impacting Women’s Progression in the Workplace .................................17
Psychological Factors Impacting Women Leaders............................................................26
Recommendations for Organizations Committed to Supporting Women Leaders ...........29
Conceptual Framework......................................................................................................30
Summary............................................................................................................................31
Chapter Three: Methodology.........................................................................................................33
Research Questions............................................................................................................33
Overview of Design ...........................................................................................................32
Sample and Population ......................................................................................................34

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Instrumentation ..................................................................................................................34
Data Collection ..................................................................................................................36
Data Analysis.....................................................................................................................36
Credibility and Trustworthiness.........................................................................................37
The Researcher...................................................................................................................37
Ethics..................................................................................................................................37
Summary............................................................................................................................39
Chapter Four: Findings..................................................................................................................39
Participants.........................................................................................................................39
Thematic Analysis .............................................................................................................41
Findings Research Question 1 ...........................................................................................42
Findings Research Question 2 ...........................................................................................55
Summary............................................................................................................................62
Chapter Five: Recommendations...................................................................................................64
Discussion of Findings.......................................................................................................64
Recommendations..............................................................................................................66
Implications for Practice ....................................................................................................69
Limitation and Delimitations.............................................................................................69
Recommendation for Future Research...............................................................................69
Conclusion .........................................................................................................................71
References......................................................................................................................................73
Appendix: Interview Protocol........................................................................................................89
Introduction to the Interview .............................................................................................89
Interview Questions...........................................................................................................90

ix
List of Tables
Table 1: Participants 41
Table 2: Participant Quotes: Mentorship and Sponsorship 48
Table 3: Participant Quotes: Barriers and Biases 59
Table 4: Table of Recommendations 67

x
List of Figures
Figure 1: Percentages of Women in Healthcare Across Employment Levels 16
Figure 2: Conceptual Framework 31

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Chapter One: Overview of the Study
Women in the United States have made strides in advancement to senior leadership roles
but remain underrepresented as healthcare decision-makers. The World Health Organization
(2019) described health maintenance as women delivered and male led. While women make up
about 75% of entry-level positions in the health workforce in Canada and the United States, they
represent only 32% of C-suite positions. Furthermore, White women hold most of the positions
held by women in the C-suite in healthcare. Women of color only account for 4% of C-suite
positions (Lean In & McKinsey & Company, 2022).
Academic medicine also lacks gender parity, as women make up 40% of full-time faculty
members but only 18% of department chairs or deans (Hastie et al., 2023). A cross-sectional
observation study of 154 emergency departments in the United States from 2013 to 2018
revealed that the percentage of women in any leadership role was significantly lower than men’s,
at 44.5% versus 55.3% (Wiler et al., 2022). The study also suggested that women in leadership
roles worked more clinical hours than men in the same position and had significantly lower
salaries than men. The healthcare industry mirrors the underrepresentation of women leaders in
the United States. Despite women obtaining more degrees than men and making up nearly half of
the workforce (46.9%), widespread gender bias in male-centric organizations prevents women
from reaching the highest success levels (Roberts & Brown, 2019). In 2020, women comprised
37% of first- and mid-level managers, 29% of senior-level managers, and only 23% of
executives (Catalyst, 2023). In the C-suite, women held 24% of positions; however, only 4%
were women of color (Catalyst, 2022b; Thomas et al., 2020).
As of 2020, 44 women (8.8% of the total) lead Fortune 500 companies (Catalyst, 2022a).
The COVID-19 pandemic exacerbated the problem, with 54 million women worldwide leaving

2
the workforce, adversely impacting gender equality and female representation in executive ranks
(Hougaard et al., 2022). In a 2022 survey of 22,000 women and 18,000 men, Lean In and
McKinsey & Company noted that women leaders were resigning at the highest rates ever to
pursue roles at companies with advancement opportunities. The report also showed that for every
100 men promoted from entry-level to management positions, only 87 women and 82 women of
color received promotions. Additionally, 37% of women leaders reported they experienced
coworkers receiving credit for their ideas compared to 27% of men leaders (Lean In &
McKinsey & Company, 2022).
Several factors contribute to women’s underrepresentation in senior leadership, including
gender bias in evaluating talent, a lack of mentorship opportunities, and fewer sponsorships for
women than men (Bono et al., 2017). Moreover, most people view leadership qualities as
masculine traits (Brescoll et al., 2018). Having more women in leadership, however, increases
return on investment, improves organizational performance, and increases problem-solving
diversity (Elsesser, 2016). In a study on gender diversity, Noland et al. (2016) noted a positive
correlation between women in corporate leadership and firm performance. Based on strong
evidence of the benefits of gender diversity in top leadership positions, this study is an
exploration of the tools that have propelled some women to the C-suite despite barriers such as
gender bias and prejudice.
Background of the Problem
Although there have been gains in gender parity in the workplace, deeply rooted
historical ideologies persist, making progress slow. Throughout history, female leaders have been
scarce. Moreover, male leaders have not considered women competent enough to hold leadership
positions (Eaglin, 2019). Therefore, male dominance made it challenging for women to transition

3
to senior leadership roles (Rast et al., 2018). The phrase “the glass ceiling” is a metaphorical
description of the industry barriers that have derailed women’s careers while simultaneously fasttracking men’s success (Miller, 2016). A more appropriate term could be a labyrinth that
repeatedly confounds female leaders’ advancement (Eagly & Carli, 2007).
A substantial amount of the leadership literature centers on men, showing that workplace
structures subconsciously favoring men have obstructed women’s progress (Ely et al., 2011).
Research is lacking on how some organizations mitigated the challenges women face to increase
female representation in the C-suite. Thus, the lived experiences of female leaders who have
overcome societal and cultural barriers to reach top leadership positions could provide direction
for future female department and company heads (Eagly & Carli, 2007).
Statement of the Problem
As women strive to break generational barriers to reach top leadership positions, the
literature suggests that stereotypes, outdated beliefs, and societal norms continue to disrupt
female employees. For instance, the backlash effect whereby society penalizes women for
breaching one or more beliefs results in various forms of prejudice (Rast et al., 2018).
Additionally, gender stereotypes play a central role in the discrimination female leaders
encounter. Society views women with agentic traits as a threat to the traditional gender
hierarchy, no longer maintaining the status quo wherein they have lower status than men (Dyatel,
2021). According to social role theory (SRT), the different roles men and women play in society
reflect perceptions of men’s and women’s roles (Eagly & Wood, 2012). For example, women are
likelier than men to hold caretaking roles at home, whereas men tend to hold employment in
authority positions.

4
The ingrained beliefs and social norms have led to a scarcity of women at top leadership
levels (Eagly & Carli, 2007). In contemporary organizations, executives and boards of directors
continue to favor dominant groups over marginalized groups (Eagly, 2018). Women who manage
to achieve executive ranks must perform in stereotypically masculine ways to maintain success.
Purpose of the Study
The purpose of this study was to examine the perceptions of women leaders in healthcare
on factors leading to women gaining C-suite positions and the challenges they face. Using a
promising practice approach and Eagly’s (1987) SRT, the study evaluated female executives’
experiences ascending to leadership positions. I addressed the following research questions:
1. How do evolved differences, social roles, and psychological factors influence a
woman’s ascension to C-suite positions?
2. How do women leaders in the C-suite successfully sustain their roles?
Significance of the Study
The significance of this qualitative study is its contribution to research on women’s
leadership development and career goals with a specific focus on the tools helping women attain
C-suite positions. This study provides insight into how women have navigated evolved
differences, psychological factors, and social roles. There is limited qualitative research
documenting women’s experiences in attaining and retaining C-suite leadership roles, and
women commonly face barriers to advancement due to cultural barriers and structural and
organizational hurdles that prevent progress (Davis & Maldonado, 2015). According to
Fuhrmans (2020), women’s career advancement follows different paths than men’s because of
early professional trade-offs, work-life constraints, ingrained mindsets about women in power,
and perceptions of the characteristics that make a leader. Additionally, women who achieve

5
success in leadership positions and exercise power do so differently than their male colleagues
(Carli & Eagly, 2001).
Using the framework of SRT, the study explored how the formation and maintenance of
gender roles support and sustain male dominance in leadership. A social psychological theory,
SRT pertains to sex differences and similarities in social behavior (Eagly & Wood, 2012). The
theory’s focus is the differences and similarities arising primarily from the unequal distribution
of men and women in societal social roles. It is an appropriate framework for this study due to
the focus on how prejudices and biases prevent women from reaching leadership roles, limiting
the number of women achieving the highest ranks. If women understand the barriers comprising
the labyrinth, they can overcome challenges to reach their goals (Eagly & Carli, 2018). As the
number of women in top leadership positions increases, organizations’ need to understand how
to support and sustain them grows. This study explored the experiences of women in C-suite
roles to understand how best to support them.
Definition of Terms
A list of relevant industry terms follows, providing a better understanding of the concepts
used in this dissertation. Although individual terms may adopt different meanings or applications
in other works based on context, the list provided outlines those terms deemed pertinent to this
study.
• Career development: The ongoing processes and lifelong sequences an individual in
any organization moves through toward changes in performance, job position,
promotion, and a better relationship with management (Chao, 2009).
• C-suite: The highest-ranking executive titles at an organization (Dictionary.com, n.d.).
“C” represents the word “chief” in many corporate titles, such as chief executive

6
officer (CEO), chief financial officer, chief operating officer (COO), chief
information officer, chief marketing officer, chief administrative officer, and chief
procurement officer. Upper-leadership rankings like those of the C-suite include
division president, president, senior vice president, and vice president (Berry &
Franks, 2015).
• Gender roles: The common positions attributed to individuals based on their socially
identified sex (Eagly, 1987).
• Intersectionality: A critical framework that emphasizes how power operates and
creates variability in privileges and oppression within interactive processes that occur
between, within, and among social groups, institutions, cultural ideologies, and social
practices (Crenshaw, 1991).
• Leadership labyrinth: A metaphor that describes career pathways, showing the
various challenges and decision points that individuals negotiate throughout their
leadership journeys (Eagly & Carli, 2007).
• Mentee: An individual who is inexperienced and less knowledgeable in a subject area
or job-related task and requires guidance from a more knowledgeable and
experienced other (Murray, 2006).
• Mentoring/mentorship: A structured, purposeful, and intentional program in an
organization for employees of different levels to work together (Mujtaba, 2007).
• Self-efficacy: “People’s sense of personal efficacy to produce and to regulate events in
their lives ... how well one can execute courses of action required to deal with
prospective situations” (Bandura, 1982, p. 122).

7
• Social roles: The social norms attributed to people related to their social and work
positions (Eagly, 1987).
• Socialization: The process whereby an individual learns to adjust to a group (or
society) and behave in a manner approved by the group (Britannica, n.d.).
Organization of the Study
This five-chapter study began with Chapter One, introducing the problem, background,
significance of the study, and theoretical framework used to guide the investigation. A review of
the literature follows in Chapter Two, detailing previous findings and significant ideas that
shaped the study topic and approach. Chapter Three presents the study’s methodology, including
organization, participant selection, and methods for data collection and analysis. Chapter Four
analyzes the data and findings. The dissertation concludes in Chapter Five with a discussion of
the findings, suggestions for future research, and final thoughts.

8
Chapter Two: Review of the Literature
This literature review examines the complexities that often derail women from reaching
the C-suite and factors that help women achieve leadership status despite obstacles. The chapter
begins with an overview of the background of women’s progression in the workplace. There is a
discussion of current trends that have impacted women’s rise in leadership. Next, the review
addresses the theoretical framework of SRT to explore factors affecting the perceptions that
influence men’s and women’s behavior before delving into how social roles and psychological
factors contribute to the barriers women face in the workplace. Finally, the chapter concludes
with a summary and research-based best practices for closing the gender gap in top leadership.
Despite substantial literature on the causes of disparities between men and women leaders in the
workplace, there is little empirical research focused on the C-suite and the factors that enable
women to ascend to top ranks despite the challenges.
I searched ProQuest, University of Southern California Libraries, Google Scholar, and
SAGE databases. Sources of information included peer-reviewed journal articles, books,
government statistics, theses, and studies. I included the key phrases “advancement to the Csuite,” “barriers to women in leadership,” “women leaders,” “gender identity,” “healthcare
women leaders,” and “motivation for women leaders.”
Background on Women’s Progression in the Workplace
Although women have made strides in corporate America, they still experience barriers to
advancement. Most of these barriers stem from historical challenges, such as cultural barriers,
structural issues, and organizational hurdles (Davis & Maldonado, 2015). A Deloitte (DeHaas et
al., 2019) study showed an increased number of women promoted and appointed to corporate
boards in Fortune 500 companies since 2012. Women gained 187 new board seats between 2012

9
and 2016, a 20% increase. In contrast, men lost 235 board seats during the same time, a 5.1%
decrease. Lean In and McKinsey & Company (2022) reported a 24% increase in women in the
C-suite between 2015 and 2019. Despite these gains and a push for more diversity, the U.S.
Equal Employment Opportunity Commission showed that efforts to close the gender gap at the
executive level have been ineffective, with a less than 1% change in gender representation
between 2008 and 2018. Additionally, women held only 31% of senior/executive seats despite
accounting for more than 50% of professional employees.
The 2023 Catalyst report unveiled that women lag men in pay, receiving just $0.82 to
men’s $1 wage in the United States, while over a career span, women receive nearly $400,000
less than their male colleagues (Catalyst, 2023). Black women receive nearly $908,000 less than
their male colleagues over a career span. Moreover, a gender wage study by the Institute for
Women’s Policy Research exposed an incremental pay decrease tied to race and ethnicity
(Hegewisch & Barsi, 2020). The pay disparities parallel the promotion gap for women, with only
27% of global chief executives being female (Catalyst, 2020). Historically, women have faced
discrimination, stereotypes, and biases in the workplace that led to movements such as the Civil
Rights Act of 1964 (Williams, 1992).
Stereotypes
Since women started working outside the home, stereotypes have impacted their
advancement. Stereotypes influence behaviors that uphold common gender role expectations
(Wood & Eagly, 2015). Often, men’s ingrained beliefs about women’s capabilities meant they
did not view women as having the competence to hold leadership roles (Eaglin, 2019). Wood and
Eagly (2015) indicated that stereotypes do not accurately show ambition, effort, or creative
ability; however, they continue to impact women’s workplace advancement. Furthermore,

10
stereotypes are means of reinforcing behaviors and beliefs that align with traditional gender role
expectations (Wood & Eagly, 2015). According to Dyatel (2021), stereotypes suggest that
women with agentic traits threaten the traditional gender hierarchy and maintain the status quo
by remaining in a lower status than men.
It is a long-held belief that succeeding in top management and executive-level positions
requires masculine traits, such as aggression and emotional durability (Hoyt & Blascovich,
2007), that do not align with female stereotypes. A common misperception is that top
management and executive positions require achievement-oriented aggression and emotional
toughness antithetical to a woman’s nature (Eaglin, 2019; Hoyt & Blascovich, 2007). Moreover,
women who exhibit behaviors associated with men, such as disagreeing or staring, could find the
behaviors damaging to their reputations. Even women who achieve the highest corporate
leadership levels face stereotypes. Krishnan and Park (2005) identified five significant
challenges women experience as they advance up the corporate ladder: assignment to highvisibility projects, demonstration of critical skills necessary for effective job performance, toplevel mentorship or sponsorship support, projection of innovative or entrepreneurial enterprise,
and perception of the embodiment of company values.
In an earlier study, Eagly and Steffen (1984) examined how stereotypes affected working
women by comparing agentic and communal traits. The authors observed that gender roles in the
workplace aligned with stereotypical assumptions about status and authority. The participants
attributed agentic traits (e.g., competitive, visionary, and decisive authority) to men and
communal behaviors (e.g., subservient, caring, and diplomatic followership) to women. Eagly
and Steffen concluded that stereotypes of good leadership align with societal myths of males as

11
the dominant, all-knowing, capable, bold, and profit-minded gender. Meanwhile, stereotypes
present women as empathetic, fragile, submissive to commands, and caring.
More recently, Herz (2014) analyzed two historical workplace stereotyping cases. The
first case occurred in January 1968, when a supervisor at Havens International stereotyped
Isabell Slack, a Black industrial worker. Slack’s supervisor asked her to spend the morning
cleaning her department’s workspace but excused her White female coworker, explaining that
team leaders hired Black people to clean because they cleaned better than Whites (Herz, 2014).
The Ninth Circuit Court ruled that Slack experienced discrimination at Havens International, as
her supervisor reduced her to her race without knowing whether she could clean better than her
colleague (Herz, 2014).
The second ruling came on May 1, 1989, when U.S. Supreme Court justices radically
expanded the concept of Title VII stereotype in Price Waterhouse v. Hopkins. Ann Hopkins
claimed her supervisor told her to dress, speak, and act more appropriately to her sex. After
hearing her testimony, the justices concluded that the Price Waterhouse supervisor stereotyped
Hopkins differently than Slack’s employer stereotyped her. Slack’s employer did not mention her
characteristics, whereas Hopkins’s employer obsessed over them. While the Havens International
supervisor suggested that Slack was like other Blacks, the Price Waterhouse supervisor saw that
Hopkins was not like other women and held it against her. According to Herz (2014), the Havens
International supervisor engaged in ascriptive stereotyping by assigning a characteristic to Slack
without judging her as an individual. On the contrary, the Price Waterhouse supervisor correctly
perceived Hopkins’ traits but judged them against an inappropriately gendered baseline,
engaging in prescriptive stereotyping. Herz proposed that a broader application of the Price

12
Waterhouse ruling could be a way to resolve the inability of traditional Title VII approaches to
address modern workplace bias.
Negative stereotypes alone do not impact the treatment of women in the workplace.
According to Proudfoot and Kay (2022), positive gendered stereotypes can have negative
emotional and motivational consequences for women. The Civil Rights Act was a remedy to
stereotypes, discrimination, and other hostility against women. Despite the Act’s impact, it soon
lost momentum (Proudfoot & Kay, 2022).
Civil Rights Act
The Civil Rights Act (1964) was a landmark civil rights and labor law that addressed
some workplace barriers for women; however, it was not a solution to gender inequality.
Williams (1992) described workforce imbalances as glass barriers to women’s career
advancement, challenging women to shatter them for good. The purpose of Title VII of the Civil
Rights Act (1964), later amended in 1991, was to prohibit discrimination in all employment
matters (M. P. Bell et al., 2002). The Civil Rights Act (1991) included creating the U.S. Glass
Ceiling Commission to understand the hurdles women and minorities face. The commission’s
goals were to study artificial barriers to women’s advancement and increase women’s
opportunities and development experiences to foster their advancement to management and
higher authority levels in business (U.S. Glass Ceiling Commission, 1991).
The Civil Rights Act led to significant immediate gains for Black and female workers
(Herz, 2014); however, the accomplishments have slowed. Meeting the burden of proof for the
Civil Rights Act has become more difficult because of its distinctive, historically contingent
model of open race and gender hierarchies that have become increasingly challenging to
accommodate bias. Due to this conceptual misalignment, employment discrimination plaintiffs

13
have had dismal outcomes, and workplace inequity has persisted (Herz, 2014). To capture the
problem’s intricacies, scholars developed the labyrinth metaphor to illustrate the complexities
and the resources required for women to reach the C-suite (Carli & Eagly, 2016).
Labyrinth Versus the Glass Ceiling
Scholars have documented how cultural barriers, structural issues, and organizational
hurdles have harmed women in leadership, including how they view themselves. Huang et al.
(2019) determined that women believe their gender is a barrier to career advancement. Moreover,
Debebe (2011) noted how women’s self-esteem impacts their behaviors and estimations of their
skills and capabilities. Over time, the terminology used to describe invisible barriers has evolved.
In 1986, The Wall Street Journal introduced the term “glass ceiling” to represent an “invisible
and impenetrable barrier” (U.S. Glass Ceiling Commission, 1995, p. iii) to women reaching the
highest leadership levels. Eagly and Carli (2007) maintained that the glass ceiling is an
inadequate metaphor for the life experiences of rising leaders that misrepresents the complex
journey to leadership. Arguing that the glass ceiling focused on unseen barriers and did not
address the role of navigating a path to leadership, the scholars used the labyrinth metaphor to
describe the barriers women face on the path to leadership. According to the labyrinth metaphor,
there are difficult but possible pathways to advancement (Eagly, 2018; Eagly & Carli, 2018).
Wyatt and Silvester (2015) expanded the labyrinth metaphor to include other underrepresented
professionals.
Williams (1992) used the phrase “glass escalator” to illustrate how men advanced more
consistently and quickly than their female colleagues because of the gendered career
expectations. Fuhrmans (2020) further explained the differences between men and women
seeking leadership in the C-suite. Ambitious men and women differ because of early professional

14
trade-offs, work-life constraints, and entrenched beliefs regarding traits that make a person a
successful leader. Furthermore, Eagly and Karau (2002) surmised that the more women adapt to
traditional female gender roles, the less likely they are to seek and advance to top leadership
roles. Krishnan and Park (2005) studied the impact women in top management have on
organizational performance. The authors concluded that men view power in terms of influence
and, therefore, are more likely to exercise authority to achieve their objectives. Women, however,
tend to approach power through information distribution and leveraging associates’ power. As a
result, female leaders enhance information processing, share knowledge, and possess a more
remarkable ability to cope with complex environments (Krishnan & Park, 2005). Nonetheless,
Frankel et al. (2019) suggested that women are less optimistic than men regarding executivelevel advancement. Women’s skepticism around career growth stems from their need for more
networking opportunities and limited time with executives who can guide career progression.
Family demands are another challenge in navigating the labyrinth for women. Family
pressures and obligations often disrupt women’s careers more than those of men, resulting in
slowed career progression and a wider earnings gap (Eagly & Carli, 2018). The Women in the
Workplace (Lean In & McKinsey & Company, 2022) report indicated that for every woman at
the director level promoted to the next level, two female directors left their companies. Some
scholars refer to this cycle as the broken rung.
The Broken Rung
Before a leader reaches the C-suite, they normally serve as a manager. Obtaining that
status does not come easy for many females, however. The largest challenge facing women on
the path to senior leadership is at the first step up to manager (Lean In & McKinsey & Company,

15
2022). Shropshire (2019) added that the broken rung phenomenon seems to be the most
substantial and pervasive problem.
Thomas et al. (2020) defined the broken rung phenomenon as a key point on the
corporate ladder where women lose the most ground to reaching the first step to manager. For
every 100 men achieving manager level, only 87 women and 82 women of color do. As a result
of the broken rung, 62% of managers are men, while women hold 38% of manager roles (Huang
et al., 2019). Furthermore, studies reveal that women’s upward career trajectories stalled when
they reached mid-level (Shropshire, 2019; Thomas et al., 2020).
Kevin Sneader, global managing partner of McKinsey & Company, insists that repairing
the broken rung is essential to developing more leadership opportunities for women (Thomas et
al., 2020). The broken rung and other disparities between men and women are evident in
healthcare leadership. Although women make up most healthcare positions, women are
underrepresented in the most senior-level leadership roles.
The Underrepresentation of Women Leaders in Health
In healthcare, having senior leadership reflect the community it serves is vital to health
outcomes. Research shows, however, that women who work in healthcare occupy few executive
positions (Soklaridis et al., 2017). Of the 526 hospitals Christopher et al. (2022) studied, 55%
had at least one woman in the C-suite, and only 15.6% had more than one. Having a woman
CEO at a healthcare organization could impact performance outcomes. The findings revealed
that hospitals with a woman CEO performed significantly better than men-led hospitals on one
financial metric: days in accounts receivable (Christopher et al., 2022).
A 2019 American College of Healthcare Executives (ACHE) survey conducted every 5 to
6 years since 1990 suggested that female healthcare leaders are significantly less likely than their

16
male colleagues to perceive their employer as gender-neutral as it relates to hiring, promotion,
evaluation, and compensation (Athey & Kimball, 2020). The findings underscored that the
perception of “lack of gender equity is associated with lower overall satisfaction, engagement,
and willingness to stay with the organization on the part of women executives” (p. 307). The
ACHE survey also revealed that 16% of male healthcare executives started their careers as vice
presidents compared to 8% of female healthcare executives (Foundation of the American College
of Healthcare Executives, 2019). Figure 1 shows the percentages of women in healthcare in the
United States and Canada.
Figure 1
Percentages of Women in Healthcare Across Employment Levels

17
Note. From “Women in the Workplace pipeline data 2021,” by McKinsey & Co., 2021
(https://www.mckinsey.com/industries/healthcare/our-insights/women-in-healthcare-and-lifesciences-the-ongoing-stress-of-covid-19). Copyright 2021 McKinsey & Company.
Current Trends Impacting Women’s Progression in the Workplace
Several trends have impacted women’s workplace progression. Movements such as
#MeToo and Black Lives Matter propelled organizations to focus more on diversity, equity,
inclusion, and belonging (DEIB) efforts, and DEIB roles increased by 55% in 2020 following
demands for broader racial equity and justice after George Floyd’s murder (Maurer, 2020). The
efforts have had some benefits. On one hand, 2023 marked a milestone for women leaders, who
now lead more than 10% of Fortune 500 companies, including one company in the top 10. In
December 2022, Reuters reported that Citigroup promoted more than 100 women to the role of
managing director, the highest ever. On the other hand, the COVID-19 pandemic and how it
reshaped how organizations do business made it more challenging for some women, increasing
stress, burnout, and work-life demands.
Impact of COVID-19 Pandemic on Gender Equity
COVID-19 is an infectious disease also known as severe acute respiratory syndrome
coronavirus 2 (Texas Medical Center, 2021). As people around the world recover from the effects
of COVID-19, studies show that the economic fallout from the pandemic has impacted gender
equality. The McKinsey Women in the Workforce 2022 report indicated that women’s jobs are 1.8
times more vulnerable to the crisis than men’s jobs.
Additionally, the virus significantly increased the pressure of unpaid care on women, who
take on the burden more than men. As a result, women’s employment dropped faster than

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average (Lean In & McKinsey & Company, 2022). The pandemic changed the way businesses
operated in the United States. Before the virus spread, remote work opportunities comprised
about 4% of available jobs. Post-pandemic, Bloom (2021) contended that 70% of firms have
moved toward a version of hybrid work. Most working women have embraced the move, as the
McKinsey Women in the Workforce 2022 report highlighted that only one in 10 women want to
work primarily onsite. Moreover, outcomes revealed that having an option to work in the
arrangement they prefer resulted in less burnout, more job satisfaction, and lower turnover for
women.
The McKinsey Women in the Workforce (Lean In & McKinsey & Company, 2022) report
also underscored that women of color, people with disabilities, and those who represent the
lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ+) community, experienced
fewer microaggressions and higher levels of psychological safety when working at least some of
the time remotely. The same report, however, unveiled that women experienced more burnout in
2022 than earlier in the pandemic. Meanwhile, Aldossari and Chaudhry’s (2020) study on
burnout among women revealed the shift from the pandemic made it necessary for women to
develop coping mechanisms, such as denial, disengagement, and energy conservation, to
maintain the increased responsibilities at work and home. Understanding how to address the
stress and burnout that have amplified the challenges for women leaders is essential to
supporting them in the workplace (Yıldırım & Solmaz, 2020).
The pandemic also caused an increase in stress, which escalated faster among women
than men (Lean In & McKinsey & Company, 2022). One in three women surveyed said they
were considering downshifting their careers or leaving the workforce in 2022. In contrast, one in
four women considered downshifting their careers or resigning a few months into the pandemic.

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More than two million women have taken permanent or temporary leaves from their careers to
tend to family needs (Thomas et al., 2020). A Deloitte Global and Forbes Insights (Deloitte,
2020) survey of 385 women globally in August and September 2020 showed that nearly 82% of
women reported that the pandemic adversely affected their lives. The women cited negative
impacts on mental and physical well-being and work and life balance. A separate study also
noted a correlation between the pandemic and mental health challenges for women. Two out of
five women reported experiencing high levels of anxiety and increased stress, while 25.3% of
women responded to being depressed, which was slightly higher than the 21.1% of men who
claimed to suffer from depression (National Women’s Law Center, 2021). Moreover, nearly 70%
of women who experienced pandemic-related disruptions expressed concern regarding limited
career growth (Deloitte, 2020).
As many employees return to working onsite, some women risk facing a hostile work
environment. In the Stop Street Harassment report (Kearl, 2018), 25% of women respondents
disclosed experiencing some form of sexual harassment on the job. The #MeToo movement
challenged employers to change policies and management practices and create diverse and safe
work environments to eliminate hostile and sexual harassment (Groves, 2019). The #MeToo
movement’s impact on women leaders was both positive and negative.
#MeToo Movement
In 2017, the #MeToo hashtag went viral, becoming a global movement that shined a light
on sexual violence by empowering women to share their stories of harassment while on the job
(Torres, 2018). Sexual assault survivor and activist Tarana Burke founded the movement to bring
resources, support, and pathways to healing where none existed before (Pflum, 2018).
Additionally, Burke and others built a community of advocates determined to interrupt sexual

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violence wherever it happens. Whether the movement helped advance or hinder women in the
workplace is up for debate. Exposing longstanding issues of sexual harassment led to some
backlash for women. Atwater et al. (2019) cited that 19% of men communicated that they were
more hesitant to hire attractive women. Twenty-one percent of men expressed they opposed
hiring women for roles that require close interpersonal interactions with men, such as business
travel. Twenty-seven percent avoided one-on-one meetings with careerwomen. In a separate
study, Lisnek et al. (2022) examined whether a perceived increase in women’s voices contributed
to the perceptions of bias against men. The results suggest that some people perceive women’s
empowerment around sexual assault as a threat to men. The authors surmised that while the
#MeToo movement brought awareness of issues of sexual assault, it also generated a backlash
among more conservative individuals, who felt the movement went too far. Furthermore, the
authors claim that perceptions of men’s victimization will lead to negative consequences for
women.
Like the #MeToo movement, Black Lives Matter (BLM) also raised awareness about
racism and sexism in the United States that previously went ignored. Moreover, the Black Lives
Movement made employers evaluate their practices and policies as these related to DEIB. The
next section details the BLM impact on women’s workplace advancement.
Black Lives Matter Movement
In 2013, Patrisse Cullors, Alicia Garza, and Opal Tometi created the Black Lives Matter
Network to highlight and combat the violence and oppression aimed at Black people in the
United States (Rickford, 2016). Summer 2020 saw an influx of BLM protests in response to
Floyd’s murder on May 25 of that year. The protests were a vehicle to mobilize against systemic
racism and social injustice (Cohn & Quealy, 2020). Literature reveals the movement also had an

21
impact on women’s career mobility. Chavez et al. (2022) hypothesized that recent attention paid
toward racism against Black Americans in the United States could reduce hiring discrimination
against Black jobseekers due to increased pressure to hire and retain Black employees and
address racism. The authors predicted Black women may experience a smaller reduction in
discrimination than White women if there are strong signals of childless status, flexibility, and
commitment to work to offset the beliefs that Black women as mothers lack the commitment to
work.
Additionally, Flood et al. (2021) examined the number of women who returned to the
workforce after exiting during the pandemic. The authors noted that by August 2021, after BLM,
college-educated women’s employment rate had nearly fully recovered, and for White collegeeducated women mothers, the employment rate had fully recovered. Despite women maintaining
46.6% of the workforce, their underrepresentation in the C-suite points to deeply ingrained
stereotypes and biases that persist in society. The next section explores how social roles and
perceived differences between men and women influence the behaviors of individuals in the
workplace.
Implications of Social Roles
Early studies found that stereotypes and beliefs about gender play an important role in
restricting women’s leadership opportunities. A seminal study revealed the difference in gender
roles in the workplace aligns with stereotypical expectations of status and authority (Eagly &
Steffen, 1984). The authors compared agentic and communal traits in women who were in the
minority at the workplace, revealing the difference in gender roles that aligned with stereotypical
expectations of status and authority. For example, competitive, visionary, and decisive authority
are agentic personality attributes ascribed to men, whereas women’s subservient, caring, and

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diplomatic followership align with communal behavioral characteristics (Eagly & Karau, 2002).
Gender roles have influenced occupational expectations for women, making it more difficult for
them to attain C-suite-level status (Koenig & Eagly, 2014).
In a later study, Koenig and Eagly (2014) used SRT to address the stereotypes associated
with the observable behaviors of occupational roles. The findings illustrate the expectation for
male leadership across various occupational roles (Koenig & Eagly, 2014). According to SRT,
individuals base the roles of men and women on perceptions of male and female societal roles
(Eagly & Wood, 2012). As a result, women are likelier than men to have caretaking roles at
home, whereas men tend to work in authority positions.
Debebe (2011) pointed out that suppressing women’s accomplishments and abilities
denies their self-knowledge. Additionally, the author suggested that dismissing the gendering of
women’s work in the workplace impacts their promotion opportunities. Other consequences of
traditional role expectations include complicating women’s good intentions to change maledominated industries (Eagly & Carli, 2007) and female leaders experiencing unfair backlash if
they counter stereotypical behaviors (Rudman et al., 2012). For instance, in contemporary
organizations, executives and board directors favor men over women (Eagly, 2018). Additionally,
although the global workforce is nearly 60% female, career progression for women is still
stagnant in many male-dominated industries because of barricades (Catalyst, 2023). Moreover,
the 2020 Catalyst report acknowledged that women remain behind men in pay, receiving just
$0.79 to men’s $1 wage in the United States. Consequently, over a career span, women receive
$400,000 less than their male counterparts (Catalyst, 2020, 2021). Though traditional leadership
characteristics of agentic, dominant, and transactional behaviors support the male leader over the
female leaders (Northouse, 2019), successful leaders combine communal and transformational

23
character traits to navigate complex business scenarios and blend clear communication with
empathy and insight to develop trust and engagement (Bolman & Deal, 2017). For women to
advance to the C-suite, organizations need to address gender bias. Disregarding the gendering of
women’s work environments further constrains their opportunities for promotion and affirmation
in their chosen fields (Debebe, 2011). The next section investigates gender bias and its effects.
Gender Bias
When female leaders overcome adversity to lead departments, they often face gender bias
from those they direct and those to whom they report. Research corroborates biased beliefs about
women’s greater emotional expressiveness. Gender biases associated with personality
characteristics and cognitive aptitude are up to four times more common than gender biases
associated with personality characteristics and cognitive aptitude (Brescoll, 2016). Although
some individuals label females as irrational, career women who exercise reason and sound
judgement often receive backlash for not displaying female emotional behaviors in the
workplace (Caprino, 2017). Moreover, Pavco-Giaccia et al. (2019) found that both genders
subconsciously associated men with rationality and women with emotionality. Results conveyed
that when women do not conform to perceived female behaviors, their colleagues view them as
cold and distant.
As the incongruity between the female gender stereotype and the leadership role
increases, the more prejudice they experience in such roles (Carli et al., 2016). For instance,
compounding research suggests that women who do not represent stereotypes elicit dislike and
lower performance evaluations, hindering their chances for future promotions (Eagly, 2018).
Furthermore, Lee and James (2007) noted that investors’ reactions to the appointment of female
CEOs were significantly more negative than those of male CEOs. The disapproval comes from

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both sexes. Research indicates that female coworkers perceive female leaders as unsupportive
(Castaño et al., 2019). In an earlier study, Carli (2001) surmised that for leaders to perceive
women as having competency equal to men, women must outperform men, thereby adding
pressure on women to be influence agents and superior in skills.
The bias and judgement aimed at women point to a need for more female department
leaders. Many women who make it to leadership suffer from the queen bee syndrome, a
competitive environment of pitting women against each other instead of collaborating. Castaño
et al. (2019) described the queen bee syndrome as successful, senior-level women in maledominated workplaces demonstrating aggressive behaviors to oppose and prevent other women
from advancing. Scherer (2021) studied the queen bee syndrome in seven women employed at
U.S.-based Fortune 500 companies in traditionally male-dominated industries. All seven
participants experienced queen bee syndrome in senior and mid-level women in the workplace
(Scherer, 2021). The findings did not align with the queen bee theory, which indicates that
senior-level, successful career women primarily demonstrate socially aggressive behaviors. In
contrast, the participants experienced queen bee behaviors from women at all professional levels
(Castaño et al., 2019). Fernández-Mateo and Kaplan (2020) suggested, however, that the mere
existence of the term could illustrate sexism and a misunderstanding of women in top leadership.
Although women leaders are scarce, having more than one woman in leadership has
benefits. A widely cited 2006 study published in the Harvard Business Review showed that
progress is difficult when one woman is on a board and that they reported feelings of isolation or
being ignored. Nevertheless, dynamics shift when three or more women are on a board.
Researchers observed that board members regarded women as simply directors versus female
directors.

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As women continue to face prejudicial treatment while advancing to leadership levels,
studies imply that their struggles force them to change their leadership style and ambitions. In
some instances, women may resort to fulfilling traditional gender roles. The following section
details how the pressure to conform impacts career women and their choices.
Pressure to Conform
The perceived beliefs of ambitious women striving for the C-suite have led some women
to decide to abandon their dreams and conform to traditional gender roles. The narrative that
high-level corporate positions require long hours, making it difficult for women due to the
competing demands of work and family, has derailed participants’ career trajectories (Ely &
Padavic, 2020). Additionally, cultural gender biases known as push factors or regular reminders
that women professionals are wrong to be at work instead of at home further impacted the career
goals of the women studied. Castaño et al. (2019) pointed out that although many people
perceive female leadership styles as superior to men’s, Fels (2018) revealed that when work and
home life conflict, most women either reduce their ambitions or abandon them altogether to
fulfill traditional feminine familial roles. While some theorists dispute that the balance between
work and family jeopardizes women’s career advancement, another viewpoint is that the
contemporary cultural belief that working overtime and exhibition of male behaviors and
relational styles is the only pathway to positions of power in the C-suite (Ely & Padavic, 2020).
The work/life balance struggle and other adversity can lead to an emotional toll on many
working women. The next section breaks down psychological factors impacting women on their
journey to leadership, such as self-efficacy, imposter syndrome, and stereotype threat.

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Psychological Factors Impacting Women Leaders
Research suggests women are more emotional and react more than men to negative
experiences. Consequently, individuals assume women are unable to restrain their emotions,
thoughts, and behavior. Moreover, this perception contributes to the claim that women are less
rational and have more difficulty receiving unfavorable feedback compared to men (Brescoll,
2016). Studies have also shown that negative feedback can impact self-efficacy in women. The
next section delves into self-efficacy and the role it plays in upward mobility for women.
Self-Efficacy
Organizations striving for gender parity share a responsibility to cultivate an environment
that influences self-efficacy. Self-efficacy is an individual’s belief in his or her capabilities to
produce specific performance attainments (Bandura, 1982). Beckwith et al. (2016) described
self-efficacy as an essential trait in women, including African American female executives who
excelled amid challenges. The authors noted how it helps employees build relationships, climb to
executive levels, and reach desired goals, further enabling self-efficacy. For instance, individuals
who see themselves as positive and optimistic benefit from quality mentoring (Richard et al.,
2019).
In Jackson’s (2022) study on African American women in leadership, participants
responded that they were confident in their ability to succeed in their careers. Despite a sense of
job satisfaction, Jackson noted that challenges related to career optimism and the long-term
outlook on promotional opportunities overshadowed participants’ fulfillment. Jackson concluded
that organizations need to support emerging African American women leaders by changing their
strategies for recruiting, retaining, and rewarding employees from marginalized communities.
Finally, in another study, positive self-evaluation led to more proactive behaviors with

27
professional networking (Liang & Gong, 2013). Leadership self-efficacy “has been linked to
better leader performance and to more interest and effort towards becoming a better leader”
(Alvarez-Huerta et al., 2022, p. 76). For women advancing to the C-suite, self-efficacy plays a
vital role in their performance and growth. Moreover, proper representation in leadership helps
mitigate imposter syndrome, which some women experience working in male-dominated
environments.
Imposter Syndrome
Despite having the skills, education, training, and work ethic required to serve in
leadership, many females still suffer from imposter syndrome. Edwards (2019) described
imposter syndrome as the feeling of being a professional fraud who lacks the self-belief that they
rightfully earned the praise and accomplishments they have received. A KPMG (2020) study
polled 750 women executives who are one or two career steps away from the C-suite. The report
uncovered that 75% of female executives across industries have experienced imposter syndrome
in their careers.
Collins et al. (2020) provided insight into the imposter syndrome that women and people
of color face during their careers. The research underscored the representation of minorities and
women in professional fields and highlighted that imposter syndrome could stem from
stereotypes that plague the individual over time. Collins et al. noted that embracing one’s
identity, inclusive of race, gender, and professional status, without the fear of consequence or
backlash is the key to mitigating the behaviors of imposter syndrome. Haskins et al. (2019)
further explained that imposter syndrome could lead to physical and psychological effects on
individuals who experience the phenomenon, including depression, anxiety, and low self-esteem.
Stereotype threat is another psychological factor deterring women from leadership.

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Stereotype Threat
Stereotype threat contributes to women leaders’ underrepresentation in the United States.
McKinsey and Lean In (2018) revealed that, on average, women reported having lower hopes of
becoming top leaders than men. Stereotype threat is one key factor in women’s lower aspirations
to be chiefs (Simon & Hoyt, 2012). Kalokerinos et al. (2014) defined stereotype threat as an
individual’s concerns about conforming to negative stereotypes associated with the individual’s
social group.
Role congruity theory suggests that stereotypes are the root of discrimination against
women in leadership (Eagly & Karau, 2002). Individuals perceive leaders most positively when
their traits align with stereotypes about the social group the leader represents. Since leadership
typically aligns with masculine stereotypes related to agency (Eagly & Karau, 2002), stereotype
threat could explain why men have greater chances of obtaining and sustaining leadership roles
at a faster rate than women.
Research also insinuates that stereotype threat negatively impacts women leaders’
aspirations by reducing women’s leadership self-efficacy (Hoyt & Murphy, 2016; Walsh et al.,
2022). Walsh et al. (2022) reason that stereotype threat attributed to social media reduces
women’s leadership goals through opposing effects on leadership self-efficacy, and mindfulness
exacerbates the effects. Given the increasing use of social media and its potential to negatively
impact women’s attitudes toward leadership, the authors recommend building mindful awareness
as a potential strategy for mitigating stereotype threat as a barrier for women leaders. The next
section details recommendations for organizations to support women leaders.

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Recommendations for Organizations Committed to Supporting Women Leaders
While many organizations have shifted their priorities from gender parity, many
organizations remain committed to DEIB. The Society for Human Resource Management
reported in 2020 that DEIB roles increased by 55% following demands for broader racial equity
and justice after George Floyd’s murder. Recently, however, a survey showed that the attrition
rate for DEI roles was 33% at the end of 2022, compared to 21% for non-DEI roles.
For organizations still committed to advancing women and other individuals from
marginalized communities to leadership ranks, several studies highlight effective strategies and
suggestions that can help. Decady Guijarro and Bourgeault (2023) observed four promising core
practices that helped to advance women in leadership, including active listening to hear and
amplify marginalized voices, active learning to respond to translation exhaustion, active
observing of microaggressions and their consequences, and active intervention.
In another recent study, Philippe et al. (2019) noted that specific factors impact an
employee’s perception of need, satisfaction, and motivation at work. These factors include work
environment and climate, organizational policies, styles of management, and coworker
relationships. Finally, organizations require accountability to promote gender diversity in
healthcare leadership and workforce, which is essential for responding to the needs of a diverse
population. Establishing measures for organizational accountability of women in leadership can
enhance gender parity in C-suite roles (Elliott et al., 2022). These components combined should
give employees a roadmap to navigate their career path confidently and freely convey their
feelings while performing at the maximum level in their specific role.

30
Conceptual Framework
The conceptual framework guiding this study illustrates the relationship between the
problem examined and the study’s variables (Grant & Osanloo, 2014). The conceptual
framework expands on SRT, as the research explored perceptions that influence men’s and
women’s behavior during their ascent to the C-suite. At the core of SRT, stereotypes, or gender
role beliefs, form as people observe male and female behavior (Eagly & Wood, 2012). The
origins of men’s and women’s social roles lie primarily in humans’ evolved physical sex
differences, such as men’s size and strength and women’s reproductive activities. The SRT
framework explores gender roles along three pillars of attributes: evolved physical and
behavioral differences, psychological factors, and social role expectations according to societal
norms.
According to SRT, the prospective advantages or disadvantages of one gender relative to
another influence adult career aspirations. Presumptive social role expectations in an
organizational environment determine gender roles (Eagly, 1987). Ingrained gender norms and
stereotypes can also shape gender differences in how women and men express their leadership
styles (Yukl, 2010). For instance, women are more likely than men to have transformational
leadership styles (Eagly et al., 2003).
The conceptual framework further expands the SRT by delving into how gender
attributions counter or reinforce traditional roles. The study investigated how evolved
differences, social role expectations, and psychological factors impact women’s ascent to the Csuite. Additionally, the study examined if the pillars affected the sustainability of women
currently working in top leadership positions. Figure 2 illustrates the conceptual framework
embodying the study’s philosophy of the three pillars’ impact on women pursuing C-suite roles.

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Figure 2
Conceptual Framework
Summary
This review of literature provided a comprehensive overview of trends impacting women
leaders, organizational deterrents to women’s advancement to the C-suite, and the historical
background on women in leadership. Additionally, Chapter Two delved into the implications of
social roles and gender biases, such as queen bee syndrome, and provided recommendations for
organizations that desire to increase the number of women in leadership. In conclusion, women
have made strides to reach C-level executive status at the highest levels than ever before
(Thomas et al., 2020) and have shown they possess the knowledge, skills, and tenacity to
ascertain C-level positions (Larcker & Tayan, 2020); still, research shows corporations have
failed to cultivate and sustain enough women in top leadership positions. Fostering diversity
C-Suite
Women
Leaders
Evolved
Differences
•Gender Barriers
•Racial Bias
•Pressure to
Conform
Social Roles
•Work Relationships
•Interaction with
other women
•Working Mother
Psychological
Factors
•Self-Efficacy
•Imposter
syndrome
•Stereotype Threat

32
improves an organization’s effectiveness and responsiveness to a diverse population’s needs
(Decady Guijarro & Bourgeault, 2023).

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Chapter Three: Methodology
The study aimed to understand the experiences of females in C-suite positions in
organizations in the United States. The study examined the tools that have propelled some
women to the C-suite despite barriers such as gender bias and prejudice. Chapter Three outlines
the study’s design and shares the descriptions of the study’s participants. Additionally, the
chapter addresses the data collection methods and instrumentation used.
Research Questions
To understand the lived experiences of women C-suite leaders, the following research
questions guided the study:
1. How do evolved differences, social roles, and psychological factors influence
women’s ascension to C-suite positions?
2. How do women leaders in the C-suite successfully sustain their roles?
Overview of Design
This qualitative approach aimed to capture the in-depth and personal career experiences
in the participants’ words (Creswell & Creswell, 2018). The two research questions served as the
guide for the data collection research methodology. Merriam and Tisdell (2016) suggested
qualitative interviews as the appropriate research methodology for gaining first-hand
understanding. Moreover, a qualitative study is most appropriate for this approach because it
may or may not involve a theory that explicitly states but always has theoretical underpinnings
that guide the study (Grant & Osanloo, 2014). The qualitative phenomenological field study
interviews took place with 12 female C-suite leaders across various industries in the United
States. Qualitative interviews are an essential approach for learning how each woman navigated
her career, mitigating industry barriers and overcoming the odds to reach top leadership status.

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The interviews sought to learn best practices from the stories of career experiences and inspire
readers to become future chiefs.
Sample and Population
The participants were women who currently or recently served in C-suite positions or
senior leadership positions for healthcare organizations in the United States. The respondents
identified as women and represented various industries and U.S. regions. Interviewees
represented individuals from various races, including White, Black, Asian, Native American, and
Latinx. According to Creswell and Creswell (2018), researchers use purposeful sampling to
select participants that will “best help the researcher understand the problem and research
question[s]” (p. 185). As such, the research included the women C-suite members using a
method known as snowball sampling. A professional network of healthcare professionals
referred the participants.
I contacted each interviewee using an assigned University of Southern California email
address to request and confirm participation in the study. Each participated according to the
study’s parameters. Pseudonyms protected the participants and their organizations, allowing for
anonymity in the data collection. The participants’ anonymity, as well as that of the gathered
information, encouraged expanded information sharing to support equity in the C-suite. In
addition, the data offers guidance for future female leaders and organizations striving for DEIB.
Instrumentation
The study used SRT as the framework to examine women leaders’ experiences of
working in the C-suite. The literature suggests that the shared lived experiences of female leaders
who have overcome societal and cultural barriers to reach top leadership roles could provide
direction for future female leaders (Eagly & Carli, 2007).

35
This semi-structured interview protocol, in Appendix A, consists of 15 primary questions
and corresponding prompts used to identify barriers, sentiments, motivation, and persistence
involved in each participant’s work experiences. Before the interviews, I emailed each woman to
confirm the interview time. Next, I conducted the interviews using Zoom. The interview
questions were open-ended to reveal the women’s perspectives on their career-path choices,
strategies that helped mitigate challenges, and reflections on how organizations can best advance
women to the C-suite. Additionally, open-ended questions offered a learning opportunity and a
chance to solicit unexpected responses compared to more closed-ended questions that can be
more rigid (Robinson & Leonard, 2018). Understanding what led women to male-dominated
executive leadership roles effectively empowers women to diversity in the C-suite.
Qualitative research stems from constructionism, phenomenology, and symbolic
interactionism to understand a problem or situation from the participant’s view (Merriam &
Tisdell, 2016). The theoretical framework used for framing this study is SRT. Eagly (1987) first
described SRT by showing that gender stereotypic behavior results from different male and
female role expectations. Moreover, the author explained that differences between these gender
stereotypes and actual sex differences are not as great as individuals believe (Eagly, 1987).
According to SRT, individuals base the roles of men and women on perceptions of male and
female societal roles (Eagly & Wood, 2012). The conceptual framework builds on the three
pillars of SRT, which are psychological factors, evolved differences, and social roles. I
strategically selected questions to allow participants to provide thought-provoking responses,
enriching the feedback as it applies to the study’s research questions.

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Data Collection
I conducted the interviews in a virtual format using the Zoom application, which
transcribed each interview. The interview protocol consisted of open-ended questions to prompt
participants’ genuine, candid responses. Maintaining an ongoing log of interview notes, research
notes, reflective journal notes, a career biography of each participant, and emails related to the
study ensured accuracy. These documents aided in ensuring reliability.
Finally, collecting and securely storing data in document files on a personal computer
using password-protected programs such as Microsoft Word and Excel ensured privacy and
protection. The participants’ names and identities are anonymized. Therefore, in addition to the
careful design and continuing refinement of the interview protocol, I established a rapport with
study participants by having small talk and explaining the purpose and confidentiality of the
research. On average, the interviews lasted about an hour each.
Data Analysis
Data analysis explains how data are processed (Merriam & Tisdell, 2016). I analyzed the
data according to Creswell and Creswell’s (2018) eight-step coding process. In Step 1, I read the
individual interview transcripts and recordings. Next, there was note-taking and a thoughtful
review to identify meaningful content. In the third step, I analyzed each transcript for emergent
themes according to topics and importance. The fourth step involved coding the transcripts for
categorical alignment and new understanding emergent from the data. In Step 5, I mapped
adjacent themes and established relationships from the responses. The study sought to uncover
the participants’ related everyday experiences (Merriam & Tisdell, 2016). The categorization and
coding organization coordinated with the study’s conceptual framework and the research

37
questions. This study aimed to understand the underlying structures of the participant’s career
experiences that aligned with their career path.
Credibility and Trustworthiness
For a study to serve as a tool for organizational change, the data collection process needs
to be credible, and the investigator, the investigator’s intentions, and respect for the respondents
need to be trustworthy (Clark & Estes, 2008). To provide credibility and trustworthiness in this
study, interview transcript review, researcher reflexivity, peer reviews, and thorough descriptions
ensured the understanding of context and findings. In addition, I confirmed the participants’ data
by checking LinkedIn, website biographies, and the Google search engine for titles and
organizational memberships, further establishing the trustworthiness of the gathered information.
Furthermore, I shared the transcript data with each participant to verify accuracy (Merriam &
Tisdell, 2016).
To maximize the interviews’ reliability and content validity, I built on prior research.
Additionally, to avoid bias or leading questions, I designed the questions to avoid problematic
ways of asking, such as using ambiguous wording. Moreover, three doctoral peers reviewed the
questions, and I ran the questions through two pilot interviews for confirmation of the logic and
appropriateness of the questions and language. Finally, reflexive journaling helped to confirm the
impressions during the interviews and support the study’s findings.
The Researcher
It was essential for this study to be grounded in industry knowledge and share the
participants’ career lived experiences (Maxwell, 2013). My positionality aligned with the
participants’ positionality as a woman with ambition who has worked in mid-management
leadership roles throughout various industries in the United States. My positionality strengthens

38
my understanding of the research. As a cisgender, heterosexual, Black woman with a career in
corporate communications spanning 15 years, I have endured stereotypes, microaggressions,
imposter syndrome, and the queen bee syndrome throughout my career. The bias manifested in
lower pay than colleagues with less experience, promotion oversight, stress, and feeling
undervalued. I used this study to understand how to overcome obstacles that have stalled my
career at the mid-manager level.
To mitigate potential assumptions and biases, several cohort peers of various
backgrounds, sexes, and races have reviewed interview questions and protocol for author bias
and assumptions. Additionally, the participants represented various industries, races,
nationalities, sexual orientations, and socioeconomic backgrounds to offer various viewpoints.
My committee consisted of a man and two women of various backgrounds, races, and ethnicities.
I strategically chose them to hold me accountable for being objective and fair. Additionally, I
asked open-ended questions to allow participants to elaborate on their own experiences in their
own words to avoid leading them in any way. According to Merriam and Tisdell (2016),
researchers would avoid leading questions because they reveal a bias or assumption.
Ethics
This project shares each participant’s career lived experiences. Opening interview
questions allowed them to comfortably engage with the interview process and support their study
involvement. I started the interviews after each participant indicated they understood the purpose
and methods used in the interview. Each participant consented to the interviews and signed
consent documentation for inclusive participation after the interview. I informed participants that
they could stop the interview immediately should answering any of the questions be
uncomfortable (Merriam & Tisdell, 2016). The same set of interview questions served as the

39
base for each participant, allowing for purposeful diversity and variation in the interviews. The
study followed the university’s institutional review board procedures for ethical conduct in
research. Lastly, I included the data collection and data analysis in the research notes, allowing
for review and replication of the interview steps.
Summary
Chapter Three provided an overview of the qualitative phenomenological field study
methodology and data analysis used to implement the study. The following chapter presents the
study’s findings related to the research questions. Finally, Chapter Four examined the data
collection findings and their relationship to the study’s purpose. This study aimed to share best
practices to ensure future leaders and organizations mitigate challenges facing women on the
journey to the C-suite.

40
Chapter Four: Findings
This study aimed to unveil the experiences, motivations, and support systems that help to
propel women to C-suite roles in healthcare in the United States. Using a promising practice
approach, this research uses the SRT model to establish best practices to overcome barriers.
Through a qualitative interview design methodology, the study findings suggest factors at the
individual and organizational levels are essential to support women during their assent to the Csuite and for sustainability once they reach top leadership levels.
While the participants were determined and self-advocated to overcome barriers, findings
revealed that support systems and intentional business practices also positioned them to succeed.
This study addressed two guiding questions:
1. How do evolved differences, social roles, and psychological factors influence
women’s ascension to C-suite positions?
2. How do women leaders in the C-suite successfully sustain their roles?
Participants
The 12 participants in this qualitative research are female executive leaders at large
healthcare organizations and medical schools, including presidents, SMOs, COOs, senior vice
presidents, and CEOs. The participant selection aimed to develop a framework for understanding
the antecedents, factors, and barriers that affect entry into these roles. The participants are all
married. Additionally, all participants had a minimum of 10 years of leadership experience.
Thus, their interactions provide an in-depth understanding of the factors that affect knowledge
sharing in the healthcare sector. I collected data through semi-structured, open-ended, 45-minute,
and 1-hour interviews. Priori coding informed the findings and subsequent analysis. Providing
interview questions to participants before the interviews allowed for reflection and preparation.

41
Zoom offered flexibility for location to reach across geographical areas. To keep the participants’
identities anonymous, pseudonyms replace real names with no reference to employers. Table 1
depicts participant demographic information that includes the participant-assigned pseudonym,
title, age, race, parental status, and highest degree obtained.
Table 1
Participants
Participant Age Ethnicity/race Highest degree
obtained
Size of
team
Title Is a
Parent
Lisa 58 Black Medical degree 125 Senior associate
dean at a
medical
school
Y
Lori 54 Hispanic,
White
Master of Health
Administration
1,500 Chief operating
officer
Y
Sandy 48 Black Doctor of Nursing
Practice
700 Chief nursing
officer and
VP of
operations
Y
Monica 55 Black Master of Science
in Nursing
86 Regional
administrative
leader
Y
Julia 53 White Master of Science
in Nursing
1,100 Chief operating
officer
Y
Donna 48 Black Master of Arts,
Strategic
Communication
& Leadership
10 Chief marketing
officer
N
Alana 40 Hispanic,
White
Master of Public
Health
500 Assistant
medical
group
administrator
Y
Kate 40 Hispanic
(White,
Asian,
Native
American)
Medical degree 25 Chief medical
officer
Y
Paula 58 White Master of
Business
Administration
1,500 Chief executive
officer
Y

42
Participant Age Ethnicity/race Highest degree
obtained
Size of
team
Title Is a
Parent
Amy 41 White Master of
Science,
Educational
Psychology and
Counseling
50 Vice president
of operations
and executive
director
Y
Carole 48 White Master of Health
Administration
53,500 President,
Northern
California
Y
Jane 43 Black Master of Health
Administration
2,350 Chief, hospital
operations
Y
Thematic Analysis
The data analysis sought to identify recurring themes relevant to individual and
environmental factors that affected the participants’ ascension to C-suite positions. Themes
emerged during data collection, interpretation, and coding. I reviewed interview transcripts and
searched for patterns across the responses to identify key phrases that represented recurring
perspectives. This analysis considered frequency, significance, and alignment with the two
research questions.
Findings Research Question 1
This study examined personal beliefs with questions specific to evolved differences,
social roles, and psychological factors that influenced the interviewees’ ascension to C-suite
positions. Through the lens of a promising practice methodology, three themes emerged. The
three themes that helped the participants overcome barriers that can hinder women’s
advancement were individual factors, outside support, and organizational structures.
Participants reported that individual attributes such as self-efficacy, sense of purpose, and
self-advocacy played a role in their advancement to leadership positions. Furthermore, each
leader expressed having a strong push from individuals both inside and outside of their place of

43
employment, such as a spouse, mentor, or sponsor, to help mitigate barriers such as
microaggressions and self-doubt. Participants also expressed taking ownership of their careers by
aligning themselves with organizations that are intentional about diversity, equity, and inclusion
in leadership.
Individual Factors
The interviewees possess an innate positive can-do mindset and drive that pushes them to
overcome challenges. Despite the scarcity of women in healthcare leadership, resilience and
confidence helped them reach their executive leadership goals. The participants exposed how
women leaders use their power to leverage relationships, seek out challenges, and take control of
their careers. Moreover, they have a sense of purpose that drives them to navigate the many
obstacles they encounter in the workplace. However, despite a strong will, individual efforts can
only get women so far. All the interviewees emphasized having a solid support system that
influenced their careers, including an effective leader who provided stretch assignments,
reassurance, and resources. Self-efficacy was a common thread in the participants’ traits. Selfefficacy also gave the leaders the confidence to lead even in times of uncertainty.
Self-Efficacy
Self-efficacy is vital to the growth of women who aspire to elevate to the highest levels of
power in healthcare. All 12 participants indicated self-efficacy was an impetus for overcoming
barriers. During times of crisis such as COVID-19, participants’self-efficacy drove them to step
up to the challenge. “I’m not a person that will shy away from something difficult because I
don’t have the skill set to do it,” Jane professed. While they have faced barriers, the participants
welcomed the obstacles as a way to add value to the organization and effect change during
difficult times. Carole described, “In every challenge, there’s an opportunity.” For instance, Kate

44
gained the opportunity to work as a leader in her organization of more than 500 people by chance
during the COVID-19 pandemic after the CEO fired her boss and hired Kate to replace him. Kate
explained, “I had an advantage as an ER doctor. We are kind of crisis specialists. The fact that I
was relatively calm and could sit with the discomfort of the not knowing what was going to
happen next really helped.”
While adversity derails some women from leadership, the strong will and determination
the participants share helped them through challenges. Lisa shared, “I’m just someone who has
always been very, very driven. I’m not someone who would just kind of acquiesce and take no
immediately for an answer. So, I think I can be relentless and persistent.” Additionally, C-suite
women’s confidence helps them stand out from their peers. “I’m driven, you know. I’m
competitive,” Julia declared.
Self-efficacy also mitigated the effects of gender bias as the confidence in their abilities
trumped any self-doubt. Sandy rationalized, “I’m pretty optimistic about how things can go and
what I can do to make them go well, and so I don’t tend to give up. I have a saying that
perseverance wins the race, you know.” Women can close the gender gap in leadership in
healthcare with self-efficacy and confidence to navigate the labyrinth of obstacles they may face.
However, they must combine self-efficacy with other attributes, such as a sense of purpose, for
them to reach the C-suite.
Sense of Purpose
What distinguishes a person who just serves in a leadership role from a person who
transforms the workplace as a transformational leader is a sense of purpose. A sense of purpose
helped the participants’ performance. Fulfilling their calling allowed them to see themselves as
changemakers and commit to their work. Lori proclaimed, “I have loved every single job I’ve

45
ever had because that’s how I show up.” She continued, “I make it my business to make it
rewarding and find the purpose in it. And if it’s not a job I love, I transform it.” Some
participants said having a sense of purpose was imperative to thrive in the demanding healthcare
industry. Jane noted, “You have to have purpose behind what you do every day.” She continued,
“Because I think purpose keeps us. I think that keeping purpose in front of you actually reminds
you of why you got into this particular work industry.”
The narratives also established that having a sense of purpose increased job satisfaction
among the participants. Sandy remarked, “I like what I do. I like the difference I’m able to make
every day.” Julia’s sense of purpose allows her to approach challenges as opportunities. She
reflected, “I see leadership as a way to create an environment.” The sense of purpose participants
shared motivated them to advocate for themselves to advance to higher leadership positions that
allowed them to make a greater impact at their organizations and in their communities.
Self-Advocacy
Advancing to chief positions takes more than knowledge, loyalty, and drive. It requires
self-advocating for highly visible positions that are competitive and scarce in number. Amy
shared her advice to women who aspire to reach the C-suite:
Do not be afraid to do a little bit of self-promotion. There is a strategic way to do it. I
usually do that by sending a nice email to my boss when I receive positive feedback from
a client saying, “I just wanted to share this email I got that says, ‘Hey, Amy, that
presentation you gave was amazing.’” Because if you are hiding in the shadows, you’re
more likely to get passed up for promotions.
Self-advocacy for some of the participants meant being intentional about the types of
roles they took on. Jane commented, “I think over the years, I’ve been very deliberate about

46
executing in a way that really showcases my expertise.” For other participants, self-advocacy
resulted from discouragement from their leaders. Julia explained that her manager tried to deter
her from pursuing her master’s degree, but she used it as motivation. Julia stated, “That was a
drive for me right there. And by having my master’s degree, it opened up doors for me.”
Though self-advocating is important to reach leadership, some participants admitted selfpromotion does not always come as natural for them as it does for some men. Amy explained,
“Nearly my entire team who reports to me are women. I only have one man on my team, and he
is the only person who has requested a raise.” Still, most participants said they advocated for
themselves to reach C-suite. Some of the leaders said it took the help of their support systems to
motivate them to overcome their discomfort to self-promote.
Support Systems
Leveraging reliable professional and personal relationships allowed the participants to
gain exposure and elevate them to the highest ranks in healthcare. Mentors, sponsors,
networking, and spousal support emerged as the most common support systems to help women
leaders navigate a male-dominated system. Mentors and sponsors showed participants the
possibility of what they could achieve. Networking offered women a support group and access to
opportunities. Spousal support provided the flexibility to balance work and home life. All these
support systems combined were a game changer for participants.
Mentors and Sponsors
Guidance and support from accomplished individuals encouraged and informed women
during their leadership journeys. Lisa elaborated, “Had I not had sort of that person cheerleading,
leading me on, sponsoring me, I don’t know that I would have been able to do the things that I
have been able to do in my professional life.” The participants gained the support of mentors and

47
sponsors early in their careers by working hard. Carole reflected, “Luckily, I had amazing
sponsors very early on who wanted to see me succeed. They would not have done it if I didn’t
have results to back it up.” Collectively, narratives reflected a willingness to seek out mentors
and sponsors. Some participants, however, highlighted that their mentors saw their leadership
capabilities early on and tapped them. Monica explained, “My mentor saw my potential when I
didn’t see it. I didn’t know it was there.” The same sentiment was shared among most of the
participants. Table 2 includes additional thoughts participants disclosed regarding how
mentorship and sponsorship helped them reach their goals.

48
Table 2
Participant Quotes: Mentorship and Sponsorship
Participant Participant quote
Donna There have always been mentors who have said, “I’d like to help you. I see
something in you.” I’ve been very lucky that people have offered me that gift,
and so what I’ve done in return is try to offer mentorship to those that I come
across in my path.
Lisa I can’t emphasize enough how important it was for me to have seen other women
of color, one of whom was, in fact, my lifelong mentor. So, yeah, I’m driven,
I’m relentless, persistent, all of those things. But the reality is, had I not had
sort of person cheerleading, leading me on, sponsoring me, I don’t know that I
would been able to do the things that I have been able to do in my professional
life.
Monica Find mentors, multiple, and preferably mentors that are connected. My first
leadership role was because an African American woman who grabbed me by
the hand and said, “Oh, you got all these ideas, huh? Come over here and do
it.” Then she let me lead, and she let me make mistakes.
Lori What can contribute to more women in the C-suite is women mentoring other
women. For years, I’ve watched other female leaders and took cues from them.
I observed what I felt like worked well for them and what didn’t work for them.
Kate What allowed me to succeed in my role was the faith of a female mentor who
believed that I could do it, even though I hadn’t done it before. Women, and
especially women of color, are not extended the faith that they can do things
that haven’t already done already. It was a really remarkable opportunity to
have someone say, “You haven’t done this yet. I think you can.”
Carole I have been the beneficiary of mentorship and sponsorship, and there’s definitely
a difference between the two. I’ve also been the beneficiary of executive
leadership programs and senior leadership programs. And it gets you connected
and networked with different individuals throughout an organization.
Jane Having sponsors throughout the journey has led to my success. Sponsors come in
various forms. They can be your actual boss. They can be people, colleagues,
that you actually work around, but I think I’ve been fortunate enough to have
people that are willing to speak about my skill set and what truly reflects who I
am. In environments and at tables that I may not even be sitting at, I think that’s
another key component.
Alana Throughout my career, I have always tried to identify someone who’s a mentor.
Someone that I can trust, someone that is willing to also provide tough
feedback, even if it’s presentation or delivery, or in a meeting. Someone who
will text me and say, “Your poker face is not very good look right now.”

49
Participants mentioned the words mentorship and sponsorship more than any other words
when describing success factors. In addition to having a mentor, some participants used
networking with other leaders as an additional tool to learn how to navigate their careers and find
opportunities. For many of the leaders, whom they knew was just as important as what they
knew.
Networking
Working in the C-suite requires dealing with many people at different career levels.
Networking and establishing relationships were essential to opening doors for participants. As
Paula described, “You have to have excellent people skills. And you have to know how to make
sure that you’re meeting people and not managing them. It’s all about having more influence
when you get to this level.” Networking made women more influential while offering them
support from like-minded leaders. Monica summarized, “I do believe that a lot [of] this is tied to
our relationships. The relationships that we’ve built open doors. It’s not always check the boxes.
It’s not easy. So, having established relationships I know are key.”
There is power in numbers. An African proverb states, “If you want to go quickly, go
alone. If you want to go far, go together.” Participants used the power of connections to gain
access to career opportunities and build their reputations. Lisa explained, “I’ve been fortunate to
have had supportive women along my journey.” Lisa continued, “We have a group, and it’s kind
of our leadership team, a women’s group. We would dine out on a monthly basis just to have
some fellowship together.” Lori highlighted the psychological benefits of women leaders
supporting each other:
I feel, as women, we owe it to each other to lift each other up and to make sure that we’re
not fighting against each other, jockeying and positioning because we feel like the spots

50
at the top are limited. As a female executive, it’s very hard to find other female
executives that you can be truly open and transparent and authentic with because most of
the people are somehow reporting up to you. So, I think it’s really important to find
people within the organization at similar levels to fill that, to be sounding boards and
release valves. And it’s important to nurture those relationships constantly because I
think if you stop nurturing them, you can slide into unintentionally competing with each
other.
Organizations such as Chief offer women leaders connections with like-minded
individuals, advocacy, and growth. The leaders of Chief brand the organization as the only
private membership network focused on connecting and supporting women executive leaders.
According to Women in Healthcare (n.d.), the organization promotes “the professional
development of women in the healthcare industry to empower one another, support growth and
mentorship, and support business through sharing successful techniques, leads, contacts,
products, and services” (para 1). Several participants are members of these and other groups that
support women leaders. Participants also relied heavily on spousal support for strength and
balancing home and work life.
Spousal Support
One of the main ways women leaders have evolved is in how they maintain both work
and home life. Traditionally, women worked in the home while their husbands worked outside
the home. All the participants, however, served as examples of how women leaders today
balance being wives, mothers, and executives. The narratives underscore that women do not have
to choose between work or family. While it can be challenging, women can maintain a satisfying
presence in both the home and career with the help of a spouse. Amy acknowledged that having

51
a supportive spouse helped her reach her goals. “My husband pushes me, but he knows we have
two children.” Amy continued, “To push me to move up the ladder, that requires more time and
effort, so he supports me by saying, ‘I’m going to take the kids to school,’ or ‘I’m going to pick
them up.’ I’m very lucky.” When Lori advanced to the C-suite her husband became the full-time
caregiver to her infant sons for 6 months. Although it came with challenges, he pushed through,
allowing Lori to focus on her career. She explained, “People said the most terribly cruel things to
him without even realizing it.” Lori continued, “I’m blessed to have a husband who kind of
shakes that off and, in some ways, finds himself playing a supportive role to me. It’s definitely
not the way of the 1950s.”
Even with a supportive wife who supports her career and helps her balance the household
responsibilities, Paula admitted there are still sacrifices leaders must make when they are married
and have children: “There have been some trade-offs. I’ve tried my best to never miss my
children’s events.” Paula continued, “But sometimes you get to them late because you just can’t
leave the meeting. Sometimes, you know, grocery shopping doesn’t get done until Saturday. I
don’t know how you would do it without someone being supportive.” Julia reflected on how she
sacrificed time with her kids when they were young to meet job demands. “I just felt guilty about
not being able to spend more time with them.” Now that Julia’s children are adults and she is
starting over as a step-parent she has learned to set limits. “I think it's learning to set the
boundaries. I can't be there all the time. But tell me what's really important. I will be there,” Julia
said.
The trade-offs and conflicts can take a mental toll on women leaders. Therefore, an
understanding spouse provided much-needed advice for participants when they encountered
conflicts and stress. Alana elaborated, “He’s always been supportive of my growth and my

52
development. I think that he’s a good sounding board for me also for different conversations.”
Top female leaders manage responsibilities with more satisfaction when they have a life partner.
Still, women leaders need organizational support from their organizations to reach C-suite.
Organizational Structures
Successful leaders have a growth mindset. Participants expressed the importance of an
inclusive organizational culture and effective leadership to reach the C-suite and sustain women
leaders once they get there. Organizations should be intentional about ensuring women have
equal access to career development and promotions as men to overcome years of male
dominance and unconscious bias. Organizational culture that supports women emerged as a key
factor in helping participants reach and stay at the C-suite level.
Organizational Culture
The saying “culture eats strategy for breakfast” rang true for study participants. Paula
recalled how her organization’s commitment to development impacted her ascent to regional
leadership. “I was at another organization before this one, and it was like a one-and-done. You
take one course, and they think you are developed.” Paula remembered, “In our organization, it’s
continuous learning. They offer it in the beginning and all the way up until you are an
executive.” Paula emphasized that the leaders at her large nation-leading organization
intentionally prepared women for top roles. “It was a conscious decision by one of our very high
leaders that was very well esteemed,” Paula confirmed: “That is where we start breaking through
the glass ceilings of how our people are selected for roles.”
Carole also stressed how essential a company’s role is in creating an environment that
supports women leaders. “There are historic paternalistic structures that don’t make it easy for

53
women to be seen in all of what they’re capable of and the results that they produce,” Carole
continued,
If people don’t think that there’s inherent bias and don’t recognize the inherent bias and
are explicit about doing something about that inherent bias, you’re going to end up hiring
people that look like you that you are comfortable with.
While employers must implement change in systems to break generational male
dominance, Jane pointed out that aspiring women leaders should seek out employers who have
already put action behind their commitment to diversity, equity, and inclusion. “I think that there
are organizations that actually understand the importance of having diversity at the table, not just
women, but all diversity at the table,” Jane declared. She added, “I think I’ve been fortunate
enough to work for organizations that actually practice what they preach. It’s easy to say, ‘We’re
a diverse organization, and we believe in diversity in our community.’ But do you actually
practice that?”
The investment in leadership development for women is well worth the cost. Women
leaders drive profit and show a commitment to gender parity. Another significant way
organizations can solidify their commitment to diversity is by ensuring effective leadership that
can develop future leaders.
Effective Leadership
Being a great leader means being a great follower first because leaders learn from other
leaders. Of course, the kind of leadership is important. Effective leaders helped the participants
defy any odds stacked against them. Effective leaders led by example and set future leaders who
reported to them up for success. Organizations achieved gender parity in top positions when
women had access to developmental opportunities that challenged them and allowed room for

54
mistakes. Lori described her former manager’s approach to developing her as the catalyst for her
transition from a public affairs leader to a COO for a medical center:
He carved out pieces of the business to let me get in there and, many times, fail but learn
rapidly. So, he’d say, “Oh, you think you can solve that? Go for it. Here’s your
assignment.” That opened up so many doors for me. He saw something in me that I didn’t
see in myself. So, I honestly feel like we need to do more to actually tap people on the
shoulder.
Like Lori, Alana’s former manager also empowered her with stretch assignments. She
recalled, “I think I’ve been very lucky to have stretch assignments.” Alana said, “It has given me
the opportunity to either test out my abilities in a new space and also figure out if things are a
good fit. It contributed to my success.”
Direct managers can also serve as advisors to their direct reports. Lisa remarked how a
former boss she worked with for 10 years aided in her growth by sharing advice: “She would tell
me, ‘In these roles, if you don’t have your integrity, you have nothing.’ It stuck with me.”
Moreover, some participants stressed that leaders granting them autonomy to make decisions
was important. For Kate, autonomy was imperative to her advancement as a leader. “My former
boss was really into professional development. Letting me pursue whatever it was that I needed
where I saw fit allowed me to grow.” Effective leaders do more than manage people; they can
influence them in ways that can change the trajectory of their careers for the better or the worse.
Discussion for Research Question 1
Three themes illustrated how evolved differences, social roles, and psychological factors
influence women’s ascension to the C-suite. Given the responses shared during the interviews,
individual factors, support systems, and organizational structures had a profound impact on

55
participants’ ascension to the C-suite. While the perspectives varied among the 12 participants,
all had support from all three areas in different forms. The narratives reiterate that presumptive
social role expectations in an organizational environment determine gender roles (Eagly, 1987)
unless there is a conscious effort made to decode outdated beliefs that only men are leaders. Still,
individual factors such as self-efficacy allowed women to push past challenges to reach their
goals. Connections with individuals such as mentors, spouses, and other leaders mitigated
challenges and offered development for leaders.
There is a gap in healthcare leadership for African American women and White women.
African American participants, though successful, did not reach the height of leadership as White
participants. Of the six non-White participants, only Jane, Kate, and Donna worked chiefs for
local entities while the others worked as senior executives on the local or regional level. In
comparison, five of the six participants who identify as white worked at the top highest level of
leadership for their organization either regionally or nationally.
Findings Research Question 2
While participants are overall satisfied in their careers now that they have reached top
leadership, the themes of individual factors and organizational factors emerged as ways to help
them maintain their success. For individual factors, continuous learning helped participants keep
up in the fast-paced healthcare field. In addition, strong will and determination allowed them to
overcome barriers.
While important, sometimes individual factors are not enough for women to reach top
leadership. Organizational factors shape opportunities and culture for women. Organizational
factors refer to how a company facilitates women’s development, advancement, and
empowerment. This can encompass a range of initiatives, policies, cultural shifts, and cultural

56
awareness, including unconscious bias training to help mitigate gender and racial bias.
Participants who identify as women of color often face additional barriers that can impact their
psychological safety. A commitment to gender inclusion is imperative to ensure that women
have equal hiring and promotion opportunities so that the pool of women available for leadership
roles increases.
Individual Factors
Participants illustrated clear acknowledgement of their power to control their destinies
and drive their paths. Each shared how much they worked hard to improve their skills and
knowledge to stand out in a male-dominant C-suite role. One way all the participants maintain a
competitive advantage is through continued learning.
Continued Learning
While all the participants have advanced degrees, a natural desire to learn and grow helps
them maintain a competitive edge. New learnings also allowed them to enhance their decisionmaking skills, problem-solving abilities, and emotional intelligence. Paula expounded, “What’s
important for me is keeping myself educated. I really do a lot of reading. I have joined quite a
few different groups.” Another participant mentioned the value of returning to school after
becoming a leader. Alana insisted, “It was 10 years between graduating undergrad and then
going back to grad school. That was a great experience because it expanded my network, and I
learned from all kinds of professionals.” Carole stressed that the continuous search for answers
in the workplace is one of the most important characteristics of a leader: “If you don’t have a
level of curiosity, I think that there’s an inherent level of innovation that is just not a part of who
you are.” Responsible leaders ask good questions such as “What could we be doing better, and
what are other people doing?” Lisa learns by listening to her team and other leaders: “I think

57
they like that I’m always willing to sit and listen.” The continuous learning allowed participants
to stay relevant and valuable to their organizations and employees. Their knowledge, combined
with strong will and determination, have allowed participants to maintain their place in
leadership, thrive, and leave their mark on their organization.
Strong Will and Determination
To persevere at the C-suite level, women leaders need to have strong will and
determination to overcome challenges in a trying environment. Participants spoke of having
encountered strong personalities and conflicts throughout their careers. Rather than allow the
issues to deter them, some participants viewed clashes as opportunities. Alana remembered a
time she had to assert herself when a male colleague repeatedly spoke over her and dismissed her
ideas:
I think it gave me an opportunity to say, “You know what? This is enough because I’ve
allowed you to interrupt me. I’ve allowed you to talk over me. I’ve allowed you to say
what you had to say. Now, I’m going to finish my thought here.”
Other participants confessed to experiencing the queen bee syndrome. Carole remarked that
having experienced harsh treatment from other women leaders early in her career: “I was the
young whipper snapper coming in, and I didn’t have the street cred. … There have definitely
been women who’ve made it difficult.”
Moreover, having strong will and determination prompted participants to take risks and
step outside of their comfort zone in difficult environments. Whether it was to advocate for
patients, employees, or themselves, Julia noted, “You have to be willing to be uncomfortable” as
a leader in healthcare where decisions can affect lives. Julia elaborated,

58
It’s a really tough environment. Our workforce has changes. Being a leader should be
more than just having a title. You have to lead in so many different ways. It’s exhausting.
You don’t turn this off. I don’t know how to. It’s just there’s one thing after another that
that happens on a daily basis and that we’re responsible for navigating.
As with continued learning, strong will and determination allow the interviewees to
tackle the various challenges they face. While individual factors are important to maintain the
demands of leadership, organizational factors also impact women leaders’ longevity. The more
organizational support they have, the more likely they are to stay at the organization.
Organizational Factors
Women leaders have come a long way, but there is still a long way to go for there to be
gender parity in the C-suite in healthcare. Part of achieving gender parity is the sustainability of
women who are currently in leadership. The study sought participant perceptions of their
organizations’ impact on their longevity. Two subthemes emerged from interview questions
designed around a commitment to gender inclusion and unconscious bias. Organizations
recognizing gender and racial biases were intentional about showing their commitment by
creating spaces at the table for women, bringing awareness to unconscious bias, and holding
themselves accountable for their actions. A strong commitment to gender inclusion can make
women leaders feel more valuable in the organizations they serve.
Commitment to Gender Inclusion
Practicing gender parity in C-suite roles requires intention and commitment at the
leadership level. Kate underscored the importance of leaders positioning women for success:
“Everyone’s got to be intentional. People in positions of power have to be intentional about
spreading good gossip about you.” Moreover, healthcare organizations with higher-than-average

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rates of women in executive roles realize gender inclusion is backed by action. It starts with an
acknowledgement and awareness of where there are gaps. Julia admitted her organization needs
more women physicians and leaders: “I’m part of the executive diversity inclusion committee.
And we speak about this all the time. … This is an area that we need to do better.” Jane also
finds it necessary to be a part of the evolution toward gender equality at her organization. She
explained the importance of incorporating inclusion in her decision making: “I’ve been very
purposeful about making sure people feel included and being thoughtful across the board,
especially for women, and certainly for women of color … I don’t shy away from the truth.”
Organizational cultures with gender inclusion intertwined into their work practices
nurtured advancement opportunities for women in leadership roles. In addition to having gender
parity in leadership, organizations need to develop policies, procedures, and training to mitigate
any hostility toward female workers. When women have psychological safety, they are more
likely to stay long enough in roles to advance to higher levels. Exposing unconscious bias is one
way to help lessen prejudice against women in the workplace.
Unconscious Bias
Organizations that hold themselves accountable for gender inclusion often require
unconscious bias training to help managers and staff recognize and understand their own biases.
Unconscious bias impacts women leaders by undermining their authority and potential for
success. It can manifest in various ways, such as doubting their competence, assigning
stereotypical roles, or overlooking their contributions. These biases can hinder their career
advancement and perpetuate gender inequality in leadership positions. Addressing unconscious
bias is essential to create a more equitable and inclusive environment for women leaders to
thrive. Table 3 includes participant responses related to barriers they face in their roles. The six

60
non-White participants addressed having an extra burden of fitting in while overcoming
intolerance.
Table 3
Participant Quotes: Barriers and Biases
Participant Participant quote
Kate For the most part, if you’re a woman of color and working in
majority White environments, you’re trying to figure out,
how do they not see me as a threat?
Sandy People have a lower tolerance for me as a woman and as a
Black woman.
Monica Black People are not high on the totem pole at my
organization. I know that we’re not high on the totem pole
because we’re not represented in the C-suite.
Lisa I’ve had a lot of more threatening approaches by men. The
ones who thought I was taking their job was often from
men. So, I think it’s just a lot of intimidation tactics that I
experienced.
Lori I needed to overcome people seeing me as a woman because
not that being a woman is a problem, but until they could
stop seeing me as a woman, first and foremost, they
couldn’t see me as a leader who happened to be a woman.
So, I went to dark pants suits for a while and paid more
attention to not drawing attention to my femininity.
Jane I have walked into rooms as a director earlier in my career or
maybe a senior-level manager, and I’m there to drive the
conversation, and the folks that are in the room don’t think
I’m the person that is there to drive the conversation.
There’s not even an expectation that someone could be in a
meeting driving a conversation that’s of color, or me as a
Black woman being here to lead the conversation.
Donna Regardless of where you are, you’re always going to face
challenges as a woman. There is still a bit of a patriarchy in
every aspect of every place that I have been in. Anyone
telling me to calm down really still grinds my gears. In a
man, it would be called passionate about something.
Unconscious bias affects women leaders by undermining their decisions, attributing their
success to external factors, and setting higher standards for their performance compared to their
male counterparts. These biases can result in women leaders receiving less support and few

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promotions, perpetuating the gender gap in leadership roles. Achieving gender parity in the Csuite and sustaining women leaders requires accountability.
Organizational Accountability Fosters Responsibility
Accountability in organizations plays a crucial role in achieving gender parity by
ensuring that policies and practices actively promote equal opportunities for all genders.
Furthermore, Donna stressed, “Having access to those opportunities is your organization’s
responsibility. Organizations and institutions should provide professional development
opportunities in many different ways.” Leaders who hold themselves and their teams accountable
for diversity and inclusion goals are more likely to implement change. Jane recommended
accountability as the starting point for developing inclusive practices. “Hold yourself
accountable for what you say you’re going to do. This should be Number 1 on the list,” Jane
proposed. Paula emphasized that organizations should hire a leader in diversity, equity, and
inclusion to hold themselves accountable: “Take the first step and hire someone. Then there must
be some type of infrastructure and process in place to make sure that that person becomes
successful.” Accountability fosters a culture of transparency and responsibility, which is
essential for breaking down systemic barriers and empowering women to ascend to leadership
positions on an equal footing with men.
Discussion for Research Question 2
Women getting to the C-suite is one thing, but helping them remain there is another.
Women in the C-suite maintain their status by demonstrating exceptional leadership skills,
fostering strong professional and personal relationships, and continually expanding their
knowledge and expertise. Additionally, they actively seek out opportunities for continued growth
and skill development to stay at the forefront of their industries. By proactively managing their

62
careers and consistently delivering results, women in the C-suite can sustain and enhance their
status as influential leaders in their organizations. Furthermore, as previously mentioned,
accountability in organizations plays a central role in achieving gender parity. Leaders who hold
themselves and their teams accountable for diversity and inclusion goals are more likely to
implement fair recruitment, retention, and promotion strategies. Regular monitoring and
reporting of progress toward gender parity compel organizations to confront disparities.
Moreover, accountability fosters a culture of transparency and responsibility, which is essential
for breaking down systemic barriers and empowering women to ascend to the C-suite.
Summary
The narratives and lived experiences of the 12 participants unveiled a common can-do
spirit that evolved through leadership development and interactions with other leaders. Women in
the C-suite in this study have mastered mitigating the effects of evolved differences,
psychological factors, and social roles that can deter some women from reaching leadership.
Participants reached new heights by self-advocating for better opportunities and self-promoting
their accomplishments. Additionally, fortitude prompted them to pivot when they needed to make
a change. Whether it was going back to school to position themselves for more competitive roles
or apply for a position with companies that bolstered diversity and inclusion, these women took
control of success. While these leaders have worked hard to gain their status, they admit that they
could not do it without support systems, effective leadership, and an organizational commitment
to gender parity in leadership. Narratives suggest there needs to be a combination of factors to
circumvent years of ingrained biases and misconceptions that favor male leaders. Whether it was
a spouse, mentor, or the person they reported to, many of the women in this study did not aim for
top leadership ranks until someone they respected told them they had what it took.

63
The accounts from participants who identify as women of color imply they face
additional barriers that require organizational and emotional support. Organizations should
provide continued learning, leadership coaching from women coaches, support groups for
women, unconscious bias training, and therapy to mitigate the effects of microaggressions some
Black, Asian, and Indigenous women leaders encounter. Women leaders are strong, but they are
not unbreakable. During their ascent to leadership and to sustain their roles once they reach the
C-suite, women leaders need autonomy, trust, and grace. To ensure they have equal access to
opportunities as men, organizations should hold themselves accountable for inclusion outcomes.

64
Chapter Five: Recommendations
The study aimed to examine the perceptions of women leaders in healthcare on factors
leading to women gaining and sustaining C-suite positions. Using a promising practice approach
and Eagly’s (1987) SRT, the study evaluated 12 female executives’ experiences ascending to and
maintaining leadership positions in the C-suite. The study addressed the following research
questions:
1. How do evolved differences, social roles, and psychological factors influence a
woman’s ascension to C-suite positions?
2. How do women leaders in the C-suite successfully sustain their roles?
This chapter begins with a discussion of the findings, followed by recommendations for
addressing leadership advancement barriers and increasing female representation in the C-suite
in the healthcare sector. The chapter concludes with limitations and delimitations of the study
and recommendations for future research.
Discussion of Findings
This study’s findings addressed the two targeted research questions. This section
discusses the themes that emerged from the data analysis and their relationships with the
literature reviewed in Chapter Two. While most barriers to leadership women face stem from
historical challenges, such as cultural barriers, structural issues, and organizational hurdles
(Davis & Maldonado, 2015), the participants suggested that individual factors such as selfefficacy, self-promotion, positive relationships, and strong will positively impact their
advancement and sustainability. Furthermore, leadership in the C-suite also requires effective
organizational factors that foster an environment of learning, mentorship, sponsorship, and

65
inclusivity. Finally, accountability measures for gender diversity and inclusion ensure that
advancing women to leadership positions is not just an aspiration but a measurable goal.
Finding 1: Individual Factors
All 12 participants indicated self-efficacy, self-advocacy, or a strong sense of purpose as
individual traits that were essential in their advancement to the C-suite. Narratives reinforced
self-efficacy as an essential trait in women, including African American female executives who
excelled amid challenges (Beckwith et al., 2016). Additionally, self-efficacy helps to mitigate the
effects of bias and stereotypes some women leaders face when they are in demanding leadership
roles. Nine out of 12 participants credited self-efficacy for helping them overcome challenges.
Still, per Eaglin (2019), some men do not consider women to have the competence for
leadership roles. Self-advocacy and having a strong sense of purpose help women leaders
overcome the psychological impacts unconscious bias and stereotypes can have on them, such as
imposter syndrome and stereotype threat. Research insinuates that stereotype threat negatively
impacts women leaders’ aspirations by reducing women’s leadership self-efficacy (Hoyt &
Murphy, 2016; Walsh et al., 2022). In addition to possessing strong individual qualities, study
participants aligned themselves with positive support systems and organizations.
Finding 2: Support Systems
Previous studies have highlighted women leaders suffering from the queen bee syndrome
and a competitive environment of pitting women against each other instead of collaborating.
Castaño et al. (2019) determined that collaboration and support for women were imperative for
growth. All the participants had female mentors or sponsors who have helped them advance to
leadership levels. Participants also relied on support at home from spouses to help balance work
and home life. All 12 participants have supportive spouses they credit with helping them thrive

66
in their careers. Encouragement from spouses helped participants advocate for themselves, help
with decision making, share household responsibilities, alleviate stress, and affirm leadership
capabilities. Women often face unique challenges in leadership roles due to persistent gender
stereotypes and biases.
Finding 3: Organizational Factors
The literature highlighting self-efficacy, self-advocacy, and a strong sense of purpose as a
gateway to leadership is relevant. However, several researchers overlook the influence
organizational factors have on women leaders. Debebe (2011) pointed out that suppressing
women’s accomplishments and abilities denies their self-knowledge. Women need leaders who
will offer them stretch assignments and autonomy to make decisions. All 12 participants stated
that effective leadership at their organizations helped shape them as leaders. Effective leadership
also significantly bolstered self-efficacy among participants.
Finding 4: Organizational Accountability Fosters Responsibility
Healthcare organizations require accountability to promote gender diversity in leadership
and the workforce. Establishing measures for organizational accountability regarding women in
leadership can enhance gender parity in C-suite roles (Elliott et al., 2022). By holding healthcare
organizations accountable for women’s advancement into leadership positions, the entire sector
can work toward a more equitable, effective, and diverse leadership landscape that benefits
patients and the communities they serve.
Recommendations
Four key recommendations address future considerations in the healthcare sector. The
recommendations are intended for organizations to better support women leaders in navigating

67
the labyrinth. The findings recommend changes at individual and organizational levels to
facilitate women’s path to C-suites.
Recommendation 1: Improve Women’s Self-Efficacy and Self-Advocacy
McKinsey and Lean In (2018) revealed that, on average, women reported having lower
hopes of becoming top leaders than men. Organizations can support women leaders and their
self-efficacy by providing executive coaching, mentorship programs, and leadership courses.
Women executive coaches who understand women leaders’ needs can increase the self-efficacy
women leaders need to grow. Additionally, women should regularly self-advocate for
development opportunities, high-exposure job assignments, and fair salaries. Table 4 illustrates
recommendations women can implore to advocate for themselves.
Table 4
Table of Recommendations
Strategy How
Articulate goal Clearly express ambitions to occupy leadership roles. Let
mentors, peers, and higher-ups know career path.
Showcase expertise Demonstrate knowledge and skills confidently. Take
initiative to lead projects, present at conferences, or publish
research to establish authority.
Seek feedback Request regular performance reviews and ask for feedback
not only from superiors but also from peers and
subordinates to understand how to improve and prepare for
leadership roles.
Negotiate for
opportunities
Make a case for why you should be considered for leadership
opportunities.
Speak up Offer insights and solutions to problems in meetings to
showcase critical thinking and decision-making skills.
Volunteer Take on leadership tasks by being chair of a committee or
leading initiatives to drive results and show skills.
Promote achievements Share successes using performance metrics and outcomes to
highlight contributions to the organization.

68
Recommendation 2: Develop a Fair Way to Distribute Stretch Assignments
Research suggests that challenging experiences develop women’s leadership skills in new
and demanding ways, aiding in creating a leadership brand (Cook, 2022). Assigning stretch
assignments can be an effective strategy to improve gender parity in leadership at an
organization. Allowing women the grace to fail during the learning process and the autonomy to
practice decision making helps them grow into productive leaders. Leaders can leverage stretch
assignments by identifying high-potential female employees who demonstrate the capacity for
growth, creating opportunities that can help bridge the experience gap between current abilities
and those needed for leadership roles, and making sure the stretch assignments are highly visible.
It is crucial that women on stretch assignments can present their work to senior leadership.
Recommendation 3: Commitment to a Culture of Inclusion
Organizations should actively commit to inclusive leadership by setting gender-sensitive
targets for hiring, development, and promotion practices. This commitment guarantees that
women candidates are available for every leadership opening. Organizations must take
intentional actions to structure leadership teams and transparently share their strategies, metrics,
and accountability for gender inclusion, thus pledging to balance gender in professional and
career opportunities (C. N. Bell et al., 2023). By proactively creating leadership development
opportunities, organizations can make concerted efforts to cultivate potential women leaders,
preparing them to join the C-suite pipeline.
Recommendation 4: Women Leaders Need Foresight
Foresight is important for women leaders because it provides several advantages that can
help them navigate the complex and rapidly changing world of healthcare and medicine.
Foresight allows leaders to anticipate future challenge and opportunities. Women leaders can use

69
this skill to develop effective long-term strategies that address gender-specific issues or leverage
opportunities unique to their perspective. Additionally, women leaders can use their foresight to
create inclusive cultures that value and promote diversity, which can lead to better decision
making and improved employee engagement. Moreover, foresight can help women plan their
career trajectories and set realistic goals, proactively make decisions about balancing their home
and work life, and anticipate and prepare for potential setbacks. In summary, foresight is crucial
for women leaders because it empowers them to navigate their leadership journey effectively and
contribute positively to their organizations and communities they serve.
Implications for Practice
Gender parity in the C-suite in healthcare can have wide-ranging implications, including
diverse perspectives, improved financial performance, innovation, and better patient outcomes.
Women can bring different perspectives to leadership, reflecting the diverse patient population
healthcare organizations serve. More women in senior leadership improve decision-making
processes and outcomes. Furthermore, having more women in leadership increases return on
investment, improves organizational performance, and increases problem-solving diversity
(Elsesser, 2016). Additionally, more women in leadership may have a stronger emphasis on
work-life balance, flexible work arrangements, and policies that help reduce burnout among
healthcare workers. Proper representation in leadership helps mitigate imposter syndrome and
other psychological factors some women experience working in male-dominated environments.
Limitation and Delimitations
Researchers need to examine their study’s methods and address limitations and
delimitations (Creswell & Creswell, 2018). Although I took the measures necessary to ensure
participant credibility, several limitations and delimitations potentially affected the outcome.

70
Limitations are elements outside of the researcher’s control requiring disclosure to ensure the
study’s trustworthiness and credibility (Maxwell, 2013). This study focused on women who
currently hold healthcare C-suite positions. The data were derived from semi-structured
interviews with open-ended questions so that the narrative reflected the participants’ lived and
relevant experiences. The data gathered were self-reported, so they were exclusively the
participants’ opinions and perspectives. Some participants chose not to answer questions.
Moreover, as the study sought to highlight the organizational factors that contribute to gender
parity and inclusiveness, participant bias was inherent in their accounts.
Additional limitations included the lack of access to documents and employer
information, so the research relied solely on participant narratives. Time constraints limited the
sample size and prevented other stakeholders, such as human resource leaders, from participating
in the study. As busy women, participants’ time was limited to 45 minutes for some interviews.
Delimitations are factors controlled by the researcher that could impact a study (Mauch &
Birch, 1993). Delimitations for this study included limited interactions to a single interview
rather than multiple checkpoints over an extended period. Additionally, this study only focused
on women who currently live in the United States and work in the C-suite in the healthcare
industry.
Recommendation for Future Research
Most research on women in leadership tackles organizational and societal barriers
preventing women from reaching the C-suite. An area for future research includes investigating
how stay-at-home spouses impact the effectiveness of women’s leadership. The narratives will
provide valuable insights into a new way some women leaders position themselves for success.
A further area for future research would be a qualitative study on Black women in the C-suite.

71
As the smallest representation of women in the C-suite, understanding their perspectives could
help them overcome barriers. Another recommendation for research is to evaluate the
effectiveness of policies designed to promote women’s leadership, such as gender quotas,
parental leave, and anti-discrimination laws. Finally, qualitative research on the types of stretch
assignments that best support women leaders would also add value to organizations seeking to
increase gender parity in research.
Conclusion
While women have made significant advances in healthcare, they are still
underrepresented in chief positions that are most impactful. Gender parity in healthcare can lead
to better health outcomes and contribute to economic growth. The 12 participants’ narratives and
lived experiences revealed they were extraordinary women who made extraordinary sacrifices to
get to where they are. Their confidence developed through leadership growth and interactions
with peers. The women in the C-suite of this study demonstrated proficiency in overcoming the
challenges of evolved differences, psychological barriers, and societal expectations that often
hinder women’s advancement in leadership. By advocating for themselves and promoting their
achievements, these participants attained new professional levels. The stories indicate that
overcoming deep-seated biases and misconceptions favoring male leadership requires a
multifaceted approach. Additionally, participants aligned themselves with organizations that
demonstrate a commitment to gender parity in leadership.
Women of color among the participants conveyed that they encounter additional
obstacles, calling for both organizational and emotional backing. Organizations must offer
ongoing education, leadership training by female coaches, support groups, training to address
unconscious bias, and therapy to alleviate the impact of microaggressions that some Black,

72
Asian, and Indigenous women leaders face. Despite their resilience, women leaders are not
invulnerable. This study provides strategies for women aspiring to reach the C-suite and tools for
organizations that want to support them. Overall, these women defied the odds by being strong,
determined, and confident but they could not do it alone. Gender parity takes an asserted effort
by both individuals and organizations.

73
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Appendix: Interview Protocol
To understand the drivers for women C-suite leaders, the following research questions
will guide the study:
1. How do evolved differences, social roles, and psychological factors influence
women’s ascension to C-suite positions?
2. How do women leaders in the C-suite successfully sustain their roles?
Participants: Women working in C-suite positions in the United States.
Introduction to the Interview
Thank you for agreeing to this interview and being part of my dissertation research study.
My name is Anasia Obioha, and I am a doctoral candidate at the University of Southern
California. I am researching the underrepresentation of women in C-suite leadership positions.
My study aims to understand the factors leading to women successfully gaining C-suite
positions. I would like to record our conversation today to facilitate our note taking. Only
researchers on the project are privy to the recordings. Therefore, I am providing you with an
information sheet for exempt studies. Essentially, this document states that (a) all information
will is confidential, (b) your participation is voluntary, and you may stop at any time if you feel
uncomfortable, and (c) I do not intend to inflict any harm.
I have 15 interview questions for you. There are no “right” or “wrong” answers, as I am
just seeking to learn from your experience and perspectives. If you see me looking down and
writing, it is not meant to be disrespectful; I am actively listening and trying to capture notes. If
you need any clarifications on our questions, would like to skip or come back to a question or
have additional information to add, please feel free and speak up. I have planned this interview to
last about an hour, so if time begins to run short, it may be necessary to interrupt you to push

90
ahead and complete the interview. Lastly, to help expand best practices for gender parity in the
C-suite, would you be willing to share your name and your company name/position for the
purposes of validity and credibility of this dissertation study? Again, I want to thank you for your
agreeing to participate! Do you have any questions before we start, or are you ready to begin?
Conclusion to the Interview
Thank you again for agreeing to participate in this important research. As we have
discussed, your responses will remain anonymous, and I will be using a pseudonym for our
organization. I want to sincerely thank you for your candor, as it will help ensure that this
research project contributes to this very important topic. If you have any questions or additional
thoughts, please reach out to me.
Interview Questions
The following interview questions solicited participant responses and identified
psychological, social role, and evolved difference factors as they relate to barriers impacting
women leaders during their ascent to the C-suite.
1. What are key factors to being successful in your role? (RQ2)
2. What strategies has your current or past employer used to help you advance in
leadership? (RQ2)
3. The number of women in the C-suite has increased in the past 5 years, what factors
do you feel contributed to that? (RQ2)
4. Although women make up nearly 50% of the workforce, they hold 24% of positions
in the C-suite. What factors played the biggest role in you being able to successfully
overcome barriers that have deterred some other women? (RQ1)

91
5. What do you think are the biggest reasons more women are not at the C-suite level?
(RQ1)
6. Reflecting over your career in the field, how has your experience been as a woman in
leadership? How were you treated? (RQ1)
7. What has been your biggest challenge as a woman working in the C-suite? (RQ1)
8. How many women leaders work in the C-suite at your organization? How does that
make you feel? (RQ1)
9. How have your various roles (wife, mother, leaders, philanthropist) impacted your
career advancement? (RQ1)
10. What key leadership advice do you have for young women wanting to follow in your
footsteps? (RQ2)
11. What kind of feedback have you received from leaders you report to? (RQ1)
12. What kind of feedback have you received from the individuals you lead? (RQ1)
13. What has been your experience working with other women leaders? (RQ1)
14. What is the biggest misconception of female leaders? (RQ1)
15. What attributes do you possess as a leader that have helped you reach the C-suite?
(RQ2)
16. In what ways have you changed to reach leadership status?
17. What suggestions do you have for organizations to help support women seeking
leadership positions? (RQ2)
18. Is there anything I have not asked that you would like to share about your experience
that would help other women looking to advance to the C-suite?

Abstract (if available)

Abstract Men continue to dominate leadership positions in healthcare. Despite women in the United States accounting for 75% of entry-level positions in the healthcare field, they make up only 32% of chief positions. That number decreases to 4% for women of color. This dissertation assessed the personal, behavioral, and environmental factors that shape women in senior leadership positions at healthcare organizations in the United States using the social role theory as a framework. The impetus for the study centered on providing perspectives of organizational support for women seeking healthcare C-suite positions and identifying factors and best practices that drive women to executive roles despite barriers. The study applied a qualitative approach to data collection through interviews with 12 women leaders at various U.S. healthcare organizations. The findings support four recommendations for women seeking chief roles in healthcare: seeking stretch assignments, establishing support systems to help mitigate professional challenges, self-advocacy, and working for employers with systems that create a culture of inclusivity for women in leadership with strategic goals and measurements to evaluate progress.

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Asset Metadata

Creator Obioha, Anasia (author)

Core Title Secrets from the C-suite: women leaders on the bridging gap

School Rossier School of Education

Degree Doctor of Education

Degree Program Organizational Change and Leadership (On Line)

Degree Conferral Date 2023-12

Publication Date 11/28/2023

Defense Date 11/17/2023

Publisher Los Angeles, California (original), University of Southern California (original), University of Southern California. Libraries (digital)

Tag c-suite,gender bias,gender parity,healthcare,OAI-PMH Harvest,self-advocacy,social role theory,women leaders

Format theses (aat)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Datta, Monique (committee chair), Kim, Esther (committee member), Pritchard, Marcus (committee member)

Creator Email anasiaobioha@gmail.com,aobioha@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC113778572

Unique identifier UC113778572

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Legacy Identifier etd-ObiohaAnas-12497

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Rights Obioha, Anasia

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