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Prescription for change: gender barriers impact on healthcare leadership equity

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Prescription for Change: Gender Barriers Impact on Healthcare Leadership Equity
by
Allis W. Gilbert

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

August 2021

© Copyright by Allis W. Gilbert 2021
All Rights Reserved

The Committee certifies the approval of this Dissertation

Derisa Grant
Cathy Sloane Krop
Alexandra McDermott Wilcox, Committee Chair

Rossier School of Education
University of Southern California
2021

iv

Abstract
The gap in equity for women in leadership roles continues to be disparate from the representation
of women in the workforce and even greater for women in healthcare. Equity in leadership in
healthcare is driven by policies, procedures, and programs to intentionally promote and hire
women into leadership roles. This study explored drivers of leadership equity through the Clark
and Estes (2008) gap analytic framework in looking at assumed knowledge, motivation, and
organizational needs towards decreasing organizational gender barriers for women to advance
into leadership roles. This study was conducted with women in healthcare in various roles that
support a community hospital facility. A review of literature explored gender barriers through
history, and across themes that impact women’s advancement into leadership roles. The
influences were identified as either assets, partial gaps, or gaps through semi-structured
interviews. Findings revealed needs in areas of knowledge, motivation and a critical support
theme emerged from the organization as a barrier to equity. Based on these findings a set of
recommendations was provided to support both women and organizations to support aspiring
women leaders. This study serves as a first step for organizations to understand the experiences
of women aspiring to healthcare leadership and provides structured actions to improve these
experiences as well as impact the gender gap in healthcare.

v

Acknowledgments
Thank you to Dr. Alexandra Wilcox for your patience, understanding, and for teaching
me to embrace the iterative process. Thank you for your diligence and dedication to reading
every word and draft and providing exceptional feedback and guidance.
Thank you to the dissertation committee, Dr. Derisa Grant and Dr. Cathy Krop for your
invaluable insight, inspiration, and exceptional support.
Thank you to my colleagues in Cohort 13, your friendship transcends this journey and the
connections, laughs, and community that we created is an invaluable gift. As peers you have
pushed, comforted, and provided deep comradery through this experience.
Thank you to my wonderful friends and family. Your patience, grace, and unconditional
love lifted me up to achieve this goal. I greatly appreciate the moments of levity you have
brought on tough days and the cheers you shared with me at every milestone.
Thank you to Allen and Amelia, my husband and daughter. You both have sacrificed
time, and often our kitchen table for this pursuit. Your constant presence, patience,
encouragement, and unconditional love has been a pillar of strength and a light of guidance as
we walk this journey together and begin a new chapter in our collective narrative.

vi

Table of Contents
Abstract..................................................................................................................................iv
Acknowledgements................................................................................................................v
List of Tables..........................................................................................................................ix
List of Figures ........................................................................................................................xi
Chapter One: Introduction......................................................................................................1
Background of the Problem........................................................................................5
Field Context..............................................................................................................6
Global Field Goal.......................................................................................................7
Importance of Global Culture Change.......................................................................8
Description of Stakeholder Groups............................................................................9
Purpose of the Study and Questions ........................................................................10
Overview of the Conceptual and Methodological Framework..................................11
Definitions......................................................................................................12
Organization of the Project........................................................................................13
Chapter Two: Literature Review............................................................................................15
Organizational Gender Barriers Then and Now........................................................16
Getting It Right – Breaking Down Barriers...............................................................20
Continued Barriers to Women’s Leadership Advancement......................................23
Organizational Awareness and Change.....................................................................35
Clark and Estes (2008) Gap Analysis .......................................................................39
Stakeholder Knowledge, Motivation and Organizational Influences .......................40
Conceptual Framework..............................................................................................55

vii

Summary....................................................................................................................57
Chapter Three: Methodology ...............................................................................................58
Participating Stakeholders.........................................................................................58
Qualitative Data Collection and Instrumentation......................................................61
Credibility and Trustworthiness................................................................................67
Ethics.........................................................................................................................68
Summary....................................................................................................................69
Chapter Four: Results and Findings......................................................................................70
The Experiences of the Northern Healthcare Leaders ..............................................70
Results for Knowledge, Motivation, and Organizational Influences.........................72
Knowledge Influences Findings.................................................................................74
Knowledge Results Summary.....................................................................................98
Motivational Influence Findings.................................................................................98
Motivation Results Summary.....................................................................................111
Organizational Influences Findings............................................................................112
Organizational Results Summary...............................................................................126
Synthesis.....................................................................................................................127
Chapter Five: Recommendations and Discussion...................................................................130
Findings and Results....................................................................................................130
Recommendations for Practice....................................................................................131
Organizational Influence Recommendations...................................................132
Knowledge Influences Recommendations.......................................................144
Motivation Influences Recommendations........................................................146

viii

Recommendations Summary......................................................................................152
Integrated Implementation and Evaluation Plan.........................................................153
Implementation and Evaluation Framework: Kirkpatrick Evaluation Model.............153
Limitations and Delimitations.....................................................................................166
Recommendations for Future Research.......................................................................167
Conclusion...................................................................................................................168
References...............................................................................................................................171
Appendix A...............................................................................................................................I
Appendix B...............................................................................................................................VI
Appendix C ..............................................................................................................................IX
Appendix D...............................................................................................................................X
Appendix E...............................................................................................................................XIII
Appendix F...............................................................................................................................XVI

ix

List of Tables
Table 1: Knowledge Influences, Types, and Influences Assessment ....................................46
Table 2: Motivational Influences and Assessment.................................................................50
Table 3: Organizational Influences and Assessment..............................................................55
Table 4: Stakeholder Demographics.......................................................................................60
Table 5: Primary Interview Questions....................................................................................63
Table 6: Observations Table...................................................................................................66
Table 7: Asset Determination Thresholds..............................................................................73
Table 8: Summary of Presumed Knowledge Needs and Results...........................................75
Table 9: Awareness of Organizational Gender Barriers........................................................77
Table 10: Overview of Women Directors’ Response to Conceptual Knowledge.................78
Themes
Table 11: Behavioral Changes for Gender Role Expectations.......................................................80
Table 12: Summary of Women Directors’ Response to Procedural......................................84
Knowledge Factor

Table 13: Responses regarding leveraged support systems ............................................................92
Table 14: Summary of Women Directors’ Response to Metacognitive......................................93
Knowledge Factors
Table 15: Summary of Presumed Motivational Needs and Results......................................102
Table 16: Summary of Stakeholders’ Response to Expectancy Outcome............................106
Motivational Factors
Table 17: Summary of Stakeholders’ Response to Self-Efficacy.........................................107
Motivational Factors
Table 18: Summary of Presumed Organizational Needs and Evaluation Results.................113
Table 19: Stakeholders Statements of Fear and Job Risk..............................................................116
Table 20: Culture Setting: Gender Inclusion – Best practices measures.....................................117

x

Table 21: Stakeholders Statements of Job Support Needs....................................................118
Table 22: Comparison of Informal Mentorship and Peer Group/Coach Goals.........................120
Table 23: Stakeholder Statements of Peer Group Needs.......................................................123
.
Table 24: Summary of Stakeholders Organizations Hiring and Promotional Factors...........124
Table 25: Summary of all Needs and Influences Results.............................................................129
Table 26: Summary of Organizational Needs and Recommendations.....................................135
Table 27: Stakeholders Mentorship / Peer Group Engagement Needs...................................140
Table 28: Summary of Knowledge Needs and Recommendations.........................................144
Table 29: Summary of Motivation Needs and Recommendations..........................................147
Table 30: Key Summary of Recommendations.......................................................................152
Table 31: Implementation Plan Table ......................................................................................155
Table 32: Level 4 Outcomes, Metrics, and Methods for Internal and......................................158
External Outcomes
Table 33: Critical Behaviors, Success Measures and Methods of Data Collection..................160
Table 34: Required Drivers to Support and Monitor Critical Behaviors....................................161
Table 35: Evaluation of the Learning Components for the Program..........................................165

xi

List of Figures
Figure 1: Conceptual Framework of Knowledge, Motivation, and Organizational..............56
Influences
Figure 2: Support Model........................................................................................................87
Figure 3: Illustration of Expectancy Outcome Theory for Stakeholder Motivation.............99
Figure 4: Illustration of Self-Efficacy Theory for Stakeholder Motivation..........................99
Figure 5: Organizational Needs for a Supportive Leadership Culture..................................133
Figure 6: Organizational Culture Assessment Instrument.....................................................136
Figure 7: Talent Management Map.......................................................................................143
Figure 8: Locke and Latham (1990) SMART Goal Setting Theory.....................................149
Figure 9: Performance Feedback Loop.................................................................................151

Figure 10: The New World Kirkpatrick Model....................................................................154

1

Chapter One: Introduction
The Department of Labor reports women constitute 51% of the national workforce, yet
represent only 6% of executive leadership, and 15% of board chair positions of Fortune 500
companies (Beeson & Valerio, 2012; Hill, 2016; O’Neil et al., 2015; Walker & Aritz, 2015).
This national trend transcends into the healthcare field as well with women representing 80% of
the workforce yet hold fewer than 20% of the senior leadership positions (U.S. Department of
Labor Statistics, 2019). Notably, women lead only 19% of hospitals, and 4% of healthcare
company CEOs are women (Bell, 2018), and are 52% less likely to be promoted into leadership
roles in healthcare (Diversity Best Practices, 2016). The problem of practice addressed in this
study is the impact of organizational gender barriers on women’s leadership advancement in the
healthcare sector. Specifically, organizational gender barriers refer to gender role expectations,
gender biased hiring, promotional practices, talent development, and organizational culture.
(Aisenbrey et al., 2009; Carrison, 2018; Collay & Cooper, 2008; Cook & Glass, 2014; Ely et al.,
2011; Ewoh, 2013; Hartman & Barber, 2020; Hoyt & Burnette, 2013; Hoyt & Murphy, 2016;
Lee & Huang, 2018; McDonagh, 2012; O’Neil et al, 2015 ; Ryan & Haslam, 2005; Welsh et al.,
2017).
The evolution of gender discrimination over the past sixty years has developed into
systemic organizational gender barriers which prevent women from advancing in their careers.
According to O’Neil et al. (2015) organizational gender barriers are the organizational policies,
practices, and structures that fuel the disadvantages women encounter in organizations and can
take many forms. For the purpose of this study gender role expectations and gender bias,
promotion and hiring practices, and healthcare organizations culture of healthcare (Loden, 1987;
Mitchell & Martin, 2018; Mulac et al., 1985; Todd, 2019). Bias is prevalent in evaluative
2

performance, promotion and compensation practices, as well as in hiring criteria (Hoyt, 2010;
Roberts & Brown, 2019; Beeson & Valerio, 2012).
For this study the analysis is from the perspective of the researcher. The researcher
identifies as cisgender female, feminine, heterosexual, white, currently able-bodied, Christian,
and a woman veteran. As a woman who has held numerous leadership roles the researcher brings
to the study a perspective of overcoming gender barriers along with the emotional toll of those
that could not be overcome or were detrimental to the researcher’s career growth. While the
majority of literature does not specify race in the studies, the researcher's perspective as a white
woman is the lens with which the literature is evaluated and developed for this study. This
perspective is identified because this lens is not inclusive of all women and it is important to note
that this is the initial perspective of the organizational gender barriers impact on women in the
Northern Colorado geographical region, where this study takes place. The researcher tried to put
themselves in the role of the interviewee and what risks may impact their roles, careers, and
associations. The framing of the study was from the perspective of a women leader who has
achieved a director-level role. Understanding the personal experiences of the researcher that was
developed through their familiarities surrounding this topic helped to develop the study and
established credibility with the stakeholders. Shared experiences provided safety and bonding but
also a challenge the researcher had to navigate to ensure impartiality. Interpreting findings with
shared reflections of the researcher’s background, gender, culture, and history helped to clarify
biases related to the stakeholders and was also communicated through the outcomes of the study
(Creswell & Creswell, 2018). Sharing similar career roles provided safety for the stakeholders
along with the management of the information and questions.
3

This study is rooted in a specific geographical region, Northern Colorado. Northern
Colorado is defined as a two-county region of Larimer and Weld counties, which is north of
Denver and is referred to as the “front range”. In this context, due to the limited racial and ethnic
diversity (85% White not Latinx, less than 4% BIPOC, 11% Latinx) in the region of Northern
Colorado, the women represented by the study and in the healthcare field are white women
(United States Census Bureau, 2020). This definition is not the sole perspective of the literature
for this study, but this study does recognize that the population is limited, and it is not the intent
for this study to represent all women collectively. This study recognizes that this is a narrow
perspective and not inclusive to women of color or women of varying identities as stakeholders
of the study. This study also recognizes that the gender related barriers are many times more
severe for women of color. This study does not intend to minimize their experiences or
generalize the experience of white women for all women.
The experiences of many women (e.g., women of color, women who identify as part of
the LGBTQIA+ community) confronting organizational gender barriers is not intended to fit into
the perspective of a white woman and this initial perspective is intended to provide an
understanding of systemic organizational gender barriers that influence organizations in this
region. As an incredibly complex issue, gender barriers impact women in unique ways and the
identity of this study group is not intended to apply to all women and their individual identities.
Each woman experiences leadership from their own lens and worldview including the
intersectionality of values, and beliefs that may be informed by their salient identities; including
but not limited to race, ethnicity, gender, ability, religion, age, and sex (Crenshaw, 1989). The
women in this study, the researcher, and the literature are a sample of women in the geographical
region of Northern Colorado only. In the future, as discussed in greater depth in Chapter 5, the
4

study should expand to include women of varying identities to develop an inclusive perspective
of gender barriers and the intersection of race, gender identities, ability, age, and sex and the
impact on leadership advancement.
For this study in Northern Colorado the participants demographic data was not collected.
The only requirement for the study was that the participants identify as women leaders and have
achieved the level of manager or director. Additional research and collection of demographic
data is needed to understand the experiences of women of varying identities.
While there are many definitions of leadership, in this context, leadership means director
level or higher positions which impose organizational influence to maximize the efforts of
others, towards the achievement of a goal (Kruse, 2015). Within organizations a lack of gender
equality, when considered on the male or female gender spectrum, among leadership roles begins
before the director level and is set in motion at the beginning of a woman’s career (Bloomenthal,
2020; Carter & Silva, 2010).
This problem is critical to address because organizational gender-related barriers take
many forms, and if left unaddressed will significantly compound the gender gap and decrease the
likelihood of women’s leadership advancement to senior leadership roles (Ellmann & Warner,
2018). Notably, the gender disparity has reached a tipping point in 2020 in the healthcare sector,
in particular. With women representing 80% of this community service workforce, the
expectations of women continue to increase during the COVID-19 pandemic; however little
research has yet to be concluded on the impact of gender and the expectations of women during
and post pandemic (Association of American Medical Colleges, 2020). The Association of
American Medical Colleges (2020) estimated the pandemic has created an additional 8.5 hours a
week of work in and out of the home for women compared to men.
5

Background of the Problem
The focus of this review is on organizational gender barriers women in Northern
Colorado face throughout their careers in healthcare. The research indicates leadership
expectations in the United States primarily align with masculine values of leadership; these
values commonly emerge through pay inequity, organizational policies of performance
management, and hiring practices (Auspurg et al., 2017; Beeson & Valerio, 2012; Buse &
Bilimoria, 2014). These practices result in a 70% selection rate of men over women for senior
leadership roles, typically director level or higher (Saseanu, 2014; Walker & Aritz, 2015).
Masculine values appear at the beginning of the hiring process with the descriptive words to
determine the characteristics of positions; on average, of the 92 terms used to describe the skills
and behaviors for success in a role, 60 are descriptors align with a masculine gender stereotype
(Sabharwal, 2013). Additionally, studies indicate organizations are 30% more likely to select
women for leadership positions who display culturally masculine characteristics such as
autonomy, task orientation, and direct communication (Dresden et al., 2018; Walker & Aritz,
2015).
Emerging literature indicates a need for evaluation and change in hiring and promotional
practices to reduce gender bias. A key focus is understanding organizational gender barriers in
organizational tools, such as performance practices. In performance management women
contend with gender-biasing in their performance evaluations, known as a gender penalty (Solal
& Snellman, 2019). In an archival field study of 400 evaluations, gender penalties are evident in
comparison performance evaluations where men score, on average, 19% higher than their
women peers (Lee & Huang, 2018). In identical roles, 105 evaluations were conducted through
observation of the evaluated leaders. In this study organizational practices focused on job role
6

evaluations, also known as performance management, favored men as more influential leaders
leading to 65% of the study’s promotional selections (Lee & Huang, 2018).
While organizations initiate efforts to recognize bias and implement programs addressing
this problem, trends continue to demonstrate a preference of men over women in leadership
(Rivera & Tilcsik, 2019). Diversity Best Practices (2018) supports outcomes related to healthcare
organizations specifically targeting gender gaps and a focus on diversity programs. Additionally,
programs aimed at inclusion practices, when successful, are likely to achieve “supportive action
initiatives” (Jonsen et al., 2010, p. 557). These practices are strategic mentorship programs, cross
departmental equity programs, equal pay initiatives, or equitable promotion and hiring practices
(Jonsen et al., 2010). Successful programs result in an increase in gender diversity at all levels of
leadership. While 88% of healthcare companies report to American Medical Association
Colleges (2020) having gender inclusion initiatives, the leadership demographics remain
primarily male (Barry, 2018). When women remain underrepresented in healthcare leadership
positions, women’s experiences and perspectives are overlooked as part of the healthcare field.
This issue impacts an organization's ability to support women’s career advancement and ensure
equity in career progression. Each woman who chooses to pursue a leadership role in healthcare
holds valuable insights into the practices that perpetuate gender bias, and their experiences can
potentially reduce the gender gap.
Field Context
While women continue to make gains in the leadership positions, representation of
women in senior or executive leadership roles remains unequal (Smith, 2014). The field of focus
for this study includes Northern Colorado women leaders in the healthcare sector who are
directors and seek to pursue higher levels of leadership into senior director or higher roles.
7

Aspiring women leaders, currently directors, are the focus group to discuss their experiences
confronting organizational gender barriers in their career growth, identifying organizational
policies and practices, and support structures that intersect with gender diversity among
leadership levels. The study evaluates the experiences of Northern Colorado women, how these
women progress into director level leadership roles, and what they need to overcome in their
organizations to become a senior leader in the healthcare field.
Global Field Goal
By January 2025, healthcare organizations will identify and leverage practices to identify
and reduce organizational gender barriers. Identifying and reducing organizational gender
barriers will support the development of aspiring women leaders and increase equitable
representation of women in leadership roles year over year. Giscombe (2011) details the attempts
of diversity and inclusion programs which impact organizational gender barriers, yet
organizations are still failing to bridge the gender gap in senior leadership roles. A 2011 Catalyst
report considers a lack of mentorship, informal networking, organizational culture, challenges in
navigating the processes of the organization and talent development as major influences on
aspiring women’s ability to overcome gender barriers to achieve their leadership goals.
Healthcare delivery systems and awareness of organizational gender barriers to aspiring women's
advancement is obtained through understanding the experiences of the women who aspire to
senior leadership roles. Women currently in director roles in healthcare may identify
organizational barriers they have encountered and continue to encounter and may influence the
implementation of best practice initiatives, policies, and programs to support organizations
efforts to understand and decrease gender barriers inherent in their hiring practices, evaluations
methods and promotional processes.
8

Importance of Global Culture Change
It is essential to address organizational gender barriers to decrease the gender gap in
healthcare leadership. Notably, diversity among health leaders is understood to improve the
performance of organizations, including outcomes for hospitals and healthcare companies
(Carrison, 2018; Loden, 1987; Todd, 2019). Identifying known and unknown gender biases that
impact women seeking advancement opportunities within healthcare entities impacts the overall
organizational culture. Organizational culture is a shared set of beliefs, values, principals, and
attitudes, which determines the approach to address barriers (Hofstede, 1980; Ritter 2004). It is
through the organizational culture that policies, programs, and efforts collectively address the
gender gap. Progress in closing the gap through organizational change is slow as evidenced by
only 18% of healthcare organizations reporting women in senior leadership roles (Hauser, 2014;
McDonagh et al., 2014). Failure to close the gap will continue to degrade women's ability to
contribute to the direction of global health and influence the growth and sustainability of health
service organizations.
Studies show that while there is growth in women's promotion to leadership roles in
various industries, the vast majority of these promotions occur during an organizational crisis,
known as the glass cliff (Carrison, 2018; Cook & Glass, 2014; Dishman, 2018; Sabharwal,
2013). As women take on the leadership of organizations in crisis, they are evaluated with
greater scrutiny resulting in disproportionate failures of women leaders (Hoyt & Burnette, 2013).
The perpetuation of glass cliff promotions reduces an organization’s effectiveness and
profitability continuing the barriers that impact women's advancement opportunities.

9

Description of Stakeholder Groups
Several stakeholder groups impact organizational gender barriers of women’s
advancement to leadership. Primary groups in this field study include organizational leaders,
chairpersons, board members, and aspiring women leaders.
● Organizational leaders and board chairpersons determine the organizational goals
and influence the culture that determines the willingness of an organization to
address the organizational gender barriers.
● Human resource leaders influence and implement policies and procedures for
hiring, promotions and pay equity.
● Women leaders who currently hold or have recently held titles or positions as
manager or directors, and in their leadership roles, navigate organizational gender
barriers.
Stakeholder Group of Focus for the Study
While all stakeholders contribute to reducing organizational gender barriers for women in
leadership in healthcare, aspiring women leaders who reside in Northern Colorado and who have
advanced to a director role with ambitions of senior leadership are the stakeholder of focus for
this study. This stakeholder group was identified because the women have overcome initial
barriers to advance to a leadership role, yet they have not advanced to senior leadership roles.
The literature suggests they have experienced gender barriers within their organization to
advance to a director level and understanding of these barriers may support organizations to
decrease barriers for more women to advance as well as this stakeholder group to advance to
senior levels. An in-depth analysis of the experiences of women who seek to aspire to higher
10

level leadership positions is critical to identifying organizational gender barriers. As women
progress into influential leadership roles, their experiences throughout their careers may help
develop organizational policies to help women overcome organizational barriers in order to help
them advance in their careers and improve gender equity in leadership roles. Developing
knowledge of women's experiences throughout their careers and in leadership positions informs
decision-making stakeholders as they contemplate policies, procedures, or programs. The women
who have encountered and possibly overcame barriers provide a critical perspective to
identifying and addressing organizational gender barriers that are systemic across various
industries. Organizations’ failure to identify inherent organizational gender barriers will continue
to widen the gender gap across organizations (Giscombe, 2011). Unaddressed organizational
gender barriers will perpetuate the widening of the gender gap and decrease the likelihood of
women entering leadership roles successfully. Therefore, the stakeholder goal is that by 2025,
aspiring women leaders will advance to the leadership roles to which they aspire.
Purpose of the Study and Questions
The purpose of this project is to explore the barriers that women encounter as they
progress through their careers and advance to manager and director leadership roles. While a
complete evaluation would focus on all stakeholders, for practical purposes, the stakeholder of
focus is aspiring women leaders (manager or director level) who reside in Northern Colorado and
who are employed in the Healthcare field. The analysis will focus on the knowledge/skills,
motivation, and organizational resources that influence the equitable advancement of women
within their organizations. The questions that guide the focus of the study are as follows:
1. What are the knowledge and motivation influences related to the organizational
gender barriers that impact women in the advancement of their careers?
11

2. What is the interaction between organizational culture and context and women's
knowledge and motivation as it relates to the organizational gender barriers that
impact them in the advancement of their careers?
3. What are the knowledge, motivation, and organizational recommendations to
overcome organizational gender barriers?
Overview of the Conceptual and Methodological Framework
As a qualitative study crafted from the gap analysis framework of Clark and Estes (2008),
this study focused on identifying organizational gender barriers and offers a problem-solving
approach to providing evidence-based recommendations regarding opportunities for women to
advance equitably in organizations. Clark and Estes (2008) address three key areas: knowledge,
motivation, and organizational needs. Each impact how the stakeholder group, aspiring women
leaders, impart their experience to initiate change in future organizations. Evaluation of the
conceptual model begins with knowledge and skills, or whether women know how to achieve
their goal of a leadership position within their organization or a position for which they are
interviewing. The next component of evaluation is motivation, which applies to women’s desire
to seek leadership and continue to strive for this set goal in the face of barriers. The last
component of the Clark and Estes (2008) KMO model are the organizational barriers, referring
to the processes and procedures in place that explicitly or inadvertently impact women’s
advancement options. All three aspects work together and build from one another. Ultimately,
women may possess the knowledge and skills and motivation to advance into leadership yet are
stifled due to the organizational barriers (Clark & Estes, 2008; Hoyt, 2010; Hoyt & Burnette,
2013). Evaluation of organizational gender barriers were examined during interviews and
analyzed to identify organizational gender barriers that are critical to address within
12

organizations to increase aspiring women’s leadership opportunities. Incorporating the
experiences of these women and what knowledge and motivation they needed to rely on to
overcome the organizational gender barriers they experienced in their healthcare field may
inform policies and procedures to reduce organizational barriers.
Definitions
Leadership: is a manager, director or higher-level positions in a healthcare organization who can
impact the policies, programs, and procedures of the organization (Hauser, 2014).
Gender Penalty: gender-biased performance evaluation (Solal & Snellman, 2019).
Organizational Culture: the foundation for which organizations develop formal policies, formal
and informal procedures, and the social network of the operations (Kossek et al., 2017).
Women: people who identify as women on the social, economic, political and cultural aspects of
the gender spectrum; the gender spectrum is used instead of identifying physical sex (John
Hopkins University, n.d.).
Stakeholders: individuals who identify as women, as indicated in the study requirements and
who were interviewed for this study, additional demographic data was not collected particularly
about their race or ethnicity, or if they are cis-gendered.
Healthcare: the organized provision of medical care to individuals or a community through acute
care, emergency care, hospital, outpatient, behavioral health facilities (Association of American
Medical Colleges, 2020).
Glass cliff: promotion of women to senior leadership roles, C-Suite, when an organization is
failing or struggling due to ethical, financial, stock, or other corporate failings
(Ryan & Haslam, 2005).

13

Masculine traits: refers to the cultural expectations of men in leadership regularly using defining
terms of; non emotionally, decisive, aggressive, assertive, self-reliant, independent, dominant,
ambitious (Sabharwal, 2013).
Feminine trait: refers to the cultural expectations of women in leadership regularly using
defining terms of; gentle, kind, agreeable, empathetic, nurturing, sensitive, helpful (Sabharwal,
2013).
Gender barriers: are the organizational policies, practices, and structures that fuel the
disadvantages women encounter in organizations include gender role expectations and gender
biased, promotion and hiring practices, and organizational culture (Loden, 1987).
Gender bias: the attitude and expectations of a person’s ability, and performance based on their
gender, typically a negative expectation (Hoyt & Burnette, 2013).
Organization of the Project
As part of the five-chapter organization of this study, Chapter One provides the reader
with the key concepts and terminology commonly used in the discussion of the advancement of
women in leadership roles, along with the introduction of the global goal, stakeholders, and
framework for the project. Chapter Two provides a review of the literature surrounding the scope
of the study and addressing topics of role expectations, inclusion policies, procedures, and
programs, and evaluation tools for women leaders. Chapter Two presents the knowledge,
motivational, and organizational influences that impact organizational gender barriers throughout
healthcare organizations. Chapter Three details the methodology for choosing stakeholders, data
collection, and analysis of women's experiences to evaluate organizational gender barriers they
encountered in their careers. Chapter Four provides the data and the assessment of women who
have encountered and overcome organizational gender barriers to achieve a senior leadership
14

role. Lastly, Chapter Five provides recommendations for healthcare organizations to identify
organizational gender barriers within their organization and best practices to decrease
organizational gender barriers and support women's advancement.

15

Chapter Two: Review of The Literature
This chapter reviews the literature on organizational gender barriers for women’s
advancement, historical legislation, and organizational awareness to enact change, along with
how these issues relate to knowledge, motivation, and organizational needs to address systemic
change to reduce barriers for women’s advancement to leadership. This review begins with the
historical evolution of gender integration and equity through legislative efforts in the workplace,
aimed to solidify and enhance women’s labor equity. Additionally, an evaluation of barriers that
continue to challenge women’s advancement and the organizational gender barriers that
organizations attempt to address through DEI practices informs the perspective of the literature
regarding women-owned or led businesses. While legislative history illustrates the progress
made in addressing a limited perspective of women’s integration in the workforce, continued
barriers prevent leadership equality. The integration measures historically did not specifically
address women of color or transgender women. The literature does not indicate if it is
representative of specifically white women, and it is difficult to discern if the literature is applied
across all women or specific groups of women. Barriers that are rooted in gender role
expectations and biased evaluative processes are vital influences on continued limitations.
Finally, a review of organizational awareness of organizational gender barriers, promotion
practices, and change efforts highlight the knowledge and attempts to reduce and eliminate
barriers to women’s advancement. The Clark and Estes (2008) Gap Analysis Conceptual
Framework is utilized as a model to identify the knowledge, motivation, and organizational
influences that support the reduction of organizational gender barriers towards equitable gender
leadership.

16

Organizational Gender Barriers Then and Now
Women have challenged gender barriers in healthcare since 1849 when the first woman
was awarded a Doctor of Medicine degree (Wiener, 2020). Since then, women have come to
represent 80% of the healthcare workforce (Bell & Melford, 2018). Yet, only 18% of the
healthcare organizations report women as CEOs illustrating the inequity in senior leadership
levels (Hauser, 2014; McDonagh et al., 2014). This inequity is even more pronounced in the
healthcare companies on the Fortune 500 list; 4% have women leaders, which is equal to one-
woman CEO (Bell & Melford, 2018). Over the past 48 years, organizations have developed
programs, policies, and initiatives to address the diversity, equity, and inclusion shortcomings
(DEI) of women in leadership roles. DEI policies and procedures help to create the framework
for organizations to develop equity amongst the employees and leadership. Yet, an average of
78% of healthcare companies have DEI policies and procedures, calling into question why these
processes are not producing more women in leadership roles (Donnelly, 2017). Companies that
invest in diverse leadership and policies prove to have high rates of return and a more robust
bottom line (Dreher, 2003; Elias, 2018). Reducing and eliminating gender-based barriers to
women in leadership is critical to support organizational financial growth and increase available
advancement options for women throughout their careers. Women who break through the glass
ceiling, a term first coined in 1978 by Marilyn Loden to signify an invisible barrier keeping
women and minorities from advancing to managerial and higher-level roles, are proven to lead
companies to substantial financial outcomes and have higher rates of employee retention (Ewoh,
2013; Loden, 1987; Saseanu, 2014). Organizations operationalize diversity practices through an
intentional commitment to narrowing the gender gap through support programs and policies
17

leading to women in the top leadership roles (Beeson & Valerio, 2012; Elias, 2018; Ewoh, 2013;
Crystal Hoyt, 2010; O’Neil et al., 2015).
Historical Perspective and Legislation
A historical review of American diversity policies, executive orders, and laws begin with
a study anti-discrimination law and executive orders that date back to 1941. President Franklin
D. Roosevelt signed the first executive order, Executive Order 8802, barring discrimination in
hiring practices based on race. However, President John F. Kennedy's 1963 Equal Pay Act was
the first to address equity for women in the workplace (EEOC, n.d). Additionally, Lyndon B.
Johnson's Executive Order of 1967 added sex to the anti-discrimination protected categories
(Kelly & Dobbin, 1998). Anti-discrimination policies evolved to Equal Employment Opportunity
(EEO) policies in the early 1970s, focusing on legal compliance and establishing policies,
grievance procedures, and internal dispute recommendation (Ewoh, 2013). These policies led to
the establishment of Affirmative Action (AA) in the 1980s; AA moved the focus from legal
compliance and policy to focus on historical inequities of marginalized populations. AA efforts
focused on moving people of color and women into the organizational and promotion pipelines
through recruitment programs, mentorship, and training (Smith, 2014). Ewoh (2013) compares
EEO and AA to the shift for diversity programs, as seen through human resources teams' policies
and a focus on inclusivity and respect of differences.
Executive Orders encouraged employers to implement changes in hiring, training, and
promotion of marginalized people. Yet, the 1970s saw only an average of 4% of employers
developing an AA office and less than 20% adopting EEO/AA policies (Kelly & Dobbin, 1998).
Policy implementation doubled by 1980 to 40%, reaching 60% policy implementation by 2019
(Donnelly, 2017). Throughout the following decades, political and organizational strides
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increased the number of women in the workforce and managerial roles leading to the first CEO
of a Fortune 500 company in 1972. Companies report a steady increase of women leaders
plateauing at 63 women in leadership by 2020 (Progress in Action, n.d.). The Bureau of National
Affairs set a goal to reach a "balanced labor force," but with no date to achieve it. Current
literature indicates the workforce remains substantially unbalanced, with 96% of the senior
hospital leadership represented by men. Current trends reflect equity numbers of the 1970s, with
18% of healthcare companies reporting diversity employment rates, the vast majority of
companies maintaining homogeneous leadership throughout the corporate board and top
leadership levels (McDonagh et al., 2014; Vanderbroeck & Wasserfallen, 2017).
With women in leadership positions growing to just under 5% the phrase "glass ceiling"
was coined in 1978; it was added to the dictionary in 1993 and became a commonly used phrase
to describe the invisible barrier women face in reaching senior leadership levels (Loden, 1987;
Vargas, 2018).
As legislation has changed so has the roles women hold in the healthcare sector. While
Elizabeth Blackwell, MD was the first woman granted a Doctor of Medicine degree in 1849
(Weiner 2020). Fifteen years later, Rebecca Lee Crumpler, MD became the first African
American to graduate from New England Female Medicine College (Weiner, 2020). As women
began to expand their roles in the healthcare facilities, healthcare leadership continued to remain
male centric, it was not until 1993 that the first woman was appointed the surgeon general,
leading the nations policies on healthcare. In over 171 years of women working in the healthcare
sector it took 156 years for the first woman, Susan Salka, to be appointed as the CEO of a large
healthcare system in 2005 (Hawkins, 2021). While women’s roles have expanded, their
representation in leadership has not, with only 13% of department chairs being women (Roth et
19

al., 2016). The hierarchy and historical nature of the practice of medicine has perpetuated gender
barriers and bias for over 170 years (Roth et al., 2016).
Greater Differences of Gender Equity Law
Addressing the historical context of women in the workforce is ongoing. Inclusion of
women historically focused on heterosexual cis-gendered women. It was not until the 2020
Supreme Court ruling that discrimination based on gender identity was ruled to be included in
the Civil Rights Act of 1964. President Biden reaffirmed this ruling in a 2021 Executive Order
on Preventing and Combating Discrimination on the Basis of Gender Identity or Sexual
Orientation (Department of Labor, n.d.). Organizations, such as the Department of Labor (DOL),
have enacted policies to support people to express their gender identity openly, and specifically
create policies to support anti-discrimination for people who identify as transgender, femme,
masc., or non-binary along with protecting people who do not prescribe to a preconceived notion
of a particular gender. The Federal Office of Personal Management further provides protection to
transgender individuals and prohibits discrimination based on gender identity. Prior to this ruling
a 2015 survey by the DOL indicates 77% of federal employees took actions to conceal their
gender identity to avoid mistreatment in the workplace.
The 2020 ruling was predated by a district court ruling, Prince Waterhouse v. Hopkins
(1989). This ruling set the standard for discrimination based on gender role expectations.
Hopkins (2005) describes her experience of the legal process and her fight for equity against
gender discrimination. Hopkins brought forth experiences of gender discrimination after she was
denied partnership in her accounting firm for “not looking feminine enough” and “too strong in
her voice”, along with voting comments surrounding her attire. This landmark lawsuit shed light
20

on gender roles and discrimination of people who do not act or look like the culturally prescribed
versions of men or women.
As of April 2021, there are two areas, federally funded program and public spaces and
services, of civil rights law that still do not address sex-discrimination on the basis of gender
identity, sexual orientation, and sex. The protection areas the Equality Act aims to include are
education, housing, credit, public spaces and services, federally funded programs, and jury
service. The Equality Act currently under consideration in the United States Congress would
update the civil rights laws to strengthen anti-discrimination laws (Human Rights Campaign,
2021).
Getting It Right - Breaking Down Barriers
Companies that include women in their leadership teams report significant influence on
policy development to support women in leadership and increase the professional growth of
women throughout their careers. Additionally, different studies provide data to support improved
outcomes of women in leadership. Buse and Bilimoria (2014) conducted a mixed methods study
of qualitative interviews of 495 women in leadership roles, followed by an analysis of narratives
and found women in leadership are proven to increase the organizational bottom line from 30%-
180% in some situations. While 180% is an extreme outcome for shareholders, women are
regularly called on to deliver turnaround results for cooperation needing a kickstart change.
According to Carrison’s (2018) qualitative study of over 21,980 companies, those who had 30%
of their leadership roles filled by women saw a 6% increase in revenue compared to those who
did not have women in leadership roles. Increased revenue and shareholdings are a byproduct
and indicator of leadership success (Buse & Bilimoria, 2014; Todd, 2019).
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Organizations with women in leadership roles report a higher number of new policies and
programs developed and implemented that support women's advancement. The Diversity Best
Practices Report (2017) lists three Fortune 500 pharmaceutical companies; of the three led by
women, one is led by a woman of color.. These three organizations are listed as best places to
work, for their focus on critical initiatives that support women's advancement, such as
mentorship, focus groups, supportive policies for family care and leave, and published diversity
numbers (Diversity Best Practices, 2017). Transparency in organizational cultures challenges the
corporate norms that support historical gender roles. Publishing diversity rates, pay scales, and
equity initiatives promote the organization's culture and attract influential leaders dedicated to
advancing gender equity across industries (Jonsen et al., 2010).
Diversity, Equity and Inclusion Policies and Programs to Support Women
While anti-discrimination laws have been in existence in the United States since 1961,
their evolution to DEI policies and practices has taken about fifty years. While DEI covers more
than gender gaps, women's advancement will be the focus of this evaluation. As companies look
to remain profitable and sustainable in today's economy, a commitment to develop their
workforce to represent the populous is essential. Using a global survey tool capturing 25,000
responses the Boston Consulting Group (2017) concluded that 98% of companies have a
diversity program. However, according to a survey of nearly 22,000 public companies one-third
of global companies have zero women in their senior leadership positions (Saler, 2018). This is
represented in a smaller survey by the American Hospital Association (2017) of 200 health
systems in the United States where only 4% of healthcare CEOs have a woman as the chief
executive officer. While companies include diversity programs in company policies, operational
practices do not ensure women's advancement to leadership levels.
22

As companies began to develop DEI initiatives, mentorship and women’s networking
programs worked to bring women together as well. Programs such as Catalyst and Women’s
Foundation mission focus on uniting women and providing resources for them to develop
leadership skills and begin to push against the glass ceiling (Working for Change. (n.d). Efforts
by Kossek et al. (2017) to determine the key factors through a multilevel phenomenological
evaluation study, discuss the impact women’s gender integration and equity focus have on key
components for all DEI programs. By evaluating the specific needs of women within the
organizations and this study, of over 500,000 survey respondents, Kossek et al. (2017)
recommends three dimensions of support; fairly implemented inclusion practices, inclusion in
decision making, and integration of differences. As prescribed by Kossek et al., (2017) programs
that focus on supporting the needs of women are more successful in retaining women into
leadership and developing women within a company that invests in the priorities that women in
their organization value.
Impact of Women Led Organizations
Healthcare companies where women hold key senior leadership positions report
increased patient outcomes and higher retention rates; in 2017, those organizations reported
earnings 226% higher than their male-led competitors (Diversity Best Practices, 2017).
While the most visible outcome of women in leadership is the bottom-line, women also
make a substantial impact on culture and the reputation of the organization. Companies that
promote women into leadership roles make a statement for inclusivity and diversity to national
and international competitors (McDonagh, 2012). A study observing 12 women-led
organizations through longitudinal panel data resulted in 144 observations from 1983 to 2011
over four years concluded women-led organizations are less susceptible to the "groupthink"
23

phenomenon, allowing for greater creativity and opportunities to take risks (Smith, 2014).
Additionally, through an evaluation of ten inclusion methods to incorporate women in
leadership, Ewoh (2013) determined a gender balanced decision-making group likely supports
women's advancement and leads to greater corporate responsibility and a commitment to
diversity.
Modern Healthcare reports in 2019, women-led healthcare organizations saw an increase
in retention and satisfaction among physicians, nurses, technologists, administration, and
frontline staff. Additionally, organizations who report women in the C-suite are ranked in the top
25 national healthcare systems listed by Modern Healthcare (2019). Satisfaction and retention
support a healthy bottom line as well. A 2015 qualitative study by Roth et al., (2015) of 279
organizations, reported that women in healthcare leadership roles in 70 organizations
outperformed the other three-quarters of the organizations by 41% along with an increase in
productivity by 56%. Through an inductive approach Roth examined the subjective leadership
experiences perceptions of women in healthcare leadership roles. This study seeks to examine
how to increase women in leadership roles in healthcare and focuses on 844 leadership roles of
which 30% are women and only 13% are department heads or chair positions (Roth et al., 2015).
Continued Barriers to Women’s Leadership Advancement
Since the first woman promoted to the CEO position of a Fortune 500 company was in
1973, women have made only marginal growth gains into leadership roles across industries
averaging two percentage points of growth over ten years (Ellmann & Warner, 2018). The lack
of substantial growth in leadership in corporate environments does not match the educational
outputs of women who continue to outpace men in graduation rates (Dresden et al., 2018). The
impact of systemic organizational gender barriers continues to stifle women's advancement even
24

with more women than men entering the workforce with advanced degrees (Dresden et al.,
2018). While numerous barriers exist hindering women from advancing into leadership, two
primary gender-related challenges are prevalent in the literature; gender role expectations and
biased evaluative processes (Biernat et al., 2010; Carrasco et al., 2014; Diekman & Eagly, 2000;
Elias, 2018; Hoyt, 2010; Kawakami et al., 2000). Gender is woven into the expectations of
employee’s behavior and performance as examined by Biernat et al., (2010) over three studies
focused on gender behaviors and expectations. After completion of the second study Biernat et
al., (2010) repeated the study to verify the results. The surveys of 332 participants concluded
gender impacts the promotions, programs to support professional development, and policies that
represent the organizational culture (Biernat et al., 2010). As organizations continue to develop
programs, their focus begins with understanding the societal role expectations of women and
how expectations impact women's hiring and promotions, and women's experience once in the
leadership role (Diekman & Eagly, 2000; Dresden, et al., 2018; Ely et al., 2011).
Gender Biases Impact on Expectations of Leadership
When exploring gender roles and bias, it is essential to discuss the definition of gender
bias and gender roles as well as traditional views as a basis of evaluation. Gender roles are
defined as what is desirable for each sex, taking on descriptive (what is actually) and prescriptive
or injunctive (what ought to be ideal) norms (Ritter & Yoder, 2004). The gender stereotype
theory defines traditional gender view as a relatively enduring characteristic encompassing traits,
appearances, interests, and behaviors that have traditionally been considered more typical of
women and men (Kachel et al., 2016). When these expectations are applied to leadership
qualities gender bias, or a preference or prejudice toward one gender over the other, may
25

manifest as conscious or unconscious and both subtle and overt (Dresden et al., 2018; Hill, 2016;
Hoyt & Burnette, 2013; Lee & Huang, 2018; Roberts & Brown, 2019).
Violating Gender Norms and the Fall Out
As women navigate through their careers they may experience abject appearance
backlash, defined as the simultaneous distaste and intrigue women experience from other women
(Mavin & Grandy, 2016). Mavin and Grandy (2016) explain the positions of formal power
women may hold yet are marginalized because their feminine bodies are out of place in the
masculine role they hold. Eight-one women of various backgrounds (the women identified as:
white, women of color, multi-racial, and non-declared) in an intersubjective study explained
through semi-structured interviews focused on understanding the shared and personal
experiences of “being judged unfairly” based on their appearance, hairstyle, clothing choice,
skirt length, and appearance-driven critiques (Mavin & Grandy, 2016, p 1107). Women
experience abject appearance bias in various ways, but appearance bias often puts pressure on
women to conform to an ideal image for their role. Women describe abject backlash feelings of
shame and embarrassment when they feel pressured to change their appearance or conform to a
prescribed standard, whether formal or informal. The impact of abject appearance is deeply
detrimental to women’s personal and professional growth; this bias manifests in comments and
organizational standards related to clothing, hair, make up, shoes, jewelry, any aspect of a
woman’s appearance in which judgement can be applied (Marvin & Grandy, 2016). This
paradoxical judgement is applied to both feminine and masculine ideals against women in
leadership and may be referred to as both too feminine and too masculine because they hold the
leadership role (Dresden et al., 2018). This judgement situates women leaders into an “others”
category. They are not a part of the ideal leader group and are not members of the employee
26

force. The double standards place women leaders between the model white male masculine
leadership role and the social norms and expectations of women and their bodies (Mavin &
Grandy, 2016).
The mixed messages women receive about the persona they gender bias implies they
portray involves being considered a strong leader are ambiguous, complex, and contradictory.
Twelve women in a leadership study focused on gendered leadership traits recounted similar
experiences of the guidance given about effective leadership skills; they should ‘be different,’
‘not too girly,’ but ‘be themselves’ yet ‘don’t use your femininity’ (Kawakami et al., 2000).
Eight of the women in Kawakami et al., study refer to the balance of feminine characteristics and
leadership ideals as ‘power dressing’ or a need to achieve a professional appearance that is not
overly feminine. The social expectations of how a woman dresses and presents herself in a
professional environment is a muddy river to cross. A recent study of intra-gender relations
contends that senior women experience higher standards for their appearance and behaviors from
both men and women resulting in concerns about women being ‘too powerful,’ creating a
dominance penalty for women in leadership roles (Mavin & Grandy, 2016).
Women who achieve a leadership role and violate the gender norms of their organization
often suffer worker backlash or a social and economic penalty for violating the expectations of
women’s behaviors, or gender stereotypes according to a review of experiential evidence (Phelan
& Rudman, 2010). Worker backlash is described as diminished hirer-ability, likeability, and
competence; the diminishing of capabilities is described in different ways for women of color
and white women.

27

Gender Norms and Women of Color
While this study’s participants represent a specific population in Northern Colorado, this
literature review considers explicit prejudice faced by women of color when challenging social
norms in the workforce. Throughout the literature review, it is evident that there is a lack of data
available focused on racial demographics in executive leadership roles. Women of Color (WOC)
represent only 3% of the executive leadership and board positions within healthcare
organizations (Stewart, 2021). Considering the lack of WOC representation in healthcare
leadership positions, women appointed, hired, or promoted to these roles find themselves
challenging gender and racial norms. This review focuses on the intersection of gender and
leadership, and it is essential to understand how WOC’s experiences with respect to challenges
of gender norms are different from white women. As WOC navigate the leadership ladder, they
are confronted with gender as a discrimination factor but gendered racism as well (Sanchez &
Davis, 2010). A study by Glass and Cook (2020) investigates how WOC navigates the leadership
career path into elite positions. Through interviews with 34 WOC, Glass and Cook (2020)
examine how WOC align themselves with members in the organization of the “dominant group”
(Glass & Cook, 2020, p. 1241). The interviewees discussed reluctance to champion diversity
measures. The WOC sought mentorship and proximity to white men in positions of
organizational power. These relationships are noted for the WOC overcoming burdens of doubt
about their competency and credibility. However, the experience of having a white man
especially sponsor a WOC to progress in the organizations left the women frustrated and
degraded in their sense of self (Glass & Cook, 2020).
Additionally, in a study by Key et al., (2012) of 367 women leaders, 21% of the
respondents identified as women of color. The WOC shared registered responses to a survey
28

asking about formative experiences and how they relate to them. The WOC responded
affirmatively on a Likert scale to the questions about overcoming and experiencing sexual
harassment and racial discrimination in the workplace. The women in the Key et al. (2012) study
refer to the glass ceiling as a concrete ceiling or a brick wall to their career goals.
WOC have historically participated in caregiving occupations and makeup 44%-54% of
nurses, nursing assistants, home health aides, personal care aides, and medical aids in the nation
(Frye, 2020). At the same time, WOC represents a majority of front-line medical positions; the
women are not represented in the leadership roles(Frye, 2020). In an interview with Cheeks
(2018), a WOC shared that when she reported to a WOC for the first time in her career, she
"performed better" and "was a lot more confident and comfortable" (Cheeks, 2018, para 5.).
Another WOC shared the inverse experience about being coached to make other people feel
more comfortable, and she could not be her authentic self (Cheeks, 2018). She comments, "By
society, and its predominantly white institutions, to feel that as a black woman I come across as
aggressive, bossy, and selfish when I speak my mind compared to a man or white woman
making the same statements." (Cheeks, 2018, para 6). The social norms WOC are asked to
subscribe to are not norms in which they report they are their authentic selves. This dynamic
requires WOC to change their personal and professional styles to accommodate societal norms
(Cheeks, 2018).
Lastly, Women of Color contend with additional prejudice when they challenge the
social norms for women in the workforce (Rudman et al., 2012). Worker backlash is evident
when WOC violates the gender norm prescribed by her organization. She may receive backlash
by men and women (Rudman et al., 2012). It is perceived as disruptive to the organization
(Rudman et al., 2012). This disruption is a gender incongruent situation and is evident in
29

behaviors, performance, communication, and organizational culture and policy (Lee & Huang,
2018).
The perspective of WOC is essential to consider throughout the literature of this study.
When the literature cited does not indicate the racial demographics of the study, it is vital to
continue to consider how WOC experience the intersection of race and gender in related
literature.
Gender Bias in Performance Evaluation
How women are expected to act as leaders is often the application of societal and
personal beliefs to performance evaluation. When less consideration of a woman's skills and
abilities contributes to an assessment, the spillover effect occurs (Carrasco et al., 2014; Jonsen et
al., 2010; Lee & Huang, 2018). The spillover effect is when a person’s emotions affect
environmental behaviors and impact learned beliefs that focus on traditional gender roles create
an environment of criticism towards women, which translates to harsher evaluations of women
than their male counterparts (Sanchez-Hucles & Davis, 2010). Descriptions of successful leaders
often include traditionally masculine terms, such as confident, competent, decisive. In contrast,
characteristics associated with women, such as collaborative, empathetic, and approachable, are
used to define a meets expectations description, not exceeding or exemplary descriptive
performance reviews (Phelan & Rudman, 2010). Mitchell and Martin (2018) using a 25-question
survey given to 68 respondents evaluated the performance of women and men in identical
environments; women's open-ended comments within the evaluations focused on personality
instead of skills. Additionally, this study revealed men receive an average of .25% higher rating
than women on the Likert scale ranking their performance on a 1-5 scale. Notably in 23 of the
questions the women all rated lower than the men (Mitchell & Martin, 2018). The evaluative
30

outcomes lead to promotions, salary increases, bonuses, and career growth. The bias intrinsic in
evaluation standards limits women's potential career progression and perpetuates inequity in
compensation and advancement (Rivera & Tilcsik, 2019).
Evaluating competence is a typical metric for leadership evaluations, yet women are rated
significantly lower than men when their skills and experience are identical (Rivera & Tilcsik,
2019). Through two complementary studies, Rivera and Tilcsik (2019) examined data from a
quasi-natural experiment and a survey experiment of a gender randomized transcript review to
support the need of decreasing the range of the Likert scale. Rivera and Tilcsik (2019) conducted
105,034 surveys with 440 respondents over 9.5 years and determined through this study that
women face greater scrutiny when the scales are larger and allow for more differentiation in the
rating. When organizations seek to use a numerical scale for performance evaluation this study
indicates a limited scale supports gender equity (Rivera & Tilcsik, 2019). Notably, in this study
women rank a perfect ten in 19% of evaluations, where men receive a ten rating of 34% of the
time (Rivera & Tilcsik, 2019). The implied perfection required for a numerical ten rating aligns
with a white male majority cultural association for a flawless performance, usually reserved for
the top 10% of a rating scale, also known as the bell curve. Women are most commonly rated an
eight out of ten, while men are most often rated a ten out of ten (Rivera & Tilcsik, 2019). When
reducing the same numeric scale to a one through six ratings, fewer differentiating numbers for
performance neutralizes gender bias. When raters have a more significant distinguishing
opportunity to critique men's and women's accomplishments, women are less likely to receive a
10/10 rating, yet men and women equally receive a 6/6 rating (Rivera & Tilcsik, 2019). The
subtle difference in perceived quality allows the evaluator fewer opportunities to interpret gender
bias into the evaluation (Biernat et al., 2010; Lee & Huang, 2018; Rivera & Tilcsik, 2019).
31

Additionally, 68% of 800 women surveyed about career ambitions indicate they have
aspirations to advance to senior leadership levels (Powell & Butterfield, 2013). As women seek
career opportunities, they are only likely to apply for a position where they meet 100% of the
qualifications, and men are inclined to apply when they satisfy 60% of the listed requirements
(Fine et al., 2019). In male-dominated fields such as engineering, 14% of women with
engineering degrees never enter an engineering profession and 30% of those who do leave the
field citing hostile organizational climates (Dresden et al., 2018).
Additionally, a meta-analysis of 45 studies measuring gender stereotypes of hiring
practices, concludes when competing against men for promotions or hiring, women are more
successful when they align with traditionally male stereotypes of power and competition,
dispelling feminine characteristics that are viewed as a liability and diminish professional
qualifications (Jonsen et al., 2010). Gender penalties often require additional qualifications of
the women to meet the standard for hiring; observations of hiring practices indicate perceptions
of men as more qualified than women for the same roles (Lee & Huang, 2018). Gender
stereotyped behaviors influence evaluation standards, metrics, and performance rating outcomes,
this incongruity of traits and behaviors often leave women considered a poor “fit” for top-level
positions (C. Hoyt, 2010; Walker & Aritz, 2015).
Consequently, pro-male leadership ideology aligns with an association of social role
congruency and determines a higher likelihood of a man's selection over a woman (Ritter &
Yoder, 2004). In organizations that are led by women, women are six times more likely to be
chosen for top leadership positions (Smith, 2014). The perception of success for an
organization's senior leader impacts the reputation and pre-evaluative assumptions. These
premises take on operational meaning, as illustrated in higher business loan percentages and
32

lower overall approval rates for women-led organizations. This trend impairs women-owned or
led organizations to compete equitably with men-led or owned businesses (Lee & Huang, 2018).
Ultimately, the perception of masculine or feminine behaviors and their alignment with role
congruity determines the trajectory of a woman's ascent to leadership. As evident when the
impression is of a woman candidate, as not masculine enough she is less likely to be selected for
a promotion or hiring selection, stagnating her careers and the downstream potential of future
career and economic growth (Hogue & Lord, 2007; C. Hoyt & Burnette, 2013; Kachel et al.,
2016; Loden, 1987; Mulac et al., 1985).
Impact of Gender Bias - Opting Out of the Workforce Phenomenon
As described by Ryan (2007), women are faced with two factors that impact their
workforce engagement decisions, known as push and pull factors. Ryan (2007) defines pull
factors as the personal need decision, family, health, or another lifestyle consideration. Where
the push decisions are work environment factors that impact their decision to leave an
organization or the labor force (Ryan et al., 2007). Additional push factors such as opportunity
for professional growth and personal satisfaction or meaningful work impact women opting out
(Ryan et al., 2007).
Personal choice, increased sense of agency, lack of commitment, and lack of desire, are
all various reasons that the literature suggests women leaving the workforce, or opting out, are
rooted in organizational gender barriers and discriminatory labor practices that women encounter
in their careers (Hogue & Lord, 2007). A recent Kossek et al., (2017) survey of 503 participants
indicated that 40% of women surveyed who faced hardships in their work or home life opt out of
the workplace compared to 24% of men. While the initial evaluation of opting-out data assumes
women are leaving the workforce, emerging evidence indicates that 90% of women who
33

organizations report as leaving the workforce are only leaving organizations and are continuing
their careers in other organizations or becoming entrepreneurs (Catalyst, n.d). This new data
redefines the opting out phenomenon as a career transition and not an exit from the workforce
(Ryan, et al., 2007).
The underrepresentation of women creates fewer role models in top leadership positions.
A lack of inspirational women in leadership at the uppermost levels impact women’s perception
of their ability to achieve the same success (Cabrera, 2007). Without role models, exclusion of
women from critical social networks that are male-dominated limits women’s access to the social
capital required to network into leadership roles and advance in their careers (Cabrera, 2007;
Powell & Butterfield, 2013). Exclusion from the social networks limits vertical organizational
gender integration or underrepresentation of genders in hierarchical organizations. A lack of
gender integration limits the mentorship opportunities for women and decreases the likelihood of
women to advance within the organization. When organizational culture is relationship-focused,
this increases the chances for women to develop the social resources to advance in their career
(Kossek et al., 2017).
Opting out is a phenomenon that evokes explanations about the underrepresentation of
women in the workforce. The opt-out concept assumes that women are choosing another path
above her career. The literature indicates women are not leaving the workforce but choosing
other organizations or career ambitions over the traditional leadership career ladder (Cabrera,
2007). Opting out provides organizations an explanation that is easier to accommodate than
addressing the root issues surrounding gender equity and integration.

34

Impact of Pay Inequity on Women Leaders
After fifty years since the signing of equal pay legislation into law white women earn on
average 81% of their male counterparts for the same roles, the disparity is even larger for women
of color averaging 57% of their male counterparts (Catalyst, 2020). Research attributes 60% of
pay inequity to known factors; occupation, union membership, experience, race and ethnicity,
and industry, consequently leaving 40% of the wage gap open to unknown causes (Farrell &
Glynn, 2014). While some women have made strides in pay equity, if the pace of change
continues at the rate of the past 50 years, it will take another 40 years for white women to reach
full pay equity, and women of color waiting for a staggering 110 - 204 years longer (Hegewisch
et al., 2019). Pay inequity occurs at all levels, and for various reasons across industries, while
pay inequity is a blatant bias against all women, microaggressions continue to undermine efforts
for equal pay. Bonus systems based on bias evaluative criteria, recognition pay, and job
requirements contribute to the 18% pay gap between men and women (Farrell & Glynn, 2014).
Unbalanced Education Rates of Women Leaders
The U.S. Department of Education (2021) reports women are graduating from four-year
degree-granting institutions with bachelor’s degrees at rates of 24% higher than men. Graduate-
level degrees report similar percentages (32%) and doctoral levels (9%) (Scott, 2018). These
education rates indicate women are entering the workforce with comparable and regularly higher
educational backgrounds than male counterparts. In organizations where education levels are
used for hiring and promotion criteria; a recent study determined women are held to a higher
educational requirement than men (Hogue & Lord, 2007). Organizational gender barriers are
prevalent in the application pools where women seeking the same job as men. Women report
holding a degree higher than their male competition to receive the same offer, including
35

equitable compensation. As women continue to surpass men in education achievements, the bias
in hiring and promotional practices counter the gains women made in degree attainment
(Hartman & Barber, 2020; Kachel et al., 2016).
Various studies investigate and address the barriers aspiring women leaders face and the
inequity of women in key leadership roles. These studies indicate there are key barriers
embedded in dress code, policies, lack of gender representation, and evaluative processes that
appear across healthcare organizations which impact women’s professional growth into
leadership roles. These studies investigate the paths women take in healthcare and how they
navigate organizational gender barriers (Baldner & Pierro, 2018; Carrasco et. al., 2014; Elias,
2018; Ely et al., 2011; Ewoh, 2013; C. Hoyt & Murphy, 2016; Kachel et al., 2016; Mavin &
Grandy, 2016; McDonagh, 2012; Roberts & Brown, 2019; Saseanu, 2014; Smith, 2014; Walker
& Aritz, 2015). These varying barriers create a navigational maze of the cultural norms and
standards, policies, spoken and unspoken expectations, and the backlash among men and women
towards women leaders.
Organizational Awareness and Change
Transparency in diversity data reporting supports gender-inclusive environments and
effectiveness cultures, yet only 3% of companies publish their diversity information. These
dismal self-reporting standards leave women with no data to make organizational decisions in
their careers and indicate a lack of importance placed by organizations on integrated diversity
standards (Donnelly, 2017). Organizations that embrace diversity changes as a part of the
organizational culture and are operationalized throughout all the aspects of their operations are
able to report on their diversity standards, metrics and efforts with clear and concise data. This
36

information is supportive of the operationalized diversity values which support the
organization’s commitment to gender equity at all levels of the organization.
Keys to Successful Gender Inclusion Programs
To address organizational gender barriers for women in leadership, organizations need to
acknowledge and accept the barriers that exist (Hill et al., 2019). Gender inclusive initiatives
evaluated by a Harvard Business Review (2020) study, determined goal setting, data collection,
benchmarking across competitors and industry, and the use of alternative reporting mechanisms
for harassment or bias complaints as essential for a successful gender inclusive program. An
organization needs to also maintain awareness of its demographics, and in what environments
across the organization underrepresented populations, such as women, are likely to become a
token representative (Ewoh, 2013). Data collection and sharing are vital indicators that an
organization is willing to enact change to impact women’s advancement. The development of a
token woman in roles and departments that are seeking to expand their gender diversity often
does more harm than good (Cook & Glass, 2014). Cook and Glass (2014) also discuss
occupational subgroups through a dataset analysis of CEO transitions from 1996 - 2010, in this
study when a single woman is on a leadership team, the woman is less likely to perform well and
will likely experience a gender penalty in evaluations. These experiences are key findings for the
development of gender data sharing to evaluate the organizational climate. While evaluating the
current climate and demographics is the first step to developing programs for equity only 3.2%
of healthcare companies report gender data. Lastly, organizations that are successful in gender
equality involve managers at the onset of program development to ensure cross department
engagement and successful implementation in a grass roots structure (Pedulla, 2020). The gender
diversity programs are most successful when the metrics are included in the leadership
37

evaluations, as of 2017, 22% of healthcare organizations demonstrate this program through the
Diversity Best Practices Report, 2017. Personal accountability from the senior leaders through
managers is an essential aspect of impactful diversity programs.
Breaking the Glass Ceiling but Promoted to the Glass Cliff
The glass ceiling metaphor for the invisible barrier preventing women’s advancement to
leadership was first used in 1978 and is a common theme in evaluating gender inequity in
leadership (Cook & Glass, 2014; Dreher, 2003; Ryan & Haslam, 2005; Sabharwal, 2013).
Another emerging trend is the precarious timing and situation under which promotions of women
occur. A phenomenon called the glass cliff creates an over-representation of women leaders in
failing or struggling companies due to ethical, financial, stock, or other corporate failings (Ryan
& Haslam, 2005). In a review of 119 organizations that made corporate leadership selection
during or after experiencing a crisis 63% of these organizations hire or promote women leaders.
Compared to 67% male hiring or promotion for organizations not enduring a crisis (Dishman,
2018). Theorists believe women are overrepresented in these situations because men are
unwilling to take the position citing a higher risk of failure and more significant opportunity in
thriving organizations (Bertrand et al., 2018; Carrison, 2018; Ryan & Haslam, 2005).
Additionally, due to this trend, board leaders have begun to look for women to take the helm in
times of crisis. While women are often more successful than men in organizational crisis
turnarounds, they also see failure due to the precarious organizational situations they inherit and
risk a reputation of corporate failures (Sabharwal, 2013).
Lack of Substantive Change
Implementation of DEI policies, demographics reporting, and development programs are
fundamental components to successful employee development initiatives. By tailoring to the
38

specific needs of women and to address the systemic barriers affecting the underrepresentation of
women in leadership the initiatives will begin to impact women's advancement (Newman et al.,
2017). While the development of programs is well-intentioned, only 36% directly link to
women's advancement into leadership (Developing the Next Generation of Women Leaders,
2018). Diversity Best Practices (2018) reports pipeline succession plans to indicate that only
15% of women access formal mentorship programs to establish career growth plans.
Women's experiences indicate organizational initiatives and policies only address the outcomes
of organizational gender barriers and lack the depth of support for the bias that sustains the
barrier (Women in Male-Dominated Industries and Occupations: Quick Take, n.d.).
Additionally, women report the programs to become a hindrance to their advancement. Upon
returning to work, 476 women surveyed report wages 30% lower than women who did not utilize
the family support programs (Judiesch & Lyness, 1999). An identified outcome of an
organizational policy lacking full support is a parental level policy that creates a gender pay gap.
Developing programs that create cross-organizational acceptance and integration require
grassroots engagement in contrast to top-down initiatives (Judiesch & Lyness, 1999).
Pay inequity is one of the top areas that organizations can address gender inequality in
leadership roles. Scale models are often used to address pay increases based solely on the time of
service. While on the surface, this model appears unbiased; it does not take into account the
gender role expectations placed on women over men again penalizing women (Working for
Change, n.d.). A monetary value placed on educational degrees, time of service, performance
bonuses, and additional factors that are in addition to the job description women will
unconsciously be disadvantaged (Aisenbrey et al., 2009; Fuller & Hirsh, 2018; Hill, 2016).
39

Organizations are developing efforts to improve gender equity; however, there is no
single recommendation for organizations to implement to ensure equity and equality.
Justifications of continued inequity perpetuate injustice among women and men that are rooted
in social dissonance for what “should be” and “what is” as it relates to gender equity (Kawakami
et al., 2000; Minkov & Hofstede, 2012; O'Neil et al., 2015; Roberts & Brown, 2019; Scott,
2018). Best practices are only successful in organizations that are committed to systemic change
throughout their culture (Ehrhart & Schneider, 2014). Initiatives that focus on the outcomes of
organizational gender barriers do not address systemic bias.
The remainder of this chapter will focus on the knowledge, motivation, and
organizational factors that influence organizational gender barriers to women's advancement to
leadership. Specifically, it will focus on three key areas: (1) women's experiences and the
knowledge they developed about how to advance in their careers, (2) how women develop and
maintain the motivation to overcome organizational gender barriers and (3) the organizational
programs, policies, and procedures that impact women's knowledge and motivation.
The Clark and Estes (2008) Gap Analysis
Clark and Estes (2008) assert three main contributors to organizational performance gaps:
knowledge, motivation, and organizational barriers (KMO). Deficits in one or all of these three
focus areas cause a gap in the desired outcome that decreases the likelihood of goal achievement.
It further develops each focus area into categories that specify the areas of the deficit.
Knowledge and skills are further categorized into factual, conceptual, procedural, and
metacognitive knowledge (Clark & Estes, 2008; Wang et al., 2008). Motivation is described by
Clark and Estes (2008) as a person’s desire to “get going” and “keep going” (p. 80) along with
their internal meter of how much energy to expend on a task. Collectively, these three internal
40

processes correspond to active choice, persistence, and mental effort. Lastly, organizational
barriers consist of three key areas: work processes, material resources, and organizational culture
alignment (Clark & Estes, 2008; Ely et al., 2011; Rudman et al., 2012). Organizational barriers
impact women directly as well as misalignment of organizational goals and embedded cultural
nuances.
Understanding these variables is critical to determining and understanding the depth of
the needs associated with developing women into leadership roles. Initial evaluation of
knowledge is followed by motivational and finally, organizational needs. In Chapter 3, the KMO
model is used to explore the methodology and background of the study.
Stakeholder Knowledge, Motivation, and Organizational Influences
Knowledge and Skills
Women’s advancement to senior leadership is a global goal which impacts various facets
of healthcare organizations; to include culture, the financial bottom line, and in limited studies
patient outcomes, while also supporting the professional advancement of women to overcome
organizational gender barriers that inhibit promotion into leadership (Hauser, 2014; McDonagh
et al., 2014). This study will focus on three areas of knowledge that women in the healthcare
industry in Northern Colorado need to possess to overcome the organizational gender barriers to
support their advancement to leadership.
The framework for how people utilize knowledge and skills is outlined in four main
categories; factual, conceptual, procedural, and metacognitive (Clark & Estes, 2008; Krathwohl,
2002). Factual knowledge is the knowledge of basic elements, terminology, and information; for
example, the educational background or training certificates needed to qualify for a position
(Krathwohl, 2002). Conceptual knowledge is described by Krathwohl (2002) as the
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understanding of categories, principals or underlying theory; for example, women seeking
leadership roles need to know and understand the behavioral requirements of the leadership
positions and whether their experience and persona meets them. Krathwohl (2002) continues
with a definition of procedural knowledge as the knowing how to complete a task through
techniques, methods, and necessary steps; in this case, it relates to how women seek and utilize
the training opportunities to gain the required experience or skills for a leadership position.
Lastly, metacognitive is the self-awareness of strengths, abilities, barriers, and opportunities
(Krathwohl, 2002). For example, metacognitive knowledge is the knowledge a woman possesses
about how they may leverage their strengths or what obstacles they need to overcome in their
leadership.
Knowledge Influence 1 – Conceptual Knowledge of Promotion Process
Women need to know the organizational gender barriers that impact their promotional
process. Women are likely to encounter organizational gender barriers through biased evaluation
and promotion processes that support a male leadership preference (Baldner & Pierro, 2018).
Inequitable evaluation and promotion bias creates greater void women may need to overcome to
achieve a promotion or leadership appointment (Baldner & Pierro, 2018; Dreher, 2003; Dresden
et al., 2018; Hill, 2016; Jonsen et al., 2010; Judiesch & Lyness, 1999; McDonagh, 2012).
Identifying and understanding what barriers they need to overcome is critical to advancement in
their organization. The majority of organizations do not plan women's ascent to leadership
(O’Neil et al., 2015). This lack of intentional mentorship and career planning results in a lack of
support for women’s advancement in the organizational process. Organizations attempting to
apply a gender-neutral or gender-free training and development approach will not adequately
support women’s specific developmental needs or consider the gender context in which women
42

operate to achieve career progression to leadership (O’Neil et al., 2015). Additionally, a study of
women leaders by Elias (2017) discusses successful professional training programs that are most
successful for women all include the following components: a peer network, mentorship, and
developing an understanding and navigation of the unwritten rules. The complexity of leadership
development is most successfully developed through organizational mentorship of planning and
support for women through mentorship (McDonagh, 2012). While 76% of healthcare
organizations report having formal mentorship programs, the recruitment for the programs only
indicated 15% of women, of which only 9% includes recruitment of African American women
(Barry, 2018). Organizations which ensure knowledge growth in these three areas will help
women overcome organizational barriers that result in 30% of women leaving their organization
(Elias, 2018).
Knowledge Influence 2 – Procedural Knowledge of Advancement Support
Women need to know how training opportunities are leveraged to support advancement
in their careers over organizational gender barriers. The knowledge of what training supports
their efforts to overcome organizational gender barriers and how to leverage this training is
associated with how women advance through organizational promotional practices. A key
challenge that women face is the availability and organizational opportunities to join training or
development programs, such as mentorship, specific to their needs. While 76% of healthcare
organizations report having mentorship programs only 15% of women are recruited to formally
engage in them (Barry, 2018). Within organizations there are formal and informal training and
networking avenues that help to develop a leader. Beeson and Valerio (2012), list formal
mentorship programs as a key best practice recognized by the American Hospital Association for
supporting women’s advancement.
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In order for mentorship programs to support women’s advancement, leveraging informal
relationships may support their knowledge of how leaders typically behave in their organization
(Fuller & Hirsh, 2018). The networks developed in the workplace often hold key information to
how people advance. In male dominated fields women are at a disadvantage and need to know
how to identify the informal networks and how to access their membership (Fine et al., 2019).
Formal training, networking, and mentorship programs support gender inclusion efforts and are
critical for women to know how to access the informal networking environment and replace it
with formal networking with a focus on advancement (Gipson et al., 2017). Additionally, it is
critical for women to know how to fund and attend training that is required for advancement.
Observing other women leaders in their organization, provides an example of how training and
support tools are used to develop women in advancing their careers. Additionally, leveraging
training focused on managerial selection and promotion can provide the protocol for women to
advocate for training or experience they lack for promotion (Jonsen et al., 2010).
Knowledge Influence 3 – Metacognitive Knowledge: Strategies to Support Advancement
Women need to reflect on their skills and abilities to overcome organizational gender
barriers. Self-awareness is considered a critical aspect of an authentic leader (Beeson & Valerio,
2012). Women who are aware of their skills and abilities have an increased likelihood of
identifying personal development needs and supportive programs which will help in advancing
to leadership (Gipson et al., 2017; Northouse, 2016). Women who can develop awareness of
their strengths, barriers, and opportunities have a unique ability to leverage that knowledge to
their benefit and seek roles and development opportunities that allow them to continue to grow in
their careers (Gipson et al., 2017). Northouse (2016) discusses how self-awareness includes the
ability to reflect on your values, identity, emotions, motives, and goals to then align these
44

personal needs with that of your organization and career aspirations. Personal understanding of
strengths and weaknesses allows leaders to understand how they impact others (Northouse,
2016). This awareness enables women to articulate the skills they bring to a position or
organization and present themselves as authentic leaders.
Additionally, self-aware women can develop their leader identity or the characteristics
they wish to display as a leader. Unless women conform to traditional gender role characteristics,
they will likely challenge gender norms and exacerbate gender role bias (Marvin & Grady,
2016). As women pursue advancement, they encounter gender role values that are entrenched in
the policies and procedures for advancement and hiring practices (Mavin & Grandy, 2016).
Women need to remain aware of the gender norm they are violating and how they need to
address the “ideal” image of a leader in their organization. The evidence suggests a prescribed
"ideal" body for leadership is a masculine frame, voice, and mannerisms, which undermines the
authority of women leaders by the nature of physical form (Mavin & Grandy, 2016).
Understanding this inherent barrier is necessary for women to overcome it, not by changing their
physical form but recognizing it is a bias they need to leverage their strengths to prevail (Hoyt,
2010; Mavin & Grandy, 2016). Gender-biased social norms embedded in promotion and hiring
practices are prevalent in the most senior level leadership positions and boardrooms across the
industries, and women need to have awareness of their strengths and opportunities to counter the
entrenched bias (Dresden et al., 2018). Kawakami et al. (2000) found women are perceived as
effective leaders when displaying more masculine traits. These same women are also evaluated
by peers and superiors more harshly for not displaying prescribed feminine characteristics. This
double standard can only be overcome if women are aware of what behaviors they embody and
how those characteristics are preserved (Gipson et al., 2017).
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Gender role expectations inform the standard within the organizational culture for
expected and anticipated behaviors for men and women, translating into expectations for
leadership. Violations of those expectations often leave a leader labeled as a "poor fit" (C. Hoyt
& Burnette, 2013). Women who are aware of their leader identity and how it challenges
traditional gender roles will likely successfully navigate the labyrinth of their advancement into
leadership. Organizational gender barriers may be seen or unseen, at times covert and other
obvious. The literature suggests women often try to overcome these barriers on their own and
understanding their skills and abilities will support their aspirations into leadership roles.
Table 1 summarizes the knowledge influences, indicators, and assessment methods for
each influence.

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Table 1
Knowledge Influences, Types, and Influences Assessment
Industry Global Goal
By January 2025, healthcare organizations will identify and leverage best practices to encourage and develop
women leaders and help them further advance in their careers.
Stakeholder Goal
By 2025, women leaders will advance to the leadership roles to which they aspire.
Knowledge Influence Knowledge Type Knowledge Influence
Assessment
Women need to know the organizational
gender barriers that impact their
promotional process.
Conceptual

Semi-structured interviews that
assessed the barriers women
identify as challenges to
attaining leadership roles or
career advancement.
Women need to know how to leverage
support to overcome organizational
gender barriers.
Procedural Semi-structured interviews to
understand how support
opportunities can be or are
utilized to overcome
organizational gender barriers.
Women need to reflect on their skills and
abilities in order to overcome
organizational gender barriers
Metacognitive Interview items which probe gender
barriers encountered, and how
their skills and abilities impact
their experiences with the barriers.

Motivation
The second concept of Clark and Estes (2008) of the three facets for performance is
motivation: which is derived from active choice, persistence, and mental effort. Active choice
includes the initial action taken to pursue a goal; it is the first step towards goal attainment and
the setting of intentions, whether verbally or internally, to take measures to achieve an outcome.
After choosing to strive for a goal, persistence is the ability to continue toward the goal when
distractions or challenges arise. These distractions or challenges may impact emotional, physical,
47

and cognitive resources. Lastly, in addition to persistence, mental effort is the decision of how
much to invest personally in achieving the set goal. The investment made into achieving a goal is
determined through personal confidence levels, over and under confidence will impact a person’s
ability to continue to work toward a goal (Clark & Estes, 2008).
In the instance of women advancing to leadership positions, two key influences impact
women's motivation to seek or accept a leadership role: expectancy outcome and self-efficacy.
Expectancy outcome refers to women's anticipated results, probability of success or failure, the
skills that a woman possesses, and their alignment with the likelihood of success as a leader
(Vroom, 1964). Self-efficacy draws on the woman's beliefs in her abilities or confidence, and
associates to the persistence required to pursue leadership and challenge the male stereotype of a
leader (Hoyt & Murphy, 2016). The expectation of success and the effort it requires is a
challenge women may need to weigh against their motivational resilience. Women are
challenged to determine if they will assimilate into or overcome the expected gender stereotypes
of leaders in a particular organization (Jonsen et al, 2010). Expectancy outcome and self-efficacy
are motivational influences that impact how organizational gender barriers impact women as
they strive for career growth and pursue leadership roles.
Motivational Influence 1 – Expectancy Outcome Theory: Aligning Women’s Effort with
Aspirations of Leadership
Women need to believe their skills and abilities combined with their effort will overcome
organizational gender barriers. Expectancy Outcome Theory relates to the motivational force
women will expend on their achievements and the expected outcome for their efforts on their
accent to leadership (Heneman & Schwab, 1972; Vroom, 1964). The combined three factors of
expectancy, instrumentality, and valence multiply to determine motivational force. The
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implication of expectancy is that increased effort will result in a certain course of action.
Organizational gender barriers may impact the expected outcome women experience. As women
seek leadership roles, this may manifest in the number of hours they work and their belief in the
outcome of their long hours. If their belief is that long hours indicate hard work, which then
results in a promotion, women may expend more hours than men in peer roles expecting that
their efforts will result in a promotion (Jonsen et al., 2010). The second component,
instrumentality, is the belief that increased performance will lead to a desired outcome. In the
pursuit of leadership women may experience this through their review or evaluation process.
Reviews are typically used to support promotion or hiring, as a track record for successful
performance. Women may believe that high scores on evaluations or annual performance
reviews will lead to a promotion or leadership selection (Lee & Huang, 2018). The challenge
with this outcome expectation is that evaluations maintain an organizational gender bias that may
not result in the intended outcome of a leadership position (Hoyt & Burnette, 2013). The same
expectation may be applied to hiring practices. A woman may be qualified for a position based
on the listed requirements, but a man will likely be selected over her because of the gender bias
in hiring processes and procedures (Walker & Aritz, 2015). Valence is the desirability of the
expected outcome, or how a woman may value leadership compared to how the organization
values leaders. While a woman may work hard and obtain high marks, if she does align with the
value of leadership of the organization she will not be selected as a “fit” for leadership within the
organization (Heneman & Schwab, 1972).
As women traverse their career, they may experience gender bias or barriers that impact
their motivational force to advance. While women may believe in their abilities and skills, they
may not be able to overcome the gender barriers related to their expected outcome for their
49

efforts. Additionally, consistent messaging about the likelihood of success in leadership could
diminish their belief that they belong in a leadership role and will be accepted as a leader.
Motivational Influence 2 – Self-Efficacy: Believing Leads to Achieving
Women need to believe their abilities will overcome organizational gender barriers for
leadership positions and will they be accepted as a leader. As women seek leadership roles, their
experiences, role models, and feedback received from their supervisors, impact their belief
that their skills will overcome organizational gender barriers to become a leader (Bandura,
1977). These three areas fuel women's perceptions of their abilities to overcome organizational
gender barriers and their likelihood for success. O’Neil et al., (2015) discusses how women
encounter gender barriers in their organizations and how it impacts the risks they are likely to
take when applying for a promotion or new role. This is evident as women seek advancement;
they often wait until they are one hundred percent qualified for a role or promotion while men
attempt the advancement on average at sixty percent confidence (O’Neil et al., 2015). A
woman’s strong belief in her abilities and skills may increase her willingness to take risks and
push for training, or advancement opportunities prior to being one-hundred percent qualified
(Krueger & Dickson, 1994).
As women move through their careers one factor that is key to developing strong self-
efficacy is feedback. Women typically receive less overall feedback from supervisors and leaders
on their performance, management, and leadership skills. This void leaves women to determine
how their leadership presence is perceived and how they may fit into the ideal models of
leadership (O’Neil et al., 2015). As women seek leadership, they may encounter stereotype threat
within their organization, or the challenge to traditional gender stereotypes of a leader.
Threatening organizational gender stereotypes of leadership leads many women to experience
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belonging uncertainty, which undermines their acceptance as a leader (Hoyt, 2013). The greatest
impact to women’s persistent exposure to stereotype threat is the erosion it may cause on her
belief in her skills, as she challenges the organizational gender norm and barriers. A woman’s
self-efficacy supports her continued challenge of gender stereotypes and expectations within the
organization (Hogue & Lord, 2007; Hoyt, 2013).
Table 2 summarizes the motivational influences and assessment methods for each
influence.
Table 2
Motivational Influences and Assessment
Industry Global Goal
By January 2025, healthcare organizations will identify and leverage best practices to encourage and
develop women leaders and help them further advance in their careers.

Stakeholder Goal
By 2025, women leaders will advance to the leadership roles to which they aspire.
Assumed Motivation
Influences
Motivation Type Motivational Influence Assessment
Women need to believe their
skills and abilities combined
with their effort will
overcome organizational
gender barriers.

Expectancy Outcome
Theory

Interview items which asked manager and
director level leaders a.) What did your
organization do to demonstrate their
belief in women in leadership? b.) what
are the results of efforts toward leadership
advancement?
Women need to believe they
will overcome
organizational gender
barriers and will be accepted
as a leader.
Self-Efficacy Interview items asking what skills they used
to overcome gender barriers and how
their organization supported their
leadership advancement.

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Organization
Organizations that recognize the importance of gender diversity in leadership often see
impacts on the bottom line and increase the organization's performance, including improved
health outcomes, employee retention and morale (Ehrhart et al., 2014; Ewoh, 2013; Hauser,
2014). While knowledge and motivation are critical to professional growth, development, and
career progression, they exist within the greater context of the organizational culture and
operations. The organizational culture provides the identity, boundaries, and rules derived from
the history and traditions of the organization (Ehrhart et al., 2014).
An organization's culture is arranged on a bipodal system, one of models and settings.
The cultural model of an organization is internalized and is the invisible sense of values, beliefs,
and attitudes that are automatic in the organizational fabric (Ehrhart et al., 2014). Women in
leadership roles across industries may hold similar values and beliefs through their shared
experiences. Additionally, organizational culture is revealed through established policies,
procedures and programs that support hiring, promotion, and pay equity (Ewoh, 2013; Fine et al.,
2019). Where the cultural setting is the visual expressions of the shared beliefs, values, and
attitudes into various modalities of action (Clark & Estes, 2008; Gallimore & Goldenberg, 2001).
Evaluating both the cultural models and settings supports Clark and Estes (2008) process
to identify organizational needs. These size and variation of the gaps may be due to a lack of
resources or faulty processes and procedures. Without an inclusive culture where the beliefs and
values are enacted through policy and procedures, highly motivated and knowledgeable women
will likely struggle to overcome the organizational gender barriers to ascend to leadership roles.
Cultural Model 1: Gender Inclusive Organizational Culture
Organizations need to have a culture of inclusion to counter gender role expectations.
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Several factors impact gender inclusivity within an organization. This study will evaluate
indicators of organizational gender barriers; organizational culture through processes, policies,
and procedures, including leadership demographics, pay equity, and evaluation bias. An example
of the disconnect that occurs in the intent and actions of companies stated goals is in how 82% of
healthcare companies set DEI targets and 46% tie compensation to those goals; but only 18%
achieve their goals (Barry, 2018).
Organizational structures known as vertical and horizontal gender integration structures
indicate the likelihood of a woman’s advancement in an organization and evaluates the
organization's leadership pipeline. Vertical refers to the integration of women throughout
hierarchical leadership levels, such as those in the health systems. In contrast, horizontal gender
integration refers to the equitable distribution of men and women in leadership pathways, in such
organizations as a science (healthcare), technology, engineering, and mathematical (STEM) field
or finance (Kossek et al., 2017). These integration measures may be outcomes of the cultural
norms that impact human resource policies, which lead to promotion and hiring practices.
Human resource practices are additionally integrated and visible throughout the organization
through fairness and nondiscrimination practices, clear talent development, and workplace
support mechanisms (Kossek et al., 2017).
As healthcare organizations seek to narrow the gender gap in leadership, identifying
intrinsic bias embedded in the evaluation methods, training opportunities, and promotion and pay
equity processes may support the balance of gender in leadership (Hauser, 2014). These four
organizational competencies develop a culture of inclusion and encourage psychological safety
for women. Safety is derived from organizational trends such as the regularity and the intentional
process for regularly promoting and valuing women (Carrasco et al., 2014). Organizational
53

culture ultimately requires supportive leadership behaviors to develop and implement programs
that encourage and support the intentional narrowing of the gender gaps across the organization
(Beeson & Valerio, 2012; Newman et al., 2017).
Setting Influence 1: Formal and Informal Mentorship
Organizations need to connect women with mentors at senior leadership levels, and with
women who have successfully reached leadership roles to support the possibility of progression
to senior levels. Albert Bandura (2005) discusses the social cognitive theory's role as a vehicle to
learn social roles through observations of social interactions, experiences, and external media
influences, then converts the information into an idea of performance. Role models and mentors
are proven to inform women about the expectations of a leader, setting an example of modeled
behaviors. The concept of modeling is key to developing women in leadership; an example of a
woman leader that aspiring women leaders can relate to and identify with, provides an example
of acceptable and anticipated leadership behaviors. This modeling can occur in informal and
formal settings. A formal mentorship setting with women in decision making and leadership
roles is a crucial aspect of career progression (Fine et al., 2019). A formal mentorship
relationship is considered an essential aspect of career development, yet is often underutilized
(Elias, 2018). Organizational programs often lack the structure of a formal mentorship program
and aspiring women often navigate finding a mentor independent of the organization. Learning
from the experiences and perspective of a woman senior leader can help other women navigate
their career path and overcome organizational gender barriers. Yet, men can also be essential
mentors if they are aware of the challenges in the organization and across industries women face
in seeking leadership roles. Men can be a guide to the unspoken rules of leadership and
54

organizational culture. They can also advocate for change in an organization and support women
into a gender-equitable succession plan (Elias, 2018; McDonagh, 2012).
Setting Influence 2: Evaluation Gender Bias
Organizations need to be willing to evaluate and adjust promotion and hiring practice to
reduce and eliminate gender variances in the selection process. Performance evaluation comes in
many forms across organizations and is a key metric for promotion and hiring. Human resource
departments regularly try to validate gender-neutral evaluation processes through numeric rating
scales and gender-neutral performance requirements. Yet these attempts are often ingrained in
gender inequity and perpetuate the distinction in gender equity (Rivera & Tilcsik, 2019).
Furthermore, rating criteria based on "fit" describe male-dominated traits associated with
traditional leadership and hinder women in the evaluative process (Hoyt & Burnette, 2013). This
variation in language creates 11% higher likelihood women will be evaluated based on
personality instead of skills and performance. While evaluation of employees is against their job
performance, when organizations track men's and women's ratings in the same roles, they may
identify trends in evaluation bias that appear as subtle differences in perceived performance
quality (Castellano, 2015; Rivera & Tilcsik, 2019).
Additionally, higher performance standards for women than men in standard scales are
common and result in a disparity of monetary worth, and rank ordering. The use of subjective
response evaluations results in more equitable ratings for women and men (Biernat et al., 2010).
Identifying and dismantling these types of evaluation metrics is critical for organizations to
determine their performance management systems that support and not hinder women's
advancement. Table 3 summarizes the organizational barriers, influences, and assessment
methods for those influences.
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Table 3
Organizational Influences and Assessment
Industry Global Goal
By January 2025, organizations will identify and leverage best practices to encourage and develop women leaders and help
them further advance in their careers.

Stakeholder Goal
By 2025, women leaders will advance to the leadership roles to which they aspire.
Assumed Organizational Influences Organizational Type Organizational Influence Assessment
Organizations need to have a culture of
inclusion to counter gender role
expectations.
Cultural Model 1:
Gender inclusive
culture
Interview item which explored how women utilized
formal and informal mentorship programs and how
that training (if any) fit into others organizational
priorities, psychological safety, and gender role
expectations.
Organizations need to connect women
with mentors at senior leadership
levels, and with women who have
successfully reached leadership
roles to support the possibility of
progression to senior levels.
Setting Influence 1:
Mentorship
Interview items that explored formal and informal
programs of woman-to-woman support programs
and networks and their impact on career progression.
Organizations need to evaluate and
adjust promotion and hiring
practices to reduce and eliminate
gender variances in the selection
process.
Setting Influence 2:
Evaluation Bias
Interview items that focused on the hiring experiences of
women and how their organizations accommodate
gender variances in selection processes.

Conceptual Framework
Interaction of Stakeholders’ Knowledge and Motivation within the Organizational Context
The conceptual framework (Figure 1) is a visual representation of the perceived
influences, variables, and assumptions that weave throughout the study and exist with
organizational gender barriers that impact women’s advancement into leadership.

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Figure 1
Conceptual Framework of Knowledge, Motivation, and Organizational Influences

It illustrates the building relationship of personal knowledge and motivation and the necessary
interplay of all three concepts to enact change in women’s advancement. The relationships
between the three concepts are deeply connected (Clark & Estes, 2008). While the organization
may have a substantial system for supporting women if a woman does not know her skill set, or
the path to take to achieve a leadership goal, the organization will not have met the necessary
goals for gender equity.
Gender equity in leadership requires a joint effort of men and women leaders to pull back
the layers of implicit bias and inequity to develop programs that support women now and into the
future (Hogue & Lord, 2007). Organizations identifying widespread bias can begin to take steps
to curve the trend of inequity. While there have been great strides for women in the past fifty
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years, injustice still exists (Archard, 2013; Baldner & Pierro, 2018). It will take men and women
to advocate for women’s equitable representation on board seats, board chairs, senior leadership
positions, and mentors (McDonagh, 2012; Saseanu, 2014). It’s not only the responsibility of
women to push for advancement but for men to face the inequity of the system from a historical
and non-personal perspective to enact real change (Biernat et al., 2010; Hoyt, 2010).
Summary
This chapter has provided a review of the literature in the area of organizational gender
bias’s impact on women’s advancement into leadership. After a brief discussion of the history of
women’s rights legislation and organizational constructs that are getting gender equity right,
there was an overview of challenges that women still face. Role expectations, evaluation bias,
and opting out were areas of focus, with an investigation into additional areas surrounding
worker backlash, pay equity, and education rates between men and women. Along with
organizational awareness is key to the overall development and understanding of organizational
gender barriers. Lastly, an evaluation of women’s advancement into leadership through the lens
of Clark and Estes (2008) framework for gap analysis focused on knowledge, motivation, and
organizational gaps. All assumed influences related to the gap analysis are collated to assist in
development and understanding of the study (see Appendix A). The next chapter will include the
research methodology to evaluate and assess these assumed influences on women who have
achieved leadership roles of a director or higher, data collection and analysis, and a presentation
of credibility and ethics concerns.

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Chapter Three: Methodology
This study is a field study to evaluate organizational gender barriers that impact the
Northern Colorado women’s advancement to leadership in the healthcare industry, which
includes identifying the personal and organizational knowledge needed for promotion or hiring,
and the understanding of motivational factors that may impact these women’s decisions to seek
advancement or persevere against organizational barriers. This chapter will provide the design of
the research study as well as the data collection methods, storage, and analysis.
The guiding research questions are the following:
1. What are the knowledge and motivation influences related to the organizational
gender barriers that impact women in the advancement of their careers?
2. What is the interaction between organizational culture and context and women's
knowledge and motivation as it relates to the organizational gender barriers that
impact them in the advancement of their careers?
3. What are the knowledge, motivation, and organizational recommendations needed
to overcome organizational gender barriers?
This chapter will examine the stakeholder of focus group, the criteria for their selection, and
the reasoning for the sample. The data collection, instrumentation, and the analysis will follow.
Finally, the chapter will conclude with credibility, trustworthiness, ethical considerations and
limitations of the study.
Participating Stakeholders
The participating stakeholders for this study are women leaders who resided in the Northern
Colorado region, and who served as director level leaders in the healthcare industry at the time of
the study. Recruitment occurred through purposeful sampling via professional associations or
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direct recruitment. Network sampling occurred through women focused leadership networks,
personal associations, or direct recruitment. A total of nine stakeholders were recruited for this
study until saturation was reached. The direct recruitment organizations are all healthcare
delivery facilities; hospitals and clinics, where physical and mental health care services are
provided. The researcher and the clinics do not have a personal relationship which limits the
potential for a power differential between the researcher and the stakeholders. In one of the three
hospitals where recruitment occurred, the researcher is known but does not have a personal
relationship with any of the stakeholders. The organizational distance of the researcher’s role and
that of the stakeholders neutralizes any potential power balance between the researcher and the
organizations where recruitment will occur. The researcher is not in or associated with the
evaluation matrix of the stakeholders’ organizations. The researcher also does not have influence
on the stakeholder’s performance or organizational relationships. The stakeholders
organizational experience is in community hospitals or health clinics. Both organizational types
have hierarchical leadership positions and scaffolded departmental structures indicated on their
websites and organizational charts, supporting internal leadership career growth opportunities.
Stakeholder numbers were assigned to all interview stakeholders, and this is also how they are
referred throughout the remainder of the study. The stakeholders' demographic data surrounding
age, gender identity, race, and ethnicity was not collected for the study and did not impact their
participation as it was not a requirement for the study. There is no required time in leadership
positions for the participants only that they have held or hold the indicated leadership level.
Evaluation of interviewed experiences based on literature focused on organizational gender
barriers and the support systems the stakeholders personally and professionally relied upon for
their career trajectories.
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The participating nine stakeholders were women who currently hold director-level roles
in healthcare. The stakeholders comprised various healthcare roles including physician,
electronic health record, nursing, administration, culinary services, and training. Experience in
their fields and roles ranged from less than five years to over thirty years of experience as a
manager or director. All nine of the stakeholders are director-level leaders. Additionally, the
stakeholders’ education levels are vastly different; eight hold a bachelor's degrees, while four
achieved a master's, three achieved a doctorate or terminal degree, and one leader achieved some
college but did not graduate. Table 4 provides applicable demographic information regarding the
stakeholders.
Table 4
Stakeholder Demographics
Stakeholder* Role and Healthcare Category Length of time
in leadership
role(s) (years)
Length of time
before becoming
a leader (years)
Education Level
S1 Director of Surgery 5 3 Doctor - Physician
S2 Director or Electronic Medical
Records (EMR)
25 8 Some college
S3 Director of Culinary Services 15 5 Bachelors
S4 Regional Nursing Director 7 4 Two Masters
S5 Healthcare Trainer/Coach 20 5 Doctor - PhD
S6 Administration Director 35 2 Doctor - EdD
S7 Administration Director 29 3 Masters
S8 Director of Cancer Center 33 8 Masters
S9 Director of Cardiovascular
Services
3 3 Masters
*Stakeholder (S)

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Qualitative Data Collection and Instrumentation
This study is a qualitative field study, focusing on the lived experiences of women
leaders as stakeholders (Newman et al., 2017). Semi-structured open-ended interviews allowed
for follow-up questions and developing an understanding of the organizational gender barriers
stakeholders experienced in their career growth (see Appendix B). Video recording collected
voice and video interview data, accompanied with researcher notes during the interview. A
review of both notes, and transcripts after the interviews combined to create the data sample (see
Appendix C). This study attempted to understand the organizational gender barriers these
Northern Colorado women overcome to advance to a leadership role and what they continue to
experience along their career journey. Creswell and Creswell (2018) discuss how people “make
sense of their lives” (p. 15) and the processes or actions they experience. The trends that emerged
may help organizations implement practices that support women and decrease the gender gap in
leadership roles (Saseanu et al., 2014). This study's credibility is supported through the
experiences of the stakeholders as leaders. As a field study, this research attempted to understand
the lived experiences of women who reside in Northern Colorado with respect to the
organizational barriers they face as leaders in director level leadership roles who wish to advance
within the healthcare industry.
Recruitment of women for this study included women's leadership networks, personal
associations, or direct recruitment. The stakeholders' experiences were varied with respect to
their organizations, with backgrounds in large and small organizations. All women listed in
Table 4 have held director level roles. All stakeholders received recruitment, confirmation, and
questionnaire communications (see Appendices D and E). The questionnaire provided after
commitment to the interviews in an email provided with meeting instructions, was intended to
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provide additional context to the experiences of the women and cross reference backgrounds of
stakeholders. All stakeholders received information and consent forms to ensure they were
provided with informed consent prior to agreeing to participate in the study (see Appendix F).
All of the stakeholders were assigned stakeholder numbers. The women selected for the study
were chosen because of their career position in their organization as a director; they may not
have overt knowledge of encountering gender barriers but may have overcome them to gain
access to the leadership level. Knowledge of gender barriers was not screened prior to the
interview.
Interview Protocol
Prior to asking questions the stakeholders were given an overview of the study.
Additionally, the time and place of the interview was recorded. The researcher also provided the
background of the study and shared an Informed Consent (Appendix D: Communications), with
each stakeholder upon the stakeholder indicating interest in participation. The researcher
disclosed their background and interest in the topic along with any conflicts of interest that may
emerge through the interview.
The interviews were semi-structured to support the capture of lived experiences, as the
stakeholders responded to the interview questions. The conversational nature of the interview
was intended to provide a supportive environment for the stakeholder where they could share
stories and experiences. The semi-structured approach allowed for a clear direction of questions
yet remained flexible. This format allowed the researcher to ask for examples or elaboration to
the responses of the stakeholders (Merriam & Tisdell, 2016). The questions were intentionally
open-ended and provided opportunity for the stakeholder to elaborate on their response and give
their perspectives and opinions (Creswell & Creswell, 2018). To understand the stakeholders’
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motives the questions allowed for experiential narrative and probing follow up questions as
described by Creswell and Creswell (2018) such as “tell me more” or “how do you feel about
that?” (p. 191). The questions listed in Table 5 are the promoting questions to begin exploring
the experience of the stakeholders.
Table 5
Primary Interview Questions
Interview Question Key Concept
1. Tell me a little about your current role Introduction and comfort
creating
2. Did you intentionally pursue a leadership role? Motivation and goal setting
3. Who are the leaders in your organization? How do you define senior leadership?
What roles equate to a leader in your organization?

Organizational culture and
structure
4. What organizational programs or systems have you found supportive in your
career?
Supportive measures
5. Have you experienced support in your career from another person? Who and How? Supportive measures
6. Who are the women leaders you are inspired by? What inspires you about them? Motivation and modeling
7. Have you experienced one or all of the following: gender related bias, barriers, or
discrimination in an organization in which you have worked? Can you provide
an example(s)?
Organizational culture
8. What skills or techniques did you use to overcome gender barriers? Motivation – self
determination
9. Can you tell me about an experience that was personally and/or professionally
impactful in your development as a leader?
Development of self-efficacy
10. How/what should organizations do to support gender equity in leadership? Organizational support
measures

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The researcher provided follow up instructions if there were any questions and offered an
abstract of the study to stakeholders. To develop an understanding within the KMO influences
this study asked questions about, experience, knowledge, motivational factors, self-efficacy and
organizational culture.
The field research approach as described by Creswell and Creswell (2018) focuses only
on the lived experiences of the research stakeholders (p.13). The focus of the research was on the
lived experiences of the Northern Colorado women who have all ascended to a leadership role
and aspire to senior leadership levels, and the gender barriers or gender inclusive support
experiences they encountered on their career trajectory. The researcher aimed to provide a setting
for emotional safety allowing the interviewees to share stories of their careers that may include
challenging and emotional moments. The topic of the study has potential to trigger experiences
that women have encountered in their careers. The discussions of gender and its impact on their
career may reveal memories and emotions that are difficult or hurtful to the stakeholder. The
questions are not intended to elicit emotion, but the personal nurture of the topic may result in
pain. Understanding this potential, the researcher was cognizant of setting an environment that
was confidential and provided emotional and psychological safety. Developing a rapport through
shared experiences and understandings between the interviewee and the researcher helped to
support emotional safety. The interviews were held via zoom conference, with a phone number
for a backup option. There is not a required number of questions that were asked, but there was a
list of ten questions to guide the interview, additional questions that guided the interview are
indicated in Appendix B (Table 5 and Appendix B). The opening questions were an ice breaker
and asked about the stakeholder’s current role. Not all questions were answered for the
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researcher to obtain the necessary information and supported the researcher to remain focused on
the challenges or barriers of their leadership accent (Merriam & Tisdell, 2016).
Interview Procedures
The interviews were 35-60 minutes in length and conducted via zoom. Zoom allowed for
a face-to-face interaction but allowed for social distancing required due to the COVID-19
pandemic protocols. While some interviews were short in duration the stakeholders opened up
within 1-2 questions and covered the research questions to the satisfaction of the study. The only
requirement for stakeholders was web access via phone service or computer platform. The Zoom
platform allowed for video and audio recording of the interview. The recordings were then
transcribed by a professional transcription software, Transcriblee. The stakeholders were asked
to join the interviews from a quiet, private space which was also reflected in the researchers’
space. The background was blurred to prevent bias toward or against the researcher. The
stakeholder was offered the option to obscure their name display. After collection, the data was
transferred to an external hard drive which was logged and coded with an individual identifier of
the stakeholder, S#. A password protected spreadsheet of identifiers was held on a hard drive.
The hard drive was stored in a locked drawer of a private office
Data Analysis
Interviews were conducted through a video meeting platform, Zoom. The interviews
were recorded within the meeting platform then transcribed on a secure purchased transcription
service, Transcriblee. During the interviews the researcher kept detailed notes in the format
indicated in Table 6, to record observations, themes that emerged, and notes to refer to after the
interview.

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Table 6
Observations Table

Stakeholder ID:
Pseudonyms:
Industry:

Question
asked
Key
response
words
Trend concepts Non-verbal’s (tone, volume,
speed of speech, etc).
Response Recorded below each question

The table was identified with the interviewee assigned number and saved with the transcript of
the interview. Post interview and transcription processing, the stakeholders verified the messages
and transcription were accurately processed. Post interview the researcher conducted a multi-
phase coding and analysis process that included identifying patterns and themes within
individual interviews as well as across multiple stakeholders from the transcriptions and session
notes. The data collected underwent a content analysis approach to understand the patterns of
verbal language, meanings of the encounters, experience and barriers, and the cultural
symbolism the stakeholders convey (Merriam & Tisdell, 2016). Content analysis consisted of the
conventional approach focused on verbatim word codes via the transcripts. Capturing key words
that appear in the text and then identifying theme patterns across the texts established the code
categories for the evaluation. The categories are related to the research questions and the
theoretical framework. The codes were listed under the framework themes to determine the
gravity of the code. The patterns derived from the coding process were subsequently coded
according to type and frequency of use along with their relation to the guiding research
questions. Quotations and perspectives of the stakeholders were identified to support the themes
that emerged. Connections were made if the theme concepts and key phrases were noted to
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demonstrate patterns in the results and discussion. In a concluding phase, the coding was
revisited to determine if any gaps developed in the data collection and if any additional data was
needed.
Chapter Four will discuss the findings and correlation of the data to the key research
questions.
Credibility and Trustworthiness
As a qualitative study the results cannot be generalized to all women and are intended to
be considered in the context of the study alone. Additionally, due to the qualitative nature of the
study and specific experiences of the women in this study it is also not transferable across
demographics. The initial assurance of credibility is the number of interviews undertaken to
ensure saturation was met for the data collection. After seven interviews the researcher
determined an adequate sample had been collected to determine themes. Two more stakeholders,
totaling nine, were interviewed to authenticate the saturation. The saturation point was met when
no new themes emerged, and the information began to develop the themes that were previously
identified (Saunders et al., 2018). This occurred over the course of the interviews and was
identified after the seventh stakeholder interview and no new themes emerged. It was determined
additional interviews would not provide new concepts or thematic data; the additional two
interviews confirmed the saturation point at seven interviews. Saturation was additionally
confirmed using the grounded theory method during the coding process, by evaluating the data
through a retrospective view ensuring no new codes emerged (Urquhart, 2013).
Interviews were derived from nine stakeholders ensuring the experiences of a cross
section of stakeholders were captured and represented the population of the region for this study.
The themes, major findings, cultural descriptions, and case analysis that is interpreted from the
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data, were member checked by the stakeholders. Lastly, the data analysis intended to relate back
to the research questions to tie the interview data to an analysis that was meaningful to the
research questions. The credibility of the study was rooted in trust of the stakeholders, the data
collection methods, and meaningful analysis. The stakeholders shared experiences that could
have an impact on their career advancement and their organization. It was critical to the integrity
of the study that the stakeholders felt safe and confident their data would be secure and used only
for the means of the study as they were laid out in the pre-study communications, the consent
form, and the pre interview explanation. The researcher received consent prior to recording the
interview and the stakeholders were provided a copy of the transcript to ensure accuracy after the
interview was complete. Any potential conflict of interest on the part of researcher or
participation was disclosed and evaluated for disqualification from the study (Creswell &
Creswell, 2018).
Ethics
Researching with human stakeholders presents specific challenges that are accounted for
to be sure to protect those in the study. University review boards help to ensure protections are in
place for the safety of the stakeholders and companies that allow research often maintain an
internal review board along with the university. As a field study, the internal review process was
conducted at the university and was determined to be an exempt review level.
This field study required human stakeholders to provide personal stories and experiences
from their careers. The stakeholders agreeing to interviews risked sharing experiences that
family, friends, or colleagues may not know. Divulging experiences in a study that they have not
shared with others risks the experiences of stakeholders coming to light in their lives before they
are prepared, creating an emotional and possibly a personal toll on the stakeholder. They also
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risked negative consequences from their employers by sharing negative experiences related to
their organizations. Experiences that reflected negatively on an employer could create a situation
where the stakeholder encountered retribution from the employer. Prior to discussing their
experiences or answering questions, all stakeholders received an informed consent to ensure the
risks were clearly identified for the stakeholders and they had opportunities to ask questions and
determine personal impacts (Merriam, 2016). Stakeholders were informed they may remove
themselves from the study at any time. In addition to the women, the organizations in which they
are leaders are also at risk for identification. If the experiences of the women reflected negatively
on the organizations, this could have led to reputational damage for the organizations. In extreme
cases, information may be shared of a legal nature and might have risked the compliance of
organizations. Pseudonyms would have been assigned to all organizations if referred to by name.
They also may have received an identifier that was only known to the researcher, such as
“Organization A.” There were no organizations referred to by name in this study. Limited details
of the organization, size, and other identifiable characteristics were only used as necessary to
discuss the cross-industry findings.
Summary
This chapter provided the methodology of the study evaluating the organizational gender
barriers women face in their pursuit of leadership roles. A discussion of the participating
stakeholders was discussed, followed by the data collections and instrumentation, and the
interview protocol and procedures. Analysis procedures for the data were described, followed by
the credibility, trustworthiness, and ethics of the research. Lastly, treatment of the stakeholders
and limitations and delimitations were reviewed. Chapter Four will present the data and include
an analysis.
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Chapter Four: Results and Findings
The purpose of this field study is to explore the barriers that women encounter as they
progress through their careers and advance to manager and director leadership roles. While a
complete evaluation would focus on all stakeholders, chairpersons, board members, and aspiring
women leaders, the stakeholder of focus is aspiring women leaders (manager or director level)
for practical purposes. The analysis focuses on the knowledge/skills, motivation, and
organizational resources that influence women's equitable advancement within their
organizations. The questions that guide the focus of the study are as follows:
1. What are the knowledge and motivation influences related to the organizational
gender barriers that impact women in the advancement of their careers?
2. What is the interaction between organizational culture and context and women's
knowledge and motivation as it relates to the organizational gender barriers that
impact them in the advancement of their careers?
3. What are the knowledge, motivation, and organizational recommendations to
overcome organizational gender barriers?
The Experiences of the Northern Colorado Healthcare Leaders
Prior to exploring the findings associated with knowledge, motivation, and organizational
influences that have had an impact on the women of this study, it is important to discuss a key
theme that emerged with the women in this study. Trust and a desire to share their stories was a
need that came through in the interviews. It appeared the women wanted to be asked about their
stories but were hesitant to share until they were asked. In all interviews the stakeholders opened
up in 1-2 questions and began sharing personal stories, emotional accounts and deep reactions to
the questions. The stakeholders quickly shared personal experiences, feelings, frustrations, and
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memories about their experiences in the workforce and the thoughts they have about being a
woman in their organization and role. When asked the stakeholders said:
(a) S1- I joke less, my bubbly self can be interpreted as weakness.
(b) S4 - The women I am around let me be vulnerable.
(c) S5 - I didn’t feel I was worth the offer that was made, it made me wonder how often
we minimize ourselves.
As the interviews began the stakeholders opened up quickly when the question was clear and
specific to an issue. A question about experiencing gender bias resulted in two stakeholders
discussing sexual harassment.
No one will help you, I walked out of two jobs and was literally almost homeless, but I
had to, I could not accept a proposition as a condition of my job (S6).
For me at the time, it was fear. I felt like my job was at risk, so I just didn’t say anything
(S5).
The stakeholders who shared their experiences of sexual harassment felt they were left powerless
against the organizational culture that was derived from gender barriers. This culture deprived
the stakeholders of their motivation and knowledge to overcome the barriers and pursue
leadership. A National Public Radio survey, reported in 2018 that a startling 81% of women in
the work force have experienced sexual harassment. In this study that resulted in 7-8 of the
stakeholders experiencing some form of sexual harassment. While that was not a direct question
of the interview the stakeholders made comments such as S8, who said:
He terminated female employees that reported to him, it was obvious beyond measure
what the difference was. You could not be too vocal or chatty, he would say they did not
have substance in their thoughts.
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The stakeholders within this study opened the door to share their stories and memories of the life
they have lived and the experiences that have crafted their careers.
The stakeholders shared stories of hope, sadness, challenge, and support. S2 said “I really
get what my team needs, men and women. They trust me.” This sentiment is shared by S8, S9,
and S7. They have created their brand of leadership as S6 says “when you can be authentic and
genuine you can do what is right”. Challenging organizational gender barriers is not something
that these stakeholders encountered and have conquered. It is an aspect of their careers that they
continue to encounter and have decided to confront, as S7 says “you have to know when to not
back down, I know I have my support system to help me keep standing”.
The stakeholders shared stories that spoke to their courage and strength, along with the
fear and insecurities. The following sections will explore the nuances of the knowledge the
women have and need, along with the motivation they developed to overcome barriers and the
barriers they were unable to overcome. Lastly the organizational outcomes are those that wrap
around knowledge and motivation. The organizational culture and influences are discussed by
the stakeholders through their experiences and their impact on the stakeholders’ career.
In the following sections this study explores influences of knowledge, motivation and
organization as impacts on aspiring women leaders progressing to senior leadership roles. It
explores the stakeholders’ experiences to better understand how they overcame gender barriers
and what barriers they still encounter.
Results of Knowledge, Motivation, and Organizational Influences
The results presented below follow the conceptual framework discussed in Chapter Two
and guided by the research methodology in Chapter Three. The following findings use the
framework of the KMO model to provide structure to a complex topic and understanding of the
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stories that were shared by the stakeholders. All women were offered to decline to answer
questions that they felt may harm them or their job; there were no declined answers within the
interviews. Interviews were evaluated first independently and collectively to determine whether
KMO influences were assets, gaps, or partial gaps. Within this study, gap influence means that
analysis of data confirms the need exists for seven or more stakeholders, and a resolution is
required to influence a change in organizational gender bias. Asset means that seven or more of
the stakeholders confirmed a gap does not exist for the assumed needs identified in the
conceptual framework as a barrier to advancement into leadership. Partial gap means between
four and six stakeholders confirm a gap exists, but it does not meet the four-stakeholder
threshold to designate the need as a gap. Partial gap also includes gaps that did not present a
critical barrier to women’s advancement into senior leadership roles. Table 7 provides asset
determination thresholds for the stakeholder group as determined by the researcher for the
purposes of the study and applied to the corresponding influence.
Table 7
Asset Determination Thresholds
Assertion Threshold
Gap Gap influence means that analysis of data confirms the need is not met for seven or more of
the stakeholders, and a resolution is required to influence a change in organizational
gender bias.
Partial Gap Partial gap means between four and six stakeholders confirm a gap exists, but it does not
present a critical barrier to women’s advancement into senior leadership roles.
Asset Asset influences mean that seven or more of the stakeholders confirmed a gap does not
exist for the assumed needs identified in the conceptual framework as a barrier to
advancement into leadership.

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Each KMO results section begins with a summation of the findings, and a supporting table that
identifies the needs associated with the specific KMO assumed influence. Detailed discussions of
the results follow the summary of findings for each section, including the critical data points and
quotations obtained from the stakeholders’ supporting the findings. Chapter Four concludes with
a synthesis of conclusions associated with KMO needs and influences. Chapter Five presents’
recommendations related to the gaps associated with the influences.
Knowledge Influence Findings
This study examined three knowledge influences, conceptual, procedural, and
metacognitive through interviews of current women leaders at the director level in healthcare.
First, the study evaluated the women's conceptual knowledge of the promotional process within
their organizations and the impact gender bias had on their knowledge of the advancement
process. Second, the study developed understanding of the women's procedural knowledge
regarding what supports they leveraged to overcome organizational gender barriers. Finally, the
study assessed women’s metacognitive knowledge with respect to their skills and abilities to
overcome organizational gender barriers to their advancement to senior leadership levels.
Clark and Estes (2008) indicate a need for knowledge and skill enhancement for job
performance or advancement. The knowledge element of KMO necessitates women have a depth
of knowledge related to process and practicable understanding to improve performance or
advancement. The stakeholders need to possess knowledge of the process and underlying
organizational gender barriers (conceptual) for advancement as well as knowledge of the support
mechanisms (procedural) needed to develop in their roles. Clark and Estes (2008) also indicate
there is a need for continuing and advanced education. This condition connects to the
stakeholders’ ability to reflect on their skills and abilities and the need to seek additional
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education to advance in their roles. The results indicate that while the first two knowledge
influences surrounding process and motivation are closely aligned; the second and third
influences, focused on support skills and abilities knowledge, have a more significant impact on
women's advancement.
The summary of presumed knowledge needs, and results is illustrated in Table 8.
Table 8
Summary of Presumed Knowledge Needs and Results
Assumed Knowledge Influence

Knowledge
Type
Knowledge
Influence
Assessment
Validation
Women need to know the organizational gender barriers
that impact their promotional process.
Conceptual Interview Partial Gap
Women need to know how to leverage support to
overcome organizational gender barriers.
Procedural Interview Asset
Women need to reflect on their skills and abilities in order
to overcome organizational gender barriers.
Metacognitive Interview Asset

Note. The assumed influences are the overarching influence and are informed by multiple factors as described in the
following sections.

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All stakeholders understood the nature of organizational gender barriers and how it impacts
conceptual, procedural, and metacognitive knowledge and professional advancement. Yet, four
of the nine did not recognize they were experiencing gender barriers even as they described their
experiences which were impacted by organizational gender bias.
I don’t think I experience gender barriers; I work with a lot of women. It is strange
though, when we have a male colleague on the floor a patient or other hospital employee
will direct their questions to him before me (S4).
The barriers experienced were embedded in the organizational and societal culture as described
by S5 and S4.
Jokes and “old boys clubs” do not bother me. I try to engage where I let go of the rest”
(S5).
When I was training a male nurse, an elderly patient assumed he was the doctor and
commented “why would he want to be a nurse?” (S4)
Five of the nine stakeholders below identified various organizational gender barriers and
indicated they have worked personally to understand this dynamic and had language to describe
their experiences.
(a) S6 - It is everywhere, sometimes I have to choose if it is worth it to say something. It
can be exhausting.
(b) S1 - It is important to have a peer group to talk about the daily experiences with
colleagues and patients and challenges we have faced, as providers and women.
(c) S7 - I have had to learn how and when to show emotion, it makes me a good leader,
but it is not what I was taught.
(d) S8- I have rebuilt my self-confidence and I am emotionally on the other side.
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(e) S2 - I see the hard work other women are putting in and I want to encourage them. It
is the same approach I took, work harder and longer than my male peers and I
will be successful.
While one of the stakeholders recognizes gender barriers, they describe participating in the
perpetuation of the bias.
It just doesn’t bother me that much, you know. I can be a part of the boy’s club and get
stuff done (S8).
Factors that are examined throughout the knowledge assessment and thematic analysis of
stakeholder interviews revealed factors of awareness among the women. Check marks are
indications that the stakeholder expressed through their stories or direct questions that they
experienced the barriers illustrated in Table 9.
Table 9
Awareness of Organizational Gender Barriers by the Stakeholder
Measure Stakeholders
S1 S2 S3 S4 S5 S6 S7 S8 S9
Encountered gender barriers

Awareness of encountered gender
barriers

Not aware of encountered gender
barriers

Challenged gender barriers they
encounter

Perpetuates gender barriers they
encounter

Engages in self-study of gender
barriers

Note. A checkmark indicates the influence is experienced by the stakeholder. All sections can assume “stakeholder''
is the focus of the evaluative metric.

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Findings of conceptual knowledge: Women need to know the organizational gender barriers
that impact their promotional process - Partial Gap
The factors impacting the stakeholders conceptual influence is subtle and embedded in
organizations policy language and evaluative role expectations of the stakeholders as
organizational leaders. S1 discussed her involvement in identifying the gender language in her
organization.
In large meetings I speak up about policy creation and evaluation examples and ask that
we change language that uses gender pronouns. I try to suggest non-gendered words and
use titles or committee names over pronouns.
Table 10 illustrates the themes and factors that impacted the conceptual knowledge
influence of organizational gender barriers of the stakeholders.
Table 10
Overview of Women Directors’ Response to Conceptual Knowledge Themes
Measure Stakeholders
S1 S2 S3 S4 S5 S6 S7 S8 S9
Promotional process

Gender barriers in the organization

Efforts to identify and decrease
gender barriers

Support for advancement within
organization

Organizational requirements for
promotion or advancement

Note. A checkmark indicates positive confirmation that the influence is practiced by the stakeholder. “Knowledge”
is assumed for all themes.

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Eight of the stakeholders are aware of gender barriers within their organization and field.
The eight stakeholders indicated a default to gendered pronouns as a microaggression they
experience through gendered language in organizational policies. Notably, five stakeholders
discussed this gendered language in policies associated with performance, promotion, and
evaluations. S1 describes additional efforts to impact gender barriers in language.
I try to call out the language in policies that we review, but it also occurs to me that we
are working uphill because of the historical language of the medical field. We need to
stay consistent in language and need to remove gender pronouns or assumptions
whenever possible. Sometimes I feel like I am the only one who sees it.
S1 participates in an example to identify and decrease gender barriers as a committee member to
review the organization's policies; she noted the other committee members, majority men, do not
take note of the pronouns used in the creation of the policies. She makes a point to identify them
and request changes before the publication of the policies. The use of gendered pronouns is an
organizational bias and barrier that indicates the preference of the organization. S4 comments
“gendered language impacts the patients as well as the staff.” and continues “our posters,
materials, and other handouts are gender specific as well and I worry that impacts our patients”
(S4). Language is an indicator of organizational gender bias the eight stakeholders observed
throughout the organization's policies and job descriptions. Historically gendered pronouns
attached to roles such as a doctor (male) versus midwife (female) are an institutional barrier that
the women in physician and nursing roles encountered (Rivera & Tilcsik, 2019). S1 discussed
the impact of language in hierarchy and authority of medical care as a physician.
As a woman physician, I have to draw on my composure to not acknowledge comments,
perceptions, or language colleagues and patients use that is coming from a place of
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gender influence. When I am seated with a male nurse or technician, staff and patients
who do not know me, assume the male next to me is the physician and direct patient care
questions to him. I feel like I have to defend my education.
Gendered language enforces the expectations surrounding the organizational gender barrier of
who the leader is in a group and who has the authority to make requests, suggestions, and in her
case, care of the patient.
The second key finding within the conceptual influence was the existence and challenge
of role expectations, whose factors are illustrated in Table 11.
Table 11
Accommodating Gender Role Expectations

8
9 9
3
9
0
1
2
3
4
5
6
7
8
9
10
With hold emotion Lower voice Strong tone Less
Playful/Jovial
Assertive
Accomidating Gender Role Expectations
Stakeholders
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This finding connects with the language barrier and leads to the evolution of emotions,
tone, and performance expectation differences. Notably, all nine women identified the
organization's language and tone expectations as an organizational gender barrier. S4 discussed
changing her demeanor based on the group of people with whom she was interacting.
I act more like one of the guys when working with my male colleagues than my more
feminine self. I am more sensitive and caring when working with my female colleagues.
Even my written communication is different. When writing to a male I am more direct
and less formal. With women I use emojis and ask how they are doing and tell them why
I am calling or writing before asking for what I need.
All stakeholders indicated they change communication style, attitudes, and physicality in
lowering their voice. Eight of the stakeholders mentioned a need to show little emotion in their
language and voice. Notably, S7 related a coaching experience to embrace a male colleague's
style.
With a finger in my face, he told me, “We cannot show emotion...You need to be super
stern, direct, and demand accountability". I tried his style once and realized that style did
not work for me. It was not authentic to me and was more aggressive than assertive. His
style made people cry, he was okay with that, and I realized I was not.
Stakeholders exemplify role expectations within their organization through behaviors evaluated
in performance standards. Two stakeholders (S1 & S6) discuss how role expectations impact
their daily environments. As doctors, medical and academic, they experienced both shared
examples of the disconnect associated with expectations of communication.
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When I ask for things associated with patient care, I may ask the same way a male doctor
does, just using the facts, but I have to do it with a smile, or I get comments like “what’s
in her bonnet today?” I am tagged as demanding (S1).
S6 provides similar experiences and notes feeling marginalized by male counterparts.
On a group call with all male counterparts, my voice was not heard. I would make
suggestions for community health needs, and they would literally ignore my suggestion.
Yet on the next planning call one of the men would bring up the same idea and it was
universally accepted. It was demoralizing.
Similarly, S3 reported a substantial pay inequity. S3 shared an experience about being one of
three people in her position across the system, she was the only woman. She holds a master's
degree while her male colleagues’ hold a bachelor's degree. She discussed the additional
schooling she sought and said, “I felt like I needed to have additional credentials to be
competitive” (S3). After hearing her colleagues comparing salaries post annual evaluation, she
realized her pay started at entry-level for the role, while the men began in the middle of the pay
scale. Both she and the men came into the roles with the same level of leadership experience in
the industry, but the men had more years of industry experience. Upon a request of a pay inquiry,
S3 reports the following response:
After realizing I was being paid three-quarters of my male colleagues, I requested an
inquiry. The response felt like a canned human resource answer of "all salaries are based
on experience." It was confusing because we have the same experience and I have a
master's degree along with a registered dietitian certificate, and they do not. It felt like I
was being penalized for having taken the time to gain additional education and training.
This was a devaluing experience, and I left the role because of the disparity.
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S3’s experience with education and experience to pay ratio aligns with the literature surrounding
educational rates and pay inconsistencies between men and women. In identifying the language
and role expectations within their organizations, S7 shared a worry about how expectations
impact her career.
I had to learn how to behave as a leader in the organization, and what that was expected
to look like. While I try to bring in my own voice, I worry it will not be what is expected.
Findings of procedural knowledge: Women need to know how to leverage support to overcome
organizational gender barriers - Asset
All nine stakeholders demonstrated comprehensive procedural knowledge to leverage
support in overcoming organizational gender barriers. The stakeholders’ awareness of the
following four factors of procedural knowledge was informed through interview questions and
experiences the stakeholder shared as an influence on their advancement: availability of
development opportunities, availability of support systems, formal or informal mentorship, and
personal advocates within the organization. The stakeholders leveraged the resources at their
disposal and identified when resources were lacking.
I use self-development books and have joined a women’s book club that has started with
some of the other women directors (S8).
These factors are illustrated in Table 12.

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Table 12
Summary of Women Directors’ Response to Procedural Knowledge Factors
Measure Stakeholders
S1 S2 S3 S4 S5 S6 S7 S8 S9
Development opportunities are
available to women

Professional development
opportunities that make the
greatest impact on advancement

Mentorship opportunities formal or
informal

Support from leaders in the
organizations, a personal
advocate

Note. A check mark indicates positive confirmation that the factors are practiced by the stakeholder. “Knowledge”
can be assumed as the evaluative theme.

Seven of the stakeholders indicated leveraging two of the evaluated knowledge factors,
knowledge of professional development opportunities and mentorship. S2 and S8 had mixed
results associated with their procedural knowledge of gender barriers.
I wish I had someone like that (an advocate). I have never really had the opportunity to
seek out a leader to have those heart-to-heart conversations and learn about the direction
of the organization, and I would like to (S2).
S8 shared an experience about a lack of formal mentorship.
We don’t have any formal growth resources that I am aware of, I think it is a cultural
mindset, our region (Northern Colorado) does not have the same career ladder and
mentorship opportunities as my colleagues in Arizona, they are brought along, and we
have more of a fear of keeping roles.
As predicted, mentorship and professional development was the most impactful for
women to overcome gender barriers. The stakeholders discussed feeling that they would need
additional formal education to ensure they are competitive as leaders. The stakeholders used the
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following phrases to emphasize their concern about lacking knowledge surrounding support for
their advancement; “If I could get the role, I would try to make a difference” (S6). “For me it
was fear of failure” (S5). “I’m young, do you really think I am ready for this?” (S8). “I think I try
to develop my own self-confidence that I am a good leader” (S1). “I do not have a degree, so I
always wonder if that has degraded my voice” (S2). All nine stakeholders indicated they had
sought professional education or development to strengthen their field knowledge, resulting in
advancement. This theme aligns with the literature presented by Hogue and Lord (2007) relating
to the education levels that are required of women to advance in comparison to male
counterparts. Notably, seven stakeholders relied on formal or informal mentorship to support
their advancement. While the stakeholders were not assigned a mentor or participated in a formal
mentorship program, they sought the mentorship of more senior leaders. S9 talks about how her
mentorship developed with senior leaders.
He kept coming around every day and I was able to ask questions. It started because he
was rounding, and I was about to just say “hey what do you know about…”. And he took
the time to stop and answer. He taught me about strategy, team building, and budgeting. I
felt like he cared about how I did, and it would be rare that I would not see him.
The stakeholders’ knowledge of organizational development opportunities dropped to
five stakeholders, indicating the majority of stakeholders pursued professional development, like
S1 independent of the organization as demonstrated by their interview responses.
I read everything I can about leadership. I don’t have a formal group to discuss this with
but I do reach out to my Facebook group to bounce ideas around.
S5 shared experiences in professional coaching and how this external resource she sought has
become a critical aspect of her toolbox.
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Everyone should have a coach. She is only interested in my success and helps me with
personal challenges and development areas we have determined I want to work on (S5).
Lastly, guidance provided from an advocate within the organization that is not a mentor
was limited to two of the stakeholders.
I can call her for anything. She knows how healthcare works and is someone I know is
looking out for me. I don’t trust many people, but I know she is in my corner and is in the
organization, that is rare (S6).
Among these themes, three clearly emerged from the stakeholders' procedural knowledge that
created a gap in needs: peer groups, mentorship, and self-development. These three themes were
discussed by all the stakeholders using various languages to describe the impact of the
procedural knowledge aspects and the impact on each stakeholder’s advancement.
Two themes are closely related in their impact, peer groups, and mentorship to develop
procedural knowledge to leverage support. All but one of the stakeholders discussed finding a
formal or informal mentor in their career. For all the stakeholders who had a mentor, only one
had a woman as a mentor. The other eight stakeholders all had men as mentors. In these
situations, all the women with men mentors sought women peer groups.
I need a safe place to talk about my day, peers, sometimes my boss, and sometimes my
male colleagues. I need other women to talk to (S1).
Some of the stakeholders sought safety for conversations others sought validation in their
challenges.
I don’t trust many women in my organization, and I am sometimes like, I am not crazy, I
am not making this up. It helps to know I am not alone (S6).
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Figure 2 illustrates men mentors' connection with women mentees and the resulting need for a
woman-focused peer group. The one stakeholder who had a woman mentor did not seek a
woman-focused peer group.
When I had a woman mentor, I could talk to her about everything, I felt like she really
had my back and lifted me up.
Figure 2
Support Model

Note. Assumes a formal and informal mentor/mentee relationship within the organization.

If mentor
is a man;

and a woman
is the
mentee;

then women
peer groups are
established
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Beeson and Valerio (2012) list formal training through mentorship as key to women’s
advancement to senior leadership. The stakeholder’s mentor relationships focused on building
technical skills, navigating the organization's internal politics and processes, coaching on
personnel issues, and developing emotional intelligence.
I was not sure I could do the job she asked me to do. I did not have the technical skills.
She said ‘what you need to learn I can help you with that. You’ve got everything else’”.
Stakeholders report informal mentorships developed organically with men in the organization
who wanted to see the stakeholder succeed. For example, S9 shared:
He helped me to understand strategy, it was not something I had an understanding of, but
it was critical for leadership.
As shared, the mentorship she received was critical to her advancement because she
experienced formal training from an experienced leader. S4 shared her experience with training
that occurred through mentorship.
I was coached through opportunities where I was tested and put under constructive
tension. It was a challenge, but I had the support of a mentor to guide and teach me the
skills to overcome the tension.
S7 shared how a mentor taught her to role play situations she encountered.
I learned a lot about how to manage my emotions and deal with situations through role
play. He used crucial conversation to set the stage for learning. He taught me to be clear
and kind, and less words are better.
The mentors taught the stakeholders technical, procedure, and strategic skills that they indicated
led to their advancement to directors and they hope will serve them in further advancement.
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Additionally, all nine of the stakeholders discussed a need for peer group support. The
stakeholders indicated peer groups provide a place of belonging, processing, emotional safety,
and tips for achieving an intended outcome. As S7 discussed, she experienced a feeling of
loneliness in leadership:
It's lonelier the higher you get in the organization. You can be friendly with people who
report to you, but you cannot be friends or rely on them for support. A support network of
women has been helpful to me through the years.
A feeling of loneliness is a sentiment echoed across all the stakeholders, and a key driver for
them to find a peer group. The stakeholders also discussed needing a safe place to "bounce ideas
around" and "Just talk to other women" (S4). The support of a peer community was vital for the
stakeholders to advance in their careers. All the stakeholders indicated peer groups as a critical
resource that allowed them to have a space to discuss concerns, issues, hot topics, and was an
emotionally safe place unassociated with the organization. S1 discussed the challenges of
developing a women’s support network.
I am in a mom’s physician group on [social media] and a group specific to my medical
specialty. We discuss hard cases we have had, and how we relate to them as women,
management problems, and sometimes challenges we have with male colleagues.
Recently a male colleague found out about our group and brought it to leadership because
he felt slighted to not be included. We ended up creating another group for all colleagues
while maintaining the women’s group (S1).
The women needed a safe place to express concerns and discuss issues without censoring
themselves. Elias (2017) discusses the importance of peer groups to support leadership growth
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and the male colleague’s insistence on joining the group challenged the safety to discuss all
topics and develop support relationships. S1 continued to discuss the connections in the group.
Having a place to know that it was not just me dealing with some of these issues is very
important. We will often make a connection in the group and have private conversations
to discuss the meat of the issues and solutions. It is more than a support network. We are
there for each other when we have hard days (S1).
As the stakeholders were encouraged to temper their emotions, the peer groups provide a place
for them to express their emotions and deal with issues that are impactful for their leadership and
their personal experience.
Within the organization a leader advocate helps women find and facilitate professional
development opportunities. Yet only two stakeholders report having support from leaders within
the organization. This lack of support left most women seeking out external professional
development opportunities to overcome organizational gender barriers. S3 commented that a
leader in her organization "believed in me" (S3) and yet there were no organizationally based
development opportunities identified to support S3. The commitment of support from an
organizational leader allowed two stakeholders (S3 and S9) to receive organizational support for
training needed to aid in advancement.
I was not always sure what was available and how to access the training or funds to help
pay for training. I didn’t really have the personal resources, so having someone help me
navigate that part helped to gain the training I wanted (S3).
Without an advocate, women could not get training approved, paid for, or supported to advance
their careers. The majority of stakeholders felt they needed to be subject matter experts but did
not have the organization's resources to support them to gain this knowledge. As S2 expressed,
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"Without personal support within the organization, I am left to fend for myself, and I often
cannot make myself the priority." An advocate within an organization could align the women's
goals and skills with advancement, yet few of the stakeholders identified an advocate for their
careers and goals in their organization. Eight of the stakeholders did, however, identify advocates
outside the organization for support.
It is sometimes easier to have someone to talk to that is not invested in the organization
but knows what I am doing (S8).
Consistent with the conceptual model's procedural knowledge, women need to know how
to leverage support to overcome organizational gender barriers. Table 13 illustrates how the
stakeholders developed their procedural knowledge of leveraged support systems to overcome
organizational gender barriers.

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Table 13
Responses regarding leveraged support systems
Stakeholder Statement Impact
S4 “I was coached through opportunities where I
was tested and put under constructive
tension. It was a challenge, but I had the
support of a mentor to guide and teach me
the skills to overcome the tension.”
S4 had the support of professional growth
through informal mentorship. She
identified the tension as growth
opportunities to learn new skills and
develop abilities.
S9 "He helped me to understand strategy, it was
not something I had an understanding of,
but it was critical for leadership.”
S9 had a depth of knowledge associated
with development opportunities that were
available and what made the greatest
impact on her advancement, strategic
thinking, and a mentor and advocate to
help support her professional growth.
S7 “It's lonelier the higher you get in the
organization. You can be friendly with
people who report to you, but you cannot
be friends or rely on them for support. A
support network of women has been
helpful to me through the years.”
S7 is knowledgeable about the barriers of
women leaders and sought peer groups to
develop supportive relationships. While
not professional skills based, the relational
aspects of peer groups helped S7 to
process her career growth and needs of her
role.
S1 “Having a place to know that it was not just me
dealing with some of these issues is very
important. We will often make a connection
in the group and have private conversations
to discuss the meat of the issues and
solutions. It is more than a support network.
We are there for each other when we have
hard days.”
S1 also highlighted the relationships of other
women to help support her through
leadership challenges and organizational
barriers she encountered that were cultural.
S2 “Without personal support within the
organization, I am left to fend for myself,
and I often cannot make myself the
priority.”
S2 lacked a mentor and advocate but found
support through organizational
opportunities that impact professional
growth.

This procedural knowledge influence was an asset for the stakeholders to aid in the advancement
into leadership roles. While the influence of organizational support through formal programs to
develop knowledge was not met, the stakeholders fulfilled their development needs through
personal development (self-learning) or peer groups development.

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Findings of metacognitive knowledge: Women need to reflect on their skills and abilities to
overcome organizational gender barriers – Asset
Metacognitive knowledge supports reflection on skills and abilities to overcome
organizational gender barriers. Knowledge and understanding of personal strengths or abilities
and how they impact gender barriers is key for the stakeholders to overcome the gender barriers.
Coupled with knowledge of how opportunities for men compare to those for women may guide
how the stakeholder’s approach professional advancement. This understanding was discussed
through interview questions that focused on how stakeholders reflect and evaluate performance
and identify limitations that may impact their ability to advance into more senior leadership
roles. A summary of the metacognitive factors is depicted in Table 14, the check marks indicate
that stakeholder spoke directly to the knowledge factor or used similar language.
Table 14
Summary of Women Directors’ Response to Metacognitive Knowledge Factors

Stakeholders
Measure S1 S2 S3 S4 S5 S6 S7 S8 S9
Strengths or abilities impact
professional advancement

Skills that make an impact on gender
barriers

Skills/abilities that make an impact
on gender barriers

Note. A check mark indicates positive confirmation that the factors are practiced by the stakeholder. “Knowledge”
can be assumed for all evaluated themes.

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All nine stakeholders indicated a strong understanding of their skills and abilities, yet all
nine discussed some form of challenges with personal confidence in their skills and abilities.
Reflecting on their technical skills, all nine of the stakeholders made statements similar to S2
about taking action, “I need to get in there and get the task done.” The sentiment is focused on
having a deep sense of technical proficiency and related to their confidence as a leader. While an
alternative is indicated through burring confidence concerns and “putting on a brave face” as S9
shares. S6 discussed taking on a new leadership role and initially turned it down because she did
not have experience in the subject area.
I did not want to go in there and fail, not just myself but the unit. Patients depended on
the team I would lead, and I was afraid to take the risk (S6).
As the stakeholders discussed proficiency of their skills, a theme of perfection and data-based
decision-making emerged. “I pull all the data I can before going to see my boss” (S2). These
themes appeared rooted in confidence along with a desire to have answers and not be surprised.
Eight of the stakeholders specifically mentioned questioning their confidence to do the job.
Summarizing their sentiments is an honest account of confidence from S1.
My biggest barrier to my leadership advancement is my self-confidence that I am a good
leader. Because I am unsure, I am doing the right thing, like within the process or
organization. It’s honestly my biggest impediment to any advancement (S1).
The more engagement the stakeholders have with mentors, the more confidence they developed.
S1 continues that “my mentor helped me through some issues related to my style and what I feel
is deficient in my skills and abilities.” Confidence can have an impact on how the stakeholders
view their skills and abilities. Lacking confidence caused S4 to question her skills and validity as
a leader in her initial leadership role. S4 shared the following experience.
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After being selected over a male colleague he filed a complaint with Human Resources
that I was discriminated against because of his gender. This complaint made me question
everything I was doing. I was under investigation for 18 months and thought I would lose
my job. I knew I didn’t do anything wrong, but I felt like I did. It set me back about two
years in my leadership journey.
S4’s experience challenged her sense of confidence in why she was selected for the role and how
to approach conflicts as a leader. She indicated it took eighteen months for the complaint to be
rectified. During this time, she questioned her abilities, worried her reputation as a leader was
tarnished and she may even lose her job. Her confidence was shaken S4 stated “I questioned
every decision I made”, it impacted her growth potential, especially during the investigation
period. S4’s experience is an example of how the stakeholders felt they had to keep meticulous
notes to defend their decisions. S2 also commented “I document everything, to protect myself
and ensure I have the facts when decisions need to be made”. Available information on the
history of decisions helped to support the stakeholder’s confidence in their abilities.
I don’t want to get caught not knowing why we made a decision or why I created a
process. I need to keep a history to protect myself, especially with personnel issues (S2).
Confidence in their skills and abilities lead two of the stakeholders to delay seeking or accepting
leadership roles for eight years while the remaining seven stakeholders moved into leadership
within 3-5 years after starting in their given field.
Technical proficiency was a theme that came through for all nine stakeholders as critical
for women to overcome gender expectations and barriers to their advancement. S3 discussed
how technical proficiency expands to job roles as well as working with staff.
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I like to walk and talk. I need to be able to explain the why to people and understand it
myself. That helps me build confidence in my skills (S3).
This technical proficiency drives the stakeholders’ understanding of their skills and abilities as a
leader. Bertrand et al., (2018) discuss how women lean on technical proficiency to overcome the
barriers and encourage their competency as leaders.
The stakeholders identified skills and abilities that they felt leveled the leadership field.
However, there is a disconnect about how their leadership may impact gender barriers. One
stakeholder uses assimilation to advance. S5 said, “I engage in the ‘boy talk’ and roll with what I
know is misogynistic, but it has helped me advance.” While S5 sees the gender barriers, she
chooses not to confront them, creating a discrepancy in how her acceptance impacts gender
barriers for other women. While the inverse occurs with S6, commenting, “I listen to my
intuition and lean into integrity and responsibility.” S5 and S6 take two very different approaches
to overcoming gender barriers. S5 assimilated into the environment to become one of the
stakeholders and was able to advance to leadership by “not rocking the boat” (S5). While S6
challenges the barriers and uses her value system to determine where, when, and how she
challenges the barriers. S6 willingness to confront gender bias has impacted her career as well,
she has had to move onto other roles and organizations to navigate around the gender barriers
that were too great to overcome in a particular organization.
At one point I thought I would be homeless, but I could not compromise myself and my
values to agree to what was proposed (S6).
There was little evidence that the stakeholders are aware of the opportunity differences
for women and men in the organization. Only four stakeholders discussed this influence in their
leadership journey. Two (S2 and S3) reported experiences that impacted their selection for roles
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or after their roles. S2 reports being passed over for a position “because I was a young mom of
four and they indicated they needed someone with more commitment”. S2 indicated how the
language of commitment was used to overshadow her motherhood, and the needs of her young
family. She continues “I was mad, but it also made me work harder to prove my worth”. S2
encountered a cultural barrier to women in leadership roles. Diversity Best Practices (2017)
supports the transparency of family care and leave as a key organizational culture component to
support women and women in leadership. S2 considered joining the 40% of women who leave
the workforce due to family needs and lack of support from the organization (Catalyst, 2021),
but instead she turned to her skills. Yet the underlying question remained why she had to prove
her worth and ability to balance being a mom and a good employee.
While S6 and S7 discussed the clear disparity in selecting men for the C-suite, while
women represent 80% of healthcare roles, the stakeholders report a perceived lack of women
selected for key C-Suite positions in their organization.
I have reported to men my whole career, there seems to be more men selected for the C-
suite roles than there are women, but it is only my perception (S8).
Having women role models is a key organization component in supporting women to advance
into leadership roles. The exclusion of women from C-suite levels left S6 and S7 without access
to the social capital required to advance in their organization. The lack of women leaders also
deprived S6 and S7 of opportunities for a woman mentor. S7 comments,
I tried on different styles to try to find my authentic leadership voice, I did not have a
woman leader to model and struggled to find the balance of the male leaders’ styles and
my own.
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As women reflect on their skills and abilities, they identify inconsistencies in their training,
knowledge, and background to develop their confidence to accept leadership roles. The input
from the stakeholders indicated their understanding of their skills and abilities as critical to their
personal evaluation and seeking resources to progress into senior leadership roles.
Knowledge Results Summary
The knowledge influence results indicate there is no gap for women needing to know the
gender barriers within their organization that impact promotions, how to leverage support to
overcome the barriers, and reflect on their skills and abilities to be able to overcome the
organizational gender barriers. Two of the stakeholders were not aware of the barriers they
encountered until a follow up question was asked about their experiences and they could
intentionally reflect on their advancement journey. All women recognize organizational gender
barriers exist, yet a third deflected its impact to industries that are known to have fewer women
in them. The needs evaluation confirmed the strategies and practices women use, at times
unintentionally, to support their career growth.
Conceptual, procedural, and metacognitive knowledge correlated to the stakeholders’
willingness to accept leadership roles and strive for success within those roles (Clark & Estes,
2008). Related to knowledge, motivational influences began to emerge as interwoven aspects of
the stakeholders’ ability to develop their knowledge of the organization and how to utilize their
skills.
Motivation Influence Findings
This study evaluated two assumed motivational influences through interviews of
stakeholders. The researcher evaluated organizational gender barriers and the motivational
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influences that impact leadership advancement in healthcare through interviews. This evaluation
included two theories to frame outcome-focused motivation, represented in Figures 3 and 4.
Figure 3
Illustration of Expectancy Outcome Theory for Stakeholder Motivation
Note. This model shows how expectancy outcome theory influences the stakeholder’s motivational outcome to
overcome organizational gender barriers (Heneman & Schwab, 1972).

Figure 4
Illustration of Self-Efficacy Theory for Stakeholder Motivation

Note. This model shows how self-efficacy theory influences the stakeholder’s motivational outcome to overcome
organizational gender barriers (Bandura, 1977).

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The two motivational influences assumed to be barriers to stakeholders overcoming
organizational gender barriers are: (a) expectancy outcome theory or that women believe that
their skills, abilities, and effort will overcome gender barriers to support them to succeed, (b)
self-efficacy theory, or the belief that the stakeholders can overcome the organizational gender
barriers and will be accepted as a leader.
The study indicated a gap and partial gap of the assumed motivational needs of study:
expectancy outcome (gap) and self-efficacy (partial gap). Interestingly, expectancy outcomes and
self-efficacy are conflicting with each other in numerous ways. While the stakeholders believe
they have the skills and abilities to be leaders they are not confident in additional role growth.
All nine of the stakeholders question their skills and abilities to be in leadership roles. Notably,
the stakeholders’ toggle between struggling with the confidence of their skills and abilities yet
recognize the efforts they develop to become senior leaders. Additionally, the stakeholders’ self-
efficacy conflicted with their expectancy outcome. They were personally motivated to learn and
develop their skills but did not believe they could break the glass ceiling. Notably, two
stakeholders, S2 and S6, sought leadership roles.
I saw the nurse manager and I thought “I think I can do that’. I thought I could stay on the
floor and make an impact in the unit, or I could try to make a larger impact on the whole
of the organization (S6).
The remaining seven stakeholders received requests to accept leadership positions.
I was not looking for a new position, but my boss asked if I wanted it. I thought I was just
getting this job under control (S9).
The stakeholders who did not seek leadership but were asked to accept the roles have a higher
likelihood of feeling unprepared for the leadership challenges and role. Leading to a greater
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likelihood they would experience increased performance scrutiny (Hoyt & Burnette, 2013) and
increased evaluation on competency, which the stakeholders indicate they have not developed
for the role (Rivera & Tilcsik, 2019). S7 comments, "I was asked to take on an area I was not
familiar with, I was shocked to be asked, I had no idea what to do." S7 discussed how she was
worried she would be unable to meet the needs of the role, yet she knew she was succeeding as a
leader in her current role. She continues “I had some bumps along the road, but my soft skills
helped to develop my technical proficiency.” S7 understood where she was lacking proficiency
and employed additional effort to achieve her intended outcome.
Additionally, four of the seven stakeholders reflected on their ascent into leadership roles
and S8’s comments embodied the experiences, "I took on expanded duties until I was doing the
leadership job; it was sort of accidental." A lack of intentional leadership growth career planning
led these four stakeholders to accept additional responsibilities without compensation or
positional alignment.
Seven of the stakeholders asked the following question when asked to take a leadership
role. "Do you really think I am ready?". The seven stakeholders asking this question talked
about seeking validation in their skills, showing a lack of self-efficacy in their abilities. In the
nine stakeholders' experiences, they all encountered a gap in the expectancy outcome of their
skills and abilities. Additionally, seven of the stakeholders believed they could not effect change
on the root cause of the organizational gender barriers. “I saw the bias happening, but no one did
anything” (S5). Additionally, S6 commented,
I found out later other women had similar experiences with that leader, but none of us
said anything. I think we were all too afraid. I ended up leaving the organization and it
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was not until my exit interview that I said something, but I don’t think anything happened
(S6).
Still, all nine make efforts to impact change for women that they expect to come after them. Both
expectancy outcome and self-efficacy is further analyzed below as an influence on women
overcoming organizational gender barriers, and a summary of presumed motivational needs is
illustrated in table 15.
Table 15
Summary of Presumed Motivational Needs and Results
Assumed Motivation Influence

Motivation Influence
Assessment
Validation
Expectancy Outcome Theory – Women need to believe
their skills, abilities and effort will overcome
organizational gender barriers.
Interview Gap
Self-Efficacy Theory – Women need to believe they will
overcome organizational gender barriers and will be
accepted as a leader.

Interview Partial
Gap
Note. The difference in theories relates to the beliefs of effort to overcome and acceptance upon overcoming
organizational gender barriers.

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Findings influenced by Expectancy Outcome Theory: Women need to believe their skills,
abilities, and effort will overcome organizational gender barriers – Gap.
Stakeholder interviews indicate a gap in the conceptual framework assumption that
women need to believe their skills and abilities combined with effort will overcome
organizational gender barriers to support them to succeed. The stakeholders experienced and
observed gender barriers that challenged their growth as leaders and devalued their belief in their
skills and abilities to overcome the gender barriers. The degradation of stakeholders' experiences
resulted in a lack of confidence that their skills, abilities, and effort could help them overcome
institutional gender barriers to advance into leadership. Stakeholders were asked questions
related to leadership goals, career trajectory, and skills for leaders. From these questions four
theme factors emerged for the stakeholders:
1. Stakeholders believed they have the skills to be a leader.
2. Stakeholders believed with hard work they will advance in their career.
3. Stakeholders intentionally sought leadership roles.
A trend that developed with seven of the nine stakeholders was a request by the
organization to accept leadership roles to which they did not apply. Only two, S2 and S6,
purposefully sought leadership throughout their career. After S2 initially sought leadership at the
beginning of her career, she experienced significant gender bias triggering her to leave the
organization. S2 commented:
I really felt slighted by not being chosen, and it was evident that it was because I am a
mom of four kids, versus a male individual who had no children.
After dedicating additional time to the organization, she said:
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Being passed over motivated me to apply to a position that was out of state. The position
allowed me to grow to another level as a director (S2).
It is gender barriers such as the one experienced by S2 that all nine-women report encountering
in various forms. The stakeholders determined if the effort they expended would deliver the
outcome they desired. As stakeholders encounter situations such as the one encountered by S2,
they may determine the ends do not meet the needs, thus the gender barrier they are encountering
is too great a barrier to overcome.
Some of the barriers such as getting passed over for a promotion or asked to take on
additional duties without compensation are subtle. As S8 mentioned “It just sorta happened, I
took on more duties”. While other barriers impact the stakeholder’s belief in their skills and
abilities also created a culture of fear and sexual harassment, as S6 shared:
After a period of time dealing with the crisis, the c-suite leader and I became partners in
the effort. To ensure a smooth hand off daily we would share a meal. At one meal he
said, “you know I could have an affair with you”. When I did not agree other issues came
up that then forced me to move on (S6).
Environments such as the one encountered by S6 questioning how she fits into leadership roles
and her value as a leader. Cultures of fear and harassment also perpetuates gender stereotypes
and personal values, as noted by Hoyt (2013) as one of the greatest erodes of personal
confidence. Two other stakeholders recounted situations where they experienced sexual
harassment situations but felt they could not report the male leader. The culture of fear not only
impacts the stakeholder’s career, but filters into other aspects of the organization; training,
evaluations, promotions process, and is deeply rooted in gender barrier behaviors. For the
stakeholders fear was associated with the loss of their jobs and potential careers, as S5 noted “I
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just needed to keep my head down, if I made a thing about it, I could lose my job”. The other
impact noted by S6 was a loss of acceptance as a leader within their organization “I thought I
would lose validity in my participation in a leadership role”. Both accounts informed beliefs
about their leadership skills and pushed them both out of the leadership sanctum, or as S6 said, “I
seemed to fall out of grace with him” and was left alone to navigate the processes and
challenges.
As the stakeholders gained experience within the healthcare field, they began to gain
additional duties. Yet the additional duties lacked training to support the role expansion. There
was no indication about why the stakeholders were asked to accept additional responsibilities,
but it left them feeling inadequate in their roles. When lacking the skills or abilities to perform as
she believed she should, S4 commented, “It really killed my confidence. Like, I should know
how to do this”. S4’s comment demonstrates how all nine of the stakeholders lacked the
confidence when asked to take on a leadership role and the compounding effect it had on their
abilities to overcome the barriers they encountered.
Table 16 illustrates the experiences of stakeholders’ beliefs about their skills, abilities,
and effort.

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Table 16
Summary of Stakeholders’ Response to Expectancy Outcome Motivational Factors
Stakeholder Statement Meaning
S2 “I really felt slighted by not being chosen,
and it was evident that it was because I
am a mom of four kids, versus a male
individual who had no children. It
motivated me to apply to a position that
was out of state. The position allowed me
to grow to another level as a director.”
S2 experienced a disconnect in her
expectancy of the outcome for her efforts.
The experience led her to leave her
organization to relocate her family.
S6 “After a period of time dealing with the
crisis, the c-suite leader and I became
partners in the effort. To ensure a smooth
hand off daily we would share a meal. At
one meal he said, “you know I could have
an affair with you”. When I did not agree,
other issues came up that then forced me
to move on.”

S6 provided an experience that other
stakeholders experienced as well. The
outcome left the stakeholder questioning
her ability and worth as a leader and the
culture of an organization she had
committed to.
S4 “It really killed my confidence. Like, I
should know how to do this.”
S4 describes an experience that left her
lacking confidence and was detrimental to
her professional growth.

Findings influenced by Self-Efficacy Theory: Women need to believe they will overcome
organizational gender barriers and will be accepted as a leader – Partial Gap
To evaluate self-efficacy as a partial gap in overcoming organizational gender barriers,
stakeholders evaluated their skills through questions about being an influential leader,
questioning their skills, and experiencing gender barriers and the skills they used to overcome
those barriers. All nine stakeholder interviews did not validate self-efficacy in three of the four
self-efficacy areas: perceived self-efficacy, competency, and self-regulation. Goal setting for
leadership roles only appeared in two of the nine stakeholder responses.
It was nice to have someone to talk about my career desires, I didn’t really know what
they were until he talked to me about options (S9).
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Seven stakeholders believed they could overcome the gender barriers they encountered
and would be accepted as a leader. The themes that emerged from the stakeholders involved
emotional awareness, authenticity, relationship building, and personal development as illustrated
in Figure 4.
I leaned on my soft skills to connect with my team, that got me through the bumps (S7).
My team asks me questions, I think that is a sign that I am approachable and open to
teaching my team (S2).
These four skills support the majority, eight of nine stakeholders, to pursue leadership roles and
instill a belief that they are and would be accepted and a senior leader. Table 17 denotes the four
components of self-efficacy identified as factors in this study that the stakeholders discussed
though the questions asked, and the experiences shared related to the topic.
Table 17
Summary of Stakeholders’ Response to Self-Efficacy Motivational Factors
Measure Stakeholders
S1 S2 S3 S4 S5 S6 S7 S8 S9
Goal setting: I want to become a
leader, I want to gain education,
skills and tools

Perceived self-efficacy: I believe I
am an authentic leader

Competency: I believe I have
developed the relationship and
emotional awareness to become
a leader

Self-regulation: I believe I can
personally develop the skills I
lack to aid in my success as a
leader

Note. A check mark indicates positive confirmation that the factors are practiced by the stakeholder.

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Competency and perceived self-efficacy appear closely linked based on the stakeholders’
responses to self-efficacy questions associated with authenticity and relationship building.
Emotional awareness or intelligence and authenticity was a theme that emerged in seven of the
nine of the stakeholders’ comments. “I often get emotional to situations, and I am now choosing
not to respond that way” (S9). Control of personal emotions is a theme that eight of the
stakeholders’ recognized as a skill of strong leaders, and seven of the stakeholders identified it as
a skill they also exemplify. S1 discussed using emotional intelligence and awareness to modify
her behavior during conversations that felt as if there is a gender bias undertone to focus on the
“overall goal.” She followed up with: “my behavior is scrutinized, and to be a leader, I have to
be transparent and calm and stable.” S1 highlighted how she is evaluated with greater scrutiny
from her colleagues, peers, and superiors. She discussed a drive for perfection that we echoed by
two other stakeholders (S2 & S4). Stakeholders 1, 2, and 4 demonstrated experiences that align
with the literature surrounding harsh evaluations (Kawakami et al., 2000) and they are also the
stakeholders who provided clear examples of tempering their language, voice, tone, and
attitudes. They are experiencing gender barriers that are derived from stereotype threat and
gender role expectations.
Authenticity as a leader for the stakeholder's ties to emotional awareness; the
stakeholders describe it as giving themselves "permission to be me." S6 discussed how
authenticity is the permission to be "genuine," yet you have to trust yourself and believe in your
skills and abilities to achieve this. A notable comment that arose from S6 was finding comfort in
risking your livelihood for what is right and staying true to your beliefs and authenticity.
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It is the hardest thing, to keep your voice in the room. I have walked out on two jobs
because I could not be true to my core values and that jeopardized my authenticity. It is
courage, which is so hard (S6).
The belief that your livelihood is in jeopardy creates a great deal of fear, which six of the nine
stakeholders discuss experiencing. Yet, the six who experienced this fear determined it was more
important to stay true to their values. This authenticity helped them to overcome barriers and
secure new roles when necessary.
A key trend all nine stakeholders identified as a competency is their ability to cultivate
and steward relationships.
I listen, it is probably a key attribute that allows me to help my team to a solution when
they face problems. We either do it together or they are empowered to develop a solution
on their own (S2).
The development of relationships supported all nine stakeholders to achieve their current roles
and develop leadership skills. All nine stakeholders discuss leaning on relationships to solve
problems and craft solutions.
We are trying to coordinate our efforts to develop equality. It is not just me, and my peer
groups taught me that (S1).
The support of relationships includes peer groups, user groups for professional tools, and
individuals throughout the organization. Four of the nine stakeholders commented about their
loneliness as leaders, yet they had to draw on their relational skills to be successful. “I need to be
friendly, but I cannot be my team members' friends” (S6) as S6 notes in her leadership role she
needed to engage but from an emotional distance. S7 describes her process of engagement and
getting to know employees as part of her scheduled routine in the hospital. She asks, “Is there
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any pebble I can remove from your shoe?” She continued that building relationships gives her
great pleasure in her role and believes that relationships are a critical aspect of a good leader. As
S7 grows within the healthcare field, relationships help her to determine what the barriers are
that she needs to overcome and how to best assert her skills to address them.
I needed to know what I needed to do better and having a leader give me feedback helped
me to overcome challenges I was facing. I didn’t need anyone to dance around things, but
be direct, it is helpful to have those relationships (S7).
Understanding how to engage with the organization helps the stakeholders to develop their skills
and abilities and believe in their personal success.
Self-development was the final trend in the self-efficacy influence assumed to impact
motivation. Again, eight of the stakeholders pursue personal and professional development. The
options are not widely available through their organization and the stakeholders regularly sought
books, certifications, and additional formal education to enhance their abilities to overcome
gender barriers. S9 reflected about her degree pursuit for her master’s.
It is not something that I was like, this is my life’s passion, but I did have a natural knack
for leadership. I like having ownership and thinking outside the box. I like doing new
things and having autonomy to do that. Education allowed me to take that step (S9).
While S9 sought formal education, the seven stakeholders commented about finding leadership
development books and personal reflection. S8 commented, “I do a lot of reading, leadership-
focused resources. I even joined a leadership book club”. The book club developed the
combination of relationship building and personal development that S8 considered. The
stakeholders all appeared to seek information to inform their decision-making and confirm the
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information they have. The additional information fueled their confidence and helped them to
develop self-efficacy.
Self-efficacy for the stakeholders was not a gap that inhibited their career advancement,
but it still does not meet the asset threshold and is considered a partial gap. By focusing on
emotional awareness, authenticity, relationship, and professional development, the stakeholders
navigate gender barriers. Their personal beliefs about their abilities fueled their leadership skills
yet accepting their leadership abilities and role possibilities continue to be a struggle for the
stakeholders. There was a hesitancy to their confidence, almost an apologetic nature for three of
the nine stakeholders. They wanted to be in leadership roles, but the responses seem to question
their belonging in the role.
Motivation Results Summary
Women directors in healthcare are aware of organizational gender barriers, yet they do
not all have the language to identify they are encountering the barriers. The interviews
demonstrated that the motivation to become senior leaders required personal professional
development, which stakeholders can pursue. The greater impediment to overcoming
organizational gender barriers is the stakeholders’ expectations of their efforts. The majority of
the women interviewed experience degraded confidence that the effort they expend will support
their skills and ability to become and be accepted as a senior leader. Given the depth of
motivation the stakeholders have toward the influences that impact self-efficacy it was indicated
to be a partial gap. While expectancy outcome was indicated as a gap that influences women
overcoming organizational gender barriers.
In addition to women’s knowledge and motivation, analysis of organizational influences
impacting women’s ability to overcome organizational gender barriers is important to include in
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the gap analysis. An organization’s culture, which includes practices and structures, is critical to
supporting women’s career goals and ascent into senior leadership roles (Clark & Estes, 2008).
The organizational influences assumed to impact women overcoming organizational gender
barriers are evaluated in the following section.
Organization Influence Findings
This study evaluated interviews to examine three organizational influences that may
impact women’s ability to overcome organizational gender barriers. Evaluation of organizational
culture focused on the need to have a gender inclusive culture. The two organizational settings
examined the needs for mentorship of the women and supportive operational practices.
Mentorship assessed the need for organizations to connect women with mentors (men or women)
at senior leadership levels and with women who have successfully reached leadership roles to
support the possibility of the aspiring women leaders’ progression into senior levels. Operational
support examined the need for organizations to evaluate and adjust promotions and hiring
practices to reduce and eliminate gender variances in the selection process.
The findings suggest organizational barriers are consistent across the various positions
within healthcare where the stakeholder is employed as a director. While the stakeholders’ may
have the knowledge and motivation to ascend to leadership roles if the organization is not
meeting their needs for advancement the women will struggle to overcome the organizational
gender barriers. The organizational environment impacts the value placed on gender inclusivity
and diversity within an organization; the interviews indicated the organizations’ inclusion
programs do not counter gender roles expectations.
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There is not a diversity and inclusion program that is focused on gender. While there is
some training about harassment - you know the onboarding and annual training - we do
not have programs that impact gender equity (S8).
The findings also suggest that while stakeholders engage in mentorship, such programs lack
intentionality within the organization to directly assist women in their career advancement.
Having external groups is great but I would love to have support at a system level. I know
it is out there in other organizations, but we don’t have it (S1).
Additionally, the findings indicate organizations have not reduced or eliminated the variances in
hiring and promotion practices to overcome gender bias. Table 18 provides a summary of the
assumptions aligned with each of the organizational needs and influences.
Table 18
Summary of Presumed Organizational Needs and Evaluation Results
Assumed Organizational Influence Organizational Type Organizational
Assessment
Validation
Organizations need to have a culture of inclusion
to counter gender role expectations

Cultural Model:
Gender inclusive
culture
Interviews Gap
Organizations need to connect women with
mentors at senior leadership levels, and with
women who have successfully reached
leadership roles to support the possibility of
progression to senior levels.

Setting Influence 1:
Mentorship
Interviews Partial
Gap
Organizations need to evaluate and adjust
promotion and hiring practices to reduce and
eliminate variances in the selection processes.
Setting Influence 2:
Operational practices
Interviews Gap

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Organizational Cultural Influence - gender inclusion: Organizations need to have a culture of
inclusion to counter gender role expectations - Gap
The results associated with organizational culture and gender inclusion indicated that all
nine women interviewed experience gender bias within their roles and organization. The
interviews covered areas related to pay equity, maternity leave and family care, work
environment, harassment, retaliation claims, and support mechanisms. Several trends emerged
from the interviews as impacts on organizational culture and indicate a gap that influences
women’s advancement to senior leadership roles. Gender roles are the prescribed expectations
society, and in this case the healthcare organization in Northern Colorado, has for women and
men. S6 summarized her encounters with gender bias culture.
At times it’s only based on intuition. I can feel it in the pit of my stomach that courage is
needed. When I start to feel marginalized, I am angry, but I cannot yell. I have to decide
to call it out or not.
Women who experience gender bias are not likely to overcome the organizational gender
barriers to succeed as leaders in their organization (Marvin & Grandy, 2016). As discussed in
Chapter Two, gender roles fuel barriers associated with women’s advancement and organizations
policies and practices are critical to reducing the barriers associated with a gender exclusive
culture.
Seven of the stakeholders have shared experiences and interactions that are considered
sexual assessment. Of the seven, none of the women reported the incidents. S5 summarizes the
sentiments of the seven stakeholders:
For me at the time it was fear, I was reporting to a love-hate leader, and I feared my job
was a little at risk, and so I just didn’t feel like there was safety to do anything or say
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anything. While there were compliance lines and avenues I could have taken, I chose not
to.
While the stakeholders indicated they knew there were actions they could have taken they did
not utilize them. The stakeholders' experiences align with the Harvard Business Review (2020)
study on gender inclusion that suggested alternative reporting mechanisms are critical for a
successful gender inclusion program. “We all knew where to go, but didn’t expect change so
why risk it?” (S5). Fear of job loss did not only occur due to sexual harassment, but the
stakeholder described fear of job loss in various settings, motherhood, harassment, peer
objectification, and productivity.
After I had my child, I overheard a colleague talking about another woman who was late
to a meeting - she was pumping. He called her a cow. She was being ostracized by the
male physicians for being a mom. I was afraid it would happen or was happening to me
too (S1).
As reported in the literature 30% of women leave organizations due to hostile work
environments which impact self-efficacy and career growth. Table 19 illustrates the statements
made by seven stakeholders who experienced fear and job risk.

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Table 19
Stakeholders Statements of Fear and Job Risk
Stakeholder Statement Need Association
S1 “I overheard a fellow physician say to a
manager physician ‘Hiring young
females is risky because they are
always taking time off to have babies.’
Parenthood turns mom into liabilities.”
Policies to normalize working moms, new parents,
support post-delivery, culture of parental
support and recognizing the resources and
skills moms bring to the workforce.
S2 “The female staff work harder than their
male counterparts. I never see them
joking around.”
Expectancy outcome contributes to their belief
they will advance with hard work, in contrast
without this level of commitment they will be
passed over.
S4 “I have two small kids at home, why am I
mixed up with something that will
jeopardize my job? Then I realized it
was the right thing to do and I had to
stand up for my integrity.”
The overhanging threat of job loss impacted
current role and had she not fought for the truth
it could have impacted future roles.
S5 “I had a CEO who was sexually
harassing. It happened to others, and
we joked about it. We never said
anything to him or others, for me it
was fear. I felt like my job was at
risk.”
Lack of safety to report harassment and the power
dynamic of the offender as the CEO of the
organization.
S6 “I have stayed in a job that was toxic and
scary, but I started to walk out of
situations where I was at the final
moment, it was the hardest thing I had
to do. I risked my livelihood and was
literally almost homeless because of it.
But you cannot stand for it.”
Finding strength and taking a stand for what is
right. There is great risk in acting against a
traditional and hierarchical system. Integrity
and values help to navigate cultures and
situations that degrade a person’s character and
personal value.
S7 “I am constantly working crazy hours. I
know I need to set some boundaries
around that, but I also feel like I
should be doing the work.”
There is an association for women about hard
work and value. Reflects the expectancy
outcome belief again.
S8 “I felt like nothing I could do was
adequate. I just felt defeated all the
time.”
Relaying on core values and self-efficacy helped
to overcome environmental and cultural defeat.

In attempts to support gender diversity, organizations may implement various tools to support
practices. Interviews with the stakeholders include the questions derived from measures outlined
by Diversity Best Practices (2017) and listed below and their response to the inclusion measures.
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Table 20 depicts the responses to the gender inclusion measures that the stakeholders experience
in their organization.
Table 20
Culture Setting: Gender Inclusion – Best practices measures
Measure Stakeholders
S1 S2 S3 S4 S5 S6 S7 S8 S9
Does your organization have specific
gender inclusion policies?

?

Does your organization have gender
inclusion training?
?

? ? ? ? ? ? ?
Do you have support to speak up
against gender bias

?

Does your organization support
maternity or family leave?
?

?

Does your organization offer flexible
work environments?

?
Does your organization have an
effective diversity team or
program?

Note. A check mark indicates positive confirmation that the factors are experienced by the stakeholder while a
question mark indicates the stakeholder is unsure if the measure is addressed in their organization and a blank space
indicates a lack of resource.

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Overwhelmingly the stakeholders report not having measures in place in their organizations to
support a gender inclusive environment. While there are many tools the stakeholders’
organizations attempt to utilize, they are not fulfilling the needs of the stakeholders to find
gender inclusion. Statements made by the stakeholders correlate to an associated need for career
growth into leadership. Table 21 illustrates the statements from the stakeholders and the
associated resources that are lacking in their field to support their ability to overcome gender
barriers and achieve advancement.
Table 21
Stakeholders Statements of Job Support Needs
Stakeholder Statement Need Association
S5 “Organizations that create a trusted
HR model, connect women to a
partner, or trusted source for
help.”
Connection to a safe resource
S6 “Diversity teams – made up of
various levels but power neutral.”
Clarity of the issues and challenges women face
and actionable changes
S9 “You should never pass up free
education.”
Organizations that invest in employee education
support identifying requirements for
promotion and intentionality to pursue the
promotion
S1, S3, S4, S7 “Women’s education group

“Women’s peer group”

“Women’s support network”
Community, collaboration, support, inquiry, care,
and comfort. Women seek out these things
from other women to provide them in a safe
and personally sought environment. It cannot
be prescribed but encouraged.
S1 “Maternity leave. We get six weeks
partial paid regardless of the type
of birth.”
Supporting family needs supports the whole
workforce.

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Organizational Setting Influence 1 - mentorship: Organizations need to connect women with
mentors at senior leadership levels, and with women who have successfully reached leadership
roles to support the possibility of progression to senior levels – Partial Gap
Stakeholder interviews confirmed a lack of formal mentorship across the nine
stakeholders, indicating a parietal gap for stakeholders because the stakeholder sought informal
mentorship. The organizations did not intentionally connect women with internal or external
mentors to support their professional development. As discussed, seven of the nine stakeholders
sought out mentorship internal and external to the organization, aligning to the findings of Elias
(2018). In addition to mentors three stakeholders sought professional coaching to supplement
their career growth.
Every organization should provide leaders a coach, it is an investment from the
organization to the leaders and shows the organization wants to see the leader succeed
(S6).
As discussed in the procedural knowledge assessment, women who connected with men as
mentors 100% of the time additionally sought women peer groups, citing a need for kinship and
safety.
When I can talk to other women it helps me to not take things personally. Or atleast see
through the fog (S1).
Table 22 illustrates the goals the stakeholders sought with both mentorship and peer support
groups or coaching.

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Table 22
Comparison of Informal Mentorship and Peer Group/Coach Goals
Measure Stakeholders
S1 S2 S3 S4 S5 S6 S7 S8 S9
Stakeholders learned
organizational operations &
skills
Mentor

Peer /
Group

Stakeholders discussed leadership
challenges related to staff
Mentor

Peer /
Group

Stakeholders discussed leadership
challenges related to
colleagues or leaders
Mentor

Peer /
Group

Organizations provided the
connection for the
stakeholders
Mentor

Peer /
Group

The structures of the mentorships with men, focused on professional topics of strategic
organizational growth, budgeting, organizational politics, and emotional intelligence. S9 reflects
on an impactful mentor who informally developed a relationship that supported her career
growth.
He would spend hours with me, and I felt like everything he said was straight out of a
textbook. I’d never had someone spend that kind of time with me. He really helped me to
grow in conversations, thinking, and strategy.
The aspiring women leaders who made a connection to a male mentor, provided support for the
women to understand the nuances of the organization from the men’s perspective. This
perspective provided insight to the culture and unwritten rules of the organization.
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At times it felt like I had a window into the c-suit and understood the culture of leaders. I
learned about the nuances of leadership. I am not sure if that is helpful to me in a more
diverse environment but it infomed how I see the overall organizational and culture (S9).
The stakeholders found the support systems they needed, but they had to be internally motivated
to find mentorship. A clear program and support structure was missing for all nine women. S8
did not have a mentor or peer groups and relied deeply on professional print resources and she
also discussed using her faith as a tool to help her navigate challenging situations.
The lack of mentorship is a mindset that is lacking in my organization. It may be a lack of
resources or depth along with the culture. The mindset is not to provide mentorship
among leaders in our area, yet my peers [in another region] are not only encouraged but
provided the resources to establish mentorship. Which led to a lack of leadership ladder. I
do not feel brought along in my role or the organization. I rely on self-reflection books,
and joined a professional book club, and strengths finder tools (S8).
S8 sought tools to help build her skills when the organization lacked these resources. She also
noted how peers in other regions of the same organization receive the resources she felt were
lacking in her region. Her experience reflects the culture of the local organization. While the
larger parent company may encourage and support mentorship the local leadership engagement
is as essential. S8 continues concerning the culture within the leadership.
I reported a male leader who led from gender bias. He would criticize women for being
too chatty or too vocal and then say women should speak more in the meetings. At the
same time, he encouraged a good ole boys club in the same meetings. It was a very
awkward environment, I felt uncomfortable most of the time. He told women they were
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aggressive and that we did not have substance to our thoughts or input. It took me about
six months after he left to rebuild my self-confidence (S8).
S8 experienced mixed messages about how she was expected to perform within the culture of the
organization. She did not have a mentor to help guide her through these challenges and the
organization also lacked an outlet for her to safely register a complaint and feel she would not
experience reprisal.
The stakeholders who sought peer groups and coaching discussed a need for kinship they
lacked in their organizations due to the level of their leadership roles. Six of the nine women
discuss feelings of loneliness and isolation, compounding their desires to find or develop a peer
group. S1 provides an example of how peer groups are critical for women seeking leadership;
“We need a place to talk openly about the issues we are facing, sometimes with our male
colleagues.” The loneliness and isolation compounds mixed messages women receive. The
stakeholders navigate fear, cultural expectations, and professional skills to overcome gender
barriers that are overt and subtle. Women seek out other women to help them make sense of the
messages they are receiving and how to overcome the barriers these messages emplace. S8
reflects “with other women I give myself permission to express my feelings”. S6 comments “I
have one woman I call when I need a girlfriend moment off the record”. S1 adds “I ask for
advice from other women, lean on other working moms, and need a place for virtual hugs. It is
not something we expect to get in the workplace, but we still need it.” Table 23 illustrates the
comments made by each stakeholder that reflects the need for women peer groups.

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Table 23
Stakeholder Statements of Peer Group Needs
Stakeholder Statement Meaning or Context
S1 “I ask for advice from other women, lean
on other working moms, and need a
place for virtual hugs. It is not
something we expect to get in the
workplace, but still need it.”
Seeking support, caring, understanding and
women who are experiencing or have
experienced similar needs.
S2 “Step away from operations and
brainstorm outside the organization.”
Desire to brainstorm without influence of the
organization and safely formulate ideas.
S3 “She took it upon herself to help me.” Support from another woman to guide and mentor
through professional growth.
S4 “Just to talk to other women and ask
questions. What are your thoughts?
What have you done in this situation?
Bounce ideas around.”
Support structure for the community, and
understand others have similar experiences and
gather information about what works or does
not and how others may handle a situation.
Combat’s loneliness.
S5 “We spend time and energy trying to get
into a man’s club – women are
allowed to make similar groups.
Maybe it’s about elevating ourselves
and creating an equal playing field.”
Questioning the cultural aspects of organizational
structures and starting to differentiate between
equity and equality.
S6 “I have one woman I call when I need a
girlfriend moment off the record”
Seeking confidant, and emotional safety. Off the
record is a desire for confidentiality.
S7 “Having a support network of women has
helped me throughout the years.”
Professional and personal challenges and a place
to touch base on topic of concern or interest.
S8 “With other women I give myself
permission to express my feelings.”
The expectation is that leaders are stoic and do not
show emotions. At times emotions are
considered weak or out of control.
S9 “I seek out a lot of different feedback.
One woman I seek out more often
because I appreciate her approach,
and I feel like she has my best
interests in mind.”
Trust and vulnerability to seek and receive
feedback.

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Organizational Setting Influence 2 - operational practices: Organizations need to evaluate and
adjust promotion and hiring practices to reduce and eliminate gender variances in the
selection process – Gap
Organizations' lack of intentional evaluation and adjustment of hiring and promotional
practices is a gap in the experiences of all nine study stakeholders. The stakeholders were
unaware of the hiring practices within their organization that support gender equity.
I am sure there is a process but I am not sure where to find it or how it is applied to
leadership selections. It seems there is a different process for the front line than there is
for senior leaders (S1).
Table 24 illustrates the evaluated factors through interview questions and experiential stories
shared by the stakeholders which influence hiring and promotional practices.
Table 24
Summary of Stakeholders Organizations Hiring and Promotional Factors
Measure Stakeholders
S1 S2 S3 S4 S5 S6 S7 S8 S9
Discriminated against due to
motherhood

Pay inequities in their roles or
responsibilities

Personality was included in
performance evaluations

Org. published the selection criteria

Org. publish the selection process

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The lack of promotion structure created ambiguity for the stakeholders and for those they
supervise at time creating conflict, as discussed earlier by S4 and the gender discrimination claim
that was made against her.
A male charge nurse believed he deserved the leadership role over me. As I took over the
leadership role, he filed a complaint with the Equal Employment Opportunity
Commission (EEOC). It was ultimately cleared, and it turned out his complaint was
because I was holding him accountable for performance. While I had all the necessary
documentation it took 18 months to clear my name and called into question my integrity.
Notably, eight of the nine stakeholders were asked to take on a leadership position. Only one of
the nine regularly sought out promotions. Six of the eight who did not seek leadership thought
they organically or accidently moved into the role.
Additionally, the organizations do not provide resources to evaluate and adjust the hiring
or promotional processes within the various fields of healthcare the stakeholders represent.
Anecdotally three of the stakeholders can describe experiences of pay inequity, non-selection for
a role due to motherhood, and feelings of gender discrimination among leaders.
(a) S1 – In a meeting with our boss and a male colleague a female colleague was late
because she was pumping, and a male colleague asked if she was finished with her cow
duties.
(b) S6 – What is not right is knowing your job is in jeopardy and knowing no one will help
you. I had an exit interview and shared my sexual harassment claim and they did not
believe me or act on it. I left feeling defeated and at fault.
(c) S2 – I was endorsed by the current manager for a role and had years of experience within
the company. I was passed over for the promotion and the explanation was a concern for
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my commitment. I had four small children at that time. The candidate that was chosen
was a man with no kids or family.”
S1 identified a gender bias factor that impacts promotions which also resonated with six of the
stakeholders, motherhood. Organizations regularly use length of time in a position as a factor for
promotion; motherhood becomes a more substantial gender barrier to promotion. S1 comments
“for every child I have, I know I will be set back 2-4 years compared to my male colleagues''.
Identifying the areas that impact women negatively in the promotion and hiring process is a key
influence that is difficult to determine from the stakeholder’s perspective. S6 commented “It is
not the norm and considered an inconvenience if you have to work from home because you have
an ill child.” Table 24 illustrates several factors that impact hiring and promotions and two that
stand out are the lack of published information to stakeholders about the criteria for promotion
positions as well as the selection process. This lack of information impacts the expectations the
stakeholders have for their own careers as well as hiring or promotions for those they supervise.
Expectation setting is key for both the organization and the employee not only for the role the
stakeholders are pursuing but also the role expectations for the stakeholders as a workforce.
Organizational Results Summary.
The stakeholder data supports the conceptual theory that organizational gender barriers
exist within organizational culture and impact programs, procedures, processes, and policies. A
culture of inclusion does not exist within the healthcare field to support women’s advancement
into senior leadership roles. In addition, a lack of mentorship programs and evaluation of hiring
and promotion practices across various roles within healthcare indicate the barriers remain at a
systemic level in the healthcare field. The data confirms women seek resources outside their
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organization to support their professional development, and personal support to navigate
challenges in their roles.
The data indicates a gap and a presumed need for organizational culture, programs, and
evaluative processes to support women’s advancement in leadership. The data suggests a
thorough evaluation of the organizations’ current state may reveal the depth of organizational
gender barriers that women face in various healthcare roles. Chapter Five will discuss this factor
and other recommended practices.
Synthesis
This study evaluated eight KMO influences assumed to impact women’s advancement
into leadership roles. The study identified opportunities for improving stakeholders’ conceptual
knowledge and several areas for motivational improvement. Additionally, the study indicates
gaps exist in the organizational factors related to gender barriers that impact women’s
advancement into leadership roles. The relationships between these principles result in a gap of
conceptual framework supporting the study’s research questions.
The study revealed women are partially aware of organizational gender barriers they
encounter and are aware of the support systems that help them overcome gender barriers when
they recognize them. Additionally, the stakeholders are exceptionally reflective on their skills
and abilities to consider what resources they need to overcome organizational gender barriers. A
particular theme that emerged was the development of peer groups as a resource along with
personal investment in professional development. Although the findings suggest the stakeholders
have the knowledge to overcome organizational gender barriers, there was a fundamental
disconnect in the ability of the stakeholder to regularly identify gender barriers. This theme also
carried through the evaluation of motivational influences. While the stakeholders were reflective
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on their skills and often sought professional development, they lacked the belief that their skills
and abilities could overcome the barriers, validating expectancy outcomes as an influence. In
addition, while the stakeholder’s self-efficacy was not a prominent influence on the stakeholder's
advancement into leadership, there are concerns of acceptance as a leader and conforming to
gender expectations to ensure success. Lastly, organizational influences did not support the
knowledge and motivation the stakeholders embraced. The organization generally lacked a
gender inclusive culture and often encouraged gender barriers. Additionally, while the
stakeholder connected with mentors, a formal program is lacking to support the stakeholders,
along with a substantial gap in the evaluation and awareness of hiring and promotional practices.
A lack of evaluations within the organization hinders the stakeholder’s ability to overcome
barriers which are ingrained in the organization's structures and policies for advancement.
In summary, the KMO influences studied resulted in; two influences, (procedural and
metacognitive knowledge) identifies as assets, three partial gaps (conceptual knowledge, self-
efficacy motivation, and organizational setting mentorship), and three influences (expectancy
outcome motivation, organizational culture, and organizational setting promotion and hiring
processes) identified as gaps. Clark and Estes (2008) support these categories of deficiencies in
knowledge, as primary causes of stakeholder performance gaps, or in this study barriers that
hinder women’s advancement into leadership. Table 25 provides a summary of the study’s
results.

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Table 25
Summary of all Needs and Influences Results
Category Need Evidence
assertion
Knowledge
Conceptual Women need to know the organizational gender barriers that impact their
promotional process.

Partial
Gap
Procedural Women need to know how to leverage support to overcome organizational
gender barriers.

Asset
Metacognitive Women need to reflect on their skills and abilities to overcome. Asset
Motivation
Expectancy
Outcome Theory
Expectancy Outcome Theory – Women need to believe their skills, abilities
and effort will overcome organizational gender barriers.

Gap
Self-Efficacy Self-Efficacy Theory – Women need to believe they will overcome
organizational gender barriers and will be accepted as a leader.
Partial
Gap
Organizational
Cultural Influence Organizations need to have a culture of inclusion to counter gender role
expectations.

Gap
Organizational
Setting
Organizations need to connect women with mentors at senior leadership
levels, and with women who have successfully reached leadership
roles to support the possibility of progression to senior levels.

Partial
Gap
Organizational
Setting
Organizations need to evaluate and adjust promotion and hiring practices to
reduce and eliminate variances in the selection processes.
Gap

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Chapter Five: Recommendations and Discussion

Chapter Four presented findings related to the KMO influences, which address the
studies’ first two research questions:
1. What are the knowledge and motivation influences related to the organizational
gender barriers that impact women in the advancement of their careers?
2. What is the interaction between organizational culture and context and women's
knowledge and motivation as it relates to the organizational gender barriers that
impact them in the advancement of their careers?
Based on those findings, this chapter seeks to answer the third research question guiding this
study:
3. What is the knowledge, motivation, and organizational recommendations to
overcome organizational gender barriers?
Findings and Results
Analysis of findings from interviews indicate either a gap, partial gap, or asset. A
confirmed gap associated with the global field goal was identified and recommendations are
identified to reduce organizational gender barriers. Interviews consisted of a semi-structured
protocol with nine healthcare directors from various roles within the health delivery system.
These responses and subsequent analysis led the researcher to the findings and recommendations
that guide Chapter Five. This chapter begins with recommendations for improvements to practice
related to gaps and partial gaps aimed at addressing the needs of the stakeholders. Chapter Five
also includes recommendations for gaps and partial gaps. Chapter Five answers the third research
question by delivering concrete evidenced-based recommendations for each supported influence
identified in Chapter Four. An implementation and evaluation plan supports each
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recommendation. This chapter will also address the study’s limitations and delimitations and
conclude with a discussion of possible areas for future research along with a brief reflection on
the potential value of the study for other healthcare organizations facing similar challenges.
Recommendations for Practice
Each of the KMO recommendations in Chapter Five originates from the principles
discussed in the literature in Chapter Two, and the recommendations are supportive of
decreasing gender barriers for women to achieve senior leadership positions in healthcare. While
the initial theoretical framework progressed through KMO in order, the outcomes indicated the
recommendations may begin with the organizational influences and recommendations. These
organizationally based recommendations support the gaps and partial gaps which influence both
knowledge and motivation. The findings indicate that while aspiring women may have the
knowledge and the motivation to become leaders, the organizational influences may still impact
or impede their advancement. This study determined the organizational influences hold a greater
impact and require addressing prior to addressing knowledge and motivation deficits for women
to overcome organizational gender barriers. This section discusses evidence-based
recommendations associated with gaps or partial gap knowledge, motivation, and organizational
needs that were addressed in Chapter Four. In summary, these include:
Organizational Influences:
● Organizations need to have a culture of inclusion to counter gender role expectations.
● Organizations need to connect women with mentors at senior leadership levels, and with
women who have successfully reached leadership roles to support the possibility of
progression to senior levels.
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● Organizations need to evaluate and adjust promotion and hiring practices to reduce and
eliminate variances in the selection process.
Knowledge Influences:
● Women need to know the organizational gender barriers that impact their promotional
process.
Motivation Influences:
● Women need to believe their skills, abilities, and effort will overcome organizational
gender barriers.
● Women need to believe they will overcome organizational gender barriers and will be
accepted as a leader.
Organizational Influence Recommendations
Organizational influences are a central resource that may be a barrier to the desired
outcome of organizational leadership gender diversity. While the women may have adequate
knowledge and motivation, organizational barriers can create a deficit that is too great to
overcome (Donnelly, 2017; Ewoh, 2013; Hartman & Barber, 2020). Root cause evaluation is
needed to determine the organization's potential to address and support the desired outcome and
decrease gender barriers. This section proposes recommendations for closing the gaps in
organizational culture, resources, and processes supporting gender equity in leadership.
This study focused on three organizational influences that likely limited the stakeholders'
skills and abilities to overcome organizational gender barriers. The study findings confirm the
stakeholders experience a lack of gender-inclusive culture and its impact on their professional
growth. Additionally, the study identifies partial gaps in the stakeholder's need for mentorship.
While the stakeholders did not experience formal mentorship, they did develop mentoring
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relationships independent of a formal program. Lastly, there is little to no information about how
hiring or promotional processes reduce gender variances, confirming it as a gap.
Figure 5 depicts the role of the organizational influences on the leadership culture and
how the aspiring women leaders may ascend and support gender equity for future leaders.
Figure 5
Organizational Needs for a Supportive Leadership Culture

Note. Organizational needs support women to advance into leadership, who then continue to support the
organization and continue the growth of aspiring women leaders. Adopted from Mentoring Philosophy, 2017.

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Once the senior leaders create and demonstrate cultural and organizational changes that
support aspiring women leaders can women leaders begin to thrive in the organization and thus
create a culture of cyclical growth and gender equity. The critical organizational inclusion factors
are culture, mentorship, and equity in hiring and promoting aspiring women leaders to ascend to
leadership. To ensure these factors are rooted in the organization, Table 26 provides a summary
of the organizational needs and recommendations.

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Table 26
Summary of Organizational Needs and Recommendations
Gap or Partial Gap
Organizational Need
Principle and Citation Context-Specific
Recommendation
Culture: Organizations need to
have a culture of inclusion to
counter gender role
expectations.

Identifying intrinsic bias embedded
in the evaluation methods,
training opportunities, and
promotion and pay equity
processes support the balance of
gender in leadership (Hauser,
2014).

Organizational culture ultimately
requires supportive leadership
behaviors to develop and
implement programs that
encourage and support the
intentional narrowing of the
gender gaps across the
organization (Beeson &
Valerio, 2012; Newman,
Donohue, & Eva, 2017).

Conduct an external culture
assessment to determine if the
organizational culture aligns
with the resources, policies, and
procedures of the organization's
goals.

Conduct an external review of
policies and establish
organizational standard language
that is non-binary. Reviews of
all policies, materials, and
publications must adhere to the
language protocol for inclusion.

Setting: Organizations need to
connect women with mentors
at senior leadership levels, and
with women who have
successfully reached leadership
roles to support the possibility
of progression to senior levels.

The complexity of leadership
development is most
successfully developed through
organizational mentorship of
planning and support for
women through mentorship
(McDonagh, 2012).

Develop intentional mentorship
programs with senior leaders and
corresponding peer connection
groups for aspiring women
leaders.

Setting: Organizations need to
evaluate and adjust promotions
and hiring practices to reduce
and eliminate variance in the
selection process.

Lack of intentional career planning
results in a lack of support for
women’s advancement in the
organizational process (O’Neil,
Hopkins, & Bilimoria, 2015).

Inequitable evaluation and
promotion bias creates greater
void women may need to
overcome to achieve a
promotion or leadership
appointment (Baldner & Pierro,
2018

Appoint a talent management
professional.

Develop a talent mapping program.
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Organization Culture Setting Recommendation #1: Conduct an external culture assessment to
determine if the organizational culture aligns with the resources, policies, and procedures of
the organization's goals (Hauser, 2014).
A shared set of beliefs, values, principles, and attitudes compose an organizational
culture (Hofstede, 1980). Organizations may consider conducting third-party culture evaluations
to identify the known and unknown organizational gender bias embedded in policies and
practices. The third-party review can help an organization unearth embedded prejudice and
barriers that inadvertently reinforce gender roles, expectations and establish gender barriers.
Using the Culture Assessment Instrument illustrated in Figure 6, organizations can determine
where they align with the competing values framework and what barriers may arise within this
culture that impacts equitable advancement.
Figure 6
Organizational Culture Assessment Instrument

Adapted from: Cameron, K. S., & Quinn, R. E. (200). Diagnosing and changing organizational culture: Based on
the competing values framework (Revised ed.). San Francisco, CA: Jossey-Bass.
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By identifying the dominant culture, the organization can determine how to best support women
to advance. When there are discrepancies between the current culture and the preferred culture,
the stakeholders and the organization are misaligned. This misalignment is what the stakeholders
in this study are experiencing, as indicated in Table 28, with substantial “unsure” responses to
gender inclusion measures. For the healthcare setting a hierarchy system is most prominent. It is
based in education, which is traditionally male heavy (Hogue & Lord, 2007). To change an
environment that is hierarchical an organization will need to pull from each category in the
assessment tool, trying to get closer to the cross hairs. When developing programs and support
systems the organization can draw from the goal orientation of teamwork, empowerment of
individuals, creativity, and entrepreneurial spirit, and maintain rules and regulations to support
efficiency and safety. When pulling from each category the organization will develop leaders and
team members who feel valued and will develop a culture which supports growth (Vroom, 1964)
Identifying the organizational culture supports the leaders within an organization to
evaluate policies and procedures with a lens of what type of culture they would like to develop. It
would allow leaders to look forward to how they would like to support women to advance into
the leadership role and the type of culture that is most supportive for equitable advancement.
The policies and procedures are the infrastructure that supports the culture. Policies that are
degrading or devaluing will undercut the concepts of inclusion and support (Ewoh, 2013).
Review and implementation of pay policies and pay equity changes occurring at a minimum
annually will support women to narrow the pay gap and ideally eradicate it in their organization.
The message of inclusion, value, and growth is sent when women are paid equally, to not only
the women but all employees about the culture of inclusion and the value placed on equity.
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Organizations may consider assessing evaluation models annually to evaluate and address
their models which are likely to have biased ratings (Barry, 2018). Addressing the evaluation
once is a start to developing a culture of inclusion. However, an ongoing assessment is
recommended to support an unbiased culture. Language in job descriptions, evaluations, and
numerical evaluation systems are known to hold intrinsic bias (Ehrhart et al., 2014; Mavin &
Grandy, 2016). Removing gender based evaluative metrics and ensuring those changes are
communicated to all members of the organization will support the growth of women as leaders
and equalize the evaluative playing field from which many promotions are forged.
Organization Culture Setting Recommendation #2: Conduct a review of all organizational
policies and procedures and establish non-binary language (Barry, 2018).
Organizational culture is operationalized through policies and procedures. A critical
counter process to gender inequity and gender penalties towards women within an organization
is to ensure the policies, materials and other organizational documentation is written with non-
binary gender language (Baldner & Pierro, 2018). Utilizing key word software to code and
identify the language that is most common in the organizations policies and procedures will
provide organizations with an initial indication of their level of gender biased language
associated with the operational aspects of the organization. Once the level of need is recognized
organizations can then conduct a rewrite of support collateral following the guidelines (United
Nations, n.d.). The following three guidelines may be applied to the recommendation:
1. Take into account the type of text/oral communication, the context, the audience and the
purpose of the communication;
2. Ensure the text is readable and the text/oral communication is clear, fluid and concise;
3. Seek to combine different strategies throughout the text/oral communication.
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In addition, the following guidelines may be applied to increase gender inclusion:
1. Use non-discriminatory language,
2. Make gender visible when it is relevant to the communication and not when it is
irrelevant to the communication.
The challenge is to remove the default masculine normed pronouns or variation of a word such
as chairman, and in place use person to indicate roles, such as chairperson.
Organization Setting Recommendation #1: Develop an intentional mentorship program with
senior leaders and corresponding peer groups (Fine, Sojo, & Lawford ‐Smith, 2019).
This study aligns with the literature (Fine et al., 2019) to recommend mentorship as a
critical component to equitable leadership advancement. Mentors may be within the organization
or external. Internal mentors support their mentees to navigate the formal and informal networks.
Chopra and Saint (2017) describe skills that mentors need to possess, active listening, openness,
experience, and commitment to development. They may have a teaching and coaching
personality and should develop an evaluation process for potential internal mentors (Chopra &
Saint, 2017). External mentors may be a good personality fit for the mentee however they lack
the insight of the women’s organization which can limit their organizational growth. When there
is no mentorship program formally established, women will find a mentor 75% of the time
(Barry, 2018). Also, women seek peer groups to fill the personal gaps that mentorship, often
from a male colleague, cannot provide. The organizations that manage successful mentorship
programs develop pipelines for internal promotion and leadership growth, yet only 15% of
women utilize these formal programs (Diversity Best Practices, 2018)—this study is aligned with
the lack of formal programs and utilization. This study also determined that women seek out peer
groups to supplement personal growth and support not provided through a formal mentorship
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program. Intentionally connecting women within an organization while considering the power
dynamics of positions will help them navigate leadership's complexity (McDonagh, 2012). When
women only receive mentorship from male colleagues, as was the case in most of this study, they
lose the knowledge of how women leaders typically behave in the organization and only receive
information on how male leaders behave (Fuller & Hirsh, 2018). Women utilize peer groups and
mentorship for varying supportive needs, at times the mentorship can fill the needs of the
women. When they cannot, a peer group is established or joined to enhance the experience of the
mentorship. Table 27 describes the types of engagement stakeholders gain from the two different
types of support mechanisms.
Table 27
Stakeholders Mentorship / Peer Group Engagement Needs
Engagement Need Mentorship Peer Groups
Organizational processes and procedures (budgeting,
human resources, hiring, org. change)
✔
Organization politics ✔
Networking ✔ ✔
Personal reflection ✔ ✔
Professional goal setting ✔
Relationship/Kinship ✔
Promotional pipeline – Career planning ✔

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Organization setting Recommendation #2: Appoint a talent management director program
(Kossek et al., 2017).
Talent management is most successful when a professional Human Resources
Management (HRM) director is employed to develop a strategic, financial, performance,
productivity, and processes to support talent management (Burke, 2014). An additional benefit to
organizations utilizing a talent development specialist is to support the development of social
resources within the organization. As discussed by Kossek et al., (2017) dedicated resources for
talent management increases the opportunities for women to engage in relationship focused
career development. To ensure practices to reduce organizational gender barriers in talent
management, it is recommended that the HRM director develop gender equity protocols and
implement gender equity into performance management tools. Combining talent management
with clear human resources goals support organizations to develop programs specific to the
needs of the women in the organization. Additionally, organizations that report inclusivity and
diversity programs locate them in the human resources department. Ensuring there is a leader
who is focused on talent management will convey a commitment to talent development. A
dedicated career leader is a visible and integrated method to support women’s development in
the organization.
Taking a holistic approach to talent management is a cultural approach to human
resources and aligns with organizations developing a promotion pipeline that supports the
specific growth goals for women (Kossek et al., 2017). Additionally, talent management
professionals focus on evaluation fairness, promotions across the organization, and pay equity in
partnership with human resources. A leader focused on career planning supports women to
overcome the bias that is associated with role expectations within the organization and supports
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the organization to identify and decrease gender role expectations of leaders. Identifying pitfalls
within organizations that women encounter will support women to overcome promotional
barriers. A specialized human resource professional focused on talent management is a key
stakeholder in leadership teams to support change management (Burke, 2014).
Organization Setting Recommendation #3: Develop talent mapping program (Kossek et al.,
2017).
Talent development is best utilized in combination with mentorship to align women with
leaders who can help develop their skills and coach them through a career trajectory that aligns
with their goals, strengths, and the organization’s needs. Talent mapping also is likely best
embedded as a performance metric for the talent management directors in the HRM department.
As an independent recommendation, designing talent mapping to support the organization in
identifying and developing talent within the organization supports high performance and
continued growth (Kossek et al., 2017). Burke (2014) describes the strategic use of human
capital to encourage organizational change as a critical component of HRM’s support of
achieving organizational objectives. A talent mapping process requires the use of clear
expectations to develop high talent women and challenge them to continue to grow.
Additionally, focusing on areas of growth for women meeting expectations and developing
growth plans for women who are not meeting expectations. Talent mapping supports women’s
expectation outcome needs along with supporting self-efficacy growth. When used in
combination with mentorship or professional coaching a talent map can provide women and
leaders a clear direction for growth and expectations for evaluation. Evaluating potential along
with performance provides women and leaders with an evaluative system that combines both
current performance with growth expectation. Figure 7 provides a 9-Box Talent Map
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recommended by HRM professionals to develop performance and leadership skills incorporating
expectation management.
Figure 7
Talent Management Map

Note. The red section indicates talent that needs attention to develop strengths, while the blue sections indicate high
performers. Adopted from Succession Planning: What is a 9 Box Grid? by SHRM (2018).

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Knowledge Influences’ Recommendations
Gaps in knowledge increase the likelihood of decreased performance or failure to reach
established goals (Clark & Estes, 2008). Chapter Four confirmed a partial lack of conceptual
knowledge impacts stakeholder’s ability to navigate and overcome organizational gender
barriers. To address this knowledge gap, Clark and Estes (2008) recommend the use of:
information, job aids, training, and education. First, information fills the identified gap in
knowledge, reduces uncertainty, and supports stakeholders to focus on growth and performance
by instilling the confidence of past experiences. Second, job aids provide a substantive guide for
procedures and tasks through learning materials such as manuals, charts, checklists, etc. Third,
training incorporates a prescribed curriculum, guided by specific learning objectives and
structured feedback to develop the stakeholder's knowledge base. Finally, education is a
developed and comprehensive base of information that provides a depth of information for
complex and novel situations (Clark & Estes, 2008).
Table 28 presents the knowledge influence and evidence-based recommendation along
with the context-specific recommendation.
Table 28
Summary of Knowledge Needs and Recommendations
Gap or Partial Gap
Knowledge Need
Principle and Citation Context-Specific
Recommendation
Conceptual - Women need to know
the organizational gender
barriers that impact their
promotional process.
Identifying and understanding what
barriers they need to overcome
is critical to advancement in
their organization. These are the
facts, concepts, processes, and
principles to be aware of to
assist in overcoming challenge
or change (Clark & Estes,
2008).
Conduct informational internal
surveys of women in the
organization to share with
women’s leadership groups,
managers, human resources
groups, and other stakeholders to
help identify prevalent gender
barriers women currently
experience.

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Healthcare organizations may utilize the proposed recommendations to reduce organizational
gender barriers and improve the leadership gender gap.
Conceptual Knowledge Recommendation: Conduct regular organization informational
surveys of women to identify prevalent gender barriers they currently experience (Hoyt, 2010).
This study indicates there is a disconnect in conceptual knowledge surrounding what
gender barriers stakeholders encounter. Attempting to apply development approaches to gender
barriers without knowing precisely the barriers will not adequately support the stakeholders to
understand how to overcome these barriers (O’Neil et. al, 2015). In this study, four of nine
stakeholders discussed experiences of gender bias and barriers but did not specifically identify
they were encountering barriers. For women to grow in the healthcare field to senior leaders,
women need to identify the gender barriers that stakeholders face.
Developing recommendations to problems before defining the problem is a significant pitfall in
organizational change described by Clark and Estes (2008). To better understand the gender
barriers the stakeholders face, the recommendation for an informational survey can provide
details about their experiences in their current organization and previous experiences.
Developing an understanding of what stakeholders experience historically and currently will
support identifying gender barriers when they arise and develop skills to overcome them.
Additionally, understanding organizational gender barriers that are intrinsic to the process within
the organization will help leaders develop ways to reduce gender barriers before they impact
women within the organization. From the information provided across the stakeholders, women
will likely face gender barriers. With additional knowledge surrounding the exemplified barriers
women are more likely to employ strategies to reduce the barriers. Development of a shared
language helps create shared experiences and develop strategies (Fine et al., 2019).
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Motivation Influences’ Recommendations
This section proposes recommendations aligned with evidenced-based motivational
theories supporting aspiring women to overcome organizational gender barriers in their pursuit
of senior leadership. Clark and Estes (2008) discuss the importance of motivation to the
attainment of goals. Additionally, Clark and Estes (2008) discussed three primary factors that are
involved in motivational behavior: active choice, persistence, and mental effort. Each aspect of
motivation supports the overall behavior of stakeholders. The active choice typically focuses on
taking the initial steps towards goal implementation and decision making (Clark & Estes, 2008).
Clark and Estes (2008) describe persistence as relating to an individual’s ability to continue with
tasks while encountering distractions, resource limitations, or other impediments impacting their
progress. Lastly, mental effort is referred to by Clark and Estes (2008) as the intensity and rigor
that stakeholders exert to attain goals, solve problems, and implement decisions. The study
findings indicated that the stakeholders have a combination of active choice, persistence, and
mental effort associated with expectancy outcome and self-efficacy influences.
Findings indicate confidence limits stakeholder motivation associated with the skills,
abilities, and effort the stakeholders internalize to overcome organizational gender barriers. The
data also suggests a partial limitation in the stakeholder’s belief that they will overcome
organizational gender barriers and be accepted as leaders. The motivational recommendations
work together to achieve the best outcome. These recommendations are intended for use in a
collaborative process and not as linear steps. Table 29 presents the summary of influences as an
gap and partial gap related to motivation influences and recommendations that need to be
addressed for healthcare organizations to decrease organizational gender barriers and improve
equity in leadership.
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Table 29
Summary of Motivation Needs and Recommendations
Gap or Partial Gap
Knowledge Need
Principle and Citation Context-Specific
Recommendation
Women need to believe their skills,
abilities and effort will
overcome organizational
gender barriers.
Expectancy, instrumentality, and
valence multiply to determine
the motivational force women
will expend on their
achievements and the expected
outcome for their efforts on
their ascent to leadership
(Heneman & Schwab, 1972;
Vroom, 1964)

Ensure expectations of skills,
abilities and efforts are aligned
with organizational goals via
performance evaluations,
mentorship goals, peer ratings,
and 360-degree reviews.
Compare evaluations with the
skills and abilities that are
expected of leaders within and
across the organization (Ritter &
Yoder, 2004).
Women need to believe they will
overcome organizational
gender barriers and will be
accepted as a leader.
Experiences, role models, and
feedback received from their
supervisors, impact their belief
that their skills will overcome
organizational gender barriers to
become a leader (Bandura,
1977).
Set personal performance goals to
become a leader, identify the
steps to achieve the goal and a
path to determine the needs for
success (Ewoh, 2013).

Seek feedback from senior leaders,
peers, colleagues, and
subordinates to develop skills
(O’Neil et al., 2015).

Expectancy Outcome Motivation Recommendation: Ensure expectations of leadership skills,
abilities and efforts align with the expectations of the organization (Heneman & Schwab,
1972; Jonsen et al., 2010).
Expectation management is essential for employees and organizations to understand the
effort and outcome expectations. Yet when these do not align, stakeholders may experience
effort output without the associated intended outcome. The findings in this study suggest that
women are more likely to be asked to take a leadership role than to seek it out. Before accepting
a leadership role, women clarify the role's expectations and the organization. When women are
asked to take on leadership roles, they need to be cognizant of the state of the organization and
the expectations of their leadership. Women taking on leadership roles without knowledge of the
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financial, performance, or current state of the organization have a higher chance to accept a role
onto a glass cliff (Ryan & Haslam, 2005). Aligning their expectations with that of their superiors
or senior leaders will support their success. To support women in their career growth training
surrounding interview questions on the part of the interviewee will help give women additional
information about the current environment (Sabharwal, 2013).
Additionally, as discussed by Heneman and Schwab (1972) in support of Vroom (1964),
the stakeholders need to align their motivational force with their expectations for the outcome.
Ensuring both the stakeholder and the stakeholder's organization have aligned outcomes is
essential to ensure the stakeholders exert motivation in the appropriate direction. Stakeholders
regularly manage on-the-job training: this training may not be sufficient for the next level of
leadership. Aligning training necessary for the following role with the needs of the pursued
organization can aid in the stakeholder's likelihood to advance. The greatest chance of a positive
outcome is to ensure the stakeholders align the value applied to abilities and efforts with the
organization and the role they pursue.
Self-Efficacy Motivation Recommendation #1: Set goals to become a leader (Locke, E. A., &
Latham, G. P., 1990)
A key component of motivation is goal setting related to perceived self-efficacy,
competency, and self-regulation. Of the nine stakeholders, seven did not set goals around
leadership growth, skills, or education. These seven stakeholders indicated they were asked to
become leaders, and all seven indicated they lacked self-efficacy in their abilities. Yet as
suggested by Harvard Business Review (2020) if they had set a goal around leadership, they may
have felt more prepared to take on the role.
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Goal setting can occur with a mentor, coach, or through personal development. It is most
successful with a coach or mentor (Beeson & Valerio, 2012). Combined with the first
recommendation, and the guidance of a coach or mentor, stakeholders can develop goals around
their performance plans and their feedback. Goal setting is the first step in the feedback loop.
Goals need to be assessed in a feedback survey to ensure the stakeholder is seeking information
that will best support their professional growth. Using the SMART goal setting standard (Locke
& Latham, 1990) as depicted in Figure 8 will ensure the goals set are executable to support
leadership progress.
Figure 8
Locke and Latham (1990) SMART Goal Setting Theory

Note. A theory of goal setting & task performance. by Locke, E. A., & Latham, G. P. (1990). Prentice Hall.

What are you trying to accomplish and why?

Strategic

How will you know you have achieved your
goal?
What is your intended outcome?

Measurable

What actions will you put in place to ensure
you achieve this goal?
Attainable

How does this goal align with your role as a
leader?
Relevant

What is the timeline for achieving this goal?

Time-Bound
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The SMART goal format can be implemented in a coaching or mentorship environment or for
personal development. Including reflection in the SMART goal setting process will support the
Stakeholders to internalize their goals and how they intend to achieve them. Once this goal-
setting system is in place, the intention of motivation recommendation #2 is to provide additional
support.
Self-Efficacy Motivation Recommendation #2: Seek feedback from senior leaders, peers,
colleagues, and subordinates to identify perceived gaps (O’Neil et al., 2015).
A strong belief in the stakeholder's skills and abilities will increase their likelihood of
taking risks, such as applying or accepting a new leadership role (Krueger & Dickson, 1994). To
develop the stakeholder's ability to take risks is an effective feedback loop. Women typically
receive less overall feedback on their performance from supervisors and colleagues (O’Neil et
al., 2015). Incorporating feedback surveys that focus on leadership competencies specific to the
aspiring women leaders will help develop efficacy for the stakeholders on the skills they have
and the abilities that need focus. Surveying in a safe environment will support position clarity
with honest feedback. A survey that provides a non-substantial response will not aid in the
stakeholder's growth. Recommended feedback surveys include specific goals that the stakeholder
is seeking to address. Feedback allows aspiring women to understand their skills and abilities
and align with the organization's needs and the strategy, vision, and professional growth (O'Neil
et al., 2015). Figure 9 provides an example of a goal-specific feedback loop to aid in the
stakeholders' self-efficacy.

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Figure 9
Performance Feedback Loop

Note. Adopted from Mentoring Philosophy, 2017.
Using a feedback loop helps the stakeholder and the organization determine how the
organization needs can best meet the needs of the stakeholder. As stakeholders receive feedback,
their conceptual knowledge of gender barriers will need to be keen as they may encounter
feedback derived from stereotype threats (e.g., addressing an “aggressive tone”, or “look like a
leader”) (Hogue & Lord, 2007; Hoyt, 2013). Understanding the responses from this lens could
assist in addressing the organizational culture and issues that impact the culture surrounding
women.
Recommendations Summary
At the field level change starts parallel locations. The first is an adoption of language that
perpetuates gender inequity or terms that have gendered connotation. Additional acceptance of
gender inequity in the national healthcare associations such as the American Medical Association
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and the Association of Healthcare Executives is critical to open discussion of how gender
impacts the delivery of healthcare and the organizational cultures of our health systems.
Recognizing and accepting responsibility for inequity is the first step for the field of healthcare
to begin to see changes in the organizational structures of care delivery and support.
Table 30 summarizes key recommendations that connect to the identified KMO influences as
deficits for the women and the organizations, and which impact the proposed recommendations
for improvement of organizational gender equity in leadership.
Table 30
Summary of Key Recommendations
KMO Influences Recommendation
Conceptual Knowledge Conduct informational internal surveys of women in the organization to
identify prevalent gender barriers they currently experience.
Motivation: Expectancy Outcome Ensure expectations of skills, abilities and efforts are aligned with
organizational goals.
Motivation: Self-Efficacy Set goals to become a leader.

Seek feedback from senior leaders, peers, colleagues, and subordinates
to develop skills
Organizational Culture Conduct an external culture assessment to determine if the
organizational culture aligns with the resources, policies, and
procedures of the organization's goals.

Conduct a review of policies and establish language that is non-binary.
Organizational Setting: Mentorship Develop intentional mentorship program with senior leaders and
corresponding peer connection groups
Organizational Setting: equitable
evaluation and promotions
Appoint a talent management professional.

Develop a talent mapping program.

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Integrated Implementation and Evaluation Plan
In the final steps of the Clark and Estes (2008) gap analysis model implementation and
evaluation develop the recommendations into practice. To determine the depth of improvement
to decreasing organizational gender barriers in support of women advancing into leadership
roles, organizations may use an evaluation model to assess the functionality of the
recommendations and their internalization into the organization. Adopting the New World
Kirkpatrick Model, which builds on the original Kirkpatrick Evaluation Model developed in the
late 1950s, the New World Model examines evaluations of experiences in reverse order with
Level 4 down to Level 1 (Kirkpatrick & Kirkpatrick, 2016b).
Implementation and Evaluation Framework: Kirkpatrick Evaluation Model
Effectively implementing recommendations can become unsuccessful when not tracked
during change initiatives or the organization lacks an evaluative process during and after
implementation (Clark & Estes, 2008). To best assist organizations and aspiring women leaders
to implement the support initiatives proposed, this study combines an evaluation of the
effectiveness of the proposed recommendations with an action plan that follows the
implementation proposal. Four training and evaluation levels comprise The New World
Kirkpatrick Model designed to ensure improvements (a) are effective and sustained with
reasonable effort, (b) demonstrate material value to the organization, and (c) produces
measurable results and behaviors that facilitate positive organizational outcomes (Kirkpatrick &
Kirkpatrick, 2016b). The four designated levels (1-4) to training are reaction, learning,
behaviors, and results. The downward funnel of outcomes from Level 4 to Level 1 helps to
concentrate the outcomes. It serves as a guide for organizations to determine the critical aspects
of training and knowledge transfer of implemented recommendations (Kirkpatrick &
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Kirkpatrick, 2016b). Figure 10 reflects the focus of Level 4 on results as the critical outcome for
any training or intervention program (Kirkpatrick & Kirkpatrick, 2016b).
Figure 10
The New World Kirkpatrick Model

Figure 10. The New World Kirkpatrick Model. Reprinted from Kirkpatrick’s Four Levels of Training Evaluation (p.
11), by J. D. Kirkpatrick and W. K. Kirkpatrick, 2016, Alexandria, VA:ATD Publications. Copyright 2016 by
Kirkpatrick Partners, LLC.

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The principal focus of Level 4 is to achieve performance objectives and maximize outcomes. An
initial focus on learning indicators' desired results is the first evaluation (Kirkpatrick &
Kirkpatrick, 2016b). Level 3 is the most essential and resource intensive; it involves identifying
critical behaviors that stakeholders try to consistently perform to achieve success and desired
results from the implemented improvement plan. Level 3 intends to maintain systems and
processes that reward and reinforce critical behaviors through monitoring, reinforcement, and
encouragement. Level 2 considers how the stakeholders develop and retain the knowledge, skills,
attitudes, confidence, and commitment from their participation in the improvement plan. Lastly,
Level 1 amasses comprehensive and foundational information that evaluates individual reactions
to training instructors, program relevance, and overall satisfaction (Kirkpatrick & Kirkpatrick,
2016b). Table 31 summarizes this study with the primary components of the New World
Kirkpatrick Model.
Table 31
Implementation Plan Table
Level Measure Description Components
4 Results The impact of outcomes on aspiring women leaders
from the improvement plan.
Leading indicators,
desired outcomes
3 Behavior The depth of learning translation into performance
and action for the aspiring women leaders.
Monitor, adjust, reinforce,
and reward
2 Learning The impact on the aspiring women leaders of
knowledge, skills, attitudes, confidence, and
commitment due to improvement plans.
Knowledge, skills,
attitude, confidence,
commitment
1 Reaction The level the aspiring women leaders from the
improvement plan find favorable, engaging and
relevant to their jobs.
Engagement, relevance,
customer satisfaction
Note. Adapted from Kirkpatrick’s Four Levels of Training Evaluation (p. 11) by Kirkpatrick and Kirkpatrick
(2016b)

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Field Purpose, Needs, and Expectations
Women continue to strive to make gains in leadership equity, yet the growth is slow and
often women encounter organizational gender barriers that impede progress (Smith, 2014).
Identifying and reducing organizational gender barriers will support aspiring women leaders and
increase the equitable representation of women in leadership roles year over year. Giscombe
(2011) details the attempts of diversity and inclusion programs to impact organizational gender
barriers, yet organizations are still failing to bridge the gender gap in senior leadership roles.
This study examined the knowledge and skills, motivational and organizational barriers to
decreasing organizational gender barriers associated with the identified KMO influences.
Based on the findings, the recommendations presented in Chapter Five seek to mitigate
identified gaps by:
(a) providing detailed informational results to support conceptual knowledge of the
gender barriers women in the organization experience,
(b) developing feedback mentorship programs to facilitate motivation-based expectation
management to support self-efficacy and expectation outcomes, and
(c) exploring an organizational culture review and implementing talent development
professionals to help align healthcare organization culture and desired leadership
outcomes.
The recommendations and interventions may improve the gender gap at the senior leadership
levels within healthcare organizations and apply to various healthcare organizational settings.
Level 4: Results and Leading Indicators
Kirkpatrick and Kirkpatrick (2016b) refer to leading indicators as observations and
measurements associated with critical behaviors that positively impact the desired outcomes.
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Leading indicators may be internal or external and refer to whether observed indicators in the
organization or external stakeholders benefit from the organization's performance (Kirkpatrick
and Kirkpatrick, 2016b). Internal outcomes from process and infrastructure changes for
increased gender equity in leadership and decreased organizational gender barriers for aspiring
women leaders would raise awareness of identifiable gender barriers or biases among the
aspiring women and organizational leaders. External outcomes would be perceived as successful
when presented data to organizations that demonstrate known barriers (Kirkpatrick and
Kirkpatrick, 2016b). The recommended improvements will result in the following outcomes:
(a) internal - improved culture of gender inclusion that aligns with decreased gender barriers
and an increase in women senior leaders,
(b) internal - establishment of mentorship program and peer connection groups for aspiring
women leaders,
(c) internal - development and commitment to incorporate a professional talent management
team to align the goals of the organization and aspiring women leaders,
(d) external – decrease in gender barriers and increasingly positive reputation as a field of
inclusion for women leaders.
The success of these outcomes will help support women to ascend into leadership roles in the
healthcare field. The commitment of organizations to support women to ascend to leadership is a
message to internal and external stakeholders relayed through programs, policies, and actions to
support women in advancement. Table 32 demonstrates the outcomes for internal and external
indicators, intentional measurement metrics for success, and data collection methods to assess
the Level 4 results from the implementation plan.

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Table 32
Level 4 Outcomes, Metrics, and Methods for Internal and External Outcomes
Outcome Metric(s) Method(s)
Internal Outcome
Improved cultural climate that
aligns with decreased gender
barriers and an increase in
women senior leaders
Bi-annual assessment culture
survey to assess gender
inclusion organizational climate
and culture
Separate surveys for all women
leaders in the management
level and all employees once a
year.
Increased focus on gender equity,
including establishment of
mentorship program and peer
connection groups for aspiring
women leaders

Annual review of mentorship
partners, mentor/mentee
couplings, and new mentorship
needs.

Annual review of peer group,
annual educational calendar,
and determine training needs
that are specific to women
leaders.
Interview by human resources
mentorship lead of mentees to
ensure their needs are met
through mentorship and
assessment.
Demonstrated strategic focus on
gender equity and
organizational policies and
practices

Annual review of talent mapping
plans, personnel, and high talent
individuals for placement in
leadership.

Review of potentially high
talent women for training
deficits.
Annual interviews of talent
management teams and aspiring
women leaders ensuring
support is adequate and goals
are set and attained.
External Outcome
Decrease in gender barriers and
increasingly positive reputation
as a field of inclusion for
women leaders.

Increase reputation in Diversity
Best Places to Work

Annual report on specific gender
inclusion measures.
Annual commitment from senior
leadership to devote budgetary
resources, and personnel to
gender inclusion initiatives.
Note. Methods to capture stakeholder appreciation for initiatives that are critical to the stakeholder helps with
engagement.
Level 3: Behavior
Level 3 focuses on the learning effectiveness for recipients for the intended knowledge
and skills of a training program. As a critical aspect of training, Level 3 is vital to ensure that
stakeholders apply learned knowledge and behaviors in the intended context (Kirkpatrick &
Kirkpatrick, 2016b). Successful implementation of Level 3 evaluations require an organization
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to identify the critical behaviors and drivers needed for the behaviors (Kirkpatrick and
Kirkpatrick, 2016b).
Critical Behaviors. Critical behaviors are “specific, observable, achievable” to ensure
evaluation and achievement of Level 4 outcomes need to be consistently performed in the
changing environment by the “primary training audience” (Kirkpatrick and Kirkpatrick, 2016b, p
51). Defining critical behaviors with supervisors, managers, and high performers is determined
by Kirkpatrick and Kirkpatrick (2016b) as the most effective process to lead to Level 4
outcomes. The first critical behavior is goal setting with the aspiring women leaders for their
leadership careers. The second critical behavior is evaluating the mentorship pairings and
program to ensure an effective learning environment. The final critical behavior is annually
reviewing the policies, procedures, materials, websites, and other organizational messaging for
gender-inclusive language. Table 33 indicates the critical behaviors, success measures, methods
of data collection, and frequency.

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Table 33
Critical Behaviors, Success Measures and Methods of Data Collection
Critical Behavior Metric (s) Methods (s) Frequency
1. Mentors and supervisors set
goals with aspiring women
leaders to develop career
plans and growth goals.
Enhanced
knowledge of
skills and
abilities to
confidently apply
or accept
leadership roles.
Supervisors and talent
development teams
will track the goal
setting commitments.
Quarterly formal meetings
and engagements for
women and their
leaders.
2. Talent development teams
and senior leaders pair
mentors and mentees to best
support women’s
aspirations.
Regular engagement
with mentors to
support career
growth.
Review needs for mentees
and strengths of
mentors. Develop
pairings that support
the aspiring women's
goals.
Bi-annually review the
needs and strengths.

3. The marketing or messaging
team and the policy
development committee
review all messages,
materials, inward and
outward communications for
gender inclusive language.
Software reports for
gendered
language.

Collection of data
from committee
work of
variances of
gendered
material.
Utilize language software,
when possible, to scan
for bi-nary language.

Committee review of
proposed policies and
materials for gendered
language or imagery.

Monthly review a set
number of internal and
external items for the
current materials and
any new materials for
publishing.

Required Drivers. Required drivers maintain a bearing and reciprocal impact on critical
behaviors (Kirkpatrick and Kirkpatrick, 2016b). Required drivers are not mutually exclusive and
are essential to supporting Level 4 outcomes; they comprise four components: reinforcement,
monitoring, encouragement, and rewards (Kirkpatrick & Kirkpatrick, 2016b.) Kirkpatrick and
Kirkpatrick (2016b) recognize training, on-the-job performance, individual coaching, and
utilizing intrinsic and extrinsic rewards are valuable support drivers. In Table 34, the required
drivers identified will enable women and leaders to engage in the necessary critical behaviors
through various tools.

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Table 34
Required Drivers to Support and Monitor Critical Behaviors
Method Actions Timing Critical
Behaviors
Supported
Reinforcing Women report on goals and progress with supervisors in a
1:1 regular meeting
Monthly 1, 2
Gender inclusion updates on leadership meetings Quarterly 3
Encouraging Leadership meets with aspiring women leaders to discuss
their career goals and the organization and their options
within the healthcare field
Monthly 1, 2
Presentations to departments and leaders to discuss the
language and imagery that is used and intended to support
gender inclusion
On-going 3
Rewarding Leaders and aspiring women leaders are provided time
during their workday to meet with mentors/mentees.
Monthly 1, 2
Highlight materials that are gender inclusive and did not
require changes.
On-going 3
Monitoring Supervisors review goals and progress on the goals
regularly with the stakeholders.
Quarterly 1
Supervisors and senior leaders will review mentorship
commitments and meetings frequency as a metric for
mentor performance.
Bi-annual 2
Review the material creation and review process with the
committee and chair of policy creation to ensure
information sharing for trends of gendered language or
imagery.
Bi-annual 3

Organizational support. To support the activities described in Table 34 to implement
required drivers, healthcare organizations will need to support the teams or individuals
implementing the activities. The human resources department will likely need to maintain the
mentorship program and the talent development program. This department will need to conduct
an internal review to determine if it can implement the program or the required resources to
support implementation. The organization's leadership is prepared to support the evaluation and
findings for program implementation. Additionally, the marketing team and committee chair for
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policy review will need the training to understand the language or visual messages that may be
gendered.
Level 2: Learning
Learning Goals. Training programs are most effective with established learning goals.
Level 2 emphases the depth of effectiveness of the stakeholder’s attainment of the knowledge,
skills, and behaviors intended from the training. Evaluations take two forms either formative or
summative (Kirkpatrick and Kirkpatrick, 2016b). Level 2 evaluation considerations are outlined
in this section specific to knowledge and skills organizations need to support in executing the
critical behaviors identified in Table 33. After implementation of the recommended
organizational recommendations healthcare organizations and aspiring women leaders will be
able to;
1. Recognize organizational gender barriers. (Conceptual)
2. Set expectations for skills, abilities, and efforts for aspiring women leaders to achieve
leadership goals. (Expectancy Outcome)
3. Establish SMART goals for aspiring women leaders. (Self-Efficacy)
4. Establish and implement a 360-degree feedback program specific to aspiring women’s
leadership goals. (Self-efficacy).
5. Align organizational culture with gender inclusive initiatives, policies, programs,
resources, and procedures. (Organizational Culture)
6. Facilitate the creation of, and engagement within, a mentorship program aligned with
gender inclusive culture and aspiring women’s leadership goals. (Organizational Setting)
7. Facilitate the development and engagement of talent management programs to support
talent mapping and potential development. (Organizational Setting)
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Program. The achievement of the learning goals outlined above requires the construction
of intentional and research-based gender and diversity programs and teachings and awareness of
the gender barriers within healthcare organizations as a field problem. Implementing these
changes in a healthcare setting will set a standard and outline best practices for other
organizations to follow. In implementing these recommendations as a program, a healthcare
organization will identify gaps in knowledge that can impact the stakeholder’s performance and
accent into leadership (Clark & Estes, 2008). The use of external support systems is an
investment into the organizations that support the growth of the field and health systems like
businesses. Still, an initial investment in the women who dominate the field is important to occur
first by completing this assessment and integrating two external experts to develop programs and
processes to improve gender equity. HRM and cultural consultants are critical to leadership
teams to support the organizational alignment of gender equity goals.
One of the first programs the HRM would focus on is the development of peer groups.
One of the key groups to develop is an organizational peer group known to support women’s
career growth and support the individual women aspiring to leadership roles (Working for
Change (n.d). Peer groups could help to facilitate the development of goals, culture evaluations,
reviews of assessments, and talent development. As an integrated support network to the
workplace, peer groups would help assimilate the knowledge that women need to support their
career growth.
Human resources support is critical to the success of the organization's mentorship,
evaluations, and talent management needs. As Burke (2014) observed, an investment in human
capital is a critical transitional factor to organizational change. Hiring an HRM to develop and
manage a mentorship matching program and a talent mapping and development program is
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essential to ensure they can teach mentors how to build their mentees and what is most
supportive to career growth in the talent mapping system. Experts in HRM can provide essential
tools to the management team to support the organization’s goal of decreasing organizational
gender barriers and increasing gender equity in leadership (Burke, 2014).
An organizational cultural consultant can provide a depth of knowledge to support culture
assessment of a healthcare organization to support women's knowledge and organizational
knowledge. Identifying the gender barriers for women and organizations can be an initial barrier
for women to advance to leadership when meeting other needs. Burke (2014) refers to espoused
beliefs and values first identified in organizations by Schein (2004) as a challenge to
organizational change. These espoused beliefs and values inform a group on the problem they
need to solve and how to approach it. An external consultant can guide an organization to dispel
the views or the behaviors and ideals that contrast with the leadership and the organization
(Burke, 2014). The consultant can craft gender barrier evaluations and regularly analyze the
results to provide a detailed review of the organization's gaps that aspiring women leaders’
encounter.
Evaluations. Processes and procedures to evaluate the depth of learning are fundamental
to implementing the organizational change recommendations (Clark & Estes, 2008). Kirkpatrick
and Kirkpatrick (2016b) identify five components of learning essential for effective evaluation in
change programs: knowledge, skills, attitude, confidence, and commitment. The knowledge
learning component aligns with the conceptual knowledge of the KMO model, or the depth of
declarative knowledge. Simultaneously, the skills learning aligns with the procedural knowledge
in KMO, or the "how-to" knowledge. Attitude and confidence both align to motivation, and in
this case, attitude links closely to expectancy outcome while confidence links to self-efficacy.
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Attitude assesses the stakeholders' beliefs and perceptions about the expected result and worth of
the training or experience. In contrast, confidence evaluates the stakeholder's beliefs of their
ability to overcome barriers and utilize what they learned. These components align with literature
and research in Chapter Two regarding the significance of stakeholder influences (Burke, 2014;
Clark & Estes, 2008). Table 35 identified the proposed evaluation method and frequency for
each of the learning components.
Table 35
Evaluation of the Learning Components for the Program
Method(s) or Activity(ies) Frequency
Conceptual Knowledge – “I know it”
Knowledge check of identifying barriers Before and after organizational culture assessment.
Knowledge checks of leaders for the measures of
gender inclusion.
Quarterly after leadership meetings.
Documents notes from mentors and talent management
professionals.
During and after meetings for mentorship program
training and talent management objectives.
Procedural Skills “I can do it right now”
Mentors ask probing questions of mentees. During mentorship meetings to guide progress on the
goals.
Role play for mentees to manage difficult situations. During each role play session to gain confidence.
Discuss concepts in the peer groups and reflect on the
topics in leadership journals.
At the end of a peer group meeting.
Attitude “I believe this is worthwhile.”
Stakeholder observations of the leadership initiatives
and approach.
Bi-Annual climate survey of employees on gender
equity initiatives.
Discussions with mentors and peer groups surrounding
techniques.
During a regular peer group meeting
Confidence “I think I can do it on the job.”
Leadership journaling. After mentorship meetings and after utilizing a skill in
practice.
Post experience assessment. After the mentees utilize a skill and talk through a post
assessment.
Commitment “I will do it on the job”
Post experience discussion – peer groups, mentorship,
talent management.
During meetings with the specified group.
Personal assessment. Part of the annual review process.
Note. These components are primarily focused on the mentor/mentee program but can be applied to the talent
management need as well as the gender inclusions practices.
166

Level 1: Reaction
The degree that stakeholders are satisfied with their training or engagement is the focus
of Level 1, along with the perceived relevance to their work or professional environment. The
components included in Level 1 are engagement, relevance, and customer satisfaction
(Kirkpatrick and Kirkpatrick, 2016b). Formative reaction data obtained through stakeholder
evaluations such as an organizational culture consultant, an HRM professional, or organizational
coach. Summative assessments through interviews, mentor notes, and HRM evaluations are also
an effective tool to capture data (Kirkpatrick and Kirkpatrick, 2016b).
Limitations and Delimitations
Limitations and delimitations are a natural occurrence in research studies. Both were
accounted for and recognized through the methodology development of the study. Limitations
are the factors that are outside the researcher’s control. Limitations may not become clear until
the data is collected, and analysis begins, or even until it is complete. To ensure credibility and
trustworthiness, identifying the limitation prior to data collection helped to guide the study
(Creswell, J. W., & Creswell, 2018). To encourage stakeholders to provide the most direct
answers and provide open details, their responses were managed through a confidential process
and a summary of the transcript was provided to the stakeholder for accuracy.
Delimitations are the choices the research makes while creating the study. Delimitations
may be influenced by inherent bias of the researcher, specifically the assumption of shared
experiences with the stakeholders and the impact those experiences may have on their personal
and professional growth. The number of interview stakeholders and their geographic locations
are both to facilitate this study. The lack of racial and ethnic diversity limits the perspective of
the study and does not represent all women. The stakeholders in this study did not provide their
167

gender identity, which also limits the perspective of this study and would be an important future
study. Documents and artifacts were not considered for this study, as human resources
documents and organizational policies were not provided due to confidentiality. Individual
accounts were provided in place of formal organizational documentation. The researcher made
every effort to identify and mitigate any personal bias. Divulging any conflict of interest between
the researcher and the stakeholders helped to mitigate delimitations (Creswell, J. W., & Creswell,
2018). There were no noted conflicts of interest.
Recommendations for Future Research
In reflection on this study, additional research opportunities were identified to understand
organizational gender barriers. The research conducted a year into the global pandemic has
influenced the healthcare stakeholders; it is undetermined if responses would have varied had the
stakeholders not just weathered twelve months of the pandemic. This study aimed to understand
the barriers aspiring women leaders currently encounter in their ascent to a leadership role;
however, an additional opportunity for research could focus on women who have achieved senior
leadership roles. Additionally, understanding the barriers women encountered and overcame to
achieve their career goals can provide a road map for organizations to establish a pipeline for
women leaders. A deeper understanding of the consequences may or may not occur if women
declined an offered leadership role. The following research questions emerged through the
course of the study. Is there an impact of career growth after working in a biased, derogatory, or
discriminatory environment? How do women develop as authentic leaders?
In addition, research that seeks to understand the intersectionality for WOC and gender
bias within the healthcare field is critically missing in the greater understanding of women in
leadership. Additional research is needed to understand the experiences of WOC who have
168

attained director level roles as well as senior leadership roles. This research may be conducted in
a system approach (all one healthcare organization), or a regional study across various healthcare
entities. Both studies may seek to understand the barriers WOC experienced and the resources
they leaned on to overcome the gender and racial barriers. Questions may include: What
resources at which level (KMO) are most impactful for WOC? How do WOC experience gender
bias in healthcare organizations? How does leadership in different systems impact WOC? How
do WOC experience the leadership ladder in healthcare?
As discussed, the gender spectrum is not binary and an additional study about women
who identify across the gender spectrum is important to understand the lived experience of all
people who identify as a woman. Research in healthcare about gender identity and its impact on
career progression would help to understand how women across the gender spectrum experience
leadership growth. In addition, organizations may benefit from research about how to support
women across various identities to create systems of promotion and hiring to develop inclusive
and equitable leadership paths. Research questions may include: How do organizational
programs, policies, or systems interact with gender identity? How do Transgender women and
men experience gender bias in the healthcare field? How does gender identity impact promotion
and hiring practices in healthcare?
Conclusion
The purpose of the study was to identify and leverage best practices to identify and
reduce organizational gender barriers for aspiring women leaders in the healthcare sector. Nine
director-level women leaders in healthcare participated in this study. Multiple sources
interviewed in semi-structured interviews revealing similar experiences confirmation of the data.
Once coding and analysis were complete, this study proposed context-specific recommendations
169

to close the KMO gaps identified. Using the Kirkpatrick and Kirkpatrick (2016b) New World
Model, this study outlined a detailed plan for implementation and evaluation process to assess
the effectiveness of the implemented recommendations.
The study indicated a gap or partial gap six of the eight assumed influences in the
conceptual framework. Findings suggest increased conceptual knowledge will facilitate
awareness of organizational gender barriers to support the growth of motivational and
organizational settings. The results also indicate that a lack of confidence in skills, abilities, and
acceptance may limit aspiring women leaders' motivation. Most significantly, the data suggests
that organizational influence presents substantial barriers to women gaining confidence, skills,
and access to support to overcome organizational gender barriers. This study finds that
mentorship, peer groups, and talent mapping could impact organizational gender barriers to
women in leadership. Investing in initiatives that support awareness of and develop a
commitment to gender-inclusive cultures will begin to narrow the gap in gender equity in
healthcare.
As women challenge the glass ceiling, they confront societal norms and gender
expectations of women in the workforce and in the greater American context. Women strive to
become leaders in all aspects of American culture, yet inequities and gender barriers require
women to work longer, harder, and navigate more difficult standards to reach their career goals.
This study investigated the healthcare setting and how women are represented in leadership. It is
only the beginning of the investigation, and it is clear organizations that want to lead change can,
but they too need women to guide them - and not just white women - women of color, women
who identify as part of the LGBTQIA+ community - all women, together. The question remains
170

how do we, as American’s, raise up all Americans to be equal and valued members of our
economic and cultural fabric?

171

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1

Appendix A: Assumed Influences Crosswalk

Knowledge
Influence

Assumed Influence Methodology: Interview
Questions
Associated
Research Question
Conceptual Women need to know the
organizational gender
barriers that impact their
promotional process.

What was the promotional process
for your leadership accent?

What are the gender barriers in
your organization?

Does your organization identify
and work to decrease gender
barriers? If so how?

How does your organization
support advancement?

Are their clear organizational
requirements/processes for
promotion or advancement?
What are the
knowledge
influences related
to the
organizational
gender barriers that
impact women in
the advancement of
their careers?

Procedural Women need to know how to
leverage support to
overcome organizational
gender barriers.
What development opportunities
are available to women?

What other support was available
to you to overcome gender
barriers?

Were there mentorship programs
formal or informal?

Did you have a personal advocate
to your advancement?
What is the knowledge
recommendation to
these needs?
Metacognitive Women need to reflect on their
skills and abilities in order
to overcome organizational
gender barriers.

Can you tell me about a time
when you used your personal
strengths and abilities to
impact your personal career
advancement?

What skills make an impact on
gender barriers?

How did you identify what
skills/abilities make an impact
on gender barriers?

In your organization did women
have the same, fewer or more
opportunities than men?
What is the intersection
between
organizational
culture and context
and women’s
knowledge as it
relates to gender
barriers that impact
women in the
advancement of
their careers?

2

Motivational
Influence
Assumed Influence Methodology: Interview
Questions
Associated Research
Questions
Expectancy
Outcome
Women need to believe their
skills, abilities, and effort
will overcome
organizational gender
barriers

What skills or abilities do you
seek to be a strong leader?

Did you intentionally pursue
leadership roles?

Did you receive formal training?

Can you tell me about a time
when you had to navigate the
informal networks in your
organization?

What was and how much effort
did you expend to develop
leadership skills?
What is the intersection
between
organizational
culture and context
and women’s
motivation as it
relates to gender
barriers that impact
women in the
advancement of
their careers?
Self-Efficacy Women need to believe they
will overcome
organizational gender
barriers and will be
accepted as a leader.

On a scale of 1 to 10, 10 being
high, what degree do you feel
you have the skills of a strong
leader?

Have you ever questioned your
ability as a leader?
Can you describe the
circumstances and what
happened?

Thinking back on your
promotional opportunities and
your leadership accents, what
gender barriers, if any, did you
overcome? How confident did
you feel in your abilities to
move to the next level in your
career? Was there anything
special you did to prepare for
your leadership promotion? Is
there anything you might do
differently in retrospect?

When seeking promotion at what
point did you feel prepared to
apply/request the
promotion/take on leadership?

What are the
motivational
influences related
to the
organizational
gender barriers that
impact women in
the advancement of
their careers?

3

Organizational
Influence
Assumed Influence Methodology: Interview
Questions
Associated Research
Questions
Cultural Model
1: Gender
inclusive
culture
Organizations need to have a
culture of inclusion to
counter gender role
expectations.

What programs, policies or
practices impacted gender
inclusion of women in your
organization?

How did you express your
opinion?
How was your opinion received?

Are the women in your
organization supported? In
what ways? Could they be
better supported? As leaders?

Do you feel men and women are
treated equally?
Have you ever thought your
gender has played a role in
your missing out on a raise,
promotion, key assignment, or
advancement?
Do you think your organization
should be doing more to
increase gender inclusivity,
doing less, or is the amount of
effort currently being used
about correct?
What is the intersection
between
organizational
culture as it relates
gender barriers that
impact women in
the advancement of
their careers?
Setting
Influence1:
Mentorship
Organizations need to connect
women with mentors at
senior leadership levels,
and with women who have
successfully reached
leadership roles to support
the possibility of
progression to senior
levels.

Did you have a professional
mentor?

If so, how did you connect?

Was it a formal program or self-
appointed?

How did the mentorship programs
support your career

What are the
organizational
settings influences
related to the
organizational
gender barriers that
impact women in
the advancement of
their careers?

4

Organizational
Influence
Assumed Influence Methodology: Interview
Questions
Associated Research
Questions
Setting
Influence 2:
Operational
practices
Organizations need to evaluate
and adjust promotion and
hiring practices to reduce
and eliminate gender
variances in the selection
process.

What were the hiring, promotion
practices in your
organization?

How do you identify and address
gender variances in the
promotion process?

On a scale of 1-10 how fair would
you consider your evaluation
process to be? 10 being the
fairest among all employees -
regardless of gender.

Were there any aspects of your
career you felt you were not
treated fairly as a woman?
Can you tell me about a time
when that happened?

Does your organization have pay
equity programs?

What recommendations would
you provide to an
organization seeking gender
equity in leadership?

Are there any policies and
practices you would
implement to develop gender
equity in leadership?
What are the
organizational
settings influences
related to the
organizational
gender barriers that
impact women in
the advancement of
their careers?

5

Appendix B: Interview Protocol
Greeting

● Hello, introduction
o How are you?
o How are you and those close to you managing during the pandemic?
o Is this still a good time for us to have this conversation?
● Thank you for
o your time
o speaking with me about your career
● Situate myself again …
o Through the outreach I have done, diversity and gender inclusion I have a deep
passion for the advancement of women.

● Participation in this study is completely voluntary. If you decide not to participate there
will not be any negative consequences. Please be aware that if you decide to participate,
you may stop participating at any time. As well, when asked, you may decide not to
answer any specific question.

● The purpose of this interview is to talk with you about your leadership accent, and gender
barriers you may or may not have encountered throughout your career. Along with what
influences assisted or were detrimental to your leadership goals.
● Your participation in this study will last approximately one hour.

Confidentiality
● Now that I have described the purpose of the interview, I am hoping that you continue to
agree to being interviewed, and if you do, let me emphasize that
o This conversation is private and confidential
o I also need to confirm with you if it is okay to record this when we begin the
interview questions?
o If we can record, I will send you a transcript of the conversation to be sure that
you agree to using any or all of the information that we discuss
o If you choose not to have parts included, I can delete that from the transcript,
making it ineligible as data for the study
o I need your consent to record. And when I start the recording, zoom will indicate
that the conversation is being recorded, and there is an option for you to select in
agreement.

Introduction
● 15 questions over the next 50 minutes
● Open-ended response; I might interrupt to probe or re-direct
● I’ll be typing notes on a separate computer while you speak to not impact the recording of
your responses
● Here we go!

6

“I’m turning on the recording now”
Interview Question Key Concept
1. Tell me a little about your current role Introduction and
comfort creating
2.Did you intentionally pursue a leadership role? Motivation and goal
setting
3. Who are the leaders in your organization? How do you define senior
leadership? What roles equate to a leader in your organization?
Organizational culture
and structure
4. What organizational programs or systems have you found supportive
in your career?
Supportive measures
Procedural Knowledge
5. Have you experienced support in your career from another person?
Who and How?
Supportive measures
Self-determination
Motivation
6. Who are the women leaders you are inspired by? What inspires you
about them?
Motivation and
modeling
7. Have you experienced one or all of the following; gender related
bias, barriers, or discrimination in an organization in which you have
worked? Can you provide an example (s)?
Organizational culture
8. What skills or techniques did you use to overcome gender barriers? Motivation – self
efficiacy
9. Can you tell me about an experience that was personally and/or
professionally impactful in your development as a leader?
Development of self-
efficacy
10. How/what should organizations do to support gender equity in
leadership?
Organizational support
measures

Additional Interview Questions Key Concept
What was the promotional process for your leadership accent?

Conceptual Knowledge
Describe the leadership demographics in your organization. Organizational culture
and Setting
Did you have a mentor or a professional advocate? Procedural knowledge
and Cultural setting
What skills or techniques did you use to overcome gender barriers? Motivation – self
determination
How/what should organizations do to support gender equity in
leadership?
Organizational support
measures
What are your abilities as a leader?
When seeking promotion at what point did you feel prepared to
apply/request the promotion/take on leadership?
Self-efficacy Motivation
What skills and knowledge did you use when encountering gender
bias?
Metacognitive
Knowledge
Do you or have you ever questioned your ability as a leader? What did
you do? Did it impact your ability as a leader?
Self-efficacy Motivation

7

What programs, policies or practices impacted gender inclusion of
women in your organization?
Organizational culture

Closing
This covers the things that I wanted to ask. Is there anything we did not touch on that you would
like to share about your leadership journey?
Thank you [person] for giving me the opportunity to talk with you candidly about your
experience as a woman in leadership.
o Is there anything now that you think I should strike from the conversation?
o As I review the data, and get some preliminary findings, or if I need clarification
would you mind if I reached out to you again?
o Do you have any questions?
Other Probes
● What do you mean by that?
● Can you help me understand what you mean by that?
● Could you tell me more about your thoughts on that?
● Can you give me an example to clarify the point?
● Any other reason?
● Would you tell me what you have in mind?
● Why do you feel that way?

8

Appendix C: Zoom Instructions
These Zoom instructions will be included as an attachment in the email sent to the study
stakeholders.
Zoom Instructions
All interviews will be held online via the Zoom video conferencing platform (Zoom
Video Communications Inc., 2020). Zoom is a cloud-based platform that allows for online group
meetings, includes chat capabilities, transcription, and has the capacity for secure recording of
sessions. You do not need a Zoom account to access the Zoom meeting.
All stakeholders will, a unique Zoom ID link in an invitation to the agreed upon interview
time. The Zoom account provided by my employer and is in my name, it is approved for research
purposes. Your privacy is protected as access to any recordings is password protected.
Stakeholders can connect to the session via web browser on a computer, or an app from a
mobile device, such as a phone or tablet. Here are some additional privacy measures that can be
used during the Zoom interview:
● To turn off your device camera:
o Use the “Stop Video” function in the bottom menu bar to turn off your
device’s camera to avoid being seen
● To change your stakeholder screen name:
o open the “stakeholders” list function in the bottom menu bar
o mouse over your name in the stakeholder list
o click more → “Rename” → enter a new screen name
Zoom recording is disabled as you enter the meeting. The researcher will verbally request
that you agree to be recorded. Only once you agree will the recording be started. Zoom will then
require you to electronically consent to the recording. If you do not agree to be recorded, the
recording will not be started. For security purposes, all Zoom recordings are password protected.
More information about Zoom can be found at https://zoom.us/
This study has received approval from the University of Southern California Institutional Review
Board.

9

Appendix D: Communications
Email 1: Email to Request Participation
Subject: USC Doctoral Student: An Opportunity to take part in Research about Organizational
Gender Barriers Impact on Women’s Advancement to Leadership
Hello!
My name is Allis Gilbert and I am a doctoral student in the Organizational Change and
Leadership program at the University of Southern California (USC) Rossier School of
Education. Although I am studying at USC, I have lived in Colorado for the past 9 years.
Throughout my career and my educational studies, I have experiences and thus developed a
desire to understand more about gender barriers women encounter.
I would like to formally invite you to participate in a study focused on your experiences
as a woman leader. The purpose of the study is to identify and reduce organizational gender
barriers that will increase equitable representation and increase women's leadership
representation year over year. This study can benefit organizations to develop programs, policies
and procedures that reduce and eliminate organizational gender barriers. This study has received
approval from the University of Southern California Institutional Review Board. More
information about the study is attached in the document titled Information Sheet for Exempt
Research.
Should you choose to participate, I will conduct an interview that will last approximately
one hour. During these interviews, I will ask you about your leadership background, gender
barriers you have encountered, support mechanism that helped you succeed, and questions
related to your leadership journey as a woman. In return for participating in the interview, you
will receive an advance copy of a research report summarizing the findings.
Due to the current pandemic health precautions, the interview will be via Zoom (Zoom
Video Communications Inc., 2020), and at a time that is convenient for you when we can speak
uninterrupted.
I hope that you choose to join me for a conversation about your experience. If you would
like to participate in an interview, please click the link below and follow the instructions. The
link is to a short confidential survey of 15 questions, including your contact details. The
questions include demographic details about you and your leadership background. This

10

information will be used to both contact you, and to provide some background for the study
about the stakeholders. All information in this survey is confidential.
Thank you for assisting me with my doctoral research and for contributing to the
understanding and advancement of women to narrow the gender gap in leadership. I would be
grateful if you spent a few minutes reviewing USC’s information sheet [web link to be added]
for exempt research that describes the research’s purpose and outlines your rights as a research
subject.
If you have any questions about this study, please contact me or my advisor, Dr.
Alexandra Wilcox (amwilcox@usc.edu).

Thank you for your time and consideration,
Allis Gilbert (awgilber@usc.edu)
Doctoral Candidate, University of Southern California

This study has received approval from the University of Southern California Institutional Review
Board.

Email 2: Follow up Email Confirming Participation
Subject: USC Doctoral Student: Scheduling an Interview for Gender Barriers Research
Dear [name of stakeholder]
Thank you for offering to participate in an interview that will focus on identifying and
reducing organizational gender barriers and will increase equitable representation and increase
women's leadership representation year over year. As a reminder, this study is associated with
my doctoral studies at the University of Southern California (USC) Rossier School of Education.
Attached to this email are three documents:
1. Information Sheet for Exempt Research
2. Informed Consent for Research form to participate in this research.
3. Scheduling the Interview
Due to the current pandemic health precautions, the 60-minute interview will be via
Zoom, and at a time that is convenient for you when we can speak uninterrupted. I would like to

11

arrange a time for us to meet to have a conversation about your experience. Please use my
calendar link (INSERT LINK) to request the time that fits best for your schedule.
Once our meeting time is confirmed, I will send you a separate email with the meeting
invitation, including the Zoom meeting link.
[Name], I am really looking forward to our conversation. Thank you again for helping
with this study to identify and reduce organizational gender barriers that will increase equitable
representation and women's leadership representation.
If you have any questions about this study, please contact me: Allis Gilbert (awgilber@usc.edu)
or my advisor Dr. Alexandra Wilcox (amwilcox@usc.edu).

Many thanks,
Allis Gilbert
Doctoral Candidate, University of Southern California
This study has received approval from the University of Southern California Institutional Review
Board.

Email 3: Follow up Email Not Selected for Participation
Subject: USC Doctoral Student Research Thanks You
Dear [name of stakeholder]
Thank you for offering to participate in an interview to have a conversation about your
experience as a leader. It turned out that I had so many volunteers that I am not able to interview
everyone. I had to shortlist just 12-16 women from a variety of industries.
It was difficult for me to not talk to you as well, but I hope that you understand. As I have
said, I am committed to advancing women into leadership and narrowing the gender gap. If there
is anything that I can do to support you, please do not hesitate to reach out.
Thanks again for wanting to be a part of this conversation. I hope that my study will help
to make a difference.
All the best
Allis Gilbert
Doctoral Candidate, University of Southern California

12

Appendix E: Participation Questionnaire
Welcome!
Thank you for offering to participate in an interview about your experience advancing
into a leadership role and the gender barrier you may have faced. This study is associated with
my doctoral program at the University of Southern California (USC) Rossier School of
Education. This study has received approval from the University of Southern California
Institutional Review Board. If you have any questions about this study, please contact Allis
Gilbert (awgilber@usc.edu) or my advisor Dr. Alexandra Wilcox (amwilcox@usc.edu).
Participation in this survey is completely voluntary. Completion of the survey is taken as
agreement to consent to participate. However, if you no longer wish to participate, please
discontinue completing the survey and go to the last question to indicate you wish to be
withdrawn from the study.
I am looking forward to hearing from you, and about you!
Allis Gilbert (awgilber@usc.edu)
Doctoral Candidate, University of Southern California
This study has received approval from the University of Southern California Institutional Review
Board.

Fillable form to collect demographics?
1. Please provide your name?
2. Please provide …
Your phone number
Your email address
3. What is your year of birth?
4. How would you describe yourself? Please select all that apply.
Asian
Black/African
Caucasian
Hispanic/Latinex

13

Native American
Pacific Islander
Prefer not to answer
Write in option
5. Is there anything I should know prior to contacting you to reaffirm that you would like
to participate in an interview?

Details about your CURRENT OR PAST LEADERSHIP POSITIONS
6. How many years have you held a manager and/or director position?

7. What is your current position/title?

8. What type of healthcare organization do you work for? Please select all that apply.
Community Health Care
Insurance agency
Acute Care Clinic
Family Practice
Specialty Clinic
Hospital
Other: __________________
9. Please select the category that best fits your employer category
Public
Private
Non-profit
Government
10. What is your current employment status?
Full-time
Part-time
Other
11. What is your highest level of education?

14

Certification
Diploma
Associates Degree
Bachelor’s Degree
Master’s Degree
Doctorate Degree
Other terminal degree
12. How long did it take before you became a supervisor (Manager or Director)?
1-5 years
6-10 years
11-15 years
15+ year
13. How many leadership roles have you held?
1-3 roles
4-6 roles
7-10 roles
14. Is there anything else that you would like me to know about you or your experience?
Thank you for taking the time to complete the introductory information. I will be reaching
out via email to confirm the appointment time to talk.
If you have any questions about this study, please contact me Allis Gilbert
(awgilber@usc.edu) or my advisor, Dr. Alexandra Wilcox (amwilcox@usc.edu).
Allis Gilbert
Doctoral Candidate, University of Southern California
This study has received approval from the University of Southern California Institutional Review
Board.

15

Appendix F: Information Sheet for Exempt Research
The information sheet for exempt research will be included as an attachment in the email
sent to stakeholders who will take part in the interviews.

INFORMATION SHEET FOR EXEMPT RESEARCH
STUDY TITLE: Organizational Gender Barriers that Impact Women’s Career
Advancement; A Field Study
PRINCIPAL INVESTIGATOR: Allis Gilbert
FACULTY ADVISOR: Alexandra Wilcox, JD, MFA, EdD
You are invited to participate in a research study. Your participation is voluntary. This document
explains information about this study. You should ask questions about anything that is unclear to
you.
PURPOSE
The purpose of this study is to explore the barriers that women encounter as they progress
through their careers and advance to leadership roles. While a complete evaluation would focus
on all stakeholders, for practical purposes, the stakeholder of focus is aspiring women leaders
(Managers or Director level). The analysis will focus on the knowledge/skills, motivation, and
organizational context that impacts the equitable advancement of women within their
organizations. The questions that will guide the focus of the study are as follows:
1. What are the knowledge and motivation influences related to the organizational
gender barriers that impact women in the advancement of their careers?
2. What is the interaction between organizational culture and context and women's
knowledge and motivation as it relates to the organizational gender barriers that
impact them in the advancement of their careers?
3. What is the knowledge, motivation, and organizational recommendations to these

16

needs?
STAKEHOLDER INVOLVEMENT
Participation in this study is completely voluntary, and you have the right at any time and
for any purpose, to withdraw from the study.
You will be interviewed as a part of this study. The time of the interview will be arranged
at a time that is convenient to you. As a stakeholder, you have been informed about the topics
that will be discussed and have been encouraged to keep a diary of events or thoughts you have
on the topic. These diaries will remain as your notes unless you decide to pass them along to the
researcher. If you do pass them along, they will remain confidential.
Interviews will take place via the Zoom video conferencing platform and will last
approximately one hour. With permission, each interview will be audio-recorded and transcribed
verbatim later. The Zoom software automatically includes the identifying credentials of the
person that is logged in to the interview. If you do not want to be identified by the credentials in
Zoom during the interview, please ensure that you have followed the instructions explaining how
to remove your name from the software. If you choose not to do that, it will be edited at the time
of transcription.
CONFIDENTIALITY
The members of the research team, Allis Gilbert and Dr. Alexandra Wilcox (faculty advisor),
and the University of Southern California Institutional Review Board (IRB) may access the data.
The IRB reviews and monitors research studies to protect the rights and welfare of research
subjects.
When the results of the research are published or discussed in conferences, no identifiable
information will be used.
Every effort will be made to protect your privacy and to preserve confidentiality. All
information about your participation, as well as the content of the conversation, will be
confidential. You will have the opportunity to strike anything from the record before the end of
the interview.
The Zoom software automatically includes the identifying credentials of the person that is
logged in to the interview. Please ensure that you have followed the instructions explaining how

17

to remove your name from the software. If you choose not to do that, it will be edited at the time
of interview transcription.
Zoom transcription software will be used to transcribe the interview recorded via Zoom.
All identifying information will be removed at that time. As necessary, editing the transcript will
ensure that stakeholder details are removed from the transcript, but that what remains are
identifiers that distinguish who said what. You have the right to review the transcript after the
interview to determine if there is anything that you wish to edit, or do not want to be included in
the data analysis.
All data from this interview will be stored on a secure hard drive. The data will be
destroyed at the end of the study.

INVESTIGATOR CONTACT INFORMATION
If you have any questions about this study, please contact Allis Gilbert (awgilber@usc.edu) or
Dr. Alexandra Wilcox [faculty advisor] (amwilcox@usc.edu).
IRB CONTACT INFORMATION
If you have any questions about your rights as a research stakeholder, please contact the
University of Southern California Institutional Review Board at 323-442-0114 or email
irb@usc.edu.

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Asset Metadata

Creator Gilbert, Allis Welpton (author)

Core Title Prescription for change: gender barriers impact on healthcare leadership equity

School Rossier School of Education

Degree Doctor of Education

Degree Program Organizational Change and Leadership (On Line)

Degree Conferral Date 2021-08

Publication Date 07/29/2021

Defense Date 06/15/2021

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

Tag bias,equity,gender,gender barriers,healthcare,leadership,OAI-PMH Harvest,Women

Format application/pdf (imt)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor McDermott Wilcox, Alexandra (committee chair), Grant, Derisa (committee member), Sloane Krop, Cathy (committee member)

Creator Email allisgilbert05@gmail.com,awgilber@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC15669262

Unique identifier UC15669262

Legacy Identifier etd-GilbertAll-9933

Document Type Dissertation

Format application/pdf (imt)

Rights Gilbert, Allis Welpton

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the author, as the original true and official version of the work, but does not grant the reader permission to use the work if the desired use is covered by copyright. It is the author, as rights holder, who must provide use permission if such use is covered by copyright. The original signature page accompanying the original submission of the work to the USC Libraries is retained by the USC Libraries and a copy of it may be obtained by authorized requesters contacting the repository e-mail address given.

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA

Repository Email cisadmin@lib.usc.edu