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Tips for women moving up in the NHS

Karen Lynas, interim managing director of the NHS Leadership Academy and a noted expert on equality and leadership, offers some tips for women in the NHS looking to move into more senior roles.

I have been asked to speak a lot recently about the leadership landscape in the NHS and often start by reeling off the names of the chairs and chief executives of our significant national organisations and arm’s-length bodies. Of the 10 organisations I list, there is only one woman: Una O’Brien, heading up the Department of Health. She has recently announced she is leaving, so if we’re not careful it could become a full house. A recent list of the 100 most influential people in health reinforced that our senior leadership community is not, by any measure, a diverse one. That is without question an extraordinary fact for a system of care that is dominated by women in both formal and informal roles. 

I have written before and will no doubt write again on this issue. There are numerous activities and people much better informed than me doing important work. For now, I thought I might dare to write something very pragmatic. 

At the risk of suffering the wrath of those who feel I am playing to stereotypes or doing anything else that seeks to perpetuate rather than crash through the discrimination, here are my few top tips for women wanting to move into a more senior positon and feeling anxious about so doing. Please feel free to respond, deride, ignore or use how you see fit! 

1) Advocate for other women 

I have talked previously about the research on this and it remains a stubborn issue in health. There is a cost to women for advocating on their own behalf, and this is a real issue since successful men do it very well and it can become part of their asset base – it is the opposite in women. The evidence is quite compelling that the social cost to women who advocate on behalf of themselves – who talk about their strengths, their achievements, what they are good at – is high. 

One of many examples is around the social cost to women of negotiating salary, which many argue is hugely important to do. It reflects the discrepancy that still exists in how similar behaviours in men and women are judged differently. There is a huge amount to address here, but one very easy pointer – advocate strongly on behalf of other women. For those of you with fabulous women that work around you, keep in mind that since they can’t promote themselves it will work much better if you do. 

2) Be a mentor to a younger woman 

Up until very recently I have been a mentor for a few women, all younger than me. It is really rewarding and actually a huge learning experience. Of course it is important to help them build experience, confidence and networks; give back to the talented generation behind you. But for me it was also an enriching experience where I learned so much about what is holding me back, a different perspective on work, life and people, a refreshed view of what mattered and what didn’t. 

If you don’t already mentor a younger woman then think about how you might start – it will be worth every precious minute I promise you. 

3) Speak up! 

What you say is of course much more important than how you say it. But presence and impact matters. 

Many times I have worked with women who inadvertently undermined their position at board level by speaking with a very quiet, very hesitant voice. You can be quiet, but you must project. Don’t make people strain to hear you; it just becomes easier for them to discount you. And that hesitancy and quiet can often portray a lack of conviction in your point – if you’re not convinced by what you’re saying, why should anyone else be? 

It is a painfully simple intervention to make, but if you are someone blessed with a soft and quiet tone remember in the crash of many meetings and events in health that lovely voice might just not get heard. Coaching, presentations skills and some self-directed learning can all help. 

4) Be visible 

For us introverts, this can be hugely painful – but unfortunately it is still really important. You have to be seen to be known. 

Carolyn Fairbairn talked about this recently. As the first female chief of the CBI, she has already ascended to a position of significant influence and power, and in doing so she has very clearly made some of her own rules. She won’t get engaged in the big social gatherings that often pass for work in big business. 

Grace Dent also talked about this in her inimitable fashion in a recent Independent article. They are right of course – but being visible isn’t about being at all the swanky affairs; it is about building and sustaining your networks, being connected to people and being accessible. The NHS, whether we like it or not, still works on networks. 

5) Seek broad alliances 

Of course, none of us think the only allies in getting better diversity in our senior leadership community are people who share our experiences. Seek out the informed, supportive, energetic, values-based leaders around you who share your passion for inclusion at work. Make sure you don’t end up with the same narrow perspective as we are criticising others for having. Build a strong alliance of the willing. 

6) Don’t ever (ever) walk by 

And, by extension, make sure you are part of the solution – not part of the problem. It is down to all of us to call out inappropriate behaviour, wherever it comes from and whomever it impacts. Saving it up for months won’t help – give feedback or provide challenge in a timely and appropriate way. That is most likely to result in changed behaviour, reinforces the integrity of your position by ensuring you’re not colluding with negative behaviours and demonstrates to others around you that your commitment is real. 

7) Do what you want anyway 

For some women, the reason they aren’t sat at the top of organisations is simply because they don’t want to. We should also celebrate that choice for ourselves – and those around us. I’ve realised belatedly that my constant nagging of some amazing women I know to push themselves even further is about my needs not theirs: I want the place to be run by people like them. But it isn’t up to me to push them – the choice they make is theirs and so by definition, should be entirely right for them. You might just be pretty perfect just as you are! 

About the author 

Karen Lynas joined the NHS through the graduate management training scheme in 1990 and is the interim managing director of the NHS Leadership Academy. Starting her career in the busy hospital environments of the NHS provider sector, she soon developed a keen eye and passion for the transformative benefits that great leadership can bring to both patients and staff.  She harnessed that passion and took it into leadership development, the field in which she has worked at a national level for the past 15 years. Lynas speaks frequently at both national and international conferences, and writes regularly on leadership and equality issues.

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