Factors that influence the implementation of organisational interventions for advancing women in healthcare leadership: A meta-ethnographic study.

Background: Gender inequity in healthcare leadership persists and progress is slow, with the focus firmly on problems, barriers and on requiring women themselves to adapt and compete in a system not designed for them. Women are individually burdened to advance their careers, with little effort given to addressing systemic barriers in the health sector. A recent systematic review prioritised organisational-level approaches and demonstrated effective interventions. In this meta-ethnographic study, we further this work by examining factors in implementation of organisational interventions for advancing women in leadership.

Methods: The meta-ethnographic framework applied here follows the Noblit and Hare approach for synthesising findings and applying interpretive analysis to original research. We generated a new line-of-argument with insights for the healthcare sector. The protocol is registered (CRD42020162115) on the International Prospective Register of Systematic Reviews. Three academic databases (MEDLINE, PsycINFO, SCOPUS) were searched systematically between 2000 and 2021. Studies were analysed if they included organisational-level interventions that sought to measurably advance women in leadership. Study characteristics were extracted using a standard template for intervention details. Quality appraisal was conducted using the Critical Appraisal Skills Program tool. Data synthesis was conducted across 19 criteria of the Meta-Ethnography Reporting Guide (eMERGe).

Findings: Fifteen qualitative studies were included. Analysis revealed three meta-themes that are central to successful implementation of organisational interventions that advance women in healthcare leadership: (1) leadership commitment and accountability, influenced by internal and external organisational settings, salient for long term outcomes and for developing an inclusive leadership culture; (2) intervention fit with individuals with consideration given to personal beliefs, preferences, experiences, capabilities or life circumstances, including capacity for leadership roles in their broader life context; balanced against maintaining interventional fidelity, and (3) cultural climate and organisational readiness for change, addressing traditional, conservative and constrictive perspectives on gender and leadership in health, highlighting the facilitating role of male colleagues.

Interpretation: This meta-ethnographic research extends past work by integrating empirical evidence from a systematic literature review of effective organisational level interventions, with the identification of pragmatic themes to generate, implement, evaluate and embed evidence-based organisational interventions to advance women in healthcare leadership. This work can inform initiatives and policymakers to generate and implement new knowledge to advance women in healthcare leadership.

Funding: Epworth Health and Monash University provided scholarships for MM. HT is funded by an NHMRC / MRFF Practitioner Fellowship, JB by an NHMRC fellowship and HS by a Monash Warwick University Professorship.