Pay it forward: lessons from a CEO

By Dr Robyn Littlewood, Chief Executive Officer, Health and Wellbeing Queensland

As a female, non-medical, obesity-focused health practitioner, my CEO journey has been a process and not always an easy or clear one. I would describe it as a long, complicated, layered, strategic, phased adventure that I am not even sure I was an active participant in. In fact, I was certainly not following a planned pathway or actively seeking out opportunities. Lucky for me, my friends were all over it for me. These are the type of friends you need to surround yourself with.

They are the male and female colleagues, peers, leaders, mentors and trusted souls who are supporting you in ways you didn’t even realise at the time. For me, this was a small group of leaders from different sectors who stood out to me because of their unwavering ethics and values based on doing ‘better’ for people. I knew they were amazing, but I didn’t realise what they were doing for me (often, behind the scenes). They seemed to have a different agenda for me. They just didn’t tell me. It’s all so clear to me now.

When I look back, they are the reason why I found the right CEO role (whilst not looking), applied for the role (whilst deciding not to from the start) and securing the role (which I felt terrified about but ready to take on). Finally, 6 years on, they are the reason why I am still in the role, loving it and able to drive real change for people who need it the most.

What if they hadn’t supported me? What if I wasn’t surrounded by these smart, wonderful people who took pride in empowering others around them, and were so generous with their own time and effort, simply focussed to see others, like me, succeed?

Without them, there would be one less female CEO in Queensland and that worries me.

I have always been clear on why I became a CEO. That was easy. It was to make a difference. It’s cliché but completely true. I remember a good friend saying to me ‘you can actually change the health of people’ and I knew that was exactly why I wanted to be there.

However, I have never really explained how I became a CEO as I probably never really understood it until now. I want to share with you the biggest advantage that I had. The secret weapon that helped me understand where I was going and why, at the right time, and also what got me ready for it, albeit by stealth. It is also the single influencing factor that forced me to start thinking differently, using different words, strategies and narratives. To consider the politics, the stakeholders, the risk, whilst never losing sight of what’s important. It made me think twice about what to say, how to act and how to actually make a difference, sometimes by letting the little things go.

I’m writing this in the hope that I can pay it forward to others, especially women. There is an evidence-based reason for this.

From the start, I was a clinician and proud of it. I loved every single part of my role, especially talking and listening to children and families, both in their time of need and as they recovered and improved. I was busy and a CEO role was as relevant to me as using a fax machine and dial-up (which both coincidentally, we still used in the wards for a very long time…).

In health, we have several major challenges (which I am sure are mirrored in other sectors).

Executive or Chief Executive positions in public health are scarce in any state in Australia as well as at the National level. From memory, public health leadership roles were more a fractional component of a broader health leadership position. Stand-alone positions for preventative health and health promotion were seemingly non-existent.

Women are significantly underrepresented in C-suite roles.

Women also appear to be disadvantaged at the start of the pipeline of their career (something I didn’t know) and less likely to be called back post interview.

Women are less likely to even apply for C-suite roles.

The health and wellbeing of women in the workplace is more fragile than men.

Women are paid less.

The evidence

Healthcare is known to be the sector where higher rates of women are appointed to senior leadership roles. However, challenges in Australia still remain: ‘Despite making up 75% of the workforce, (1) women make up 45% of public hospital board chairs (2), 39% of private hospital CEOs (3) and 38% of chief medical or health officers. Women are the majority of the workforce but do not hold an equitable share of healthcare leadership positions’¹.  I was not aware these numbers were still so inequitable.

Chief Executive Women (CEW) has released its annual tracker of women in leadership positions at ASX300 companies – the 300 largest companies listed on the Australian Securities Exchange. Only 25 of those ASX300 bosses were women CEOs in 2023/24 FY, down from 26 in 2022/23 FY. Women hold 3 in 10 executive leadership positions in ASX300 companies². Women make up just 22% of CEOs, 37% of key management personnel and 42% of managers in Australia, according to November 2023 figures from the Australian Government’s Workplace Gender Equality Agency.³ This is mirrored globally: ‘Only eight percent of CEO positions in the S&P 500 are held by women, and yet they represent more than 50 percent of the United States’ population’⁴.

Sadly, these discrepancies and systematic biases are not only common for women in senior leadership roles. The research is also telling us that ‘[W]omen continue to face barriers at the beginning of the pipeline as they are less likely than men to be hired into entry-level roles, which leaves them underrepresented from the start’⁵. A study published in the American Sociological Review revealed that men were called back for 14.0% of job openings, while women received callbacks for 11.9% of openings, though this difference was not statistically significant⁶. There is a clear trend, in every single part of the process.

I look back and see similar challenges and trends throughout my experiences; I just didn’t understand it or know how to navigate it at the time.

One thing that keeps me up at night is the health and wellbeing of women in the workplace, especially those who are in senior and C-suite roles. I see what they do, what they don’t prioritise (their own wellbeing) and often how they fracture and break during the year. The research tells us that symptoms reported more often among women include headaches and poorer overall physical health⁷. Anxiety, depression, and sleep disturbances are the psychological symptoms most often reported by women, and work stress has been implicated as a culprit in these distress symptoms⁷.

Women’s rate of depression is twice that found in men⁸. One in 4 postpone having children⁹ which culminates its own pressures and stress. ‘Considerable evidence indicates that men and women experience executive leadership differently such that men’s careers tend to be linear while women’s are characterized by interruptions and exits^’10. ‘The health benefits of careers can be compromised by the health risks associated with stressors at work^’11. In my opinion, this is why women often don’t apply for higher level positions; they feel they may not have the confidence or resilience to manage them, based on the anxiety they are already feeling.

Women apply for positions less. This is well documented and well known. A study in the United Kingdom by the Behavioural Insights Team found that men apply when they meet approximately 52.1% of the qualifications, while women apply at about 55.7%¹².

Other evidence provides real insights into gender bias (for both men and women). Gender-bias hiring preferences where men are favoured over women still exist. Interestingly, this bias exists regardless of the recruiter’s gender: women exhibited the same biases (even when qualifications and experience are identical)¹³. Men are chosen first.

Women executives still often face pay inequity. The 2022 Gender Equity Insights series indicates that Queensland’s gender pay gap in total remuneration is estimated at 22.5% or $24,100 of which the professional, scientific and technical services sector and the health care and social assistance sector together account for $7,500 (31%) of Queensland’s gender pay gap¹⁴.  Further, median superannuation balances of men remain higher, for example ABS 2019-2020, men 65+ $208,200 vs women 65+ $168,000¹⁵. 

Each of these 6 issues are hard and require considered response and remedy. However, it’s when you combine all 6 factors, that the cumulative effect impacts the environment. Today, I see these scenarios play out in many different sectors, often leading to incredible women feeling disappointed as their interest and excitement dissipates whilst they crave to feel inspired and supported, often left lonely or let down.

Personally, I never felt this sense of loss or disillusionment. I continue to be curious, inspired, empowered and energised. I could navigate the environment; I understood many of the risks and I could recognise the key actors in different scenarios. I knew so much more than I thought; much of it by stealth and this is how – through osmosis.

A result of (what I now know), a deliberate, shameless, generous outpouring of time and trust by my ‘friends’ who continued to share opportunities with me. What it looked like to me was spending time with people whose values aligned with mine, who wanted to make a difference, who I wanted to be like and inspired me every day. They were incredible people who I worked closely with and were very senior to me. For some reason, they started to give me full access to their world, which was so different from mine. I spent so much time being immersed with them, listening to their experiences, their stories, knowledge and just general conversation between great leaders, without the expectation of anything in return. They trusted me. They invited me to their meetings, sometimes inside their social circles, their email discussions, events and even group coffee catch ups. It’s so much more than mentoring and it’s very hard to describe. Over the process of weeks, months and even years, I learned so much more than I had ever understood from books or courses. It was simply time, trust and respect afforded to me by the people that I most admired. I learned so much through osmosis.

Sadly, the reality is that the current trend in recruiting strong, ambitious, and capable women for executive roles in health remains limited. From personal experience, being one of few female CEOs driving a bold public health agenda in Queensland can often feel isolating, highlighting the challenges women face in reaching and thriving in these roles. I know, I must give back. Spending my time with upcoming superstars, women who value the work and the legacy they lead, women who have struggled navigating a career, women who have low self-esteem or just women….is so valuable. The return on investment is priceless.

For people who know me, one of my strongest professional and personal priorities is to support other women as they have supported me. Not through formal mentoring or meeting times (although that can be a part of it) but also through time, listening, coffee chats and sometimes even a ‘walk and talk’. Inviting people to be around each other, connecting the new and the more experienced works. For me, just being around wonderful, smart, intelligent and kind women allowed me to soak up all that was unique to being a woman in such high-level positions. The language they use, the strategies they engaged, the people they meet and the political astuteness they have acquired because of their unique perspective, both in executive roles and being female, are real achievements and something that hit me hard when I was first invited into these situations.

I had no idea the efforts some of these amazing women had to go to and through, both to ensure they were able to apply for an executive position and also, to win it. They have done the hard yards and they were giving me the answers so I didn’t have to find them.

As leaders who have had such friends and support afforded to them, I say, pay it forward for other women. Make it a bit easier for others, listen to them, support them and nurture them so they can learn by stealth, understand the new environments and how to navigate them in the best possible way. Invite them to events, to hear the narrative, the understand the politics, take a plus one (and make it a junior upcoming leader in your organisation) so they can also know how and when to progress an idea or even start with a conversation or get them known across the industry.

This is what my friends were doing for me. Without that unique opportunity of being around people like these, who, today, I call my friends, I am not sure I would have been successful in being appointed to and performing within the most senior positions throughout my career.

I will also pay the generous nature of my predecessors forward.

Sources

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