March 2018  
International Women’s Day
Gender equity in healthcare management
Once again, and all the more relevant this year considering worldwide recent revelations, Women take the lead. For this important day, International Women's Day, we give priority to female experience in European Private Hospitals. Our goal is equality and the full involvement of all our colleagues in the private health sector. Gender equality is a founding value of the EU and the UEHP is committed to support and promote the removal of gender barriers in the workplace. Please read all the personal experiences we have listed in this issue, to express our full support for this common engagement.
Dr Paul Garassus
President of UEHP
Ilaria Giannico,
Secretary General, UEHP

Gender equality is a fundamental value of the European Union (it is enshrined in the Lisbon Treaty). Promoting equality between men and women is one of the EU’s main tasks, with a focus on enhancing women’s labour market participation in highly qualified jobs, equal economic independence of women and men and tackling women’s exposure to poverty at all ages. In this field, the European Union adopted significant legislation over the decades: in addition to the legally binding directives, the European Pact for Gender Equality (2011-2020) and the Strategic Engagement for Gender Equality (2016-2019) represent a clear commitment to promote gender equality within the EU; the progresses are reported every year and presented in the publication “European Commission’s Report on Equality between women and men”.
But what is the real “state of the art” of gender equality Europe?
Sadly, we see that gender-based differences in life expectancy, life years spent in health, healthy life styles, mortality, and morbidity risks still persist in the EU. This is partly due to the socially constructed roles of men and women and the relationships between them. Gender inequalities such as unequal opportunities in education, recruitment and career advancement held responsible for such leadership deficit.

What about gender equality in the healthcare sector ?
Although the healthcare sector is one of the areas where the majority of employees are, in fact, women, NHS heavily rely on the work of women in roles ranging from physicians to nurses to midwives and allied health professions.
Current vulnerable health systems, the non-efficient human resources model in health and the mistrust amongst health stakeholders show the need for inclusive and sustainable healthcare leadership. Women leaders in healthcare remain significantly underrepresented in top leadership positions, even though they represent the vast majority of the specialized healthcare workforce*.
Despite all efforts made so far at all levels, we notice a very little improvement in gender equality in healthcare since the 17th century.
Female doctors and nurses are STILL paid less, patients STILL treat doctors and nurses differently depending on their gender, female patients STILL receive less and worse medical assistance than male ones.
*(Barriers Thematic Map (BTM) to Gender Equality in Healthcare: Valia Kalaitzi. European Journal of Public Health, Volume 27, Issue suppl_3, 1 November 2017)
At hospitals
Nurse and doctor graduated students start working at hospitals and other healthcare institutions. Nearly half of doctors are men, but nurses are predominantly women.
Some say that male medicine students are more ambitious and career-oriented. Male nurse students often decide very early in their education which unit they will join (mostly intense units and units with lots of technical instruments – ER, radiology and other). Male doctors often have steeper careers; there are more male chief doctors than female. Meanwhile, women are more flexible and tend to keep their options open, which often means going with the flow. Furthermore, the inequality in healthcare includes patients’ attitude and expectations: it is generally assumed that women are better at taking care of others, which is why nearly half of patients feel more comfortable when a female nurse tends to them. At the same time, male nurses are often mistaken for doctors (read more...).

Although the EU has been a positive force for gender balance, we must recognise that gender equality remains a work in progress. Over the last years, the gaps in pay, employment and working hours have been plateauing. At this rate of change, it will take more than a century to close the overall gender gap in earnings. A strong political will and commitment, as well as targeted measures are needed if we really want to tackle gender inequalities from the core and reach a full deployement of women’s talents within the EU.
Happy International Women’s Day to all my (female) colleagues!
There is still a long way to go
Cristina Contel,
President of the Spanish Alliance of Private Health (ASPE)

What is the proportion of women elected in your Federation's board ? What could be done if you judge the female representation inadequate?
Currently the Board of Directors of ASPE is composed of 25 members representing Territorial Health Associations, Hospital Groups, Independent Hospitals, Clinics and Outpatient Centers, of which only 2 are women and 25 men. Women are the President of ASPE, Ms. Cristina Contel, and the President of the Balearic Association (UBES), Mrs. Carmen Planas. Although the maximum representation of our institution falls on a woman, unfortunately the percentage, as can be seen, is very low.
From ASPE we can’t do much, since its members are chosen by the entities associated with our institution, who are the ones who appoint their representatives.
However, I must point out that the team of professionals working directly with ASPE is made up of 4 women and 2 men, all of them chosen for their knowledge and skills.
In the health sector most of nursing professionals are female, in contrast most of medical doctors working in operating rooms are male (less than 10 % of women in France) and the majority of health care institutions are directed by men. What do those statements inspire to you?
In accordance with the latest study of national data that we have, from the Medical Union of Granada, 66.3% of the 6.333 MIR doctors who finished their training in 2017, obtaining the title of specialist, are women, but there are differences between specialties:
  • Obstetrics and Gynecology - 87.4%
  • Pediatrics - 85.9%
  • Neurosurgery - 35%
  • Orthopedic Surgery and Traumatology - 35.9%.
In surgical specialities the percentage of women and men who have finished their training is practically the same, but in medical specialties the average of women is 67%, a figure that has grown in recent years. Forecasts say that it will continue to increase, as the percentage of women who completed the last MIR exam exceeded 75%.
However, although it seems that the future of medicine goes through an important female presence, it is not seen in the organizations that represent doctors themselves. The great majority of Medical Societies have a male president, as in the General Council of Official Medical Associations, where in addition men are also the majority of their national representatives.
Even the president of the Collegiate Nursing Organization is a man when most of nursing professionals are women. Also, if we take a look at the number academics of the Royal National Academy of Medicine, of the 50 names only 3 correspond to women. 
And we have the same situation in health management in public and private companies. One might think that women can be doctors, scientists, pharmaceutics, but only at low levels of the profession. Actually, this problem affects more or less to all sectors and professions.
Is the increase of the number of female medical doctors in hospitals and the number of women studying medicine, a discussion matter in your country ? If yes, what is the matter of discussion?
Despite being a proven reality, this issue is not discussed openly and is not seen as a problem, but in the culture of our country, a doctor is still a middle-aged man in a white coat.
The problem is not only with companies and professionals, but also with patients. Many female medical doctors often recognize that in many cases it is difficult for them to earn the patient's respect, especially if they are young.
It is also important to highlight an issue that is increasingly latent, such as the fact that there is an important part of female medical doctors who adjust or are forced to adjust their professional dedication to make their personal life compatible, so they have availability problems. Especially in a sector like ours that demands so much dedication.
In your country, does a woman always have to work harder than a man to access a position of responsibility or is this debate over?
Without a doubt, I believe that, in equal conditions, there is a clear preference for men at the time of being elected for important positions. Except for some honorable but insignificant exceptions or in the case of positions of political or public visibility where you want to maintain a parity between men and women that does not really exist.
I think that more than working harder to obtain an important position, what happens is that women who hold relevant positions must constantly demonstrate that they deserve it and that they are up to the needs of the company.
Perhaps the demand of this "constant demonstration" still comes from the underlying vision of women in their role as caretakers of the family and not from their capacity in the professional world.
Could you indicate the name of a great and inspiring women in your country (or elsewhere) ?
I would like to highlight the Spanish woman who has been named executive president of a Spanish bank, Ms. Ana Patricia Botín.
She is a Spanish banker, president of Banco Santander, CEO of the British subsidiary of the Santander Group and a member of the Coca-Cola board of directors.
Despite coming from a family of bankers, Ana Patricia Botín has managed to gain a position of great relevance in the banking sector, a mainly male sector, with their contributions and the generation of new financial services and products.
Focus on women’s health
Alberta Sciachi,
International affairs office AIOP,
President of UEHP General Assembly

Last year, in the framework of the International Women’s Day, AIOP stressed the importance of the role of female healthcare providers in the Italian NHS. This year AIOP concentrates on women as both patients and caregivers within their families.
Every year on 22nd Avril, Italy celebrates the National Day for women’s health, in memory of the Nobel prize Rita Levi Montalcini. This celebration was created on the initiative of the Italian Minister of Health, Beatrice Lorenzin, to raise awareness on the wellbeing and health of women. The Ministry, together with other relevant organizations, made targeted communication campaigns to tackle the main issues and challenges related to female health in Italy.
Protecting women’s health means protecting families’ health as well as the health of the entire population.
In fact, women play key roles within their families in the adoption of healthy lifestyles, consumption of healthy food, prevention and regular checkups. Also, 70% of women in Italy provide care at home for the elderly or disabled people in their families.
Women are seen as a resource and a added value for the NHS, in their role of health drivers and caregivers.
Despite all these positive consideration, the access to healthcare is still unequal among men and women because of economic, social, geographical reasons.
For example, as for long-term care, women are the most concerned because of their dual role of caregivers and patients, because they live longer than men.
Concerning specific health services, women “over 50” have to wait 122 days on average for a mammography (60 days more than in 2014, according to a study made by Censis).
On the financial side, things are more complicated for women as well, because private insurances penalize women because of their generally lower earnings compared to men in the labour market.
With the National Day for women’s health, the Italian government aimes at, on one side, overcoming all differences between men and women at all levels, and, on the other side, encouraging scientific research to examine and elaborate on the specific needs of women. According to the Italian Ministry of Health, gender equality should be developed in all areas of the healthcare sector in order to guarantee equality, equity and appropriateness of health services for women.
It is necessary to promote policies and actions to involve women at all stages and insure their rights to access high quality and safety in healthcare, with a special focus on ten main goals identified by the Italian Ministry of Health: fighting against chronic disease in women; improving communication to raise women awareness on health issues and women participation to their health; promoting and protecting sexual health; healthy lifestyle and healthy food; prevention of breast cancer and other type of cancer typically affecting women; protecting women’s mental health; fighting violence against women (medical and psychological assistance); protecting women’s health in the work environment; safety and quality of esthetic surgery; promoting active and healthy ageing in women.
The Ministry of Health, as well as other public and private institutions and organizations in Italy, recognizes the need to adopt a “gender perspective” in scientific research and in health policies, in order to deeply understand the biological, cultural, social and economic factors having an impact on women’s health.
A modern and responsible society is the one fully recognizing the role of women and the need to guarantee equal rights and opportunities to all women.
A persistent glass ceiling
Jadranka Primorac,
President of the Croatian Association of
the Private Healthcare Providers

What is the proportion of women elected in your Federation's board ? What could be done if you judge the female representation inadequate?
There’s about 40% of women in our board under my chairmanship. I certainly make sure that women are fully represented, however, unfortunately there are not as many of them in the leading positions in the healthcare sector, so it is impossible to include them in much bigger percentage.
In the health sector most of nursing professionals are female, in contrast most of medical doctors working in operating rooms are male (less than 10 % of women in France) and the majority of health care institutions are directed by men. What do those statements inspire to you ?
Despite the fact that, according to the law the position of men and women supposed to be equal in Croatia, women still face some forms of discrimination, even among doctors. There is definitely a large number of female doctors who have made successful careers and have become leading experts in their fields, university faculty heads, as well as heads of the departments, but then again, there are less women that are heads of clinics.
I wouldn’t say that women do not want to strongly engage in their careers and professional progress, but it is still more common that men are pushing stronger to get to higher positions, while more routine, everyday type of work is largely entrusted to women. Such mindset is of course wrong and is also present in other professions in our society. However, I’ve noticed tiny steps of progress have been made since the emancipation of women over the last few decades.
Is the increase in the number of female medical doctors in hospitals and the number of women studying medicine a discussion matter in your country? If yes, what is the matter of discussion?
The ratio of women to men enrolling in medical studies in Croatia is such that there are about 2/3 are female students and about 1/3 male students. However, if you were to count how many doctors are the heads of clinics or presidents of professional associations, you would find a ratio of about 80% versus 20% in favor of men. I'm certain that there is a myriad of good and smart female doctors who would be successful heads of services, and heads of department or clinic. Despite your industriousness, perseverance and all the effort you put into your work, having luck plays an important part; that is to say, you need to find yourself in the right place, at the right time. Women doctors often need to be dedicated to both their work and their family equally and it is sometimes difficult to establish a good balance between how much time you dedicate to your family and to your career. I think men still have it easier when it comes to this. Besides that, having children and looking after them, going on a maternity leave, etc., pulls women away from their careers, allowing men to place themselves in the foreground.
In your country, does a woman always have to work harder than a man to access a position of responsibility or is this debate over?
Eurostat notes that the difference in salaries between women and men is associated with many legal, social and economic factors that go deeper than the issue of equal pay for equal work. However, as it is apparent from the survey, it is difficult to find just one cause of this, since the countries with the greatest pay inequality between men and women are both those that are more developed as well as those that are less developed. Equally discriminating are those from the east and from the west, no matter if those countries are predominately Catholic or Protestant, whether they’re in the Mediterranean or in one of the Scandinavian countries. But even though reasons for pay inequality are diverse, the results are always the same and always come to the fact that women are not equally paid for their work as men are. Moreover, UN described global disparity in women and men's salaries, which is 24 percent, as the "biggest heist". The World Economic Forum has reported that women and men will not achieve economic equality for another 170 years. This is reality….
Could you indicate the name of a great and inspiring woman in your country (or elsewhere)?
I’m inspired by each and every woman with a personal initiative and the ability to change things and the world around her. Also, when it comes to the quality of management, I feel that we, as women, are certainly more thorough and orderly than men, we don’t take as many risks without doing the “due diligence” first, and we often use our intuition to make decisions. Women definitely need to be positively affirmed in our society and we can do that by validating those women who are giving their best in their careers and are very successful in doing so.
Women still underrepresented in the highest levels of leadership
Dejana Rankovic,
Serbian Association of
Private Healthcare Providers

What is the proportion of women elected in your Federation's board? What could be done if you judge the female representation inadequate?
Serbian Association of Private Healthcare Providers is, from its foundation in 2013, devoted to equal opportunities and gender balanced approach. Its Executive Board at this moment has 12 members, out of which 5 are women. A woman is a President of the Assembly, while a man is President of the Executive Board. All bodies and committees are taking into account gender component as well (in addition to other criteria, such as geographical representation and/or the size of the healthcare institution)
In the health sector most of nursing professionals are female, in contrast most of medical doctors working in operating rooms are male (less than 10 % of women in France) and the majority of health care institutions are directed by men. What do those statements inspire to you?
At this moment I do not have Serbian data, but you surely inspired me to look into this in details, as soon as possible! :) I think that healthcare profession(s) do not differ from other industries in that respect, namely that while the participation of women in the labor force continues to grow, women are still underrepresented in the highest levels of leadership. So, as for managerial positions, the "leadership gap" is immanent to all industries, and speaks more about the society at large than healthcare in particular. As it is no news to anyone that men are thought to be rational and assertive, while women are thought to be passive, emotional, and accommodating of other’s needs - the division is even more salient in healthcare professions, surgeons in particular. But there is now an increasing evidence (for example http://www.bmj.com/content/359/bmj.j4366 ) that the paradigms need to be shifted.
In your country, does a woman always have to work harder than a man to access a position of responsibility or is this debate over?
Absolutely. In Serbia, the debate has not even started yet.
Could you indicate the name of a great and inspiring women in your country (or elsewhere) ?
That would be five amazing women from the Association's Board: Jasmina, Violeta, Marija, Mira and Dragana (Dr Jasmina Knezevic, Dr Violeta Skorobac Asanin, Dr Dragana Milutinovic, Mr Ph Mirjana Sarkic and Marija Rabrenovic). They are highly accomplished in their professions, but still took the courage and engaged as owners and managers of private hospitals, in the country where all businesses are largely male dominated, and private healthcare was yet to be developed. In doing so, they immediately recognized the importance of gathering in the Association, as a tool for engagement in policy dialogue, and remain devoted to value-added solutions, that systematically address not only healthcare, but the complete public policy framework.
The Simone Circle
The Simone Circle (Le Cercle Simone) is a French association which brings together women managers of private health establishments. Eight members bear witness:
According to your experience, is it always necessary as a woman to be doubly qualified to attain positions of power? Or is it an outdated debate?
With the exception of one, they all find it necessary as women to be doubly qualified, "triply" even insists one of them, to attain positions of power. The debate is not outdated but "current" and even "hot". "I do not know if we must always be doubly qualified, but I believe we must always prove ourselves doubly!"
In general, they describe a particularly retrograde sector concerning gender issues. Peers, colleagues but also patients are targeted. "The medical community may be extremely macho but the patients are even more so. Women Surgeons of equal value find it harder to develop a clientele. It is difficult to establish oneself at work ".
What is the most inspiring female figure for you?
The Minister of Health, Agnès Buzyn is named twice and is described as "rather inspiring", even "remarkable on several levels". Brigitte Macron, First Lady, wife of Emmanuel Macron, enjoys the same notoriety, as Marie Curie whose "difficulty in gaining recognition" is emphasised Other historical figures are mentioned. "For me," one concludes, "it is all women who carry initiatives, succeed without losing their soul and especially assume their femininity who are inspiring. Too many female leaders are masculinized."
What would be the main action to take in order to increase the number of female hospital managers?
The arrival of large private health groups is considered by all of them as an obstacle to gender parity. "Parity within groups is fundamental". But for which position? the top! "Big groups put at the head of their establishments managers without decision-making power, women will therefore find positions! I would rather ask when will shareholders trust women to manage their group financially and politically!". Lucid, they say: "Money is power." How to get there? "Suggesting or imposing, but how?" Some believe in "the law of numbers". "Given the feminisation of studies reserved for men until recently (medicine, engineering, economics, etc.) women will gain ground and take power."
The very subject of gender parity is debated: "humiliating" or on the contrary "to be imposed". Nevertheless, the constraints are there for everyone. "Running a clinic is an important mental task, being a mother (or father) of a family also. The two are sometimes complicated to bear. Should we just simply "value all these initiatives, especially when it is beneficial to all"?
STER European Rehabilitation Centre for Burns, Wounds and Scars, Lamalou-les-Bains
Clinique STER - Centre européen de rééducation des grands brûlés, Lamalou-les-Bains
Mrs. Gwenola Ster-Mora, Executive Director
Dr Nicolas Frasson, Coordinating physician
Mr. Marc Krugler, Deputy Director

Opened in June 2017, the European Rehabilitation Centre for Burns, Wounds and Scars, located in Lamalou-les-Bains (80 km from Montpellier) will soon be inaugurated.
This new tool dedicated to the rehabilitation of burn victims is the culmination of a very important investment program and of 4 years of work.
This centre, unique in Europe, welcomes in 9000 m2 over 300 patients per year, adults and children, some of whom come from all over the world.
Mrs. Ster, Executive Director, recalls the history of the institution. "The Clinic for Rehabilitation and Functional Rehabilitation of Dr. Jean Ster was created in 1954 by my grandfather. It is still at present an independently operated and family run business. Until then, it provided, in its two distinct establishments, treatment, especially for severe multiple injury patients and amputees, as well as for the rehabilitation of top athletes. One of our specificities is our hyper specialization in the rehabilitation of burn victims. We are identified by health authorities as the inter-regional reference centre in the south of France. "
It was in the 1980s that this area of activity grew, in connection with the Montpellier and Toulouse UHCs. In 2011, more than 50 patients per day benefited from the expertise of the care teams and specific infrastructures (technical plateau for rehabilitation, filiform shower, complex dressing room, etc.). It was that year that the clinic took on a new international dimension.
The first foreign patient treated was a young woman, an English TV presenter attacked by a projection of acid on her face. She received surgical treatment in London but did not find a health care facility similar to ours in the UK. She did all of her rehabilitation in the Dr Ster Clinic.
At the end of her care, she wrote several books and created a foundation dedicated to burn victims. These books have made the clinic known in the English-speaking world.
A few months later, an Australian model - trapped in a bushfire during an ultra-trail in north-western Australia – suffered burns on 64% of her body. It was after reading the English presenter's book that she too decided to come to France for her rehabilitation. During her stay in 2013, a team from Chanel 4, an Australian television channel, made a special report onsite.
Another British national, who sustained burns to 97% of her body in a bus accident, also received rehabilitation treatment at our institution, supported by a foundation.
Other foreign patients were admitted for rehabilitation, from different origins (Singapore, Ireland, Germany, Spain, North Africa, etc.).
Although severe burn patients are now a moderate active line, the clinic currently receives around 10 foreign patients a year.
The newly opened European Centre has given itself the means to accommodate these patients in the best possible conditions.
There is no equivalent centre in Europe, fitted with a paediatric area, expert care teams, a dedicated technical centre of more than 500m2 for rehabilitation and 200m2 for nursing care. The dressing rooms, equipped with controlled air, make it possible to apply dressings in aseptic conditions close to those of an operating theatre as well as perform minor surgery.
For the patients and their companions, "great comfort" rooms are modular: it is possible to arrange a small lounge, or to adapt them to the particular requests of the patients.
Mrs Ster details the specificities of the services provided for these patients: "Some patients contact us directly, others are referred to us by their medical teams or by their insurance. Everything is arranged in advance: reinforced rehabilitation programs, orthoses, duration, tariffs. The length of stay is adapted to the needs of each patient, the average being 43 days.
For this purpose, human and material resources are multiplied, and the time for orthoses fitting is optimized. Each week the coordinating physician takes stock of progress with the team following the patient in his own country. In the Burns Unit, our medical and paramedical staff is almost entirely English-speaking, and some also speak German or Spanish. In addition, our 'operational hygiene' team is very efficient for issues related to isolation. It is fundamental to respect the regulations related to the reception of patients coming from abroad. Finally, our HAS Level A Certification is a quality criteria recognized by foreign patients. "
As evidenced by the numerous participations of the centre medical teams in European and international conferences on Burns (Miami, Hanover, Sydney, Dubai, Brussels, etc.), the reputation of the European Burns Rehabilitation Centre works in its favour and is already well known among health professionals. There is no doubt that patients will find, in the heart of Occitania, quality and highly specialized care provided by a facility rich in history and entering a new era.
10 - 11 April
Healthcare Business International 2018
27 - 29 May
Sitges, Spain
HIMSS Europe 2018 & Health 2.0 Conference
8 June
UEHP Council meeting
14-15 June
European Hospital Efficiency Forum