Academic Women in the University Medical Centres

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1 Academic Women in the University Medical Centres Inventory qualitative & quantitative research 16 th of July 2010

2 Academic Women in the University Medical Centres Inventory qualitative & quantitative research Name of student: Deanie Avalon Maria Verbeek student number: telephone number: (+) address: Maredijk 89a, 2316 VV Leiden Masters program: Started in September 2008 Management, policy-analysis, and entrepreneurship in health and life sciences. Supervisor VU: Department: Position at the department: Mr. dr. M.H.J.W van Amstel Athena Institute Assistant professor Supervisor: Prof. dr. E.A.J.M. Goulmy Supervisor institute: Chair Dutch Network of Women Professors (LNVH) and board member of the network Vitaal of the Leiden Universitary Medical Centre (LUMC). Academic background: Medical biology and immunology. Specific expertise: Transplantation biology, especially regarding minor histocompatibility antigen Position at the institution: Professor transplantation biology at the medicine faculty of the University of Leiden and co-founder and chairwoman of the LNVH. Daily supervisor: Daily institute: Position at the institution: H. Drop, MA Dutch Network of Women Professors (LNVH). Director LNVH 2

3 Content Abbreviation list page 5 Summary page 6 Introduction page 8 Part 1: Conceptual design page 9 1. Research Background; page Problem field 1.2 Urgency of change 1.3 Research contribution to LNVH 1.4 Problem definition 1.5 Defining the ladder of actors in the UMC s 2. Research objectives page Research objectives 3. Research framework page Supporting theories 3.2 Theory vandoornehuiskes 3.3 Theory VOC 4. Methodology page Five action plan 5. Research issues page Formulating the main research question 5.2 Formulation the sub research questions Part 2: Technical research design page Research design page Desk study 6.2 Scope of research project 6.3 Requested product 7. Selection procedure UMCs page Inclusion-exclusion criteria questionnaire 7.2 Inclusion-exclusion criteria interview 8. Contact participants page Inviting the participants by for the questionnaire 8.2 Inviting the participants by phone/ for the interview 8.3 Response rate 9. Analyzing the interviews page Structural analysis 9.2 Validity & Reliability of interview data Part 3: Results page Quantitative results; Profile of the academic women in the UMCs page Demographic characteristics 10.2 Working environment 10.3 Individual characteristics 10.4 Private environment 11. Literature results: Initiatives for supporting academic women page Overall initiatives for women 3

4 11. 2 Initiatives provided by the UMCs 12. Qualitative sub-results: Working environment page Experiences 12.2 Translation into CTQs 12.3 Visual summary; the working environment. 13. Qualitative sub-results: Individual characteristics page Experiences 13.2 Translation into CTQs 13.3 Visual summary; the individual characteristics 14. Qualitative sub-results: Private environment page Experiences 14.2 Translation into CTQs 14.4 Visual summary; the private environment Part 4: Conclusions page Main conclusion I Main obstacles, needs & wishes page Identified obstacles/needs/wishes of the academic women in the UMCs 15.2 Women friendly and supporting UMCs working environment 15.3 Main conclusion Obstacles, Needs and Wishes 16. Main conclusion II Recommendations & advice page Present female supporting activities in the UMCs 16.2 Diversity policy recommendations 16.3 Main conclusion: diversity policy advice Part 5: Discussion page Methodological discussion page Development of the questionnaire and interview guide 17.2 Collecting data by the questionnaire and interview 17.3 Analysis process 18. Discussion of the results page Experiences, needs and wishes into actions 18.2 Additional discussion points Acknowledgments page 90 References page 91 Appendix page 94 I List of defined UMC s page 94 II List of the women supporting activities per UMC page 95 III Questionnaire design English page 97 IV Description of final interview design page 99 V Final interview guide in English page 102 VI Manual analysis of interviews page 113 VII Final policy advice UMCs page 115 VIII Organizational structure LNVH page 134 VIIII Fulfilled learning goals during the internship & research planning page 136 4

5 Abbreviation list Assist. Prof Assistant professor (In Dutch: Universitair docent ) A. Prof Associate professor (In Dutch; Universitair hoofd docent ) CAO CTQ EU FNV KNAW LNVH MD MS NFU NWO OCW SCP SER SoFoKles UMC VSNU VOC Collective Employment Agreement Critical-to-Quality characteristics European Union Trade union confederation of the Netherlands Royal Netherlands Academy of Arts and Sciences Dutch Network of Women Professors (In Dutch: Landelijk Netwerk Vrouwelijke Hoogleraren ) Medical Doctor Medical Scientist Dutch Federation of University Medical Centres Netherlands organisation for Scientific Research The Ministry of Education, Culture and Science The Netherlands Institute of Social Research The Social and Economic Council of the Netherlands Social Fund for the Knowledge Sector University Medical Centre (In Dutch; Universitair Medisch Centrum ) Association of Universities in the Netherlands Voice of the Customer 5

6 Summary of this research project Support academic female talent at the University Medical Centres (UMCs) in the Netherlands Need to support academic female talent Women are extremely under-represented in top management and professional positions at the UMCs in the Netherlands. This research project is all about exploring women s first needs in respect to their career development and offering recommendations in order to support and sustain academic female talent in the UMCs, from a bottom-up approach. Why is it so important to support academic female talent in the UMCs? Almost 65% of the medical students are women in the UMCs. It is of great importance to sustain and support academic female talent to optimize the UMCs working processes, to gain professionalized status and ameliorate the cultural image, to stimulate the knowledge economy, to develop a more innovative, multitudinous performance as an UMC in the Netherlands. Finally, use of academic female talent as an added value for the top means an enrichment of the UMCs working environment and medical & scientific output. What is needed to investigate how to support academic female talent in the UMCs? The VOC process in combination with the benchmark career development model of vandoornehuiskes and partners, will model the methodology of this research project by a five action plan; to explore the experiences, needs & wishes of the academic women by conducted by inventory-qualitative and quantitative research existing of 62 questionnaires and 25 interviews with academic female talents (medical doctors, medical scientists, associate professors, assistant professors and professors) in the eight UMCs in the Netherlands. The model of VanDoorne&Huiskes, provides the qualitative indicators who define the underlying explanations for the phenomenon that women are underrepresented in top positions in the UMCs and offer indications for policy recommendations; divided into three segments working environment, individual characteristics and private environment. In order to support and practises this model the VOC-tool (Voice of the Customer) is added. The VOC-tool will help to identify and prioritize the needs and wishes of the female academic medical specialists and scientists put into specific diversity policy recommendations. What kind of obstacles, needs & wishes did the academic women experienced? There can be concluded that by very academic women participated in this research project different experiences, needs and wishes have been identified. Nevertheless, most of these experiences, needs and wishes can be categorized in the three segments: working environment, individual characteristics and private environment, provided by the VanDoorne&Huiskes career development model. The qualitative results show us that a lot of experiences, needs and wishes are common among academic women, and therefore are translated into the CTQs, which order to 6

7 prepare the development of the diversity policy advice. Especially the identified obstacles, needs & wishes in the segments working environment (organizational level) and individual characteristics (individual level), need to be translated into practical tools for the implementation of a successful diversity policy in the UMCs. The segment Private environment, is seen to be more or less in control by most women, when good planning and additional assistance is arranged at home. What can UMCs do to support their academic female talent? The UMCs need to re-elect their academic women into the working environment of the UMCs, by keeping in mind their individual needs and wishes, providing good internal communication and cooperation to spread the feeling of urgency, and offer a more listening and supporting role for female academic talent within all the phases of her career. Finally, this will lead to an increase of female academic talent at the top, a more women-friendly and supporting working environment, and will reinforce the open mind of the UMC Boards of Governors towards diversity policy development In order to support and sustain academic female talent in the UMCs, both on the individual level and organisational level diversity instruments can be implemented by the UMCs. Main instruments to be implemented: mentoring & coaching programs, career development programs, women networks and training to create a change of the mindset at all levels in the UMCs. How can aims be reached, also on a long term in the UMCs? In order to anchor the diversity objectives (targets), set by the signing of the Charter Talent naar de Top into actions the HRM framework needs to be adjusted. Pointing out a staff member under the Board of Governors, creating responsible lines throughout the UMC organization, exchange of successful diversity policy amongst UMCs, implementing gender training and set challenging, sustainable, daring and long term diversity goals, are just a start for the successful implementation of this diversity policy advice. 7

8 Introduction Women are extremely under-represented in top management and professional positions within the University Medical Centres (UMCs), despite the fact that the number of women in medical academic positions in the Netherlands is still increasing. Almost 65 percent of the medicine students is fulfilled by women (Eriksson-Zetterquist, 2007). This seems to imply the increasing possibility for women of achieving higher academic positions in the UMCs, as a medical specialist, medical scientist or in strategic functions within the UMCs. Nevertheless, scientific research determined that this trend is developing very slowly. Research performed by VanDoorne&Huiskes in 2008, confirmed that female medical specialists and scientists are the majority group (approx percent). Nevertheless, going up the academic career ladder shows that the participation of women decreases enormously. In the group of medical specialist and scientist only 37 percent is fulfilled by women, followed by 8 percent of the medical professors, is followed by 9 percent of the extraordinary professors and finally only 7 percent of the board is shared by women (Doorne, 2008). On average, the percentage of women professors has been increasing with the rate of 0.5 percent per year since At the end of 2008, this percentage grew to 12.9 percent in the UMCs. These figures show that the Netherlands legs far behind of most other European countries (Gerritsen et al, 2009). This means that female talents and knowledge are still being neglected. McKinsey & Co, has calculated that this will have a huge economic impact on Europe, with a shortfall of 24 million people in the active workforce by 2040 (Mckinsey, 2007). In order to support women in the academic world, numerous of equality programs and organizations have been launched with the aim to promote a more gender equal work life (Eriksson-Zetterquist, 2007). For example the Opportunity in Bedrijf organization, supported by Dutch ministry of Education, Culture and Science (OCW) (Opportunity in Bedrijf en SCP, 2009a), and the initiatives of the charter Talent naar de Top initiated in cooperation with VNO-NCW, FNV, SER and the Ministry of OCW and Ministry of Financial Affairs. These initiatives have been developed in order to strengthen the women s in-flow and flow-through towards an academic top level and to support women in maintaining their academic top positions in the UMCs (Lükerath-Rovers, ). In 2010, the majority of universities and all UMCs signed the charter Talent naar de Top. By signing this charter, the Boards of Governors of these institutions have agreed to formulate quantitative goals and policies in the following three to five years for the recruitment and promotion of women and to compile an annual report on the extent to which the formulated goals are achieved (Gerritsen et al, 2009). In order to support the UMCs in establishing their career development policy, qualitative research into work experiences of female medical specialists and scientists in the UMCs is of great importance. This in order to identify the position of academic women in the UMCs and to formulate recommendations for policymakers from an female academic employee s perspective. This research proposal is initiated by the Dutch Network of Women Professors (LNVH), in collaboration with the women network Vitaal of the Leiden UMC (LUMC). The final product will identify and clarify novel recommendations relevant for the women themselves and, of equal importance, relevant for the policymakers and boards of the UMCs in order to facilitate them to implement significant strategies which succeed in increasing the number of women at the top of their medical organization. This will be performed by combining the career development model of VanDoorne&Huiskes and the Voice of the Customer (VOC) tool. This research project is all about putting women s needs first, by (1) identifying their needs and wishes in respect of their career and (2) formulating diversity policy recommendations for policy makers, in order to support women to achieve and sustain their career goals within the environment of the UMCs in the Netherlands. 8

9 Part 1: Conceptual design The conceptual design of this research project describes the research background, the research objectives, the research framework & methodology used and finally the formulated main- and sub issues. 1. Research Background 1.1 Problem field The underrepresented women in academic positions in the Netherlands The underrepresentation of women in academic positions in the Netherlands is still enormous. In 2008 the number of men and women studying at a university was practically the same (see figure 2). The percentage of women graduates is even 6% higher than that of men who leave university with a degree. After this, the number of women decreases at every rung of the academic career ladder, from almost 42% of PhD students, down to 31% of assistant professors and 18% of associate professors, only 12% attain the position of professor. This under-representation of women in top academic positions is a continuing point of discussion (Gerritsen et al, 2009). Figure 2. Gender distribution of enrolled students, graduates, PhD students, assistant professors, associate professors and full professors at the end of Source: Gerritsen et al, This development applies to almost all universities and academic fields, regardless of their substantial differences. The bad news is that the annual increase in the percentage of women professors is very limited - only 0.5% per year on average. This will have great influence on the goals the government has set to support academic women. For instance, the European Union (EU) Lisbon Agreement states that 25% of all professors should be female by Currently, the European average stands at 19%. In the Netherlands, this percentage is even lower. If this percentage continues to rise at the current pace, the Netherlands will not be able to comply with the Lisbon standard until The Ministry of OCW adjusted its goal in 2005 to 15% women professors by If we wish to achieve this 2010 goal of 15%, 96 women professors will have to be appointed in the course of both 2009 and 2010, in addition to the number of women currently holding the title of professor. That is 66 more than the number appointed on average - taking the growth percentage into account - over the past few years (15 per year) (Gerritsen et al, 2009) 9

10 Calculating the percentage of women professors in all academic fields combined, with the exception of Medicine, 11.7 percent included women in If we take a look at the percentage of women professors at UMC, representing the majority of academics in the field of Medicine, this percentage not much higher: 12.9 percent. So, even if the percentage of women professors in the field of Medicine is included in these figures, it is clear that neither the Lisbon Goal, nor that of the OCW, will be achieved (Gerritsen et al, 2009). The underrepresentation of academic women in the UMCs When we focus at the position of academic women in the UMCs the following phenomenon can be described: in 2007 the Ministry of OCW introduced the Emancipation policy document for , in order to enhance the opportunities of women in the Dutch society within the fields of governance, education, business and the police organization (Emancipatienota, 2007). Unfortunately, the share of women within healthcare was not included, probably because the emancipation monitor 2008 (Merens, 2008) revealed that the share of women in top positions within healthcare (30 percent), is relatively high in comparison with other branches. Nevertheless, this percentage is misleading because the total share of women (in all positions) within health care is almost 80 percent. On the contrary the proportion of women at the top positions within healthcare is very low, only 6-14 percent is women. The boards of the UMCs include about 80 men and only 8 women (= 10%), only 11 percent of the women hold a professorial status and about 6 percent of the women are included in the boards of science (Merens, 2008; Berkel, 2009; Assmann, 2009). Also the number of women leaving the academic profession still constitutes an enormous neglecting of talent - talent that is a dire necessity for our knowledge economy (Fruijtier & Brok, 2007). Despite the fact that over 65 percent of the current medical students are women, they are still extremely under-represented in top management and professional positions within the UMCs. In order to give an overview of the represented women professors at the UMCs, table 1 shows the percentage of women professors at the various university medical centres. Table 1: Percentage of women professors at university medical centres. Benchmark dates: 31 December 2008 July Source: Gerritsen et al., 2009 It seems that the Groningen UMC (15.8 percent) and the Leiden UMC (15.4%) are achieving a relatively high score. Unfortunately, no data of the percentage of women professors at university medical centres and no data of the percentage of assistant/associate professors of previous years are available, which makes it impossible to see any positive development of this percentage over the past few years (Gerritsen et al., 2009) 10

11 Table 2, illustrates the gender distribution of members of the Board of Governors and Supervisory Boards of university medical centres. Table 2: Gender distribution in Boards of Governors and Supervisory Boards of university medical centres. July Source: Gerritsen et al., 2009 Only two out of thirty members of the Boards of Governors of UMCs are women. This percentage does not even represent 7 percent. This low percentage corresponds to the percentage of women on the Boards of Governors of universities. It can be ascertained from this table that women are better represented on the supervisory boards than in daily management of the UMCs. Of the 47 members of the supervisory boards of UMCs 14 are women, which are almost 30% - practically the same percentage as in the supervisory boards of universities (Gerritsen et al., 2009). Obstacles for women The explanations for the phenomenon; the underrepresentation of women in academic positions in the Netherlands, can be divided into three categories. Firstly, the notification of Differences between man and women should be considered as one of the underlying reasons why women do not achieve a higher position. Scientific articles, reviewing the differences between man and women, stated that women have better developed verbal skills (Halpern, 2007). Furthermore, De Pater (2005) revealed that women are much more inclined to prevent failing, which obstructs them of taking risks and challenges. Nevertheless, undertaking challenges tasks is of importance to improve the career development opportunities. De Pater concluded, that women are outstanding undertake more general actions, while men only undertake those action in which they perform best. Ellemers (2004), concluded that there is no difference in motivation and ambition between a male and female doctoral students. Secondly, the notification of Stereotypes can be considered as one of the underlying reasons why women do not achieve a higher position (Willemesen & van Vianen, 2007). Stereotypes can be defined as; having expectations on the characteristics and features of both man and women. These expectations steer our perceptions and colour our glasses, when it comes to behavioural aspects. Van den brink (2006) concluded, that gender bias is present during the selection procedure towards professor. When more women are participating in a nomination board, this will upgrade the chance that women get selected. Finally, the third notification of Organizational culture can be considered as one of the underlying reasons why women do not achieve a higher positions. The organisation culture is structured by it s values, norms and habits, which can be disadvantuous for women in an organization. The culture 11

12 in the scientific world is competitive and hierarchical structured, in which men feel more comfortable in than women (Van Vianen & Fisher, 2002; Benschop & Brouns, 2003). The most important obstacles restraining women from achieving a top position can be summarized; combining private life and work, also called the double burden syndrome, the impending (closed) selection procedure for top position jobs, the male-dominant organisation culture at the top, the individual ambition characteristics of the women (lower ambition), the absence of female role models and working part-time (Takkenberg, 2005; Verheijen, 2008; Mckinsey, 2007; Brink, 2009; Bijl, 2009). This struggle to the top and the need for not only supporting women but also keeping them on top positions is referred to as the war of talent (Fruijtier & Brok, 2007). Initiatives to promote academic women in UMCs; charter Talent naar de Top In order to support women in the academic world, numerous of equality programs and organizations have been launched with the aim to promote a more gender equal work life (Eriksson-Zetterquist, 2007). For example the Opportunity in Bedrijf organization, supported by Dutch ministry of Education, Culture and Science (OCW) (Opportunity in Bedrijf en SCP, 2009a), and the initiatives of the charter Talent naar de Top, initiated in cooperation with VNO-NCW, FNV, SER and the ministry of OCW and Ministry of Economics. These initiatives were developed, in order to strengthen the women s in-flow and flow-through towards an academic top position and to support women in keeping their academic top position in the UMCs (Lükerath-Rovers, ). In 2009 the majority of the universities and UMCs signed the charter Talent naar de Top Charter. By signing this charter, the Boards of Governors of these institutions have agreed to formulate quantitative goals and policies in the following three to five years for the recruitment and promotion of women and to compile an annual report on the extent to which the formulated goals are achieved (Gerritsen et al., 2009). All eight UMCs have signed the charter Talent naar de Top in order to show their support and willingness to develop and implement policy strategies to strengthen women in the UMCs (Assmann, 2009; Talent naar de top, 2009). 1.2 Urgency of change Why should the UMCs exert in order to support academic women in top positions? In order to answer this question, an argument chart, developed through the agency of Women on Top, in 2008 reveals four leading arguments; Corporate results From the corporative results UMCs perspective it is of great importance to keep and support academic female talent in order to optimize the UMCs working processes and professionalized status. Despite the fact that over 65 percent of the current medical students are women, they are still extremely under-represented in top management and professional positions within the UMCs. We can conclude there is a big leak of talent in the UMCs. The number of women leaving the academic profession still constitutes an enormous neglecting of talent - talent that is a dire necessity for our knowledge economy (Fruijtier & Brok, 2007). Furthermore, the Women Matter, study conducted by Mckinsey & Company, suggests that companies where women are most strongly represented at the board- or top-management level are also the companies which perform best. (Gender) diversity in all layers of an organisation leads to more innovative and multitudinous outcomes (Mckinsey, 2007). Unfortunately, most UMCs lack the representation of women in board- and top-management positions. 12

13 Corporate culture and image Gender diversity is of great importance for the UMCs culture and image. Gender diversity can break the dominant male culture at the top. More women at the top are good for enrichment of the image of the UMCs, and supporting diversity in all layers of the UMCs is of great importance in order to proof the UMCs take their employees seriously (VanDoorne&Huiskes, 2010). Gender diversity is also an asset for the corporate image and helps to bring closer together the whole company: its employees, its shareholders and customers. The development and implementation of diversity programs has a positive impact on the employee s motivation of the companies that implemented them, and on the customer s, in this case the patients, satisfaction, and finally for almost all companies who implemented gender strategies noted an improvement in their image (Mckinsey, 2007). Unfortunately, not all UMCs are developing and implementing gender diversity strategies, as an important impulse on their cultural environment and image. Capacity of women Women in the top of an UMC mean an enrichment of the UMC working environment, medical & scientific output. Women are handling leadership styles with more effectiveness; women who are motivated to gain a top function are very talented, probably because they conquered a lot of obstacles. Most women in the UMCs are outstanding specialist and scientist, who have a great passion for their job. This research revealed that 65 percent of the women claimed to have ambition for achieving a higher position in the UMCs. Most women not only expressed their qualities and endurance for a function at the top, they also revealed the ambition; becoming a professor, division manager, dean and even becoming a member of the Board of Governors. Furthermore, women have on average good communication skills and exhibit more empathy; women are not primarily focusing on their own interest, but attach importance to the general interest of the company (VanDoorne&Huiskes, 2010). Most women are not focused on the status & power play at the top, they are focused on the content and performance of their job, which makes women less eager and visible for the nominations towards the top. Recognition of the added value at the top Finally, it is justified to divide the power at the top proportionally. Only by the nomination of at least three women at the top, women can have an equal share in the power and add value to the top (Brink van den, M., 2009). Furthermore, women at the top of the UMCs are important for positioning role models for other layers within the UMCs (VanDoorne&Huiskes, 2010). Recognition of the adding value women add to the top of the UMCs, is made by all eight UMCs by signing the charter Talent naar de Top (Assmann, 2009; Talent naar de top, 2009). By signing this charter, the Boards of Governors of these institutions have agreed to formulate quantitative goals and policies in the following three to five years for the recruitment and promotion of women and to compile an annual report on the extent to which the formulated goals are achieved. Most women claimed that the Charter is just an important first step toward a successfully implemented diversity policy. Nevertheless, the women also expressed their concerns whether the Board of Governors are keeping their promises, by translating the goals into actions. 1.3 Research contribution to LNVH This research report will contribute to the main goals of the LNVH; promoting the proportionate representation of women in the university community and of women professors in advisory bodies in the field of scientific research and education. This research proposal will not only enlarge the knowledgebase, but will also contribute to building a network and will indirectly stimulate the 13

14 promotion of women by giving attention to this topic by outsourcing my research. Furthermore, additional tasks of this research project are to publish a scientific article and finally to develop a women supporting tool. Nevertheless these additional activities are excluded of the planning of this research project. 1.4 Problem definition Research done by Verheijen (2008) shows the importance/necessity of new and extended research into developing and monitoring adequate policies for strengthening women in the UMCs. Most UMCs do not yet have specific career development policies supporting women in the UMCs to achieve a top position. Verheijen (2008) emphasizes the importance of further research on [1] the career-experiences women have in the UMCs; [2] the obstructing factors/obstacles preventing women from achieving a top position and [3] the influence of the present organizational culture in the UMCs (Verheijen, 2008). Furthermore the importance of execution of this research project is underpinned by the European Commission (2009a). They emphasize the importance of in-depth gender specific monitoring exercises, by combining quantitative and qualitative research methods. The research conducted needs to include studies who encounter an analysis of all potential participants. The following participants needs to be consulted, including women scientists organisations, stakeholder organisations, trade unions, etc. when formulating and evaluating policies and measures to promote gender equality in research (European Commission, 2009a). Only by studying gender participant behaviour from a broad career perspective, taking into account age, career/academic, age, academic position, discipline and ethnicity, makes it possible to formulate career development policy recommendations (European Commission, 2009b). Also Gerritsen et al., state that in-depth examination of policy strategies may prove to be useful for other UMCs in order to get insight about the available measures to boost the percentage of women professors in the UMCs (Gerritsen et al, 2009). This research project will anticipate on the three research clusters provided by the career development model of VanDoorneHuiskes, (2008): the working environment in the UMCs, the individual characteristics of academic women in the UMCs and the private life environment of women academics (see also chapter 4.2). VanDoorneHuiskes plead for combining qualitative and quantitative research, in order to identify the position of the women within the UMCs. Furthermore this research project will also take into account the research recommendation mentioned above for extended gender specific research; consider all relevant participants, studying the participant behaviour from a broad career perspective, taking in account all individual characteristics of the participant and examination of current policy strategies, in order to recommendate future diversity policy. 1.5 Defining the actors in the UMC s; the academic ladder In order to make a selection of the most important actors for this research project several position hierarchy, provided by the Collective Employment Agreement (CAO) of the UMCs and NFU, has been reviewed. It is very difficult to compare the different academic positions within the UMCs, because the content and the indication of the job description differ and is individually structured per UMCs. The Collective Employment Agreement description for the UMCs in the Netherlands, has made the following division (Verheijen, 2008; NFU, 2008) (see table 3 for the male/female division per position per UMC): 1. Medical specialist (MD) and Medical scientist (MS) 2. Assistant professor (Assist. Prof) associate professors (A. Prof) are both represented by the title University Medical Specialist and Scientist. 14

15 3. Academic position professor medical specialist or professor head of department are both represented by the title Professor Table 3: Man/Women division per position (1 January 2007). (LUMC no data included). Source: Doorne& Beek, 2008 Nevertheless, the NFU enhances the following categories to define the division a the top: 1. Medical specialist (MD): defined the higher positions as professor/head of the department. 2. Strategic management (directors, salary scale 14, 15 and 16) 3. Academic positions: Assistant professor (Assist. Prof) associate professors (A. Prof) and Professor. Table 4: Share of women at the top in the UMCs (15 May 2010) (VUMC and AMC data not included) UMC Category Share of women at the top 2009 Target share women at the top in 2013 AZM Erasmus MC LUMC UMCG UMC St. Radboud UMC Utrecht

16 2. Research objectives 2.1 Research objectives The overall objective of this research project is: to identify the needs and wishes of academic women within the UMCs and to provide recommendations for policymakers to design a diversity policy from a women s perspective. Most research conducted in this research field, is focused on the position of the policymakers and/or top management and their views on women participation at the top. Research by Verheijen (2008) revealed the underlying reasons why women do not achieve a top position, from the view of the directors and P&O department of the UMCs, without the involvement of the academic women themselves. This research, aims to reveal the wishes and needs of the women towards their career development in the UMCs, based on the concept: bottom-up approach. This approach will not only detect the main obstacles, needs and wishes experiences by the customer (the academic women), but will also help to successfully implement change management within the UMCs. By extending the main obstacles, needs and wishes from the bottom, the underlying causes of the complex and multifactorial problems in an organisation becomes more clear, by which a development of a change program will finally solve the problem from the bottom to the top of an organisation (Pluym, W. 2004). In this approach the experiences of the customer, will finally model the recommendations of the additional diversity policy advice. In order to perform this bottom up approach, qualitative and quantitative data, from all eight UMCs in the Netherlands, need to be collected. In order to achieve this main objective, identification of needs and wishes of academic women and recommendations for the development of diversity policy, two sub-objectives need to be accomplished: Identification of the obstacles/needs/wishes: The first objective is to provide an understanding and identification of and reflection on the experiences (negative and positive) women have in respect with their career development in the UMCs in the Netherlands. This in order to identify the needs and wishes of female medical specialists and scientists experiences in achieving a top management position or the professorial status in the UMCs. Recommendations development of diversity policy: The second objective is to translate these needs and wishes into recommendations, in order to adjust/design (current) diversity policy for the UMCs from a women s academic perspective. 3. Research framework 3.1 Supporting theories The research framework is important for establishing the theoretical background of this research project. In order to establish a research framework, the theory of VanDoorne&Huiskes and partners (research and Advice Company), has been selected. For previous research, (Verheijen, 2008) VanDoorne&Huiskes and partners, had especially developed a benchmark for career development in the UMCs. This career development model consists of two types of indicators; quantitative indicators and qualitative indicators. The quantitative indicators give insight into the glass ceiling index and make it possible to compare quantitative data from the UMCs. The qualitative indicators define the underlying explanations for the phenomenon that women are underrepresented in top positions in the UMCs and offer indications for policy recommendations. This research project will mainly focus on the qualitative indicators represented by the benchmark career development model of VanDoorne&Huiskes and partners (Verheijen, 2008). The use of the career development VanDoorne&Huiskes, gave the researcher the opportunity to add on to this model, by exploring the 16

17 experiences, needs and wishes of the academic women towards the qualitative indicators already identified and validated by VanDoorne&Huiskes. In order to support and practises this model the VOC-tool (Voice of the Customer) is added. The VOC-tool will help to identify and prioritize the needs and wishes of the female academic medical specialists and scientists put into specific diversity policy recommendations. The VOC-tool will help to reveal the obstacles, needs and wishes of the customer (academic women), of all identified qualitative indicators set by VanDoorne&Huiskes, to define the underlying explanations for the phenomenon that women are underrepresented in the top positions in the UMCs and will help to translate those needs & wishes into diversity policy recommendations. The VOC-tool can be considered as an supporting five step action plan, in order to put the VanDoorne&Huiskes career development model into practice. 3.2 Theory VanDoorne&Huiskes Out of career development research three clusters of relevant qualitative segments, including the career development and opportunities for women, have been identified; 1. Supporting measures within the working environment The culture of the department; characteristics of the department: the criteria of availability and the amount of visibility that women will reach a top position. Secondary working conditions; part-time working, flexible working hours, distance working and present day-care at the UMC. Planning; mapping the number of women and their positions within the UMCs, mapping the number of women who are supported or on the other hand leave the UMCs; targets formulated. Promoting/obstructing women in higher positions; Present preferred policy for women when they are applying for a higher position in the UMC. Present target selection for the inflow of women towards higher positions. Present target recruitment of women for training and finally the specific attention for participation of women. Career development; offer management developing courses to women, offer mentoring and coaching programs to women and offer opportunities to women to improve their networking capacities Culture and mindset change; offer activities for female high potentials, use gender criteria in the vacancy procedures, offer diversity awareness workshops/training and address cultural obstacles within the organization that prevent women to reach higher positions. 2. Individual characteristics Professional aim (ambition) Working hours at present Working hours of the last 5 years Age Working experiences 3. Private characteristics Having a partner Having children Number of children Age of youngest child 17

18 Distribution of tasks and responsibilities at home Based on these three clusters the career development model has been developed (see figure 3) Figure 3: Career development model These three clusters give insight in (1) the support for academic female talent within UMCs, (2) keeping academic female talent within the UMCs and (3) avoid drop-out of academic female talent within the UMCs. Finally, these clusters primarily enable the researcher to determine whether, and if so in which way and to what extent academic female feel strengthened, supported and stimulated by their employers, the UMCs; the position of the academic women in the UMC. Secondly these clusters enable the researcher to formulate recommendations which seek to enhance future female-friendly and supporting career development policy in the UMCs in the Netherlands. 3.3 Theory Voice of the Customer The term Voice of the Customer (VOC), has its roots from the commercial world and is used to describe the customers needs and perceptions regarding a certain product or a service provided by a certain company. The VOC is focused on the customers behavior, by identifying his/her experiences, needs and wishes. The customer s behavior is seen as the key for designing or improving strategies processes and policy, because their insights drive and define value levers and is considered as value-added of processes. Listening to the customer provides a continuously feedback for a company (Sullivan, M., 2009), which is of great importance when strategies and processes are adapted or new policies are developed. The purpose of VOC activities is to identify the key business drivers of customers satisfaction. Only by understanding the customer s needs and whishes the researcher/policy maker will be able to effectively design or adjust policies. By using the VOC-tool the focus will be on improving current policies and developing right measurements, in order to meet the customer s needs and wishes. 18

19 This tool will help the researcher to structure the theory of vandoornehuiskes, by using the five step action plan of the VOC tool (see figure 4). Figure 4: VOC process Source: J&J, Methodology The VOC process in combination with the benchmark career development model of vandoornehuiskes and partners, will model the methodology of this research project by the five action plan (see figure 4). 4.1 Five action plan Step 1 Identify customers and determine what information is needed The first step will help the researcher to identify the customer: which participant plays a central role in this research project? The first step will be to identify the customers ; who are the main actors in the UMCs (target group), and make notes about potential segments that might be relevant for the project. During this phase it is very important to define the main customer, as well as including the internal and external customers. In this research project the professor, A. Prof and Assist. professor and Medical specialists and scientists are identified as the target group. Then you need to decide what you need to know about the needs of the customer that are identified, in order to keep the purpose of the project on track, decide how to get this information. Often there is no single voice of the customer, but are several customers involved (see also actors part). The importance of including all actors in the VOC process is to make sure every need and priority has been reviewed. Furthermore you need to focus on specific segments of the customers you have chosen, these are provided by the benchmark career development model of vandoornehuiskes and partners (Verheiijen, 2008). Every cluster has provided different segments (see also theory 4.2). The qualitative segments of this model helps to ensure that small but important customer segments are represented in the analysis, and identify important difference between the needs and wishes of the actors in the UMCs. 19

20 Step 2 Collecting data by an analyze proactive approach The second step will help the researcher to identify the way relevant data will be collected, by using reactive and/or proactive sources of data. In this research project a proactive way of collecting data has been chosen, by combining a questionnaire and semi-structured interviews. The second step is to collect data by a proactive approach. This means, collecting information by initiating contact with the selected participants. First of all the short questionnaire will give an overview of who the participants are and provide information about their working environment en position. This enables the selection of the participants for the interviews. The interviews will be held to collect information in a face-to-face interaction, to provide a wealth of data and knowledge that is not to be obtained by other means. Design of the interview guide The interview will be designed on a semi-structured basis. Therefore, the focus will be on interviewees narrations while still being able to focus on topics relevant for the various research questions. The goal of the interview will be to gain more in-depth information instead of superficial information, by asking the specific customer s point of view on working experiences, individual characteristics and private environment in relation with the underrepresented position of female academic medical specialists and scientists in UMC. The interviewees will be selected based on their profiles, working experiences outlined by the questionnaire, representation and special requests for participation; all with the equal division of participants per UMC in mind. The interviews will be recorded for further analysis. Since the interviews have a semi-structured basis they will not be fully transcribed. Creating an exact written record of an interview is not superior to other methods of managing interview data with theory based structured interviews. Considering that the process of transcription should be more about interpretation and generation of meanings from the data rather than being a simple clerical task, I have chosen to write selective transcripts of the interviews in this research. The analyzing of the interviews will be based on 6 steps, provided by Halcomb, et al (See, appendix III, 2006). During the recording field notes are made and these are to be reflected on with the recorded interview immediately after an interview. Major ideas, concepts, or issues raised by participants are documented (Halcomb et al, 2006). Short interview reports are made and sent back to the interviewee, to make sure the information obtained during the interview was interpreted correctly. Conducting Interviews Then a period of collecting information will start by conducting interviews among all eight UMCs in the Netherlands. Conducting interviews at the beginning will teach me what is important to the participants, which enables the development of hypotheses about participants needs and wishes. Step 3: Analyse the data to generate a key list of customers needs in their language The third step will be the identification of the customers needs and wishes, by conducting the proactive way of collecting data; conducting the questionnaire (62 participants, see appendix III) and 25 semi-structured interviews, within all eight UMCs (see appendix I). The collected information will be qualitatively analysed by using a coding system; by organizing language data (quotes) into related (sub) groups and differentiate between segments (see appendix III). The benchmark career development model of vandoornehuiskes and partners model will help me to provide a framework for the classified segments. It is a method to understand which process characteristics are related to different types of customer needs. It is of great importance to 20

21 meet the needs for every cluster: the segments for working environment, individual characteristics and private environment. This method helps me to understand the experiences, to explore the obstacles, needs and wishes and finally to prioritize these. Step 4 Translate the participants needs-wishes into critical-to-quality characteristics (CTQs) The fourth step will include the prioritizing and translation of the needs and wishes into the major drivers. Major means here those drivers which will ensure that the needs are addressed. Then the translation into the CTQs can be made. The CTQ represent the key measurable characteristics; the measurable action points that need to be added into policy, in order to meet the driver, which represent the major needs and wishes of the customer. After prioritizing the needs and wishes expressed by the customer, the translation of the customer s experiences, needs and wishes into underlying major drivers is the following step. The major drivers represent those which will ensure that the need is addressed. For example experiences expressed by the customer that they are not aware of the women supporting facilities the UMC is offering, will be translated into the main driver; inefficient/inadequate information supply (see figure 5). Figure 5: CTQ Source: Johnson & Johnson, Then the major drivers will be divided into detail. This breakdown of each identified major driver will make sure that you have reached sufficient detailed information that enables you to measure whether you meet the participants need or not by the developed career development policy (see figure 4) (J&J, 2008). This step includes the translation into CTQs. This useful step will not only help to prioritize the needs of the customer, but also helps to translate them into specific diversity policy recommendations for the UMC (Breitbach Z & Eilert M, 2003). Step 5 Specifications for each CTQ The specification and selection of a set of CTQs for diversity policy recommendations is the last step of the VOC process 21

22 The final step of the VOC is the specification and selection of a set of CTQs for designing the career development policy recommendations for the UMCs. By translating the CTQs into policy recommendations, the needs and wishes of female medical academic specialists are represented in the diversity policy recommendations, which will be offered to the UMCs in the Netherlands. 5. Research issues 5.1 Formulating the main research questions The main research questions are developed based on the structure of the theoretical framework; set by the combination of the career development model of VanDoorne&Huiskes and the VOC tool: 1. What are the obstacles, needs and wishes of female academic medical specialists and scientists in respect with their career development in the UMCs in the Netherlands? (The first main research question is based on the three qualitative segments, provided by the career development model of VanDoorne&Huiskes, in combination with the first three steps of the VOC). 2. Which policy recommendations can be formulated to optimize the current diversity policy in the UMCs, according to the identified obstacles, needs and wishes provided by the experiences of the female academic medical specialists and scientists? (The second main research questions is based on the three qualitative segments, provided by the career development model of the VanDoorne&Huiskes, in combination with the fourth and fifth steps of the VOC). 5.2 Formulating the sub research questions In order to answer the first main research question three sub issues were formulated. These sub issues are set by the VOC and career development model of VanDoorne&Huiskes: first you have to identify the experiences, in order to formulate the obstacles, needs & wishes of the academic women, finally to determine whether the UMCs are providing a women friendly and women supporting working environment. Sub issues with respect to the first main question are: 1. What kind of experiences do female academic medical specialists and scientists working at UMCs have, with regard to their working environment, individual characteristics and private environment? 2. Which obstacles, needs and wishes can be identified with regard to expressed experiences in the UMCs? 3. To what extent is the working environment experienced as women- friendly and women supporting? In order to answer the second research question three sub issues were formulated. These sub issues are set by the VOC: firstly you have to know what kind of initiatives are already undertaken by the UMCs to support women and you have to identify and prioritize the obstacles, needs and wishes, in order to formulate an overall accurate diversity policy for the UMCs. Sub issues with respect to the second main question are: 1. What kind of career development policy/initiatives for women are present in the UMCs in the Netherlands? 2. Which identified and prioritized obstacles, needs and wishes can give a handle to optimize recommendations for future diversity policy, in order to improve the position of female 22

23 academic medical specialist and scientists in UMCs in the Netherlands and support them in their way up to the top? 3. Which overall accurate diversity policy recommendations to support women academic medical specialists and scientists in higher positions in all UMCs in the Netherlands can be concluded from this research? 23

24 Part 2: Technical research design The technical research design of this research project describes the desk study, the scope of the research project, the requested product, selection procedure of the participants, how contact was made with the participants and how the interviews are analyzed. 6. Research design 6.1 Desk study This research project is firstly consisting of a desk study; focusing on relevant literature research in online databases, like Pub Med, Scholar Google, Science Direct, Web of Science, Different E- journals, reviews, forums and news releases. For example; The Social Science Journal, The Academy of Management Journal, The Social Science Journal, Journal of Managerial Psychology, Journal of Financial Economics, Human Resource Management Review, The Journal of Men's Health & Gender, Journal of Vocational Behaviour, Women's Studies International Forum, Women at the Top. The online information of the government of the Netherlands and the sites of the UMCs also provided me information on career development policy for women. Also the book De mythe van het Glazen Plafond by Marike Stellinga (2009), I read to give me more insight, but was kept out of side because of its subjective and manipulative argumentation for women at the top. Furthermore, close contact with Vitaal and LNVH provided me extra information on the situation in the UMCs in the Netherlands. Finally additional activities were for instance my visiting the Women- Inc festival and being part of different debates: for example international women s day at the Erasmus University in Rotterdam. The desk study was necessary to gain information about the situation in the UMCs and the supporting measures for women in higher positions; the process of becoming a professor, the identified indicators which explain why female academic medical specialists and scientists are still underrepresented in the UMCs. By developing a research framework the needs and wishes of the female academic medical specialists in all UMCs in the Netherlands are identified, reflected and to translate those needs into career development policy recommendations for the future career development policy for women in the UMCs. By selecting relevant background information the researcher got an adequate overview of the problem field. By analyzing and structuring the problem field in this way the main problems can be addressed and the main research questions and sub questions can be formulated. The background information is also used to determine the important actors in this research project (Professor, Associate Prof, Assistent Prof, MD) and to develop an organogram in order to explaining the organizational structure of LNVH. Furthermore, for the development of the career development policy recommendations different interviews with important stakeholders in de profit area (K plus V consultancy, Fluent Consultancy, Mckinsey & Co, Price Waterhouse Coopers, IBM, NFU), will provide insight in the best practice for the translation of the outcomes of scientific research into a career development policy recommendations. The following keywords to find relevant literature were used: University Medical Centres (UMCs), women at the top, underrepresented female medical specialists and scientists, Glass Ceiling, Glass Cliff, work-family (policies), flexible work arrangements, gender advantage/disadvantage, position of women, mechanisms of inequality, gender stereotypes and leadership prototypes, women leaders, job/work experiences, emotional labour (burnout/stress), gender equality, female 24

25 leadership (position/ advantage/disadvantage), professors, assistant Prof. associate prof, women (friendly) policy, emancipation, career development. 6.2 Scope of research project The scope of this research is focused on the situation in the Netherlands; including all eight UMCs; AMC Amsterdam, VUMC, Erasmus MC, LUMC, UMCU Utrecht, UMCN Radboud, AZM Maastricht en UMCG Groningen (see appendix I). Within the UMCs the scope will only include female academic medical specialists and scientists with the degree of a medical doctor (MD), an assistant professor (Assist. Prof), an associate professor (A. Prof) and professors. The amount of participants willing to participate in this research project is showed the quantitative results. 6.3 Requested product The final products will identify and bring forth novel recommendations relevant for the female academic medical specialists and scientists themselves, and equally important for the policymakers and boards of the UMCs who have a tool to implement significant strategies to successfully achieve women in the top of the medical organisation. o Needs assessment; identify the needs and wishes of the female academic medical specialists and scientists in the UMCs in the Netherlands. o Policy advice on the current career development policy and future career development policy for supporting female academic medical specialists and scientists in the UMCs in the Netherlands. Translating scientific research into a diversity policy recommendations. o Additional task (out of the scope of this research project); Writing a scientific article in order to inform UMC about the position and needs of women academic medical specialists and scientists in the UMC in the Netherlands. 7. Selection procedure UMCs 7.1 Inclusion-exclusion criteria Questionnaire The selection of the participants for the questionnaire was based on the following inclusion criteria: 1. Including different profession levels within the UMC: including professors, associate professors, assistant professors and medical doctors; 2. Including only female academic professionals; 3. Including both clinical professionals as research professionals; 4. Including different kind of therapeutic areas; 5. Including only women who are working in the 8 UMCs in the Netherlands. The selection of participants for the questionnaire was based on the following exclusion criteria: 1. Excluding male academic professionals; 2. Excluding women working who are not in one of the eight UMCs in the Netherlands; 7.2 Inclusion-exclusion criteria Interview The selection of the participants for the interviews was based on the following inclusion criteria: 1. Including different profession levels within the eight UMC: aiming for including one professor, one associate professor/assistant professor and one medical doctor; 2. Including both clinical professionals and research professionals; 3. Including different kind of therapeutic areas: 4. Including participants, who both have responded the positive- and negative experiences answers in the questionnaire. 25

26 5. Including participants who are available in the interview period: 6 April May The selection of participants for the interviews was based on the following exclusion criteria: 1. Excluding participants, who were not available for an interview in the interview period: 6 April May Excluding participants who did not give permission for an interview. 3. Excluding women working who are not in one of the eight UMCs in the Netherlands; 8. Contact participants 8.1 Inviting the participants by for the questionnaire The participants were selected with the help of the LNVH register of female professors. The LNVH register includes a membership of approximately 550 female professors (LNVH, March 2010), among them mainly extraordinary professors. These participants were at first contacted and invited with an , because it was assumed that the selected participants do not have much time. Reading an and respond by seemed to be the quickest and most effective way of getting in contact with these women. When the women responded positively, the questionnaire was both sent in the digital form and in the word file. The women could then decide for themselves which way of filling out the questionnaire was preferred. The questionnaires in Word, were put into the digital form by the researcher herself. Furthermore in the invitation the women professors were kindly asked to forward the to other assistant and associate professors. The selected participants received a reminder for participation after respectively two and four weeks 8.2 Inviting the participants by phone/ for the interview Based on the results of the questionnaires for every profession (Prof, Assists Prof., A. Prof, MD/) interview participants were selected per UMC. The participants for the interviews were selected based on their profession and the answers given in the questionnaire. The aim was to select one professor, one assist. Prof, and one associate Prof or Medical specialist per UMC. The participants were both invited by and phone for the interview. The interviews were performed at the UMC the interviewee is working, and in one case the interviewee visited the LNVH location, in Den Haag. 8.3 Response rate Overall a total of 110 s were sent to the female professors working in the eighth UMCs in the Netherlands. The correct amount of sent invitation s is probably much higher, because the invitation requested from the female professors to notify their departments. Unfortunately the research was not able to track down the exact amount of invitations sent. In total 62 female participants and 3 men participants reacted positively on the invitation to participate in this research project. In table 4 the division of participation in the questionnaire per UMC and per profession is described (see table 5) Table 5 : Questionnaire participation Division per profession; questionnaire Professor 51.61% Associate professor (UHD) 29.03% Assistant professor (UD) 6.45% 26

27 Medical Specialist (MD) 12.90% Division per UMC; questionnaire AMC, Amsterdam 17.74% VUMC, Amsterdam 8.06% Erasmus MC, Rotterdam 3.23% AZM, Maastricht 4.84% UMCN, Radboud, Nijmegen 6.45% UMCG, Groningen 8.06% LUMC, Leiden 38.71% UMCU, Utrecht 11.29% Based on the information in the questionnaires 26 women were selected for an interview. One interview was canceled. At the end 25 interviews were conducted, to provide an overview of the experiences of every profession per UMC. The aim was to perform at least 2-3 interviews per UMC and to include all the professional groups. In table 5 the division of participation in the interview per profession and UMC is described (see table 6) Table 6; Interview participation AMC, Amsterdam VuMC, Amsterdam Erasmus MC, Rotterdam AZM, Maastricht UMCN, Radboud, Nijmegen UMCG, Groningen LUMC, Leiden UMCU, Utrecht 16 % Professor 8 % UD/UHD 8 % MD 0 % 12 % Professor 8 % UD/UHD 0 % MD 4 % 12 % Professor 4 % UD/UHD 8 % MD 0 % 12 % Professor 12 % UD/UHD 0 % MD 0 % 8 % Professor 8 % UD/UHD 0 % MD 0 % 8 % Professor 8 % UD/UHD 0 % MD % 20 % Professor 4 % UD/UHD 8 % MD 8 % 12% Professor 12 % UD/UHD 0 % MD 0 % Total 100 % Professor 64 % UD/UHD 24 % MD 12 % Furthermore, the researcher also visited the Women-Inc. festival ( ), the Women s day debate at the Erasmus MC ( ), The Charter Talent to the Top meeting ( ), The researcher participated in a second debate at the Erasmus MC ( ) and was included in a focus group (arranged with Consulting K plus V). Finally the researcher organized an 27

28 exploration workshop for assistant- and associate professors of the Universities ( ) during a Mentoring day organized by the LNVH. 9. Analyzing the interviews 9.1 Structural analysis To analyze the qualitative data provided by the interviews, a structural analysis has been done. In this analysis method two central concepts are basic: pattern matching, in which the +/- 26 interviews were matched with each other and the analytic induction, in which attention was paid to the context in which the interview and the new concepts were added to the coding system. One of the reasons behind choosing this method of analysis is that the interview was semi-structured and based on the background information, the theoretical reflection with the different methods of the VOC. In the process of the structural analysis, several phases can be discerned: 1. Exploration 2. Specification 3. Reduction 4. Integration In the first phase (exploration), the transcripts (provided by listening to the recordings) were individually explored by one researcher. During this exploration phase, the researcher was focused on the context of the data, the identification of important themes and on an evaluation of the quality of the data. In the second phase (specification), the transcripts (provided by listening to the recordings) were directly labeled individually by the researcher, by encoding text fragments with a within-case analysis. Before this phase could take place, the researcher independently defined and scheduled specific categories (main concepts). In order to do so, the theoretical reflection supported by VOC, the background information and the sequence of the interview guide were used. After all analyses had been done a consistent structure of analysis and a general list of codes were provided for a general coding-system that can be used for future interviews (see appendix VII). This general coding-system contains three main categories, which are divided in multiple sub concepts. The three main categories are: (1) Working environment in UMC, divided into culture and secondary working conditions, (2) individual characteristics (3) Private environment (see appendix VII). During the encoding in the second phase, the researcher paid attention to which level (main- or sub concept) a code belonged. This means that the independent researcher could have already noticed that several codes could be combined into one bigger category and was then free to make new sub codes. In the third phase (reduction), the researcher had to have a critical eye. Every choice made in the coding needed to be reviewed since some codes were included in one bigger category, new categories had been formed and by doing so a reduction was made of the individually formed sub codes and categories. The result: a code system, with categories, sub codes and quotes from the recordings that supported the codes. The final general code-system can be found in appendix VII. Finally in the last phase (integration), the researcher tried to understand the context of the data and all the underlining connections by cross-case analysis. Per interview a summary was made for each of the three categories, specifically looking at the positive experiences, negative experiences 28

29 (obstacles) and needs (advice) addressed by every actor. Next, for each category summary, the summaries from every actor (Professor, Associate Professor, Assistant Professor and MD) were taken together. In this way, sub-results were made; containing the most important information about each category was created and translated into the obstacles experienced and (policy) advice for women and UMC. These sub results from the categories were used, not only to answer several sub research questions, but were also used to design the policy advice for the UMCs and the women themselves. 9.2 Validity & reliability of interview data Within this study different strategies have been used in order to enhance the validity and reliability of the methods and the results and to minimize effects of researcher bias and influence. The validity is increased by the specific process of data collection. A flexible way of interviewing creates the opportunity to react on the answers of the respondent right at that moment and provides in-depth answers, with, as main result, more valid answers. Moreover, the interviewer has received interview trainings in her study, in which a certain consistency of interviewing was taught. This has increased the validity of the data. By making the choice for a semi-structured interview, interviewer bias was prevented as much as possible, since it provides a guide-line for the interviewer. Another technique used to avoid too much influence from the researcher is by reflecting the background of the problem field; the researcher is aware of her own background. Also, in the interview training the interviewer was trained to be aware of being neutral during the interview, by asking objective questions and not to add a personal opinion. Another important strategy followed in this study in order to enhance the validity of results was the extensive documentation of primary data, for example by using a standardization code system. Also, the study and provided data were given a scientific value by making specific descriptions of the methods that were used for the desk study, development of the actor analysis (Actor chart/voc) and the development of semi-structured interviews and finally writing a policy advice. Moreover the specific description and accomplishment of the analysis process play a major role in the reliability. By using standard procedures like semi-structured interviews the interview was made more reliable. Finally in an attempt to improve the reliability an iterative development in the qualitative research was included: the interview design and results after using the interview design gave input during the research process for the development of a policy advice, due to the new insight the researcher gained in this process. 29

30 Part 3: Quantitative Results 10. Profile of the academic women in the UMCs The quantitative results provided by the questionnaires describe the demographic characteristics, working environment, individual career characteristics and the combination of a private life and a career of all 62 women participating in this research project Demographic characteristics The average age of the women participating in this research project is years old. Of all women 88.71% has a partner and 70.97% has children. The average amount of children these women have is 2.43 (+/- 1.55). The average age of the youngest child is years old Working environment The women participating in this research project are working in one of the eight UMCs in the Netherlands (see table 7). Table 7: Women working in the UMCs AMC, Amsterdam 17.74% VUMC, Amsterdam 8.06% Erasmus MC, Rotterdam 3.23% AZM, Maastricht 4.84% UMCN, Radboud Nijmegen 6.45% UMCG, Groningen 8.06% LUMC, Leiden 38.71% UMCU, Utrecht 11.29% In total 51.61% of the women is professor, 29.03% is associate professor, 6.45% is assistant professor and 12.90% is medical doctor. The average amount of working years in this position is 8.11 years. The therapeutic areas these women are working in, within the UMCs are very diverse: 31 different specialisms are represented in this research project. For example: neurology, pleuro-pneumonia, paediatrics, cardiology, public health, ophthalmology, infection diseases, clinical genetics, virology, clinical psychology, gynaecology, dermatology, immunology, otorhinolaryngology, cell biology, medicine use, medical statistics, psychiatry and oncology. The average amount of working hours per week is set on hours. Probably the exact amount of working hours per week is much higher; because it was unclear for most women if they had to fill out their working hours determined by their contract or the exact practical working hours. The following results can be presented based on the questionnaire (see table 8): 30

31 Table 8: Secondary UMC working conditions Secondary UMC working conditions: YES NO Do you have a flexible time schedule? 70.97% 29.03% Does the UMC offer child day-care? 72.58% 27.42% If yes, do you make use of this facility provided by the UMC? 0 % 100 % Does the UMC offer you the possibility to work at home? 70.97% 29.03% If yes, do you make use of this facility provided by the UMC? 77.27% 22.73% Does the UMC offer you career development projects? 43.55% 56.45% If yes, do you make use of this facility provided by the UMC? 37.04% 62.96% Does the UMC offer you mentoring/coaching programs, in order to support your career? 50% 50% If yes, do you make use of this facility provided by the UMC? 60% 40% Does the UMC offer you the opportunity to participate in women networks? 79.03% 20.97% If yes, doe you make use of this facility provided by the UMC? 87.76% 12.24% Do you make use of other career development activities, provided by your UMC? Do you consider your department stimulating the equal opportunities for men and women (at your department)? 37,71% 62.29% 64.52% 35.48% 10.3 Individual characteristics Of all 62 women % ( 40 women) claimed to have the ambition for achieving a higher position. These women aim for the following higher positions within the UMCs (see table 9): Table 9: Aim for higher positions within UMCs Board of Governors Dean Division Manager Head Manager Professor Associate professor (UHD) Assistant professor (UD) 10 % (2 women) 2.5 % (1 woman) 7.5 % (3 women) 17.5% (7 women) 60 % (24 women) 2.5 % (1 woman) 2.5 % (1 woman) The average current experience years these women have is years. The following results can be presented based on the questionnaire (see table 10): 31

32 Table 10: individual career perspectives Individual career perspectives YES NO Do you consider your amount of experience years enough for your future job? 68.42% 31.58% Do you think your department has a diversity organisation culture? 53.23% 46.77% Do you consider the dominant organisation culture within the UMC as an obstacle to fulfil your job or to reach your future job? Do you consider part-time working within the UMC as an obstacle for fulfilling your job or to reach your future job? Do you consider the amount of experience years as an obstacle for fulfilling your job or to reach your future job? 46.77% % 35.48% 64.52% 11.29% 88.71% 10.4 Private environment According to combining private life and work the following question was asked: Do you consider combining work and private life as an obstacle for fulfilling your job or to reach your future job? Of all women 22.58% agreed that combining work and private life is an obstacle for fulfilling your job or to reach her future job. The remaining 77.42% stated not to have problems with combining their private life and work. 32

33 Part 3: Literature Results 11. Initiatives for supporting academic women in the Netherlands 11.1 Overall initiatives for women: Nationally On national level several women supporting initiatives are taken to support and sustain academic female talent in the UMCs working environment. The initiatives taken by the government, NFU and women network LNVH will be outlined: By the Government: The Innovational Research Incentives Scheme The Dutch Minister of Education, Culture and Science (Science Budget 2000), the Royal Netherlands Academy of Arts and Sciences (KNAW), the Association of Dutch Universities (VSNU) and the Netherlands Organisation for Scientific Research (NWO) all believe that extra encouragement should be given to innovatory research in the Netherlands. This is why NWO, KNAW and the universities joined forces in 2000 to set up the Innovational Research Incentives Scheme, also known as the Vernieuwingsimpuls The aim of the Innovational Research Incentives Scheme is to promote innovation in the field of academic research. The scheme is directed at providing encouragement for individual postdoctoral researchers at various stages of their careers1. Since it is vital to the universities that talented researchers should enter the profession and gain promotion within it, two main purposes of the Innovational Research Incentives Scheme are to provide the scope for adventurous, talented and pioneering researchers to conduct creative research of their own choice and to encourage them to make a permanent career of academic research. The grants give the individuals concerned then opportunity to develop their own innovative lines of research within the research programmes of the host institutions. Vidi and Vici candidates also have the opportunity to establish and/or expand their own research teams (NWO, 2010). The target group The target group for the scheme consists of outstanding individuals of exceptional talent and originality who have a great enthusiasm for the conduct of challenging, ground-breaking research. In view of the purpose of the Innovational Research Incentives Scheme, it is obviously essential that candidates should have the ability to formulate and conduct a research programme independently. This implies that they will already have proved their abilities in the field of research in one way or another. The scheme targets the best research talent, irrespective of nationality. It is open to researchers from abroad as well as from the Netherlands. Successful candidates will be among the top ten to twenty per cent of their peer group. They will also be expected to have the capacity to persuade others of the originality and potential of their ideas. The Innovational Research Incentives Scheme comprises three forms of grant directed at three different stages in researchers' academic careers. Veni grants are for excellent researchers who have recently obtained their doctorates and are starting out on their careers, but who have already demonstrated an outstanding talent for academic research. Vidi grants are for excellent researchers who have completed their doctorates and already conducted post-doctoral research for some years, thereby demonstrating the ability to generate new ideas and bring them independently to fruition. 33

34 Vici grants are for excellent senior researchers who have shown that they have the ability to successfully develop their own innovative lines of research and to act as coaches for young researchers (NWO, 2010). Encouragement for women researchers Women are especially urged to apply. Unfortunately, women are at present seriously underrepresented in the academic world, especially in senior posts. NWO and the Ministry of Education, Culture and Science intend to take action to change this situation and hope that KNAW, VSNU and the Dutch universities will also strive to ensure that more women submit applications so that the percentage of female applicants is at least equal to that of women researchers in the target group. NWO guarantees that the average success rate for female candidates taken over a number of years will be at least equal to that for male candidates (NWO, 2010). Aspasia program Aspasia was launched in October 1999 as a scheme to increase the number of women senior lecturers. Women are generally less represented in the upper academic echelons. This pyramidal career structure is particularly present in the world of Dutch scientific education and research. The Ministry of Education, the Association of Universities in the Netherlands and NWO consider it a matter of urgency to take a proactive stance towards the problem of the underrepresentation of women in this position. For that reason the Aspasia was initiated. The program s primary objective is to help a greater number of women lecturers in attaining positions as senior lecturers. In 2000 NWO approved 30 applications, in 2002 another 40. As from 2005 Aspasia new-style has been linked to the Innovational Research Incentives Scheme. Premiums will be made available for those university Boards that ensure that women Vici and Vici laureates (round 2005 and following) are promoted to senior lecturers or professors within a year after the subsidy is awarded (NWO, 2009) By the NFU: Idealoog All the employees in the UMCs have a personal budget in order to invest in their own development. The underlying thought of attention for personal development, is that it will lead to durable employability. In order to create desirable open working culture, in which the employees and their management can freely communicate about the employee s personal development and durable employability, the dialogue is essential. When they understand and listen to each other, more equality in the employment relationship will be achieved and responsibility of the employee will be increased. In order to sustain such mature employment relationship, Idealoog was created, to stimulate and support these relationships within the working environment of the UMCs (NFU, 2010). This project consists out of two parts: I-deal: goods made to measure in the working environment of the UMCs. Dialoog: Create a open communication culture, to sustain and develop a mature employment relationship. This project is mainly focused on the development of an open communication culture, by implementing individual career development conversations. Nevertheless, the NFU stated that in this project no special attention will be addressed towards academic female talent. 34

35 By the women network LNVH: The LNVH has established a membership of approximately 550 female professors (LNVH, 2010), among them mainly extraordinary professors. They represent a cross-section of academic disciplines and are drawn from all universities in the Netherlands. The aim of the LNVH is to promote the proportionate representation of women in the university community and of women professors in advisory bodies in the field of scientific research and education. The LNVH aims to achieve this goal by organizing activities (symposia, networking meetings, workshops) for women academics, by reinforcing the ties between women professors in the Netherlands, by supporting activities that support professorship and by nominating women candidates for Spinoza Grants, membership to the Young Academy, as Academy Professors and for prestigious academic awards and positions (Gerritsen et al, 2009). The LNVH supports the female professors by providing them with all kind of relevant information, applications procedures, job information, activities etc.. Furthermore the LNVH arranges several annual meetings. Every year the LNVH organizes a comprehensive congress or symposium. Furthermore, every year the LNVH visits the Boards of Governors of all the Dutch universities in order to get informed about the percentage of women in higher academic positions and to discuss activities that could promote the proportionate representation of women (LNVH, 2007) (see figure 1). The unique position of the LNVH, representative of almost all women professors and a great amount of female associate professors in several disciplines, makes it possible to operate more independently, to database relevant information and to give support and to provide for advice (LNVH, 2010) Initiatives provided by the UMCs In 2008, Verheijen provided an overview of the women initiatives already taken by UMCs to support women (see table 11). Table 11; Overview women initiatives UMCs 2008 (Verheijen, 2008). AMC AZM ErasMC UMCG UMCN UMCU VUMC LUMC Policy for women Insight in share of women X X Education for women X X X X X X Career development program MD for women X X X X X Mentoring and/or coaching for women X X X X X Alternative career paths X X X X X X X Women networks X X X X X Cultural change Activities for women talents X X X X Diversity included in review criteria for managers. X X X X X X X X Becoming diversity aware for line management X X X X X X X Cultural research for obstacles within organisation for X X X X X X preventing women to the top Attention for diversity M/W in the communication X X X X X X 35

36 (internal/external) Nevertheless, a lot is happened in the last two years. Therefore to extend this table; the researcher also asked the UMCS to become transparent in the initiatives they have undertaken the last two years to support women. Per UMCs the researcher will outline the initiatives; including the present female career development program, Mentoring and Coaching program, Women Networks and other additional female supporting activities (see table 12); Table 12; Overview women initiatives UMCs 2010 AMC AZM ErasMC UMCG UMCN UMCU VUMC LUMC Female career development program X X X Mentoring and coaching program X X Women network X X ; not official Other female supporting activities X X X X = present in the UMC, information provided by website or internal contact P&O X= information unknown/not present in the UMC For additional information of these women supporting initiatives provided by the UMCs see appendix II. 36

37 Part 3: Qualitative Results Experiences, needs & wishes of the academic women The results drawn from the interviews are divided by the three clusters of the career development model, developed by the VanDoorne&Huiskes; experiences within the working environment, individual characteristics and private environment. In every cluster the general experiences (positive and negative) will be outlined, followed with the indentified major obstacles and needs and wishes for career policy advice. Every cluster will be finished by a visual summary. 12. Qualitative sub-results: Working environment 12.1 Female working environment experiences at the UMC The results in this cluster working environment will not only outline how women judge positive and negative working experiences at the UMCs, but also give us indicators of the obstacles women experience in the UMCs, including man/woman division, work load, secondary working requirements and the organisational culture General working environment experiences Most women working in the UMCs enjoy their jobs and are happy with the UMCs as being their working environment. The working environment of the UMCs is primarily described as a stimulating and supportive working environment, with an open culture at the department, good communication and cooperation with colleagues and management. The women experience the working environment of the UMCs as a big challenge by combining all the tasks that they need to fulfill in their job as an MD, associate professor, assistant professor, professor and/or head manager. Het UMC waar ik in zit, in de research is een hele inspirerende omgeving. Het is heel gevarieerd, Alle collega s zijn heel enthousiast. Iedereen stimuleert elkaar dus je kan samenwerkingen aangaan binnen de afdeling, buiten de afdeling. Als je wilt kan je er een hele leuke en gevarieerde baan aan hebben (int.1 UHD) Ik vind het heel erg inspirerend; ik ga elke dag met plezier naar mijn werk toe. Het is ook een uitdagende baan, heel divers, waarin onderzoek en de patient centraal staan (int. 23. UHD) Nevertheless also a lot of negative experiences came up when the researcher asked to explain the working environment. One of the negative experiences is the competition between departments but also within departments; Ik zie veel competitie om mij heen, en mensen die enkel hun eigen belangen voorop zetten (int 4 Prof/Head Manager) Je merkt wel dat mensen dan gaan zeggen ja jij hebt die bijzonder hoogleraar, waardoor je iedereen met je voor krijgt. Maar zo werkt het ook weer niet. Je krijgt ook wel jaloerse reacties. Ik ben daar ook wel voorzichtig mee, hoe ik daar mee om ga (int. 16 Prof) The hierarchical organizational structure of the UMCs also leads to negative working experiences, determines a more distance relation with colleagues and managers and works against a more open communication and transparency culture within the UMCs. 37

38 Binnen dit UMC zit een getrapte hiërarchie en dat vind ik persoonlijk nogal hinderlijk. Er zijn altijd lagen tussen de divisie en je wordt niet geacht zelf direct contact te hebben met de Raad van Bestuur. Als ik dingen gedaan wil krijgen en het moet via die lagen van bestuur, dan werkt dat enorm vertragend (int. 8 Prof). The merge between the UMCs and the Universities was also described as one of the underlying negative reasons for an obstructing working environment of the UMCs. The outcomes of the cooperation between the UMCs and the Universities were mainly described as; Sinds 2001 zijn de faculteiten en de UMC samengegaan, maar nog steeds zijn het de UMC s de clinici en de patiënten waar het om gaat. Terwijl wij vooral onderzoek en onderwijs doen. Dat botst! (int. 22 Prof/ Head Manager). Ik vind het geen verkeerde ontwikkeling, maar het is heel erg uitgedacht vanuit het UMC. En aangezien die veel groter is dan de faculteit zie je dat het kleine broertje wordt opgenomen door het grote broertje. En dan worden de zaken die het grote broertje heeft bedacht vooral goed uitgevoerd (int. 22 Prof/Head manager) Binnen het UMC houdt men meer van mannetjesmakers: mannen die meer voor de carrière gaan dan voor de inhoud. En wij worden nu gezien als een fabriek die aio s produceert en aflevert. Je ziet dan ook dat die mensen die zich op die manier goed kunnen presenteren boven komen drijven (int. 12. Prof) Tijdens het samenvoegen van UMC en de Universiteit zie je dat de onderzoeksvakgroepen er een beetje bij gaan hangen. Zo n vakgroep heeft dan een begroting van 10% van het hele ziekenhuis en dan verzuip je gewoon een beetje (int. 14. UHD) Some women also described the working environment as being frustrated by the fact that they are not being taken seriously by their men colleagues, need to put much more effort into their work in comparison with men, felt no support from their men colleagues and even thought that being a woman would have a negative effect on their career. De vrouw wordt minder gehoord en haar meningen tellen minder. Je hebt gewoon het gevoel dat je minder serieus genomen wordt. Dit gebeurt natuurlijk niet elke dag, maar het gebeurt weleens en dan raak je toch gefrustreerd (int. 2 MD) Om echt iets te bereiken moet je 1.5 keer meer doen dan je mannelijke collega s (int. 24 UHD) Op sommige momenten is het ook heel erg frustrerend als je telkens dat glazen plafond voelt (int. 24 UHD) These women really felt kept in custody, because they couldn t express their feelings to the head manager of the department or did not feel comfortable enough to share their story; De sfeer is wel goed, maar je moet je mond houden, je mag niet zeuren op de afdeling (int. 2 MD) Ik kan hier niet echt mijn verhaal kwijt, en zeker niet met mijn leidinggevende, die is daar niet gevoelig voor, integendeel (int. 2 MD) Finally, most women complained during the interviews that while they are well trained by career development programs to get a higher profession (professor), the UMCs can not offer the women a higher position because there are no job opportunities. Want nu zitten we daar met al die talentvolle vrouwen, maar er zijn geen banen (int. 4 Prof) 38

39 Men/Women division on the work floor Most women pointed out that the share of women in higher positions, especially at professor level and head managers level, is very little. Veel vrouwen die hier werken zitten vooral in lage posities; administratie werk. Zelfs de artsen, vrouwelijke, groeien langzaam door in de specialismen en hogerop (int. 23. UHD). Van de 45 afdelingen hebben er 5 een vrouwelijk afdelinghoofd. Dit beeld zie je ook terug bij het aantal vrouwelijke hoogleraren (int. 22. Prof). Nevertheless, a few departments had a big share of women, about which the women expressed their difficulty to attract more men; Er werken heel veel vrouwen, met als probleem dat wij grote moeite hebben om mannen aan te trekken (int. 14, UHD) Workload By most women the working load in the UMCs is expressed as being high. In some cases the work is so extreme high, that most women work on their free days. Ik werk ook in mijn vrije tijd. Ik heb officieel op maandag en op woensdag vrij, en maandag werk ik thuis en woensdag vaak. Iedereen verklaart me voor gek, maar ik zit elke morgen van te werken (int. 2. MD) With the result that most women are continuously busy with their work; Bij tijden is de werkdruk heel hoog; je moet het zien dat je er continue mee bezig bent en ik doe ook nog ideeën op als ik onder de douche sta, of in de auto/trein zit. Je bent er heel veel mee bezig; maar dat zie ik niet als werken (int. 24 UHD). The contract for women working in the UMCs is 36 hours per week, nevertheless the women expressed they work much more than stated in their contracts. The maximum amount of working hours per week was mentioned during the interviews as 80 hours per week. Toen ik hier kwam wilden ze me een 100 procent dienstverband geven, en toen gaf ik direct aan dat ga ik niet doen. Want dan word ik verplicht om 150 procent te werken (int 3. Prof) Because the work load is so high women want to do their job as good as possible and a lot of women need a part time working contract, not in order to work less, but to build more flexibility for fulfilling their additional tasks. Maar door een dienstverband te nemen van 32 uur kan ik zeggen, nou ik heb de vrijheid om vandaag te zeggen het komt me niet uit, ik heb geen zin. Ik koop mijn vrijheid, zo zie ik dat (int. 3. Prof). Not only the large amount of working hours per week, necessary to fulfil the job, but also other factors seem to have influence on the work load of women in the UMCs. The combination of the clinical duties and research tasks for the MDs, is a major returning cause of a high workload in the UMCs, especially in combination with the irregular working hours. 39

40 Iedereen zit met een gigantische werkdruk bij de patiëntenzorg, waardoor de research vooral neerkomt op motivatie en eigen persoonlijke drive (int. 17. Prof). Als je supervisie hebt is dat een zware taak: veel verantwoording en je moet heel alert zijn. Je moet continu scherp zijn, en dan ben je vaak moe. En als je dan ook nog diensten hebt, dat je s nachts doorwerkt, je kan niet altijd slapen dan ben ik helemaal op. En dan gaat toch weer de supervisie door en als je pech hebt weer een dienst. Dat is gewoon ongezond. Ik weet dat ik de week erna ontzettend moe ben, knikkende knieën, en slecht slapen (int. 2, MD) In some cases the large amount of travel hours to the working place was also expressed as one of the returning causes of a higher workload. Furthermore, when the atmosphere at the department is not good the workload will also increase; De werkdruk is ook meer als het niet goed gaat op de afdeling; de samenwerking met collega s onderling (int. 3. Prof). The influence of the high workload on the health status of women was mostly expressed by (short) periods of exhaustion. In some cases even more serious effects of the high workload on the health status were mentioned: sleeping problems, high blood pressure, depression, chronicle illnesses and burnout. Deze hoge werkdruk is zeker niet goed, ik hou dit nog even vol maar niet lang (int. 13. Prof) Ik had last van hoge bloeddruk, en toen ik 1 dag minder ging werken, zag je dat die hoge bloeddruk direct verdween (int. 11. Prof). Also women in a higher age category expressed they experience more negative influences of the work load on their health status related to their age; Soms ben ik moe, en dan moet ik ook ophouden. Mijn span is niet zoals die 20 jaar geleden was, toen kon ik meer aan (int. 3 Prof) The women who experience high levels of stress and serious damage of their health status are in some cases afraid of telling this to their managers of even the medical officers: Sterker nog, ik heb zelfs een afspraak gemaakt met de bedrijfsarts om hier over te praten, maar ik twijfel om te gaan omdat het nog weleens tegen me gebruikt zou kunnen worden. Ik vraag me echt af of ik hier wel naar toe moet gaan. Int 2 MD Ik kan dit niet aangeven op de afdeling. Dan moet ik er wat aan doen, niemand kan dat voor je oplossen dan jijzelf (int. 13 Prof) Nevertheless, despite the fact that the workload is high, most women expressed that they can cope with the long hours and stressful situations because they are enjoying their job so much: Dat is eigenlijk heel gemakkelijk, je moet gewoon doen wat je leuk vindt. Dan ben je nooit ziek. Ik hou echt van mijn baan, ik ben verliefd op mijn baan (int. 10, UHD). And because the job included so many varietal tasks, they can more easily keep balance in their workload: 40

41 Ik haal juist de balans uit de combinatie van taken die ik moet doen. Alleen onderzoek is het ook niet voor mij! (int. 19. Prof) Secondary working requirements During the interview questions about the secondary working requirements were asked in order to set how important these facilitations are for women in the UMCs working environment and their career. Flexible working schedule The possibility for working flexible in the UMCs working environment mostly depends on the job done by the women. For most professions a flexible working schedule is possible, but not always approved by the management of the department or by the policy of the UMCs. These women mostly expressed their needs for a more flexible working schedule; especially for the execution of their research tasks. Nevertheless, the professions that include intensive patient care are generally more restrained to non-flexible working hours. Als je supervisie hebt moet je van in huis zijn. Je moet er gewoon zijn, en dan heb je geen flexibiliteit (int. 2. MD) In some cases, women who do not have the possibility to work flexible decided to work part time, in order to have the possibility to create more flexibility in work, which means in many cases they also work on their free days. Ik vind het dan toch wel lekker dat ik twee dagen zelf kan bepalen of ik wel of niet achter de computer ga zitten (int. 10. MD) Able to work at home Also the possibility to work at home in the UMCs mostly depends on the job. For professions that include patient care and higher management; being in the UMC working environment is necessary. Nevertheless, again the professions, who have the possibility of more flexibility, also prefer of working at home. Women who have experiences with working at home express the following positive experiences: working at home means you can not be disturbed every second, it means working more efficiently, less stressfully, you don t have traffic jams and combining career and childeren is more easily. Voor mijn carrière is dat geen noodzaak, maar als je wilt werken en kinderen hebt is het wel van belang (int. 10. UHD) Nevertheless, women who have the possibility to work at home are not always allowed to do so by the management or the policy of the UMCs. Thuiswerken wordt niet geaccepteerd, hij (afdelingshoofd) vindt dat als dat voor jou geldt, iedereen daar wel om kan komen vragen. En dan weet je maar niet wat ze thuis doen (int. 6 MD) In only a few cases the women experience working in the UMCs more pleasant than working at home. 41

42 Als ik overdag thuiswerk dan ga ik thee drinken. Hier, in het UMC werk ik veel harder, dus ik heb niet zo zoveel behoefte om thuis te werken (int. 1. UHD) Most of the time women in these positions (MD/ass. Prof./associate Prof) are restrained of working less flexible or are not able to work at home. Most women in top positions (professor and head management) have the opportunity to make their own rules about when and how they work flexible or work at home, without calling to account. Most of the women agreed that working at home and having a more flexible working schema are important secondary work requirements for building a career more easily. Child day care The results of the quantitative results and the interviews made clear that most women do not make use of the child day care, even when the UMCs are providing this. Most women do not make use of the child day care of the UMCs for the following reasons: long waiting lists of the child day care at the UMCs, bad quality of the child day care, child day care of the UMCs do not take into account the irregular working hours and finally in most cases making use of the child day care of the UMCs is just not practical. Door onze onregelmatige werktijden en omdat mijn partner ook arts is hebben wij nooit gebruik gemaakt van deze regeling (kinderopvang), daarnaast wordt het ook niet financieel ondersteund omdat het niet valt onder reguliere kinderopvang, maar we hadden geen andere mogelijkheid. We hebben alles zelf moeten regelen (int. 2, MD) Kinderen moeten om 8 uur op de kinderopvang zijn en ik om half 8 in het ziekenhuis. De kinderen moet je om 6 uur ophalen, Hallo! Ik hier als assistent om half 6 weg, doe even normaal (int. 10. UHD). Most women arranged for themselves the child day care at home; by having a nanny or an au pair or found for themselves a child day care in their hometown. Most women expressed their needs for the improvement of child day care, by taking into account the irregular working hours of medical specialists. Some expressed their needs for a financial compensation if they had arranged child day care on their own. Als je tijdens je opleiding er altijd maar wilt zijn, wat ook moet in mijn vakgebied, en je wil ook kinderen en die wil je niet pas op je 40ste krijgen. Dan krijg je ze dus jonger, tijdens je opleiding, maar dan heb je hele goede opvang nodig. Een goede opvang kost geld, en daar betaalt het ziekenhuis niks aan. Via het Rijk krijg je dan een tegemoetkoming voor de crèche, maar wat heb ik aan de crèche. Helemaal niks! Daarom heb ik een au pair geregeld. Maar de au pair is helemaal nooit betaald, ze vergoeden dat gewoon niet. Ik vind het schandalig (int. 10. UHD). Additional support: own office, secretary, staff members, health support and information facility. During the interviews it became clear that additional support, for instance having your own office, secretary, staff members and good IT facility is of great importance for women in a higher position. Nevertheless, the UMCs don t have these support measurements in many cases; In de medische wereld,moet je echt je eigen broek ophouden. Je krijgt nauwelijks facilitaire steun; ondersteunend personeel, aio s, promovendi, secretaresse. Vooral aio s en promovendi moet je allemaal zelf aantrekken met geld. (int. 7. Prof) Je voelt je ook wel eens bezwaard om de secretaresse van het afdelingshoofd te vragen voor dingen. Je denkt, kan ik dit wel vragen?! (int. 6. MD) 42

43 Goede ondersteuning, een secretaresse, is echt een must! (int. 5. Prof) Most of the time women in higher positions (professor/head manager) are more secured of better additional support, while associate professors/assistant professors/md/ are not. Most women, mostly medical specialists with irregular working hours, also expressed their needs for more health support from the UMC. Vanuit de bedrijfsgeneeskundige kant bijvoorbeeld meer dan 1 dienst boven je 50 zou niet meer moeten mogen. Want iedere schilder die te hoog klimt wordt ook beschermd. Maar wij, het zal me niks verbazen dat je een aantal jaar eerder dood gaat door deze diensten. Dus dat zou veel beter ondersteund moeten worden; vanuit geneeskundig oogpunt en bedrijfsveiligheid (int. 2 MD) Another additional support measurement mentioned by some women is the information facility of the UMCs for several important issues; the communication for women about existing women supporting networks, subsidies and grants especially for women is lacking in most cases. Part time working The definition of part time working was in many cases defined by the women as working less than 5 days per week. Nevertheless, most women have stated in their contract that they work less than 5 days per week, but are filling their free days and weekends with work. With the negative consequence that women are trying to fulfil the regular tasks in the limited days at the office, which will only lead to an increasing workload. Het nadeel van part time werken in een hogere functie is dat je alles gaat proppen in de dagen die je er voor hebt staan, om dat je de overige dagen meer flexibiliteit in je werk wilt, waardoor uiteindelijk de werkdruk nog meer zal verhogen (int. 9. MD) So in practice almost all women participating in this research project are working full time or even more than full time. Most women were convinced of the importance of a full commitment to the job which means you know when you want to achieve a higher position that you can not work from 9 until 5 and only during 3-4 working days per week. In mijn functie heb ik er toen bewust voor gekozen van ik blijf hier werken 5 dagen per week, en dan vul ik de tijd die ik thuis nodig heb wel op een andere manier op (int. 23 UHD) Furthermore for professors and head managers it is of great importance to stay in touch with the department. Many women expressed this underlying reason why they are not fond of working parttime. Some women even expressed their opinion that working part time has major negative influences on the career: Al het werk gaat langzamer, en het blijft toch een wedstrijd, degene die als eerste publiceert; wie als eerste iets vindt. En dat verlies je altijd als een ander 5 dagen werkt en jij maar 3 dagen. Je moet gewoon heel hard werken om in die frontlinie te zitten. En dat lukt je echt niet met 3 dagen in de week (int. 1 UHD). Ze (vrouwen) willen minder concessies doen; ze willen part time werken, binnen de wetenschap zit je wel als top sporter, en moet je je afvragen of dat kan?! (int. 20. Prof) 43

44 Bij gynaecologie hadden we op een gegeven moment zwangere vrouwen die maximaal gebruik maakten van hun rechten: part time werken en ouderschapsverlof. Waardoor die afdeling niet meer draaide. Je staat toch wel een beetje stil als je 2 a 3 dagen werkt; dat heeft gewoon consequenties (int. 14. UHD) One woman expressed very clearly that women should become aware of the negative effects part time working has on the career, and that women should be warned when they express the need of working part time: Dit klinkt misschien heel zwaar maar ik zou wel willen dat vrouwen gewaarschuwd worden van; als je drie dagen gaat werken, dan geef je wel je carrière in de wetenschap op! Van belang is vrouwen hiervan bewust te maken, want als ze een carrière willen moeten ze daarin niet de verkeerde keuzes maken (int. 1 UHD). Nevertheless, a lot of women also expressed the importance of the possibility to work part time in order to have children and to combine a private life and a career and give conditions in which part time working is allowed; Ik vind dat moet kunnen. Ik ken mensen die part time, het moet niet 2 dagen zijn, maar iets meer dan 3 moet het wel kunnen. Als mensen gewoon heel efficiënt en constructief hun werk kunnen uitvoeren, dan kan dat in mijn ogen ook part/time (int. 6 MD) In the answers on the question if it possible to work part time and get a professorial status, the opinions of the women were divided. Some women thought being a professor combined with working part time is possible, only under certain circumstances. For example: you need to work at least 3-4 days per week, need good arrangements at home, have more flexible working hours and have the possibility to work at home; Ik vind dat er een hoop dingen in 4 dagen kunnen. Het hangt er meer vanaf of mensen daar een bepaalde mate van flexibiliteit hebben en wel de ambitie hebben om hoogleraar te worden. Je moet toch op een hoog niveau presteren; je moet je laten zien. En dan kan voor een groot deel in 4 dagen als je flexibel ben (int. 14. UHD) Some women thought being a professor and working part time is not possible; Dit zijn geen part-time banen, voor een paar uurtjes per week, dat gaat gewoon niet. Als je op hoog niveau de wetenschap wil bedrijven, dat kan niet in een paar uurtjes per week (int. 5 Prof) Almost all women agreed that combining a professorial status and being a head manager, is not possible to perform by working part time: Als je een beperkte taak hebt, als je je richt op een bepaald stuk onderzoek, dan zou het kunnen part time. Maar als je deze moet combineren met afdelingshoofd, dan zie ik de invulling van deze baan afdelinghoofd/hoogleraar/eindverantwoordelijk parttime niet voor me (Int. 8. Prof) Selection procedure In theory most women addressed the fact that the selection procedure must be a transparent and open procedure. Nevertheless, despite the arrangements the UMCs take to create this, most selection procedures are still closed; on forehand selected applicants or by consulting the network the higher positions are determined. 44

45 Voor de nieuwe positie van het afdelingshoofd heb ik gepleit voor een open procedure, maar men vond dat niet interessant. Geen open selectie, dus (int. 5 Prof) Since the higher positions are mostly possessed by men, men are more likely to select their own successors. In many cases the women stated that men select a man more easily than a woman, to become his successor. Most women point out the phenomenon of The old boys network. A lot of women experience the phenomenon of a dominant man culture at the top of the organisation, which leads in some cases to the situation that women are obstructed in achieving a higher position: Het enige waarom ik twijfel, is dat je als je hoogleraar bent een bepaalde air moet hebben. Je moet daar staan als hoogleraar. En dat is iets wat ik niet heb. En niet zo snel zal krijgen. Ik zal mij nooit gaan gedragen naar de academische standaard/gedragsregels (int. 1 UHD) Er is wel degelijk sprake van een Old Boys Network, dat zie ik om me heen gebeuren (int. 5 Prof). Men is toch op zoek naar iets wat er altijd was en dan blijven er dus maar mannen komen (int. 21. Prof) In order to create more transparency and to stimulate more women to be selected for a higher position, most UMCs have obligatorily arranged that at least one woman should be part of the nomination committee. With the negative consequence that always the same woman is asked to take part in this nomination committee, because so few women are having a higher position in the UMCs nowadays. This in some cases led to frustration of the women: In de benoemingscommissie moet 1 vrouw zitten, maar dat is vaak ook een excuustruus (int. 12. Prof) Je ziet dan toch vaak dat de benoemingscommissies gedomineerd worden door mannen, dan ik het ook lastig als er minder vrouwen zijn, dan zijn ze automatisch ook ondervertegenwoordigd in commissies. Dat is wel lastig. Want als die vrouwen er niet zijn, of het zijn altijd dezelfde; wat uitermate irritant is. Want ik zit in alle commissies, en er moet altijd een excuustruus in. Er moet natuurlijk altijd een vrouw in, maar je wordt dan wel vaker gevraagd dan de gemiddelde man (int. 20. Prof) Most women plead for more women participating in the nomination committee. Nevertheless, most women stated that the transparency of the selection procedure must be improved by the UMCs in order to gain more insight in what you need to fulfil as a woman to become more easily selected. This in order to stimulate, support and motivate your female employees to be selected and to support an open dialogue about the departments scouting for female talent. Vanuit de Raad van Bestuur zouden er mensen moeten zijn die wel degelijk gevoelssprieten hebben die spotten of er bescheiden getalenteerde vrouwen zijn die heel veel presteren en die geholpen moeten worden (int. 2 UHD) Tools introduced by the women themselves to reach more transparency are to set up criteria for both men and women applicants, to make the road towards professor/head manager positions more visible. Nevertheless, most women also stated the importance of selecting successors based on quality, and not on gender. Examples of tools to stimulate or support more women by positive discrimination or setting a quota were refused by most women. Most women struggled with the phenomenon that being selected for a higher position is not only defined by having a outstanding Curriculum Vitae, you also should be aware of the informal rules. 45

46 Het is meer dan de optelsom van feitjes. Naast iemands CV, moet je ook geloven dat hij of zij ook goed is. Zo n commissie gaat daar toch in mee, de informele regeltjes. Meestal komt het er dan op neer dat de man zich beter neerzet dan de vrouw (int. 15. Prof). Alleen met de formele criteria waar je aan moet voldoen, is niet voldoende. Het informele spel daar omheen; dat is duister. Dat moet je leren (int. 23. UHD). The interviews made clear that most women already have an outstanding Curriculum Vitae, but are not known with the informal rules, which play however a very important role in the selection procedure. Having insight in the informal rules of selection is to create a supportive area of prominent people around the applicant and having the belief that this applicant can do the job. In many cases this lack of insight about what the rules are of the selection procedure of both women and the UMCs, created a lot of frustration among women: Ik heb geen idee, ik snap werkelijk niet waar je aan moet voldoen. Het staat er wel, er zijn wel regels en daar voldoe ik ook aan, maar dan zeggen ze opeens daar doen wij niet aan. Je moet op je hoofd gaan staan, het werkt gewoon niet. (int2. MD). Ik heb bijna alle wegen wel bewandeld om het tij te keren, maar dat is allemaal niet gelukt (int. 24. UHD). Most women stated that reaching a higher position is a natural cause of hard working and being dedicated to your work, nevertheless for some women this is still not the case; Ik heb het eerst voor mijzelf gedaan, omdat ik het leuk vond, maar nu ben ik op een ander station. En moet er iets gebeuren, en als dat niet gebeurt dan raak ik op een gegeven moment gefrustreerd en heb ik er geen zin meer in (int. 2 MD). Mijn eigen selectieprocedure heeft veel te lang geduurd, voor mijn eigen perceptie. Op een gegeven moment is als je kijkt naar collega s om je heen (mannen), dat ze in die beperkte omgeving allemaal hoogleraar zijn. Op een gegeven moment denk je, waarom ik niet (int. 7. Prof). Also during the interviews many times other forms of selection procedures were discussed; for example the system enhanced in Belgium. As an applicant you will be nominated, as soon as you have met certain requirements. Which means the selection will only take place based on the formal rules, not the informal rules. Some women advocate this system: Als je ziet hoe gemakkelijk het gaat in België, maar dan zeggen ze hier (in NL); ja maar dat is dan zo n professor; Who cares! De titel ligt er, de uitstraling, en niemand die vraagt hoe zit dit nou. Moeten we nou zo moeilijk doen in NL?! (int. 17. Prof). Nevertheless, also some women were against implementing this system in the Netherlands, because they doubt the quality extended by this system Subsidies and grants During the interviews it became clear that the subsidies and grants can lead to a big chance for women aiming for a higher position. The national initiatives in the Netherlands, in order to support women The Innovational Research Incentives Scheme are at last fruitful. Ik heb die positie gekregen omdat ik een subsidie had aangevraagd, en dat ik daarmee een Aspasiabeurs heb gekregen. Hiermee kwam ik hoger in rang. Dus ik heb zeker door stimulering van NWO op een UHD positie gekomen, echter niet door het UMC of door de afdeling (int. 1. UHD). 46

47 It is also considered to work as a national pre-selection procedure for a professoral position: En die VIDI subsidie is een persoonlijke beurs, en dat wordt bepaald aan de hand van je CV Landelijk. Of die goed is, zodat je een hoogleraarwaardige subsidie daarvoor kan krijgen. Dan is de selectie landelijk gebeurd, zo zie ik het (int. 1 UHD). Nevertheless, the information facility provided by the UMCs for women about possible present subsidies and grants can be improved. Ik heb veel ideeën, maar geen tijd. Ik zou best wel ondersteuning willen in uitwerken van protocollen. Zo zou ik meer subsidies kunnen aanvragen. En dan had je geld van KWF, maar dan was er niemand die je kon helpen voor de financiële kant waar je dat geld kon onderbrengen (int. 9 MD) Organisational culture During the interviews the organisational culture was questioned by postulating different questions. The mindset within the UMCs was questioned in three several ways. First of all by asking if the UMCs are aware of the added value women can have for the organisation. Most women responded that the Charter Talent at the Top is a good initiative, because finally the Board of Governors of the UMCs were shaken up. Nevertheless, if the Board of Governors keeps its promises by putting goals into actions is perceived as being doubtful by most women. Niet alle UMCs hebben de Charter ondertekend; de ene is daarin ook actiever dan de ander. Daarnaast zeggen ze wel met de mond dat ze heel actief zijn, maar ze doen niet zoveel. Ze moeten wel; het is meer opgelegd dan echt vanuit het eigen gevoel. Ze moeten meegaan met de trend van deze tijd, maar of ze die percentages halen..ik betwijfel het (int. 24. UHD). Most women are content with the state of mind of the Board of Governors, it is mostly the state of mind of the middle- and line management the women are worried about. Most women addressed that the organisation do not see the added value of women for their organisation: Je doet je organisatie tekort als je geen gebruik maakt van vrouwen (int 4 Prof). Having a supporting, stimulating and motivating head manager, is the golden key for most women to open the door towards a higher position. The woman who have or had the privilege of a good head manager, have mostly become professor or head managers themselves overtime. Ik heb altijd veel geleerd en werd ook gestimuleerd door hem (afdelingshoofd). Door mijn zelfvertrouwen aan te wakkeren en te laten zien wat ik wel kon en niet alleen wat ik niet kon. Ik heb veel waardering gekregen voor mijn bijdragen en veel positieve feedback. Mijn leermeester is heel belangrijk geweest voor mij geweest; zowel inhoudelijk als procedureel heeft hij mij veel geleerd (int. 12. Prof) Hij (afdelingshoofd) speelt een belangrijke rol in mijn carrière, want je ziet toch wel dat mensen die een hogere positie krijgen, die beslissing ligt vooral bij hem. Dus ik ben daar wel heel erg van afhankelijk (int. 6 MD) Het werkt gewoon het beste als het hoofd van de afdeling het loopbaanperspectief van zijn werknemers in de gaten houdt (int. 5 Prof). 47

48 Nevertheless, women who do not have the privilege of a supporting, stimulating and motivating head manager, were in many cases obstructed in achieving a higher position. This led to a lot of frustration among these women. Je zult maar een baas hebben waar je het niet mee kunt vinden, dan wordt het wel heel moeilijk (int. 4. Prof /Head manager). Het huidige afdelingshoofd stelt het uit steeds uit, hij zegt continu; laten we er over een half jaar nogmaals over praten (int. 24. UHD). Ik voel me helemaal niet gesteund door mijn afdeling (int 2 UHD). In one case the male head manager made a transition himself, by experiencing the difficulties women have when they need to combine their private life and career: Toen heeft hij zelf ervaren hoe het is hoofd van de afdeling te zijn en kinderen te moeten opvoeden (na dood van zijn vrouw). Vanaf dat moment kreeg hij meer respect voor wat ik deed; en heeft me meer vrijheid gegeven, door middel van meer flexibiliteit en thuiswerken (int. 21. Prof). Furthermore, the women were asked if they considered the UMCs as a women supporting and women friendly working environment. Most women considered the UMCs working environment to be neutral: no extra women supporting of friendly measures were taken. Some considered that being a woman had nothing to do with their job or the way they are treated by their colleagues or head manager. They did not feel impaired because of their gender. Ik heb me nooit belemmerd gevoeld in mijn carrière doordat ik vrouw ben (int. 5 Prof). Ik moet eerlijk zeggen dat ik me niet als vrouw hier voel werken, maar dat ik mijzelf meer als een professional zie (int. 8. Prof). Only a few of these women did not express a need for special arrangements for a more women supporting UMC working environment. These women do not neglect the fact that some women are obstructed in their career because of the organisation culture, but they do not consider themselves being part of this group, they consider their career as being (gender) obstacle free. Binnen onze afdeling zie ik geen behoefte aan een bewustzijn van de man-vrouw verdeling (int. 1. UHD). Nevertheless, some women also expressed the lack of putting extra effort in the UMCs working environment to make it more suitable for women (more women supporting and friendly); especially becoming aware of the position of the women within the UMCs is very important. Some women did feel that their gender was playing a role in the job they do. De vrouw wordt minder gehoord, en haar mening telt minder, ze wordt minder serieus genomen (int. 2. UHD). Er zijn projectleiders,die vandaag nog beweren: ik neem absoluut geen vrouw aan die nog zwanger kan worden (int. 7. Prof). The so called stereotype thinking that women are not made for having a top position is still present in the UMC culture. Nevertheless, a positive trend is seen: 48

49 Maar ik zie ook dat de mannen steeds meer zorgtaken op zich nemen. Man en vrouw rennen tegenwoordig beiden naar hun zieke kinderen. Het wordt meer geregeld op individuele basis; wie heeft er meer tijd, dan man vrouw taken. Dus die stereotypen zijn enorm doorbroken sinds mijn tijd (int. 12 Prof). Women support was in many cases also translated into financial support for irregular forms of child day care, offering of female career development programs, female mentoring and building women supporting networks. Ik vind het UMC niet vrouwondersteunend, want ik vind dat het UMC in gebreke blijft met de financiële ondersteuning t.a.v. de kinderopvang (int. 10. UHD). Furthermore, departments with a higher amount of women employees are mostly considered as more women friendly and more women supporting by the women, which in turn has a positive effect on the inflow and flow through of women in higher positions; Wij zijn een van de vrouwvriendelijke afdelingen, in die zin geëmancipeerde vrouwen. En ik denk ook wel dat doorgaat (doorstroming), meisjes en studentes die ons zien, ook eerder geneigd zijn naar een vrouw toestappen. Dus ik krijg ook veel vrouwelijke kandidaten (int. 4. Prof). The interviews also revealed a lot of obstacles for women to achieve a higher position due to the organisational culture present in the UMCs (see above). In order to prevent this women claimed that it is of great importance that women are represented in all echelons of the UMCs; Betrek vrouwen die in de hogere regionen zitten, betrek ze in adviescommissies, of spot ze. Weten jullie goede vrouwen?! Dat gebeurt gewoon niet (int. 7 Prof). Secondly most women addressed that a diversity policy will be the solution for the underrepresentation of women in higher positions; ik hou wel van het gemengde model; ik denk dat het heel goed is; alles gemengd. Het is goed om diversiteit te hebben. Man-vrouw en qua hun achtergronden, en diversiteit qua land en verschil in privé interesse. Als je allemaal hetzelfde bent; zou ten eerste saai zijn en prikkelend en fris. (int. 9. MD) Women supported programs and policies. An important part of the interviews was about the women supporting programs offered by the UMCs; the information of the quantitative results, background information provided by the UMCs and the interviews gave information about the present women supported programs in the UMCs. Including female career development programs, Mentoring and coaching programs, additional training and education and women supporting networks; see overview result of literature and appendix II Translation into CTQs; Selected obstacles/needs/wishes The negative and positive experiences with regard to the working experiences of the women in the UMCs are transferred into the CTQs; main obstacles women experience with regard to the working environment obstructing their career and need/wishes addressed for recommendations of a career policy advice. Focused on the working environment the following main obstacles can be identified, 49

50 according the qualitative and qualitative results (see figure 6); the main obstacles are divided into four categories. UMCs characteristics obstacles: these obstacles have to do with the characteristics of the UMC working environment the women are working in; High workload; Difficult to combine clinical tasks and research tasks; Merge of University and UMCs; Hierarchal organisational structure; No available (higher) job opportunities for women; Secondary work requirements obstacles: these obstacles have to do with the secondary work requirements which obstruct women of achieving a higher position; No (limited) possibility to work at home; No (limited) possibility to work flexible; No child day care; not taking into account the irregular working hours No financial compensation/support for child day care of other forms of child day care; (au pair, nanny, day care at home) Hardly information facility; for grants and subsidies No additional support; secretary, staff members, IT, office; Organizational culture obstacles: these obstacles have to do with the organisational culture which obstructs women of achieving a higher position; No supporting line-middle management; UMC not aware of the added value women have for UMC environment/ UMC is not scouting for female talent; Discrimination, contempt of women qualities, no respect for women; Closed selection procedures; No transparency; Organizational culture obstacle: dominant men culture at the top and Old boys network ; Stereotype thinking; women do not have ambition for achieving a higher position. Women supporting programs/policies obstacles; these obstacles have to do with the absence of women supporting programs and policies within the UMCs; No women supporting programs; training, intervision groups, workshops, mentoring, coaching, career development programs especially for women; No special policy for women; No women supporting networks; not offered or not actively supported by the Board of Governors; Focused on the working environment the following main needs and wishes (CTQs) can be identified, according to the quantitative and qualitative results (see figure 7); UMC working characteristics needs & wishes: Prevent competition between departments by a good division of research items More feedback from higher echelons in the UMCs towards women in top positions (emphasize the women strengths and weaknesses, and how women can improve themselves). 50

51 More women in nomination committee (nowadays only one woman is appointed obligatory) Improve information facility towards women; the progression of the share of women in the UMCs, new activities of the women networks and new activities of the UMCs to support women, information on available grants, subsidies and programs. More attention for research (balance between University and UMCs); bring more attention towards research instead of (continuously) focusing on patient care. Create higher jobs for women; after training women well, make sure there are vacancies for women to fulfil a higher position. Secondary work requirements needs & wishes: Offer additional support; own office, secretary, staff members, financial compensations, arrangements for family, help with request for grants and subsidies, development of research proposals, to attack more doctoral students. Offering possibility for duo-positions in top positions. Offering and improving child day care; especially take into account the irregular working hours and offer financial compensation for irregular forms of child day care (nanny at home or au pair). Offer and support (more) flexible working hours (where possible) Offer and support (more) working at home (where possible) Offer health support for female employees (especially medical specialists; sport and relax facilitation. (Financial) support for work gaining experiences abroad. Organizational culture needs & wishes: Stimulate cultural change by allowing part time working Stimulate cultural change of the attitudes towards the adding value of women for the UMCs; training the middle and line management of the UMCs on gender issues; stereotyping, discrimination, bias. Support and stimulate scouting academic female talent. Support and stimulate transparency in selection procedures; make a guideline of rules applicable for achieving a higher position. Adding diversity and gender to performance assessment; the annual review on gender and diversity on individual basis. Women supporting programs/policies needs & wishes: Establishing and supporting women networks within the UMCs; these networks need especially be supported by the Board of Governors. Developing, supporting and implementing coaching/mentoring programs for women, with special attention for gender issues. Developing, supporting and implementing career development programs for women, with special attention for gender issues. Developing of intervision groups for ass. Profs and assoc. profs and new professors. Offering additional training for women focussed on: organisation, management and leadership. Supporting more female role models in UMCs Supporting and taking into account individual needs and wishes of women in these programs. 51

52 12.3 Visual summary; the working environment UMCs. Figure 6; Main obstacles provided by the working environment UMCs 52

53 Figure 7; Main needs & wishes towards the working environment UMCs 53

54 13. Qualitative sub-results: Individual characteristics 13.1 Female individual characteristics and experiences The results in this cluster, individual characteristics, will describe the women s ambitions for a higher position, the obstacles women experience in their way to the top and the participation of women in different programs in order to enlarge their chances of achieving a higher position Ambition for a higher position From the quantitative and qualitative results it was clear that most academic women working in the UMCs (MD, associate professor, assistant professor or professor) have the ambition for a higher position. Nevertheless, during the interviews the interviewees did not express themselves in this way. Ik was vroeger helemaal niet ambitieus, het moet een beetje leuk zijn. Ik ben echt niet gegaan van ik moet professor worden (int. 12 Prof). Most women are very modest about their achievements and definitely do not show off their qualities and competencies. Women are very concentrated on the content of their specialities, not trying to become the best, but to perform the best in their medical & research speciality. They emphasize the importance of their research field and the job they are fulfilling, but are not concentrated on getting a higher position for the power, status or becoming famous. Nevertheless most women who have reached a professorial or head manager status consider their power and status of secondary importance. Some women realized during their years of being a professor or head manager that having a higher position helps you to make changes, or to push your opinions and this strengthens you in gender issues; Het is leuk dat je dingen voor elkaar krijgt, dat je onbekommerd kan organiseren, wat ik doe lijkt toch meer effect te hebben en dat heeft echt te maken met die machtspositie. Het werkt. Waar ik vreselijke moeite mee had als UD, was om dingen voor elkaar te krijgen die makkelijk van tafel geveegd worden. Nu heb ik meer gezag en gebeurt het gewoon (int. 3 Prof). Voorheen zag een aantal mannen mij niet staan; en nu ik afdelingshoofd ben ineens wel (int. 22 Prof). Unfortunately not all women are aware of these benefits of having a higher position, and therefore do not make use of the power and status in their research field. The biggest part of the women who are not a professor or head manager yet lack self-confidence about their possibly becoming a professor or a head manager. These women are very much focused on the development of the department and only when people considered less capable than they do become a professor, they find themselves worthy enough to become a professor themselves. Only a few women were convinced during the interview about themselves becoming a professor; Omdat ik denk dat ik het kan, ik kan goed een groep begeleiden, ik ben sociaal sterk, kan heel goed in de gaten houden wie op welk moment support nodig heeft, en waar begeleiding in nodig is. En wie het al zelf kan gaan ontdekken. Ik heb daar de voelsprieten voor, ik denk dat dat heel erg belangrijk is voor een hoogleraar. Ook in vergaderingen en management kan ik doorzien wat belangrijk is en wat niet (int. 1. UHD). 54

55 Women main obstacles in the struggle for achieving a higher position: From the qualitative data main obstacles experienced by women aiming at a higher position have been identified: Women do not express their career wishes and needs: Women are not very pro-active when it comes to expressing their career needs and wishes and taking action to support their careers; Ik hoor zelden een vrouw zeggen; ik wil hoogleraar worden (int. 22 Prof) Ik zou toch wel verwachten dat je directe leidinggevende tegen jou zegt: joh het is toch wel tijd nu. Hoe gaan we het aanpakken waar je naar toe wilt en waar ik jou ook wil hebben. Want je zou verwachten dat hij dat ook zou moeten willen (int. 2 UHD). Women have a very different style of achieving a higher position in comparison with men: En dat doen de mannen wel, sommige mannen gebruiken ook veel meer hun ellebogen en ook wel eens ten koste van, en dat zou ik dus nooit doen. Ik zou nooit iemand zwart maken, of zeggen die moet je niet hebben, terwijl ik weet dat die net zo goed is als ik of beter. En dat doen mannen wel (int. 2 UHD) Als ze me nu zouden vragen (hogere positie), misschien doe ik het dan wel. Terwijl een man zou denken: Daar is het nu en ik spring erin (int 4 Prof). It is of great importance that women become more active in expressing their career wishes and needs and undertake actions: Je moet continu aan de deur kloppen, aangeven dit is wat ik wil, we hebben dit afgesproken, we zijn een half jaar verder. Je moet ook echt zelf willen; want als je er half in staat wordt het ook niks (int. 19 Prof). Women do not clearly define a career path for the future; Women do not clearly define a career path for the future, which might be an underlying reason why women are not very pro-active; Ik heb er niet bewust naar gestreefd, het is niet zo dat ik altijd al wist dat ik hoogleraar wilde worden. Ik dacht wel van: ik wil promoveren. Maar ik dacht niet op mijn 35 ste van: ik wil hoogleraar worden (int. 3 Prof). Ik ben niet bewust van mijn carrière, het is best ingewikkeld om erachter te komen hoe dat zit in je hoofd (int. 4 Prof). It is of great importance that women become more aware of the need to define their career path, in order to undertake more career focused decisions and actions. A supporting head manager or coach could assist women in this process. Women lack self confidence; Most women do not feel secure and have less self confidence regarding the achieving and executing of a higher position; 55

56 De jonge mensen van nu hebben die onzekerheid niet die ik had en ze kiezen bewuster (int. 12 Prof) Het zijn vaak vrouwen rond de 30, net UD, of met een vaste aanstelling en dan komen de onzekerheden. Van: kan ik het wel?! (int. 4 Prof). It is of great importance that women strongify themselves and create more self confidence. Again the support of the head manager and/or coach is necessary to achieve this. Elke keer moet je net iets verder reiken dan je zelf denkt. Door al die stappen krijg je wel steeds meer zelfvertrouwen (int. 4 Prof) Ik moet altijd mijn zelfvertrouwen opbouwen, en dan ben ik op mijn plek in de huidige positie. En dan wordt het alweer een beetje saai en ga je weer om je heen kijken (int. 4 Prof). Women are less visible; Women are excluding themselves of being visible by not participating in additional career activities after work hours; Vrouwen in de leeftijd dat ze kinderen krijgen doen weinig extra s naast hun baan, in de avonduren. En zijn daardoor minder zichtbaar, waardoor de mannen het voortouw nemen (int. 8 Prof). Women obstruct nomination for higher position themselves; Some women obstruct their nomination for a higher position in all consciousness; Ik heb geprobeerd het een tijdje tegen te houden. Vanwege mijn leeftijd en ik had mij voorgenomen dat ik twee jaar eerder nog had willen verkassen. Dus in het begin dacht ik: Jullie zijn gewoon te laat, ik doe het niet. Ik was graag rond mijn 55e benoemd, maar toen gebeurde er niks, en toen dacht laat maar (int. 3 Prof). Besides the belief that there is such as a perfect age to become a professor, women also has strict believes about when they are ready to act as a professor or head manager. These believe might also obstruct on forehand women in becoming a professor; Het is typisch vrouwelijk dat je vindt dat je meer gepresteerd moet hebben voordat je ergens aan toe bent. Mannen vinden het vaak wel goed. Die vinden zich snel goed voor een positie. Vrouwen zijn bescheidener en stellen hogere eisen aan zichzelf voordat ze tevreden zijn. En vinden eigenlijk dat ze 1.5 keer meer gedaan moeten hebben als de man, om voor dezelfde positie in aanmerking te komen (int. 5 Prof). Furthermore, some women need to take a lot of time to consider if they want to be a professor, after they have been asked to apply; Vrouwen wachten af en zeggen vaak nee, of ik wil nadenken. Dat vind ik schokkend! (int. 11. Prof). Women do not like to be in the spotlight Some women do not like the status and position a higher position brings, because these positions require a certain attitude and are most of the time bound with a lot of responsibility. Je staat als als hoogleraar op een plek van de organisatie waarin je geacht wordt dingen aan te sturen, en waar je ook een portie ellende op je bord krijgt, waarvoor je verantwoordelijk bent dit op te lossen omdat je op die positie zit. En het 56

57 is toch een functie waar heel erg naar je gekeken wordt, en dan vind ik dat je het goed moet kunnen oplossen. En dan is de ruimte krap en dan moet je geen uitglijders maken (int. 3 Prof). Women are modest about their achievements, qualities and results; Most women do not show off their results, which do not only make the women less visible but might also obstruct them in achieving a top position. Ik ben niet iemand die met mijn CV loopt te wapperen. En dat doen de mannen wel! (int. 2 UHD). Mannen durven meer, ook dingen waarvan ze weten in hun tenen dat ze het nog niet kunnen, maar die doen het gewoon. En wij (vrouwen) willen eerst wat kunnen voordat we het doen (int 18 Prof). It is of great importance that women become less modest about their achievements, qualities and results, in order to become more visible. Women should learn how to set a personal marketing. The support of a head manager and/or coach could be very useful for women in becoming more visible. Some women refuse career support (not participating in programs) Some women are not aware of the importance of participating in career development programs, mentoring/coaching programs or women networks. It is of great importance that women participate in these activities to enlarge their changes in achieving a higher position. Maar ik vind wel, vrouwen zijn net zoveel waard als mannen en als de gelegenheden worden je aangeboden, dat je die wel moet aanpakken (int. 6 MD). Women are not attracted to higher functions Some women are not attracted to achieve a higher function, because of the heavy responsibilities they will have Mijn passie is echt klinische zorg en onderzoek. Management trekt me niet aan, je verdwijnt uit je vak! Daar heb ik geen behoefte aan (int. 25 Prof). Ik was vooral bezig met alles wat ik leuk vond en ik weet niet of die taken van hoogleraarschap of ik die wel leuk zou vinden. Ik weet wat ik heb, en wat ga ik dan inleveren. Dan moet bij veel overleggen zijn en moet ik naar buiten treden en dat is ook helemaal niet mijn ding (int. 22 Prof). Women do not take career opportunities/changes to gain success; When opportunities and chances for success are offered to women, not all women do embrace these opportunities. Hier loop ik dus zelf tegenaan, want ik heb wel meer vrouwen in mijn omgeving die wanneer ze te horen krijgen: Kom op jij kan het ook! snel zoiets hebben van Ach ja misschien is het wel niks voor mij of ik wil toch drie dagen werken en dan denk ik ook wel eens van joh, pak het ook op. Ik zie in mijn omgeving toch dat vrouwen niet oppakken wat er mogelijk is. En dat vind ik erg jammer (int. 1 UHD). Samen met een collega ben ik op zoek naar een opvolging voor mijn positie volgend jaar. We hebben een aantal kandidaten, maar toen wij die belden gaven ze aan dat ze eerst moesten nadenken. Nadenken, dat begrijp ik dus echt niet, als zoiets op je pad komt dan grijp je dat met beide handen vast (int. 11 Prof). 57

58 Women want to work part time; A lot of women are working part time, but are not enough aware that working part time can seriously obstruct your career. Ambitie kan een rol spelen, maar aan de andere kant ze hebben gestudeerd, ze zijn gepromoveerd, ze hebben er al zoveel voor overgehad en zoveel jaar studie ingestopt, en dan hou je ermee op. Dat vind ik soms moeilijk om te zien. En dat zie ik nooit bij mannen, er is hier geen man die part-time werkt. Maar dat heeft toch aan het begin gelegen, en dan denk ik: Weet wat je weggooit als je part-time gaat werken! (int. 1 UHD). Women are not ]good in networking; Women are not that good in networking and/or are not aware of the importance of networking or are not networking with also the agenda to make your self more visible. This does not only happen on a national scale but also worldwide. Ik ben niet zo goed in netwerken, dat schijnt ook een vrouweneigenschap te zijn (int. 2 UHD) Ik vind netwerken heel erg onnatuurlijk, ik vind het onprettig maar ik weet dat anderen op deze manier wel hun doel hebben bereikt (int. 2 UHD) Ik doe het niet om bewust te netwerken, ik vind mijn vak en werk gewoon ontzettend leuk. En ik vind het ook belangrijk dat er mensen in die besturen zitten die goede beslissingen nemen. En als daar bij komt dat je naamsbekendheid krijgt dan is dat mooi meegenomen. Absoluut geen 1ste doel (int. 6 MD). Only a few women stressed during the interviews the importance of networking: Ik vind dat netwerken wel heel belangrijk is; ik onderhoud al mijn contacten zorgvuldig. Ik vind het belangrijk om te weten waar men zit, en dat ik weet voor welk onderzoek ik waar terecht kan (int. 10 UHD). From the qualitative data it became clear that women practice networking in a very different way in comparison with men. Women like more selective networking: Ik zit bijvoorbeeld niet bij een voetbalclub. En ik ben ook niet zo n type om naar de kroeg te gaan. Dat doen mannen toch gemakkelijker volgens mij. Ik denk dat ik gemakkelijker een uitnodiging aanneem voor een bepaald bestuur, waar een ander daar moeilijker over doet, maar ik ga niet bij een club of in de kroeg zitten (int. 3 Prof). Ik ga heel secuur met mijn tijd om; als ik dan naar borrels ga, bedenk ik wel van tevoren wie ik wil spreken (int. 5 Prof). Women have difficulties in adapting a new role; Women have difficulties when they climb the hierarchical ladder: you have to change your attitude towards the department and need to act like the boss now ; Je komt in omgevingen waar je je anders moet opstellen, maar probeer daarin bij jezelf te blijven en ga geen rol spelen. Mensen prikken door je rol heen; probeer eigen krachten voorop te stellen en een helder doel neer te zetten en dan te kijken hoe je dat voor elkaar gaat krijgen (int. 19 Prof). 58

59 Women want everything at once: Most women expressed their broad interest; they like a lot of tasks, subjects, projects, which makes it difficult for women to decide what they really want to do. Furthermore, because most women have such a broad interest, they also have difficulty to say no. Als er iets afvalt, komt er weer iets bij. Daardoor zit je gemakkelijker in zo n profiel omdat je veel dingen aanneemt. Ik ben nieuwsgierig en wilde graag promoveren, en ik wilde altijd weten hoe dingen zaten (int 3 Prof). De mensen die nu afstuderen en niet weten wat ze moeten. Ze zijn namelijk zo breed georiënteerd. Die lopen in eerste instantie tegen tegen zichzelf op, wat moet ik nou doen?! (in. 7 Prof). Women have difficulties in making choices, set priorities and saying no. It is of great important for those women who have difficulties to make choices, to set priorities and say no. These women have great benefits of getting support from a mentor/coach. Van belang is toch bij die vrouwen die heel veel willen dat je hun ambities verkleint. Want ze willen zo ontzettend veel; jonge briljante mensen willen altijd alles en dat kan niet, daar loop je op stuk (int. 7 Prof). Women do not make big career steps Women do not want to take big career steps, they want to stay in their safe zone and take steps which they can preview. Besides that, with every step women take extensive cost-benefit analyses need to be made. Ik noem dat altijd het groots en meeslepend: ik heb zelf altijd de neiging om te bouwen op wat ik heb. Wat ik kan overzien; dit kan ik en heb ik. En vanuit daar bouw ik verder. Wat ik zie is misschien is wel een gender issue. De mannen om mij heen denken Dit is het en dat moet het zijn (grote stap. Die stap is veel groter, dat noem ik groots en meeslepende projecten en dat heeft me tot nu toe gestimuleerd. Ik kan niet buiten mijn eigen grenzen kijken; ik kan niet iets groots en meeslepends opzetten als ik het niet zie (int. 4 Prof). Velen moeten hun positie nog overschreeuwen, om te bewijzen dat ze op die positie horen, omdat zeer eigenlijk zelf nog niet in geloven. Het zogeheten bedriegers-syndroom. Je komt er dan achter dat je eigenlijk helemaal geen goede onderzoeker bent. Vrouwen hebben hier wat langer voor nodig om te groeien naar de situatie ik hoor op deze positie, ik ben het waard en ik heb er de capaciteiten voor (int. 4 Prof). Women need support of the environment, in order to consider themselves capable for a higher position Most women do not have the self-confidence to judge whether they consider themselves capable of executing a higher position. Women take a look in their nearby environment and compare themselves with others, in order to determine whether they are capable of executing a higher position. Ik kan het best aardig, maar ik kende meer mensen om me heen die het beter deden. Dan moeten die eerst ook maar hoogleraar worden (int. 5 Prof). Women are less aware of the power play at the top Women are focused on building an outstanding CV, but not on the power play at the top. The informal rules need to create a supporting area towards a top function, is said to be of an additional support for the content of the CV. 59

60 Training is goed, maar uiteindelijk gaat het om de inhoud en dat je gewoon een goed CV moet hebben (int. 9 MD). It is of great importance that women become aware of the rules at the top and use these to enhance their chances of getting nominated for a higher position. Ik heb wel geleerd dat je wat meer mee moet bluffen, dat spel mee moet spelen (int. 5 Prof). Ik heb daar zo mijn trucs voor en meestal geniet ik ook wel van het spel (int. 10 UHD). Women are not that good in delegating tasks Women, who just have achieved a top function, are mainly keeping control on everything Wat mensen doen in het begin is zichzelf volledig ten dienste stellen van anderen, waardoor ze zich volledig uitputten (int. 4 Prof). Women have difficulties in taking themselves seriously Some women addressed the problem that women do not take themselves seriously. Ik heb vrouwelijke collega s die meer moeite hebben met zich profileren, om zichzelf serieus te laten nemen (int. 5 Prof). Zo coach ik ook vaak vrouwen. Bijvoorbeeld ik heb zo n meisje dat zich giechelend opstelt terwijl ze hartstikke slim is, dat moet je afleren. Als mensen willen dat je serieus genomen wilt worden dan moet je je ook opstellen op die manier (int 5. Prof). Women do not make use of their feminine charms Most women in top positions are trying to become more men-like in order to match with the dominant male culture. One woman stressed the importance of using your feminine charms, in order to discern yourself from the male crowd: Ik denk dat als er ietsis dat jou daarmee kan helpen (gedragsregels) dan is dat jouw vrouwelijkheid uitbuiten. Daar waar heel veel vrouwen moeite mee hebben, of heel denigrerend over doen, ik denk dat dat je redding is (int. 10 UHD). Women have less international experience Most women have no experiences abroad, both nationally and internationally. It is of great importance that women extend their experiences by switching of working place or working abroad. Ik zeg altijd tegen mijn mensen met ambitie: we wezen, ga ergens anders post-doccen. Want als je blijft hangen bij je oude baas, dan kom je er niet. Dan word je nooit als onafhankelijk gezien; dan blijf je degene die het werk uitvoert en niet zelf verzint. Pas als ze ergens anders ook goed presteren val je op! (int. 5 Prof). Finally, one woman expressed during the interview that we should not emphasize why women are not capable of executing a higher position, but why women should have a higher position Er zijn wel obstakels, maar als je dat alleen maar benadrukt, dan gaat niemand het meer doen. Benadrukken dat het wel kan, en niet waarom het niet kan! (int. 5 Prof). 60

61 Participation of women in women supporting initiatives The positive and negative experiences of women who did or did not participate in women supporting initiatives are very important in order to determine the further needs and wishes towards these initiatives. The women supported initiatives who are provided will be outlined based on the positive, negative experiences and needs felt by the women participating in this research project. Participation in women networks A lot of women expressed their positive experiences with women networks provided in the UMCs. Dan hoor je het ook weer van anderen, dat scheelt dan toch, want als je denkt dat je de enige bent, dan is dat heel vervelend, maar als je merkt dat er meer vrouwen zijn, dat het ook op grotere schaal gebeurt, dan is het wat minder frustrerend (int. 2 UHD). Also women, who were not participating in women networks, could imagine how important it can be. Ik kan me wel voorstellen dan als je op een afdeling zit waar je wel merkt dat je anders wordt behandeld, dan kan ik me voorstellen dat het helpt om met andere vrouwen te praten, voor ondersteuning. Maar dat heb ik helemaal niet (int. 1 UHD). Also participation of external women networks (for example LNVH) is popular among these women. Dat was een vrouwennetwerk van de hele universiteit; en dat was ook wel weer heel erg leuk; zo kon je zien hoe het bij rechten ging. het is wel nuttig geweest, er zijn daardoor wel deuren voor mij geopend (int. 12 Prof). De LNVH is heel erg actief; er zijn veel bijeenkomsten. Dat is een heel informeel netwerk en ervaar ik zeker als steun (int. 3 Prof). Nevertheless, women also stated that in their UMC no active women network was present. Het beginnetje was gemaakt met FEMALE, maar daarna heb ik er nooit meer wat van gehoord (int. 9 MD). In some cases women expressed their feelings about that the Board of Governors is not actively supporting the women networks within the UMCs. Ik heb dan het gevoel dat een Raad van Bestuur zo n Vitaal wel doogt, op papier maar niet in de praktijk (int. 2 UHD) Men zou alleen de ontwikkeling, het stimuleren van netwerken niet alleen moeten gedogen, maar juist ook moeten stimuleren. Dat zou men daadwerkelijk moeten doen. Wij geven aan we willen netwerken en de Raad van Bestuur geeft aan: Ja, Ja tuurlijk. En wil dan ook graag zijn steentje bijdragen. Maar het lijkt alsof het heel erg gedwongen wordt, het wordt niet echt omarmd, wat gestimuleerd wordt, omdat men niet anders kan. Dat geldt ook voor de charter (int. 7. Prof). Some women stated that they don t want to be associated with a women supporting network Eigenlijk hou ik er niet zo van, ik ben ook nooit bewust lid geworden van de club vrouwelijke artsen. Ik ben gewoon een mens, geen man of vrouw, ik ben toch evenveel waard. Waarom zou ik me dan afzonderen in een verenging, ik ben lid van mijn beroepsvereniging en waarom dan dat vrouwenstempel. Ergens moet dat niet nodig zijn (int. 6. MD). 61

62 Some women expressed their concerns about the lack of participation of men in women supporting networks; they also stressed the need for involving more men Wat ik heel zorgelijk vind is dat als er officiële bijeenkomsten zijn, dat er dan geen mannen zijn. Dan zijn er alleen vrouwen, terwijl de leidinggevenden voornamelijk mannen zijn. Dus dan wordt het weer niet gehoord (int. 2 UHD). Some women expressed their needs for more practical contact hours, especially for medical specialists with irregular working hours. Alleen het probleem is dat deze meetings vaak overdag zijn, en als je supervisie hebt kan je nooit. Of aan het einde van de middag, en als je dienst heb kan je ook niet. Dus bijeenkomsten kan je vaak niet naar toe. Da s heel jammer (int. 2 UHD). Participation in career development programs The participation of women in career development programs is mainly experienced as very positively. Women learn to be more aware of the gender issues and are trained to deal with these. Furthermore, most career development programs offer tools for becoming a better manager and leader. Die krijgen dan trainingen, onderhandelingen, hoe word ik zelf bewust, hoe begeleid je mensen, organisatiekunde van UMC. Dat is heel goed want vaak heb je daar geen kijk op, je weet niet hoe dat allemaal zit (int. 4 Prof). Most women participate in career development programs when they feel obstructed in their career. Als het goed gaat; dan heb je dat gevoel niet, maar als het niet goed gaat, ja dan zou ik zeker stappen ondernomen hebben (int. 18 Prof). Nevertheless, some women complained during the interview that women who successfully participated in a career development program are not certain about a job opportunity in the UMCs. We hebben nu allemaal bewust getrainde vrouwen, die kunnen onderhandelen, maar bij de mannen moet het nog doorwerken (int. 4 Prof). Some women are not participating in the career development programs because their workload is too high and/or because they don t want to be associated with a female career development program and/or they are not considering a female career development program as necessary. Het gevaar van al die programma s is dat we elkaar zielenpieten gaan vinden (int 5 Prof). Maar dan zie ik alweer zo n cursus aankomen, en dan moet ik daar een hele dag naar toe. En die dag had ik kunnen besteden aan hele andere dingen (int. 6 MD). Mijn werknemers staan onder zo n hoge druk, dat ze nauwelijks tot het doen van cursussen komen (int. 12 Prof). Ik denk altijd als je al weet waar je sterke en zwakke punten liggen, heb je daar toch geen cursus voor nodig die gaat zitten uitleggen wat je zou kunnen verbeteren, terwijl je dat zelf al weet (int. 6 MD). Female career development programs are adding more practical tools how to successfully precede your career and emotionally support women. 62

63 Ik zou graag willen weten hoe kom je verder, want heel veel dingen die ik doe hoef ik niet eens te doen. Ik bedoel ik kan die artikelen niet schrijven, maar dat ben ik nog steeds Dr. Maar dan wil ik wel weten hoe kom ik daar nou mee verder ( int 2. UDH). Ik ben iemand die me de dingen aantrekt, en daarmee rond blijft lopen. En dat wil ik gewoon kwijt, en daar zou zo n cursus in kunnen ondersteunen (int. 3 Prof). Participation in mentoring and coaching Most women consider participation in a mentoring/coaching program of great importance. Especially in the period they want to have children, a coach can support the women to make choices and set priorities. Hij legde altijd de lat net iets hoger dan dat ik de lat zou leggen voor mij (int 5. Prof). In welke tijd wil ik alles tegelijkertijd doen? Daar kan iemand heel goed bij helpen (int 25 Prof). De twijfel in kan ik het wel kan zo iemand wegnemen, maar de twijfel wil ik het wel, dat is je eigen keus (int. 4 Prof). Het is belangrijk een coach te hebben waarvan je weet daar heb ik wat aan! (int. 22 Prof). Nevertheless, some women stated not to have time for participating in a mentor/coaching program or are not willing to participate; Zowel netwerken, en ook initiatieven nemen voor een mentor programma gestart. Daar ben ik ook voor benaderd, ik heb het erg druk dus heb er nog niet op gereageerd (int. 6 MD). Ik wacht liever af en kijk hoe mijn collega dat ervaren heeft, wat zij eruit heeft gehaald en zo heb ik toch het gevoel dat ik daarop word voorbereid, erin meegenomen word. Graag op de achtergrond blijven (int. 6 MD). Some women complained during the interview, that they have the need for mentoring/coaching but the UMCs are not willing to accomplish this. Ik heb geen coach gehad, maar ik heb er wel om gevraagd. Maar dat is hier in huis ook not done (int. 10 UHD). Additional women initiatives A lot of women are willing to undertake additional tasks, training or initiatives to support their career. Ik ben altijd wel iemand die zijn mogelijkheden pakt, ik ben voor veel dingen te porren. Ik denk dat dat wel geholpen heeft in zijn totaliteit (int. 12 Prof). Ik heb altijd heel veel bestuurswerk gedaan op verschillende niveaus, en redactie van een tijdschrift. Daarnaast ook veel netwerken. Als je op zo n plek wilt komen als hoogleraar, is het van groot belang dat je op verschillende niveaus hebt meegedraaid (int. 3 Prof). Most women have undertaken numerous of additional initiatives to support their career outside the UMCs; for instance by becoming a member of all sort of committees or advice boards (national and international) and followed additional training; management, leadership, human resources. Some of these women are very self-supporting; 63

64 Ik heb de behoefte niet om lid te zijn van een vrouwennetwerk. Ik merk dat ik mijn zaken heel goed zelf kan regelen. En heb heel veel samenwerking en interacties, ik zou niet weten waar ik nog een duwtje in de rug nodig zou hebben (int. 1 UHD). Als ik iets niet beheers, dan ga ik kijken hoe ik dat mezelf eigen kan maken. Ik school mezelf (int. 18 Prof). These women consider themselves as achieving a top function more easily than other women; Ja, dat is echt mijn stijl. Dit soort vrouwen zal naar mijn mening ook sneller de top bereiken (int. 1 UHD). A lot of these women expressed the need that the UMCs should put more effort and time in the development of their talents, by offering training in management, leadership, organizational structure. Most women are outstanding scientists and specialists but are no managers. Ik ben minder goed in management (int. 12 Prof). Je bent er namelijk niet voor opgeleid om te managen, om de verantwoordelijkheid te dragen voor een groep mensen (int. 4 Prof). The broader your scopes as being a woman, the more successful you are in several competencies; Ik ben me meer op management gaan storten, studenten begeleiden, referee avonden, coördinatie cursussen, cursus infectiezieken. Ik ben minder in de wetenschap en meer algemene taken voor de afdeling gaan uitvoeren. Ook om de structuur van de afdeling te gaan snappen, en te weten waar en door wie de beslissingen worden genomen en hoe je beleid maakt voor een afdeling. Hoe je beleid maakt voor een onderzoeksgroep. Ik heb mijn scope verbreed (int. 1 UHD). Some women expressed the need for intervision groups; especially for women who have just started a new job. Ik ben al een tijdje op zoek, en het moet er geweest zijn, intervisiegroepjes voor beginnende hoogleraren. Dat je met een groepje van 6-10 beginnende vrouwelijke hoogleraren bij elkaar komt (maandelijks) zodat je je problemen kan uitwisselen en elkaar tips & tricks kan geven (int. 3 Prof). In een kleine groep van 8 vrouwen, met verschillende posities, dus niet alleen universiteit maar ook het bedrijfsleven. Daar leer je veel van; van andere situaties (int. 22 Prof). Having or being a role model Most women expressed their positive experiences in having a role model or performing as a role model Je hebt veel vrouwen met wie je samenwerkt en je hebt veel goede vrouwen als voorbeelden (int.9 MD). Want ik heb wel mijn eigen rolmodellen: een vriendin in Dublin (later gepromoveerd en eerder hoogleraar, met kinderen) en zij kon alles managen, dus dacht ik zie je wel het kan dus allemaal wel (int. 3 Prof). Ik vind het ontzettend leuk daar een steentje aan bij te dragen (deelname Vitaal). Laat ook blijken dat ik daar tijd voor vrij wil maken (int. 7 Prof). Nevertheless, some women stated during the interview that they had no role model in their working environment, or they had role models that do not suit their circumstances. 64

65 Ik heb geen voorbeelden, want dat zijn dan ook weer vaak mannen. Die zeggen van; Ach ja met jouw CV. Ze minimaliseren dan jouw CV, terwijl dat van hen niet veel beter is. Daar verwacht ik dan ook geen hulp van (int. 2 UHD) Furthermore, also some women in top positions (professor/head manager) are not aware of the role model position they are fulfilling or experience difficulties in how to perform this role. Zou graag zelf ook die rol willen vervullen, had er alleen zo nog niet over nagedacht (int. 3 Prof). Ik heb wel behoefte aan een rolmodel, als het gaat om strategieën; hoe doe je dat, hoe pak je dat aan. Ik zou het wel fijn vinden om daarover te praten (int. 4 Prof) Translation into CTQs: Selected obstacles needs/wishes The negative and positive experiences, with regard to the individual characteristics of the women in the UMCs, are translated into the CTQs; Women main obstacles in the struggle for achieving a higher position: From the qualitative data of main obstacles experienced by women aiming at a higher position, the following obstacles were identified. These obstacles can be divided into four categories (see figure 8); Secure obstacle: these obstacles have all to do with women feeling uncertain about their qualities, capabilities and medical & scientific results: Women lack self confidence; Women do not make big career steps; stay in their comfort zone and take steps which they can overlook. Women need support of environment for finding themselves capable for a higher function Women have difficulties taking themselves seriously Women do not make use of their feminine charms Women do not want to be associated with female supporting networks/(mentoring) programs Women do not know how to perform as role model. Action obstacle: these obstacles have to do with women not taking action to become more active in their careers. Women do not express her career wishes and needs (not pro-active) Women have a very different style of achieving a higher position in comparison with man; less active and violent. Women do not clearly define a career path for the future; Women obstruct nomination for higher position by themselves; take a long time for a decision, have certain believes about the circumstances to become a professor. Some women are suppressing career support (not participating in programs) Women do not take career opportunities/changes to success Women want everything at once Women have difficulties making choices, set priorities and saying no Women have less abroad experiences (No) less participation in women networks UMC and (mentoring) programs 65

66 Visibility obstacle: these obstacles have to do with women not making themselves visible (national and international) Women are less visible; Women are excluding themselves of being visible by not taking part in additional career activities. Women are good in networking; Status & Power obstacle; these obstacles have to do with women not making use of the status & power when they have achieved a higher position. Women do not like to be in the spotlight Women are modest about their achievements, qualities and results Women are not attracted to higher function Women have difficulties adapting a new role; Woman have difficulties when they need to change from profession; you have to change your attitude towards the department you need to act like the boss now Women is less aware of the power play at the top; more CV than informal rules. Women are not that good in delegate tasks The qualitative data revealed that these obstacles have a strong effect on each other; for example when a woman feels insecure, she will probably undertake less action, which in turn will lead to less visibility of her capabilities. In the end, this woman will probably not achieve a higher position and will never experience the benefits of the status & power at the top. This phenomenon will be outlined as The succeeding enlargement of women obstacles. Additional also the UMCs is providing the following obstacles which in turn accumulate the women experiences obstacles with respect to the individual characteristics. UMC obstacle: No present women network and/or (mentoring) programs in UMCs No active support board of Governors for women network UMC No participating man in women network No practical contact hours for women networks/ (mentoring) programs No available role model in UMCs Focused on the individual characteristics of the women, the following main needs and wishes (CTQs) could be identified, according the quantitative and qualitative results. Again they can be divided over the four categories (figure 9); For women: Secure needs/wishes it all starts with the security of the women confidence; Women should become more self-confidence. Women should not be afraid to take big steps. Women should take themselves more seriously. Women should make use of her feminine charms. Women should change their beliefs about participation in women networks/mentoring/career programs. Action needs/wishes; secondly the women need to take action; 66

67 Women should express their career needs and wishes. Women should set priorities, make choices and learn how to say no. Women should participate in women networks/programs and mentoring. Women should be trained to have the capacity to have more responsibilities related to a higher position; provide management, organisation and leadership training. Women should use women charms. Women should just do it, undertake actions! Women should participate in additional activities outside work Women should gain expedition experience (going abroad), switch jobs. Women should find a role model or become a role model. Women should exchange jobs more often; especially when achieving a higher position. Visibility needs/wishes; thirdly women must become more visible; Women should be supported in networking; learn to network (national and international) Women should make them selves more visible; show off your results and speak at congresses. Status & Power needs/wishes; women must use status and power at the end; Women should learn the rules of game at the top; especially the informal rules. Women should learn how to use power and status at the top. Women should learn how to delegate daily tasks. Women should learn how to get used to their new job with additional status and power. For UMC: Development of career development program/women networks and mentoring and coaching; to support the career path of women. Support women on the content of their qualities and competencies (CV and informal rules) Support women on the power play at the top (culture rules; informal). Teach women how to deal with the dominant man culture; adding gender issues to training. Development of additional training; management, leadership, human resources and organizational structure. 67

68 13.4 Visual Summary the individual characteristics Figure 8; Main obstacles individual characteristics of the women 68

69 Figure 9: Main needs and wishes individual characteristics of the women 69

70 14. Qualitative sub-results: Private environment 14.1 Experiences Private environment The results in this cluster will mainly focus on how women combine their private life and a career. Furthermore, also the role of the family, friends, partner, children and time left for them will be shown, in relation with the women s career Combining private life and career The quantitative and qualitative data, made clear that women have difficulties in combining their private life and their career, especially in the period when the children are young (0-6 years). Furthermore, al lot of women mentioned during the interview that they want to keep on doing everything and have difficulties to make choices or set priorities. Waar ik zie dat vrouwen in ernstige problemen komen, is dat ze niet snijden. Mensen willen alles: werk, een gezin, een rijk sociaal leven, nog 2 sporten erbij. Ik vind wel dat mensen heel veel van zichzelf eisen (int. 8 Prof). Most women consider themselves to be committed to their job, some women consider their job as being an important part of themselves and choose to concentrate primarily on work. Ik beschouw mijn werk als iets van mezelf, dus ik doe verder ook niks (int. 14 UHD). Maar aan de andere kant zien ze ook wel dat ik ongelukkig zou zijn als ik niet zou kunnen werken. Dus dat is nu wel goed in balans. Want ze zien wel als het nodig is dat ik er dan voor ze ben (int. 6 MD). During the interviews some women stated not to have any problem with combining their private life and their career, but felt that they should have a problem because the people around these hard working women are giving them the feeling it is not correct to work this hard and have children at the same time. These women felt they should call to account. Maar het lijkt wel alsof de mensen om je heen vinden dat daar een probleem ligt (int. 5 Prof) Ik kreeg een keer te horen dat ze dachten dat mijn kinderen geen moeder hebben, of een moeder met een hele belangrijke baan (int. 16 Prof). A lot of women expressed they feel guilty towards their children, for spending so much time and efforts into work. Nevertheless, one woman stated that no matter what you do (if you are at work or with your children) you will always feel guilty, and for the better you should learn to deal with it. Ze zien aan de andere kant ook dat er moeders zijn die voorlezen op school, en dan zeggen ze weleens, jij bent er nooit. En dan voel je je toch wel heel erg schuldig (int 6. MD). En veel vrouwen voelen zich altijd schuldig, ik ook. Maar je voelt je altijd wel schuldig wat je ook doet. Dus je hoeft eigenlijk niet te denken van ik kan dat niet maken, want dan ga ik me toch zo schuldig voelen. Je voelt je dus toch altijd schuldig. En naarmate je ouder wordt kun je daar beter mee omgaan (int. 10 UHD). Only one woman stated during the interview that if she had the feeling of not being a good mother and could not cope with combining private life and a career she would be satisfied with another, less ambitious job. 70

71 Aan de andere kant ben je ook echt een moeder, en denk je: kan dat zo wel, die kinderen van de crèche naar de oppas? Als het niet meer te combineren valt zou ik genoegen nemen met een mindere functie (int. 6 MD). One female professor made during the interview some discriminating remark about pregnant women and their presumed limited chances to a career to the top. Een professorabele promovenda, waarvan ik denk dat zij later een grote kans heeft professor te worden, is dan helaas zwanger geworden; en dan denk ik O als dat maar goed gaat. Niet dat ze uiteindelijk alleen nog maar thuis zit (int. 11 Prof). A lot of women also expressed the need for receiving tips and tricks in order to combine their private life and career. For instance if a woman wants to combine her private life with a career, during any stage of her life it is of great importance to have a planning scheme, to make choices, to set priorities, have a supporting head and to have support at home: a cleaner, nanny/au pair.. Because the time is limited to sit down with children and partner, it is important to diminish as much as possible daily additional tasks at home, to have real quality time with the family. Als je een gezin wil moet je heel goed plannen (int. 4 Prof). Het is belangrijk dat je niet alles moet willen combineren, je moet keuzes maken. Je hebt niet voldoende tijd. Maar het hoeft niet per se in diezelfde periode (int. 25 Prof). Het thuis allemaal goed geregeld hebben, is de belangrijkste faciliteit. En op het werk is het toch wel fijn als je de mogelijkheid hebt om flexibel te werken, flexibel met je tijd om te gaan (int. 5 Prof). Dat gezeur, je moet gewoon zorgen dat je het thuis goed regelt; een kindermeisje hebben, een werkster. Daar moet je niet over nadenken. En niet denken dat je dat allemaal nog zelf zou moeten doen (int. 20 Prof). Ik heb gelukkig een geweldige oppas en hulp in de huishouding, als dat er niet zou zijn, dan zou het allemaal veel moeilijker zijn. En een opa en oma in de buurt (int. 6 MD). Some women also stated that part-time working (especially in the period when the children are young) is of great importance in order to combine their private life and career. Ik kon het zo allemaal goed combineren, doordat ik part time werkte, was ik ook meer thuis. En dat vond ik heel fijn in de tijd dat de kinderen klein waren. Heb ik nooit spijt van gehad (int. 8 Prof). Most women mentioned that a supporting role of the UMCs can only be a limited one. In order to support women to combine their private life and career the UMCs could offer better child day care and other additional facilities in order to make it more easy for women and their partners. For example: the improvement of the secondary working requirements; a (more) flexible working scheme; working at home and more support by offering a secretary, staff members, IT and an own office. Als je kinderen hebt zou het UMC meer moeten doen voor ouders met kinderen; betere opvang, en faciliteren om het gemakkelijker te maken voor de vrouwen en hun partner (int. 7 Prof). 71

72 Combining private life and career can be influenced by many factors, during the interview the role of the family & friends, partner, childeren and time left for your self was questioned. In the following part the role of these factors (supportive/non-supportive) will be outlined The influence of the family& friends on the career and vice versa The role of the family was described in two different ways by the women participating in the interviews. The family can have a supporting and a non-supporting influence on the career of women. Most women stated that their family is playing an important role in their career. The family has not only a supporting role, but also stimulates them for aiming at a higher position and helping to make decisions for when the career opportunities arise. A lot of women mentioned they would never have taken the higher position when support of their family & friends would have been lacking. Zonder steun van de familie had ik het niet gedaan. Dus ook voor deze beslissing hebben we met het hele gezin het erover gehad en de beslissing gemaakt. We hebben toen gekeken naar de voor- en nadelen en welke valkuilen ik tegenaan zou kunnen lopen (int. 3 Prof). Also the background of the family is of great importance in the way women are operating in society and their attitude towards a higher position. One woman stated that in her family for centuries the women were actively working, which made it for her more acceptable and reasonable aiming at and executing of a top position within the UMC. Nevertheless, family & friends can also have a non-supporting influence on the career of women. For example, one woman stated that she was brought up in a non-scientific family, which made it hard for the family to understand what she was doing. This woman therefore received less appreciation and support from her family. Toen ik promoveerde lag mijn proefschrift nog steeds in de envelop. Het zit niet in hun wereld, ze begrepen het niet (int. 22. Prof). Furthermore, the position of the women within the UMCs also has an influence on family & friends. Most women spend less time with their family & friends, despite of the regret of some women. One woman stated that she worried about the small amount of time she has to provide aid to her degenerating mother. Mijn moeder wordt nu slechter en het baart me dan toch zorgen dat ik eigenlijk geen tijd heb mochten er acute dingen gebeuren. Ik heb niet zoveel rek (int 22.Prof) The influence of the partner on career and vice versa. The role of the partner was described in two different ways by the women participating in the interviews. Also the partner can have a supporting and a non-supporting influence on the career of women. Most women mentioned the supporting, stimulating, motivating and protecting role of the partner. Furthermore in most cases the partner also puts into question the amount of working hours in order to better combine private life and a career. Hij is heel ondersteunend geweest; hij heeft er toen ook voor gekozen 4 dagen te gaan werken toen we ons 3de kind kregen (int. 22 Prof). Ik overleg dit met mijn man (werkdruk) en die zegt dan; nou moet je er echt wat aan gaan doen, want zo gaat dat niet langer. Die probeert een beetje op mij te passen (int. 13 Prof). 72

73 Most women have the feeling of balance in their work and private life, by having a good and supportive partner. Het is goed dat ik kinderen en partner heb, anders zou ik teveel werken, ze houden me in balans (int. 15 Prof). Als je het goed in balans houdt, heeft de een de ander niks te verwijten. Zorgen alle twee evenveel voor de kinderen (int. 5 Prof). In some cases women share the care of the children with the partner, despite the fact that some women still have difficulties to leave their care tasks to their partner. Most women want to stay in control of everything. Een goed thuisfront is ontzettend belangrijk voor me, om thuis te zitten en rust te hebben (int. 4 Prof). Je moet met z n tweeën de zorg dragen voor de kinderen (int. 9 MD). Nevertheless, some women also expressed their frustrations about their partner not willing to or being able to take over some care tasks for the children or domestic tasks. Ik moet altijd alle ballen in de lucht houden. Dat is heel zwaar (int. 2. MD). Mijn man is ook medisch specialist en is niet in Leiden, dus dat werkt ook mee. Dus ik ben degene, om als een kind ziek is, alles uit mijn handen te moeten laten vallen om mijn kind op te halen (int 6 MD). In the most extreme cases the partner was jealous of the position the interviewee held because they have more status and earned more money, which made the men feel less worthy. In two cases, the women stated this had led to a divorce. In mijn omgeving zie ik wel vrouwen die een partner hebben die jaloers zijn, en die de ontwikkeling tegenhouden (int. 3 Prof). Hij heeft zich minderwaardig gevoeld, dat het moeilijker was voor hem om te accepteren dat ik meer verdiende en dat ik meer carrière heb gemaakt. Ik zou alleen maar trots zijn geweest, terwijl hij alleen maar jaloers is geweest! (int. 21 Prof). Most women stress the importance of selecting a good partner, who is capable of dealing with ambitious women, is likely to share the care and domestic tasks and has a supporting and motivating state of mind towards women. Ik denk dat het belangrijk is dat je partner erachter staat en dat je het samen eens bent over de dingen die je doet (int. 3 Prof). De meest succesvolle vrouwen hebben een man thuis zitten (int. 23 UHD). In just some cases the woman was primarily the wage-earner of the family, with the negative consequence that she felt a big pressure of performing in an outstanding way and achieving a higher position in order to support her family. 73

74 The influence of the children on career and vice versa. The role of the children can also be supportive and non-supportive on the career of their mother. Most women stated during the interviews that having children is the best thing ever happened to them. Heel belangrijk; het mooiste in mijn leven zijn mijn kinderen (int. 5 prof). Dat is een van de beste dingen die je kan over komen: kinderen! (int. 25 Prof). Having and spending time with their children helps these women to keep more balance in their life. Furthermore, the children also have a supportive and motivating influence on their mothers career. Het kinderen krijgen is ook heel goed geweest voor het relativeren van je werk en dat stimuleert me. Het maakt mij rustiger. Als ik alleen mijn werk zou hebben zou dat zo ontzettend belangrijk voor me worden. En dat gaat tegen je werken, die balans vind ik heel belangrijk (int. 5 Prof). Die zijn altijd heel stimulerend geweest. Die zeggen ook kom op mam! Wanneer gebeurt het nou?! (int. 24 UHD). Op een gegeven moment zeiden ze; joh mama laat ons nou toch los, en ga je eigen taken doen. Dan komt dat proefschrift nog eens af. En toen dacht ik inderdaad ze hebben gelijk (int 3. Prof). Most women expressed their concerns `bout becoming a workaholic if they did not have children. Ze houden me met beide benen op de grond, als ik geen kinderen zou hebben dan woonde ik in het UMC (int. 10 UHD). Nevertheless, some women also stated that having children and raising their children has a negative influence on the career. Most women expressed their assumptions that if they did not have children they could have spent more time and effort in their jobs. Kinderen krijgen is toch wel onhandig als je ondertussen carrière wilt maken (int. 5 Prof). Ik heb wel het idee gehad dat als ik geen kinderen had gehad, dat ik dan nog verder was geweest. Meer tijd in wetenschap had kunnen stoppen (int. 5 Prof). In just a few cases women made the clear decision not to have children, in order to spend more time and efforts in the job, friends and family. These women considered combining private life and career to be too difficult. Was toen een bewuste keuze, om geen kinderen te nemen. Ik heb er geen tijd voor genomen, ik wilde ook nog heel veel andere dingen doen. Ik vind sporten heel belangrijk. En ik denk ook achteraf aan de continue burn-outs die voor de deur staan. En je houdt van reizen en van je vrienden, dan geen tijd voor kinderen. Achteraf heb ik er toch spijt van. (int 7 Prof). Ik had toch het gevoel dan moet ik minder goed mijn werk gaan doen (int. 4. Prof bewust niet voor kinderen gekozen). Furthermore, having children also leads to the duty of performing more care tasks. Most women are more likely to perform these tasks themselves and have difficulties to leave these tasks to their partner. 74

75 Je ziet toch dat vrouwen eerder betrokken zijn bij hun kinderen; het zijn de vrouwen die thuis zitten als de kinderen ziek zijn, niet de mannen. Dat heeft een negatief effect op de carrière (int.11 Prof). De zorgtaken worden door de vrouw ook meer naar zich toe getrokken (int. 16 Prof). Most women mentioned the privilege when having healthy children and/or partner, because in some cases (long-lasting) diseases of children and/or partner have a great impact on women and their career. Toen mijn zoontje ziek was, kwam ik wel in de clinch (burn-out gehad), dat was ook de tijd dat ik die coach had (int. 9 MD). Finally, having children means in most cases that women made concessions towards other social activities. Especially when the children are young (0-6 years) women have less time for themselves and for friends. Ik heb nauwelijks vrienden omdat ik vind dat ik er voor de kinderen moet zijn (int. 16 Prof) Time for yourself Most women lead a busy, vital and chaotic life, which means time for them selves is very limited. Especially in the period when they have young children (0-6 years) Tijd voor jezelf in deze fase dat de kinderen nog zo klein zijn is minimaal (int. 5 Prof) De tijd dat de kinderen klein waren, schoot dat er vaak bij in en daar was ik ook wel droevig om. Maar toen dacht ik wel: ik wil werken, ik wil promoveren, ik wil sporten, het is wel heel veel ik. En moet ik dan ook nog de hele tijd naar de film en uit eten. Dat is dan maar ff niet zo. En nu ze ouder zijn gaat dat allemaal weer wat gemakkelijker, en kom ik er weer meer aan toe (int. 10 UHD). When the children are getting older time for your self is in most cases restored. De kinderen geef ik nu meer verantwoordelijkheid, waardoor ik meer tijd voor mezelf over hou (int. 2 MD). Many women stressed the importance of having some time for yourself, in order to gain balance in your life and to stay close with yourself. Especially, going on vacations, working in the garden, spend time in nature, reading books and performing a sport is mentioned to relax. Als ik werk vind ik het heerlijk om er helemaal voor te gaan, maar ik heb ook afwisseling nodig met periodes dat ik eruit bent, dan laad ik weer helemaal op! (int. 4. Prof). Nevertheless, most women express the need of more attention of the UMCs in creating relaxation support of the employees. Ja daar wordt wel aandacht aan geschonken in het bedrijfsleven, maar is het UMC nalatig. Zou toch wel lekker zijn als men tussendoor zou kunnen masseren, want ik heb tussendoor nekklachten. Want je zit veel achter de computer. Dat zou ik best heel lekker vinden (int. 6. MD). 75

76 14.2 Translation into CTQs: Selected obstacles/needs/wishes The negative and positive experiences, with regard to the private life of the women in the UMCs, are translated into the CTQs; Focused on the private life of the women, the following main obstacles can be identified, according the quantitative and qualitative results (see figure 10); Combining career and private life is still considered as an obstacle; especially in the period you have young childeren. Having a non-supporting partner can obstruct your career Having childeren can obstruct your career Having a non-supporting family & friends can obstruct your career Some women still consider having children as an obstacle; therefore a choosing not to become a mother. Women have little time for herself Women feel guilty to home front; they spend less time with childeren. Disabled and chronicle ill childeren makes it even more difficult for the women to build a career. Focused on the private life of the women, the following main needs and wishes (CTQs) can be identified for, according the quantitative and qualitative results (see figure 10); Needs & wishes for the women: In order to combine your private life and career it is of great importance that you make choices and set priorities. Because you can not do it everything at the same time! In order to combine your private life and career it is of great importance that you hire domestic support: cleaner(s), nanny/au pair, gardener, cook, to make sure you spend quality time with your children, partner, friends & family. Selecting a supporting, motivating and stimulating partner. In order to combine your private life and career it is of great importance that you share your caring tasks with your partner. In order to combine your private life and career it is of great importance to have a planning scheme per week. Reserve some (quality) time for yourself and family, friends, children and partner. Keep balance by variety of efforts and relaxation. Needs & wishes for the UMCs: Support women to combine their private life and career by offering additional support (secondary support); child day care, financial compensation, more flexible working scheme, more opportunity to work at home, extend vacations. Support women when they have a partner/childeren with a (long lasting) disease; special leave Support women to combine their private life and career by offering a coach/mentor who helps to set down priorities, creating a career path and considering when to have children is the best option. Support women to combine their private life and career by offering career development programs; adding these issues. 76

77 14.4 Summary; The private environment Figure 10: Main obstacles, needs and wishes of the private environment 77

78 Part 4: Conclusions The conclusions drawn from the qualitative and quantitative results are divided per sub question. Firstly, the conclusions with regard to the main identified obstacles, needs and wishes are described, followed by the secondary conclusions with regard to the diversity policy advice for the UMCs. 15. Main conclusion I Main obstacles, needs and wishes As stated before: the main question of the first part of this research project is: What are the obstacles, needs and wishes of female academic medical specialists and scientists in respect with their career development in the UMCs in the Netherlands? First, conclusions are drawn with regard to the three sub questions; in order to draw a final conclusion with respect to the first main question Identified obstacles/needs/wishes of the academic women in the UMCs Out of the quantitative and qualitative research and the literature study the following two research questions can be answered: What kind of experiences do female academic medical specialists and scientists working at UMCs have, with regard to their working environment, individual characteristics and private environment? Which obstacles, needs and wishes can be identified with regard to expressed experiences in the UMCs? Obstacles, needs and wishes identified by the academic women in the UMCs There can be concluded that by very academic women participated in this research project different experiences, needs and wishes have been identified. Nevertheless, most of these experiences, needs and wishes can be categorized in the three segments: working environment, individual characteristics and private environment, provided by the VanDoorne&Huiskes career development model (figure 11). For detailed information about the identified obstacles, needs & wishes see qualitative results. The qualitative results show us that a lot of experiences, needs and wishes are common among academic women, and therefore are translated into the CTQs, which order to prepare the development of the diversity policy advice. Nevertheless, the CTQs show us the basis components needed to support academic female talent, but for the fulfilment of these basis components into specific needs, the individual academic women and the respective UMC must be taken into account. Especially the identified obstacles, needs & wishes in the segments Working environment and Individual Characteristics, need to be translated into practical tools for the implementation of a successful diversity policy in the UMCs. The segment Private environment, is seen to be more or less in control by most women, when good planning and additional assistance is arranged at home. 78

79 15.4 Main conclusion obstacles, needs & wishes Figure 11: Main obstacles, needs and wishes of the academic women in the UMCs in the Netherlands. 79

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