Including more women on hospital teams yields better surgery outcomes, new study finds

A new paper appearing in the British Journal of Surgery finds that care in hospitals with higher surgery team sex-diversity was associated with better post-operative outcomes for patients.

In various industries, including business, finance, technology, education, and law, many observers believe gender and sex-diversity is important not only for equity, but also because it enriches the output of teams because members of the team bring a variety of experiences and viewpoints to their jobs. However, there is limited evidence for the value of teams’ sex-diversity in health care. Most published reports have focused on individuals’ characteristics and their associations with outcomes (e.g., how female patients respond to female physicians). There is limited data regarding the role sex diversity on health care teams and their outcomes.

Team sex-diversity likely contributes to patient outcomes through the many differences that male and female doctors bring to the workplace. Both sexes possess different skills, knowledge, experiences, beliefs, values, and leadership styles. Despite the benefits of sex and gender diversity on team performance, female doctors in operating rooms remain uncommon. The number of female anesthesiologists and surgeons has increased by only 5% over 10 years.

The researchers of this new work conducted a population-based retrospective cohort study using administrative health care data in Ontario, Canada, where 14 million residents receive health services through a government-administered single-payer system. The researchers investigated adult patients who had major elective in-patient surgeries between 2009 and 2019 to measure postoperative major morbidity.

They found that of 709,899 surgeries performed at 88 hospitals during the period, 90-day major morbidity occurred in 14.4%. The median proportion of female anesthesiologists and surgeons per hospital per year was 28%. Overall, female surgeons performed 47,874 (6.7%) of surgeries. Female anesthesiologists treated patients in 192,144 (27.0%) of operations.

The study found that hospitals with more than 35% female surgeons and anesthesiologists had better postoperative outcomes. Operations in such hospitals were associated with a 3% reduction in the odds of 90-day postoperative major morbidity in patients. The researchers note that the 35% threshold they observed echoed findings from research in other industries in various countries–including the United States, Italy, Australia, and Japan–that also showed better outcomes once female members represented approximately 35% of total team members.

“These results are the start of an important shift in understanding the way in which diversity contributes to quality in perioperative care,” said the paper’s lead author, Julie Hallet. “Ensuring a critical mass of female anesthesiologists and surgeons in operative teams isn’t just about equity; it seems necessary to optimize performance. We wanted to challenge the binary discourse of comparing female and male clinicians and rather highlight the importance of diversity as a team asset or bonus in enhancing quality care.

“Ensuring sex-diversity in operative teams will require intentional effort to ensure systematic recruitment and retainment policies for female physicians, structural interventions such as minimum representation on teams, and monitoring and reporting of teams’ composition to build accountability in existing systems.”