Leadership assessment fails to get to the heart of the matter at hospital

Report discriminatory in failing to consider head of cardiac surgery's concerns about male-dominated workplace

Leadership assessment fails to get to the heart of the matter at hospital

When a woman is in a male-dominated profession, she can face many challenges because of her gender. Those challenges can increase if she is a leader with authority over male colleagues. The context of ingrained attitudes in such circumstances shouldn’t be ignored by employers, especially when conducting assessments or evaluations. Otherwise, it could be discrimination, regardless of intent.

An Ontario surgeon was discriminated against when her concerns about being a female leader in a male-dominated occupation were ignored in an assessment of her department and her leadership abilities, the Ontario Human Rights Tribunal has ruled.

Dr. Irene Cybulsky was a cardiac surgeon for Hamilton Health Sciences (HHS), a research hospital in Hamilton, Ont., affiliated with McMaster University. She first joined HHS in 1990 for fellowship training and became a cardiac surgeon in 1996. She became head of the HSS Cardiac Surgery Service — a group of surgeons caring for patients needing heart surgery — in 2009 as well as the Cardiac Surgery Division Head at McMaster University.

When Cybulsky was appointed head of the Cardiac Surgery Services, the acting chief of surgery indicated that it was a five-year appointment that was renewable once. However, the HHS by-laws stated that ithe appointment was subject to an annual review and could be revoked at any time by the medical advisory committee (MAC). The MAC approved Cybulsky’s re-appointment each year from 2009 to 2015.

The cardiac surgery department was mostly male — Cybulsky was the only female cardiac surgeon at HHS for her entire time there; all the interventionists, cardiac surgeon trainees, and ICU attendants were male; and only about one-quarter of the anesthesiologists were male. According to Cybulsky, there were male-only cliques among the cardiac surgeons and she found it difficult to develop bonds with them. When she became head of the Cardiac Surgery Services, she was the only female head in Canada.

In January 2014, the interim Surgeon-in-Chief at HHS announced a review of the Cardiac Surgery Service due to complaints that he had received about Cybulsky’s leadership style and the direction of the service. Cybulsky asked for details about the complaints but didn’t receive an answer.

Gender-related concerns raised

The reviewer met with some of the cardiac surgeons, the director of the cardiac and vascular surgery program, site leads, the operating room manager, cardiac anesthesiologists, interventionists, the chief of critical care, the chair of the department of surgery, and twice with Cybulsky. Many of those interviewed commented on Cybulsky’s direct, abrupt communication style and a few said they felt bullied at times. Cybulsky said that she would have thought that if anyone had a problem with her, they would have sat down to talk things through. She added that she didn’t think she was intimidating or overbearing, she was just assertive and direct.

The reviewer’s report failed to consider the context of the employee being a female leader in a male-dominated workplace.

Cybulsky also noted that “One of the things I’ve learned in some of my reading is leadership programming is a challenge because leadership is a domain that has male traits: assertiveness, directness, problem solving, task oriented. Those are all things that go along with a male domain, and for a woman, they’re supposed to be nurturing and fuzzy.” She pointed out that “social science research” had found that women who demonstrate those leadership traits are often seen as incompetent, lacking authority, and aren’t well-liked by either women or men.

The reviewer completed a first draft of her report on May 21, 2014. It said that some people saw her as being a fair and competent service head, while others — including a group of four cardiac surgeons — felt she was a bully who micromanaged and shouldn’t be in a leadership position. Noting the differences in opinion about Cybulsky’s leadership abilities, the report recommended that she improve her communication style and receive training on “delivery and navigating situations of conflict.”

The MAC approved Cybulsky’s reappointment as Head of the Cardiac Surgery Service on June 26.

On July 7, Cybulsky met with the interim Surgeon-in-Chief and the HHS Chief Medical Executive to discuss the report. Cybulsky said that they needed to address her comment about the challenges of being a woman leader, which was ignored in the report. The Chief Medical Executive agreed that the reviewer “would acknowledge that some of this may well be because you are a woman and they’re men,” but it wasn’t in writing in the report. However, the reviewer had not discussed sex or gender with him.

A new Surgeon-in-Chief joined HHS in August and received a copy of the report on Sept. 9. He told Cybulsky of his concerns about how the group interacted and he would reassess her appointment within 12 months. The Surgeon-in-Chief attended three meetings with the group and they established a plan to work on the issues. However, after December 2014 he didn’t attend any further meetings or follow up on the progress of the plan. He also didn’t have any additional one-on-one meetings with Cybulsky.

Leadership position opened up for others

Cybulsky was re-appointed in June 2015   for the following year. On Sept. 16, the Surgeon-in-Chief told Cybulsky that he would be opening up the Head of Cardiac Service position to others who may be interested because he needed “someone with a different set of skills to take the group forward, who can bring the group together and will project a positive image of the group as a whole.” Cybulsky didn’t apply for the position when expressions of interest were sought in May 2016 and she left HHS in 2017.

Cybulsky filed a human rights complaint alleging that she was discriminated against on the basis of her sex and gender when the review was conducted, when the Surgeon-in-Chief invited others to apply for the Head of Cardiac Service Surgery position, and when she informed the HHS human rights and inclusion specialist about her experiences.

The tribunal noted that the purpose of the Ontario Human Rights Code was to promote “substantive equality” — which the Supreme Court of Canada described as “going behind the façade of similarities and differences.” Substantive equality required looking at the “full context” of the situation and “the continuous disadvantages that have operated to limit the opportunities available to the Code protected group,” said the tribunal.

The tribunal found that Cybulsky clearly raised the challenges of female leaders and the expectations around female versus male traits with the reviewer, the Surgeon-in-Chief, and the Chief Medical Executive. She told all of them during the review process about how the leadership traits that she had but women weren’t expected to have, could work against her.

However, the issues raised by Cybulsky were not addressed in the report, the tribunal said, despite the fact that the reviewer noted the differences in how Cybulsky was viewed, particularly with the cardiac surgeons. This indicated that the reviewer failed to consider the context of Cybulski being a female leader in a male-dominated workplace, the tribunal concluded.

The tribunal determined that HHS, the reviewer, and the Chief Medical Executive violated Cybulski’s human rights by failing to consider the role that her sex and gender played in the comments she received about Cybulsky in interviews. They also failed to respond appropriately when Cybulski herself discussed her concerns that her gender could be a factor in how some of the staff assessed her as a leader, said the tribunal.

The tribunal also found that Cybulsky was adversely affected by the breach of her human rights, as her “dignity was undermined by conclusions which were devoid of any gender analysis and the damage was compounded when those conclusion were accepted by the HHS.” It added that the assumption by the reviewer that gender wasn’t a factor in the assessment of leadership styles was likely to have a disproportionate impact on women occupying leadership roles in male-dominated workplaces as compared to men.

In addition, the Surgeon-in-Chief used the report as the basis for his decision to open the Head position up for others, so Cybulsky experienced further adverse treatment from the breach of her rights in the review — and therefore connected to her gender. While it may not have been the only consideration in the decision, it only needed to be a factor in the decision to be discrimination, said the tribunal.

The tribunal upheld Cybulski’s human rights complaint and ordered a separate process to determine remedies.

For more information, see:

  • Cybulsky v. Hamilton Health Sciences, 2021 HRTO 213 (Ont. Human Rights Trib.).

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