Many women on the wards, but few at the top: this is how the gender gap is measured and fought in Tuscany.

The Anaao Assomed Toscana study, conducted in collaboration with the Management and Healthcare Laboratory (MES) of the Sant'Anna School of Advanced Studies in Pisa, identified several tools for evaluating gender performance in healthcare and possible actions to address the barriers that prevent women from reaching top positions. The current gender gap in the National Healthcare System demonstrates how, despite representing 70% of the workforce, women hold less than 30% of senior positions. This paradox reflects persistent and still largely invisible inequalities. To address these critical issues structurally, Anaao Assomed Toscana and the Management and Healthcare Laboratory (MES) of the Sant'Anna School of Advanced Studies promoted a two-year project that led to the development of new gender-sensitive indicators for evaluating public healthcare organizations, which have been included in the PES (Performance Evaluation System) portal .

The introduced indicators allow for a precise analysis of career inequalities, access to management positions, family responsibilities, and absenteeism related to Law 104 and illness, broken down by gender. The so-called "Personnel Policy Indicator" represents an advanced composite that integrates inclusion, equity, and organizational performance. These indicators are derived from a study conducted through interviews with CUG (Single Guarantee Committees), General Directorates, and medical and healthcare managers in the Tuscany Region, which highlighted cultural and organizational barriers: from underrepresentation in competitive examinations to unequally distributed family responsibilities to the undervaluation of female leadership. The project goes beyond describing inequalities, but proposes replicable actions: strengthening monitoring and transparency through gender-sensitive indicators; training on inclusive leadership and gender medicine; interventions on organizational language and culture; reviewing personnel evaluation and selection criteria; actively promoting female participation in public competitions, including in the composition of selection committees.

The added value of this experience is its replicability nationwide. This project represents a paradigm shift for gender policy issues because: It offers a concrete benchmarking tool to compare the actions implemented by healthcare organizations regarding the management of medical and healthcare personnel. This is achieved through the identification of valid indicators included within the PES (Scuola Superiore Sant'Anna, Management and Healthcare Laboratory) platform, which can measure the effects of these policies and develop strategic levers that can truly trigger a change of direction in this sensitive area for healthcare governance. It also provides an overview of the horizontal and vertical barriers that hinder, including from a gender perspective, the growth of medical and healthcare personnel within companies and, indirectly, corporate welfare. In addition to technical tools, the project has also highlighted the strategic value of ongoing training and organizational culture as essential levers for promoting lasting change. Making visible the mechanisms that reproduce inequalities allows performance evaluation to become a tool for equity and systemic improvement, rather than a mere quantitative assessment.

The company managements involved have expressed a genuine interest in adopting objective analysis tools, useful not only for ensuring regulatory compliance but also for promoting more attractive, inclusive, and resilient work environments. This approach, which integrates performance evaluation, organizational well-being, and skills development, is fully aligned with the modernization objectives of public administration. The process launched in Tuscany, with the scientific support of the MeS Laboratory, represents a model of effective co-design between unions, institutions, and public research, capable of generating measurable impacts. The project's added value also lies in its replicability nationwide, providing a concrete basis for extending the gender-sensitive approach to other regional and healthcare contexts. It is a concrete example of how gender policies can evolve beyond mere awareness-raising, becoming an integral and strategic part of healthcare organization governance: measurable, verifiable, and improvable over time.

*Anaao Tuscany