• HERe Spotlight

    The HERe initiative is an effort that aims to inspire not only women but men invested in the professional development of women leaders in the health care field with the tools and resources they need to succeed. We hope to inspire one another, learn together, and connect with colleagues across the industry.

  • Leadership Strategies: Harness Strength of MultiGenerational Workforce to Improve Health Care

    by Karen Wagner

    Healthcare leaders should use intergenerational differences to their advantage when seeking to build cohesive and well-rounded units, departments, and systems.

    The changes are hard to ignore: The nurse texting a question to a colleague. Tattoos peeking out from shirtsleeves. Healthcare workers seemingly transfixed on computer screens, tablets, or smartphones. 

    As health care embraces the Information Age, today’s hospital or health system is definitely not your grandmother’s or your mother’s, even though both may work there.

    In fact, four generations make up today’s workforce: Traditionalists (born before 1945), Baby Boomers (1945-64), Generation X (1965-80), and Millennials (born after 1980).

    Each generation brings a different set of values, beliefs, and expectations that reflect the political and cultural times in which they were born. This diversity can represent team strength and also a serious management challenge.

    Maintaining a highly engaged, positive, and productive workforce is especially important in health care. According to a report published in January 2014 by the American Hospital Association’s (AHA's) Committee on Performance Improvement, for healthcare organizations to achieve optimal clinical outcomes and patient experiences, their leaders must develop strategies to engage the different generations. Failure to do so may lead to high employee turnover; higher costs for recruitment, training, and retention; lower patient satisfaction scores; and sub-optimal clinical outcomes.a

    Women Lead the Way

    In health care, a significant part of the responsibility for managing this generational chasm falls to women. According to data issued in 2010 by the Bureau of Labor Statistics, 91 percent of registered nurses, 72.5 percent of medical and health services managers, and 69 percent of human resource managers are women.b Such roles, including nurse managers who are often RNs, typically involve setting and implementing employee policies and guidelines.

    Many in the industry agree that the distinct generations each have their own strengths. The key is managing these strengths to create a workplace that does not alienate any age group, but leverages the differences (and commonalities) to create an optimally functioning team.

    "I think there are different work styles and motivations about life," says Deborah Bowen, president of the Chicago-based American College of Healthcare Executives. "I don’t think it’s necessarily bad or good. We're all faced with this dilemma of trying to keep the ball moving and all the plates spinning and having the right people to do that. You have to acknowledge that that might require different approaches" to managing a workforce.

    Frictional Differences

    Although descriptions differ depending on the specific generational model, certain characteristics are generally attributed to each generation. Traditionalists are considered respectful of authority and frugal. Baby Boomers are driven and focused on personal gain. Gen-Xers are considered self-reliant and skeptical. Millennials are tech-savvy and frequently seek positive feedback.

    Such differences manifest in the workplace in different ways. With respect to job skills, for example, Millennials may have undeveloped public presentation skills, but may be able to create impressive presentations with embedded video and graphics. Older generations may be more comfortable with simple spreadsheets and charts.

    Work styles and work ethic may also cause conflict. Baby Boomers may prefer consensus and meetings, while Millennials want to work individually. Traditionalists and Baby Boomers may put in long hours at the office to get the job done. Gen-Xers and Millennials may leave work early to attend to personal needs, but complete remaining work at home.

    Communication preferences are also noteworthy and should be considered by leaders. Millennials prefer to text-message, members of Generation X may prefer email, and Baby Boomers could favor in-person meetings. Finding balance, consistency, and rules of engagement for each communication preference is an important consideration for leaders.

    "Texting is a wonderful way to communicate in a way that is efficient, but you have to be careful to make sure the meaning is not lost in what you’re sending," says Sherri Elliott-Yeary, a Dallas-based author and consultant on how to manage the multigenerational workforce.

    Challenges Facing the Industry

    A multigenerational workforce poses additional  challenges when trends in health care are taken into consideration,  including a clinical labor shortage, an aging population, and a shrinking civilian workforce, according to the AHA's 2010 report, "Workforce 2015: Strategy Trumps Shortages."c

    The report, which examines workforce issues and solutions for the current decade, includes forecasts that project a shortage of nearly 110,000 physicians by 2020, according to the U.S. Bureau of Health Professionals. The report also cites the work of researchers at Vanderbilt University who in 2009 estimated that there would be a shortage of 260,000 FTE registered nurses in 2025.

    Such challenges require a new skill set for today’s managers, who must understand, appreciate, and be effective in guiding multiple generations, the report states. Of particular importance: welcoming younger generations into the workforce as older ones retire, and adjusting workplace policies and procedures accordingly.

    Another potential problem area is the coordinated care delivery model, which relies on teamwork to provide appropriate and timely care across settings and disciplines. If members of the team are in conflict, or some members have never worked in teams, projects can take longer to complete and patient care may suffer, according to the AHA report.

    A Rock Health survey reveals the top three career barriers for women in health care.

    Managing to Styles

    Effectively managing different generations can be achieved, although doing so requires a different set of skills than perhaps Traditionalist or Baby Boomer healthcare leaders are accustomed to utilizing. A few strategies for managing the multigenerational workforce include:

    Be open-minded. Simply because one person’s style of dress or communication—as long as it is appropriate to the workplace—is different from yours does not mean that person is not a good employee and should not be valued, Elliott-Yeary says. "Managers really need to check their personal bias at the door," she says. "Changing your personal bias and being more open to people who are different from you creates an awareness and acceptance that allows for everyone in this workplace to be in this relationship together in a positive manner."

    Baptist Health Lexington, a 383-bed tertiary care hospital in Lexington, Ken., has a dress code/personal style policy that is designed to allow for freedom of expression, but within certain boundaries. Body tattoos, for example, are allowed, but managers have the authority to judge case by case when one is inappropriate. "With really offensive, visible tattoos, we let potential employees know we don't want to offend one of our patients, and need to keep them covered, " says Karen Hill, DNP, RN, FACHE, Baptist’s COO and chief nursing officer. "If we said no to tattoos, we’d have no employees. We want to be open to hiring the best employees, and their personality, skill, and commitment to patient care are the most important criteria."

    Seek input. Traditional top-down management does not fit in all situations in today’s workplace. Global human resource or departmental policies that treat everyone the same cannot address individual needs, which must be valued if employers are to be engaged. According to the AHA "Workforce" report, traditional human resource policies that are applied uniformly to all workers should be replaced with policies and programs that offer flexibility and choice.

    When in doubt, or when a policy does not cover a certain area, Elliott-Yeary says, the easiest thing to do is just ask your employees. Which communication method do you prefer: phone, email, or text-messaging? What kind of training method helps you learn best: classroom-style, online, or print? How can I reward and recognize you in a way that matters to you? "This is how we build leaders of the future and increase engagement," Elliott-Yeary says. 

    To gauge a candidate’s potential for a position, The Medical Center of Plano in Texas uses peer interviewing. In all departments, from housekeeping to nursing, high performers of any tenure interview candidates for comparable positions as part of a team that also includes managers and directors, says Lisa Collins, vice president of human resources.

    It is increasingly important to include the input of all levels of employees, Collins says, especially new ones who often are members of younger generations. "We recognize and value high-performing employees, and want them to have a part in the selection process," Collins says. "A new employee as well as a 20-year employee has a voice, input, and influence in the process."

    Provide coaching. Effective management of younger employees, especially, should be constructive, not punitive, Elliott-Yeary says: "There’s a way to coach and have coachable conversations versus punitive or performance-related. And it’s received totally different by the Millennial generation because they are much more sensitive to what might appear as criticism or negative feedback."

    Rather than tell a 20-something Millennial who works in patient access that her skirt is too short or heels too high, a manager should explain the importance of appropriate dress when dealing with patients, and the difference between dressing for fashion and dressing for success in the workplace, Elliott-Yeary says. Physical barriers should also be removed so the manager does not come across as overly authoritative. For example, the conversation should be conducted side by side, not across a desk. "The difference is Millennials have not been in the workplace long enough typically to understand how to handle things as maturely as we might be able to," Elliott-Yeary says.

    Reverse the mentoring. Each generation has its own strengths that can be mined for the benefit of the others. In traditional mentoring programs, older, more experienced employees provide guidance and skills to their younger colleagues. But with so many new skills—especially technology-related—required in today’s office or clinical setting, the younger generations can provide guidance as well.

     "How many people have you heard of where they actually learned most of their social media skills either through their children or their grandchildren," Bowen says. "Sometimes, older adults are finding more help from the younger generation on how to use technology and how to use it wisely."

    A study on the benefits of reverse mentoring by researchers at Boston College found that tech-savvy Millennials have a lot to teach older generations about how social media can benefit an organization.d

    As reported in the study, after young professionals at The Hartford, an investment and insurance company, shared their knowledge of social media with senior managers, the company saved time and money by switching telemarketing techniques from telephone landlines to social media and mobile phones. The researchers concluded that reverse mentoring provides generational perspective that may be lacking in traditional organizational hierarchies.

    Cross-generational mentoring, Elliott-Yeary says, "shows that each generation has something of value to the other. It also transfers knowledge. It's more about sharing and teaching than it is dictating down to the new generation."

    When Baptist Health begins training employees on its new computer system, scheduled to be implemented in June 2016, it will use student nurses to conduct some of the training. "We’re pairing them with an experienced older worker," Hill says. "We intentionally targeted those nursing students because it’s going to be fairly easy to teach them new technology because they are coming in with a fresh slate. They also are potential new employees."

    Be flexible. In everything from communication venues to work-life balance, different generations have different preferences that should be recognized and addressed.

    Recently the Medical Center of Plano began using monthly podcasts to communicate pertinent information to employees, in addition to more traditional communication vehicles such as print and electronic newsletters. In addition, online video statements from the medical center’s CEO are offered as a way to outline the organization’s top five initiatives, Collins says.

    "We have expanded the way we communicate to address those people who prefer different styles of communication," Collins says.

    Accommodating different preferences is essential to retaining good workers. As older generations near retirement age, maintaining a nursing staff with a certain level of experience can be challenging, Hill says. Recently, the average age of her staff of 1,000 nurses dropped from 47 to 45 in one year, she says. Hill attributes the change to an increasing number of retirements.

    Hill tries to work with her staff on meeting their personal lifestyle needs, while at the same time helping Baptist retain experience.

    "I have some older employers who are wonderful; they’ve been here a long time," she says. "They’re not ready to retire, but they want to do something a little less stressful. We help them find more regular roles. Some have transitioned out of management into a less stressful staff role or to part-time. Teaching managers to work flexibly with these individuals is essential."

    One of her nurse practitioners, who is 66, works summers full time at Baptist, filling in for those on vacation. During the winter, she lives in Florida and stays in contact via email. She is well-received because she fills a niche in staffing.

    "One thing that we can’t ignore is that as we do start to see retirements in the workforce, we have to figure out a way to help transition that knowledge," Hill says. "That’s an area where I see these experienced people being of value on either a part-time, per diem, or contract basis as mentors, coaches, and project advisers."

    Building a Culture of Collaboration

    Despite the potential management challenges that can arise between the generations, there are just as many prospective benefits. Workers of different generations bring different perspectives to problems.

    "People who didn’t grow up knowing what health care used to be like can bring creative solutions to bear on problems and issues that may just not be apparent, because experience can be both a blessing and a curse all at the same time," Bowen says.

    Approaching an issue with no preconceived notions can be constructive, Bowen says, especially in health care: "The solutions of the past are not necessarily going to always work going forward."

    When all is said and done, each generation may actually have more in common than many managers think. Most workers probably desire flexibility, opportunity for growth, and a workplace culture built on respect.

    Finding the common ground and building a culture of innovation based on generational strengths may be the best strategy of all—one for which consensus-oriented managers may be especially well-suited.

    "I think the best strategy for success is not thinking about how people are different but thinking about how people are the same," Bowen says. "That’s what’s going to most helpful for the field, and what’s most helpful in leadership."

    Karen Wagner is a freelance healthcare writer based in Forest Lake, Ill., and a member of HFMA’s First Illinois chapter.


    a. "Managing an Intergenerational Workforce:  Strategies for Health Care Transformation," American Hospital Association, January 2014.

    b. "Quick Stats on Women Workers, 2010," U.S. Department of Labor.

    c. "Workforce 2015: Strategy Trumps Shortage," American Hosptial Association, January 2010. 

    d. DeAngelis, K.L., Reverse Mentoring at The Hartford: Cross-Generational Transfer of Knowledge About Social Media, Sloan Center on Aging & Work, Boston College, 2013.

  • About HERe

    The HERe initiative is an effort that aims to inspire not only women but men invested in the professional development of women leaders in the health care field with the tools and resources they need to succeed. We hope to inspire one another, learn together, and connect with colleagues across the industry.

    Continue the conversation by following us Twitter and joining our LinkedIn group.

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