Leadership of a Multigenerational Healthcare Workforce

Jay Getten | Sep 19, 2021 | 17 min read


Healthcare leaders often find themselves managing as many as 5 generations at once, each with distinctive preferences, experiences, and perspectives. Leaders must bring together health professionals who span a 50-year age range to work toward a common purpose. They must amplify each generations skills and strengths which include disciplined and loyal traditionalists, optimistic and diligent baby boomers, self-reliant and task-oriented Gen X, self-directed and enthusiastic Millennials, and imaginative and flexible Gen Z (Graystone, 2019).

This article will further examine generational cohorts through exploring the values of three distinct groups. It will investigate Gen X's transition into leadership roles within health systems, the growing Millennial presence in healthcare teams, and the emerging Gen Z workforce. Generational conflicts at a rural FQHC will be considered as well as how leaders can utilize emotional intelligence to manage intergenerational conflicts. Finally, it will explore the advantages and disadvantages of multigenerational teams, the limitations of categorizing team members by their cohorts, and steps to avoid stereotyping.

Values of Generational Cohorts

With the baby boom generation reaching retirement age and with the growing demands of healthcare leadership many of the most experienced leaders are leaving the industry. Today's healthcare leaders need to be able to acclimate to new technologies, workflows, and industry practices while still working with established organizational leaders and employees (Gallagher, 2021). Gen Xers seem to be the heirs apparent to fill the leadership vacancies left by exiting baby boomers and meet the challenges of a shifting healthcare landscape.

Amidst all the changes in care delivery and payment models, tech-savvy leaders are vital, and Gen X leaders could benefit healthcare organizations in this area. Gen Xers grew up with the first home computers, while many were in college or working their first jobs when the internet surfaced. They have been quick to adopt smartphones, tablets, and other mobile technologies. Most Gen Xers are used to conducting business online and have a rich understanding of social media and digital marketing which is crucial in keeping/growing market share. Their ability to leverage mobile and social technology allows Xers to work smarter and more efficiently (Gallagher, 2021).

A frequent criticism of Gen Xers is that they are rebellious, individualistic, and cynical. Xers are said to resent meetings and group work. It is also said they are distrustful of established institutions and planned organizational changes. They have been seen as more loyal to themselves than to their companies. While these inclinations can create disagreements with baby boomer leadership, however these beliefs also facilitate innovative perspectives (Gallagher, 2021) that can move an agency forward.

Gen X leaders may focus more on work/life balance than their baby boomer colleagues. Nevertheless, they tend to be motivated and driven to improve their organizations. Their intrinsic cynicism may also provide an edge when negotiating with health information technology (HIT) vendors, medical manufacturers, and other key players in healthcare. While Gen Xer differing expectations can cause friction between a Gen X manager and older executives/board members, an organizational shift toward balanced work lives may be a net gain. Especially, given the healthcare industry's lack of flexibility which has driven out a significant number of Millennials in recent years and Gen X's understanding and support of work/life balance could help to reverse this trend (Gallagher, 2021).

Millennial employees regularly demonstrate technological expertise and are very knowledgeable about mobile phones, tablets, and related apps. Millennials are more ethnically diverse than previous generations. They are often more tolerant and easily accept differences. Millennials may be less structured than prior generations favoring informal attire and flexible work hours. They tend to not believe in lifelong employment. Instead focusing on lifelong learning opportunities. They appreciate a program of personal development and growth opportunities in the workforce (Dahl, 2019).

To retain Millennial staff health systems should implement employee development programs. This requires an investment many healthcare organizations often find difficult to achieve. Especially, with declining and revised reimbursement models. However, effective training programs can be found online (i.e., YouTube and webinars). Some health systems are even creating their own training programs via electronic media. Mentorship programs can also be an efficient model to share knowledge, develop skills, and impart the culture of the organization to Millennials. These can be formal or informal but should be part of the organization's learning and development program (Dahl, 2019).

Gen Z will be the backbone of the future healthcare workforce and currently make up twenty five percent of healthcare workers. With baby boomers retiring at a rate of 10,000 people per day and Gen X will start to retire in the next ten years, Millennials and Gen Z will make up the bulk of the global workforce before 2030. Due to digitalization Gen Z will have limited knowledge of local markets and will mostly know a world of global markets. It is important to note that sixty five percent of students in school today will end up in jobs that don't even exist yet and healthcare organizations must adapt with the times to attract the incoming Gen Z workforce (Tilk, 2021).

Gen Z grew up during a recession and many saw their parents' struggle. As a result, Gen Z is typically more financially conservative. This is important information for health systems because Gen Z employees want to make sure that a position has stability and offers retirement benefits. They also seem to be much more worried about student loan debt than Millennials. Gen Z witnessed how Millennials have been burdened with student loan debt and they trying to figure out how they can graduate or finish their education with as little debt as possible (Children's Hospital Association [CHA], 2021) which is why health systems offering loan repayment programs like the National Health Service Corp Loan Repayment is crucial.

Workplace Conflicts Between Generational Cohorts at a Rural FQHC

CHP is a federally qualified health center (FQHC) with several sites across two counties. CHP provides medical, dental, behavioral health, pharmacy, and educational programming to nearly 12,000. Like many health systems CHP has employees from four generational cohorts. The challenges over the last year from the covid19 pandemic have exasperated existing generational conflicts.

Studies have identified several sticking points where generational differences tend to emerge, particularly around the use of technology, communication, feedback, time management, work/life balance, and organizational structure (Hirsch, 2020). Communication ruptures were common at CHP prior to the pandemic and often staff were able to move on without much impact on processes. However, this is no longer the case. As pressures have amassed there have been more communication break downs because of communication differences between cohorts.

Communication is difficult under duress in general, and it seems that even generational differences in coping mechanisms may be adding to CHP's communication breakdowns. One study found that Millennials reported sleeping (56%) and talking with close family or friends (53%), Gen X and boomer health professionals reported isolating themselves from others (45% and 44%) and exercising (46% and 45%) as methods for coping with stress (Mensik, 2020). Gen X and baby boomer isolating behaviors may be further driving a wedge between generations.

Studies show that healthcare professionals ages 40 to 54, or those belonging to Generation X commonly experience burnout at a higher rate than their older and younger coworkers. Nearly forty eight percent of Gen X health professionals reported experiencing burnout, compared with thirty eight percent of Millennials and thirty nine percent of baby boomers. Gen X healthcare workers consistently report higher levels of job-related stress that contributed to feelings of exhaustion, cynicism, and disconnection from professional satisfaction and duties (Mensik, 2020). The above statistics are playing out at CHP with many of Gen X staff and middle managers leaving the organization due to increased burn out associated with patient acuity exasperated by the pandemic and the CHP's inability to develop processes to address the rising demands.

Team generational diversity can contribute to ruptures within organizations. This can be seen when similar members are drawn to one another and those who are different develop a dislike for team members not in their generational cohort which has been described as “similarity attraction.” This situation often has a negative impact on team performance (Burton et al., 2019) and this is playing out at CHP. As demands of the pandemic have increased this behavior with CHP staff engaging in tribalism by generational cohorts and rank within the organization.

It appears that younger CHP employees are receiving the brunt of similarity attraction by their Gen X and boomer counterparts. This reinforces the idea that Millennials tend to be viewed unfavorably by older generations. One study that found that younger team members would benefit greatly from older members experiences. However, more experienced staff do not always compliment younger staff as much as the younger ones may expect which can be discouraging. The study also suggests that relationship conflict, task conflict, and procedural conflict adversely impacts job performance due to increased anxiety and decreased cognitive processing. Younger generations tend to turn task or procedural conflicts into relationship conflicts which also has a negative influence on job performance (Burton et al., 2019).

Preferences around the use of technology is another potential sticking point. Generally, older employees tend to prefer e-mail, while younger employees prefer texting (Hirsch, 2020). At CHP younger generation staff often pay less attention to information found in emails and tend to be more frustrated by the number of emails they must sift through to find information pertaining to them.

The challenge for a lot of baby boomer and Gen X healthcare leaders regarding HIT is to not just keep current systems and try to extend it out another two, three, four years. Healthcare organizations typically have been slow to adopt new technologies and CHP is no different. Their HIT/IT systems are woefully outdated, and this had led to frustration with Millennial, Gen Z, and even Gen X employees. The reality is if health systems like CHP want to attract and keep Gen Z employees, leaders must understand that incoming Gen Z employees don't want to work with dated systems (CHA, 2021).

Application of Emotional Intelligence to Address Intergenerational Conflicts

Emotional intelligence (EI) addresses specific elements of oneself, including self-awareness, personal reflection, and the enhancement of human interaction. It gives individuals the capacity to read their environment, understand how or why themselves/others react, and respond accordingly. Emotionally intelligent leaders can choose their battles more wisely and gain respect through encouragement rather than demanding it. EI allows team members to validate, understand, work together to improve problem-solving skills, and reach better outcomes. EI is also helpful in identifying and creating leaders who help staff be more engaged and focused on tasks at hand (LaCivita, 2021).

Of the elements found in EI self-awareness plays a critical role in effectively managing generational differences. Healthcare managers must be in touch with their own beliefs, values, work attitudes, and understand that these may be different from the team members they support. It is important for health leaders to use self-awareness to make sure their own preconceived notions are not distorting how work is distributed among generational cohorts (Hirsch, 2020). Leaders can utilize elements of EI to create a level of trust with their teams. A foundation of trust helps them connect with staff members at any stage in their career. Trusting teams help organizations circumnavigate changing healthcare environments while remaining focused on patient safety, clinical quality, and patient experience (Graystone, 2019).

To avoid generational disputes managers must work with team members to determine which norms work best based on collective preferences and tasks that need to be completed. Some leadership experts recommend using a five-part process to help resolve intergenerational conflicts. This includes talking about generational differences, focusing on common needs, agreeing on how to accommodate different approaches, maximizing the strengths of each generation, and determining which option will generate the best results (Hirsch, 2020).

Emotionally intelligent healthcare leaders use techniques like the Personal Histories Activity to help team members build trust and find common ground. During the activity each team member prepares a slide with photos that answer three questions: Where did you grow up? How many siblings do you have, and where do you fall in that order? Describe a unique or interesting challenge or experience that shaped who you are. This activity allows people to find common experiences, and they get to know the whole person (Hirsch, 2020).

Advantages and Disadvantages of a Multigenerational Healthcare Workforce

Leading a multigenerational workforce is not so different from leading a multidisciplinary team. It calls for flexibility, collaboration, communication, and support for different perspectives and viewpoints. It also requires all staff members to value the unique talents that each team member brings to the table. For example, Gen Y or Gen Z health professionals can benefit from mentoring advice from veteran boomer or Gen X staff. While tech-savvy, Gen Y or Gen Z staff can help their veteran colleagues keep up with ever-evolving technology (Graystone, 2019).

Nontraditional work schedules were introduced with the Gen X cohort because they typically believe that work can be performed anytime or anywhere and feel most comfortable in an informal work atmosphere. So, Gen Xers tend to be motivated by flexible work arrangements and casual work environments. This is the first generation to adopt the concept that work is temporary and lifelong employment is unrealistic which is displayed in decreased organizational loyalty (Jones et al., 2018).

The Gen X stereotype that portrays them as more likely to leave an employer for more meaningful and challenging work because they grew up in an era where companies did not reward organizational loyalty. This experience helped the cohort to be more independent and autonomous. Gen Xers like to be creative and tend to have an entrepreneurial spirit. They value productivity over the number of hours worked and tend to be more outcome focused (Jones et al., 2018). As health care payment models continue to shift from fee for service to value-based reimbursement Gen X team members with an outcome focused mentality can be a benefit to health systems transitioning to a value-based model.

Millennials are the generational cohort has seen the return of the importance of the child. This has shaped their core values which include optimism, civic duty, confidence, and achievement. Millennial's often distrust centralized authority. However, they do share some values with the baby boomer generation such as optimism about the future and a can-do attitude. They are also very technologically literate. The increase in technology for this generation has made communication less focused on face-to-face and more technology driven (Jones et al., 2018). Millennial team members values of civic duty and optimism are critical during the times of distress and can keep the rest of the team focused on the goal of patient care.

Gen Z is driving trends through the early adoption of technology. Specifically, in the areas of communication, collaboration, money, and education. Gen Z did not turn in their homework via e-mail they're using the cloud or on Google classroom. However, when they show up to work at a healthcare facility, and they must print something out, sign it three times, or send it in an email that seems very antiquated to them. Other generations may be inventing the technology, but Gen Zers make it the new normal and bring it into the workforce (CHA, 2021).

This generation has grown up learning everything on YouTube and they expect employers to offer them video-based/training on demand through their phone. They are going to drive the away from traditional "certify the trainer or go to the workshop' training (CHA, 2021). Gen Z's grasp of new technology and intolerance of outdated systems will be a disruptive force to the traditional healthcare system. Though jarring, it may be what is needed for health systems to start rapidly adopting emerging technologies.

Limitations of Categorizing Employees Based on Their Generational Cohorts

Leaders should use a level of caution when using generational research to inform organizational decision-making because it can put people in a box. The true key to understanding an employees' behavior is to look at the individual. The best way for managers to find out how to motivate and engage employees is to ask them what matters to them (Hirsch, 2020).

One way generationally sound health systems avoid categorizing employees by generational cohorts is by embracing evidence-based thinking that transcends age groups. New health professionals transitioning into practice can work on evidence-based projects and find answers that most of their multigenerational colleagues will welcome. Through evidence-based practices health systems emphasize empowerment for all team members involved in patient care (Graystone, 2019).

Building effective multigenerational healthcare teams should start with evaluating an organization's generational profile. Evaluating the data allows organizations to develop a plan for recruitment, retention, and communication for various generational groups. After determining a generational profile, healthcare organizations can begin to develop a thorough generational management plan. To take it a step further organization can develop generational competencies as part of their strategic plan. The plan should focus on developing sensitivity and understanding through training to help build a healthy multigenerational workforce that avoids stereotyping (Modern Healthcare, 2016).


Healthcare leadership ignoring generational differences may likely decrease organizational profits through employee turnover rates and increased costs for employee recruitment, training, and retention. Additionally, lack of attention to intergenerational teams lead to poor clinical outcomes resulting from disconnects in intergenerational communication styles. Poor multigenerational teamwork can lead to patient rehospitalizations, increasing the cost of care, and potential financial penalties for not meeting reimbursement criteria (Modern Healthcare, 2016).

A thoroughly developed multigenerational workforce can improve employee satisfaction and reduce turnover. It also fosters team building across generations which can improve outcomes while reducing the overall cost of care. Enhanced intergenerational communication also guarantees the effortless transfer of organizational knowledge from older more experienced staff to younger ones, which helps avoid the loss of intellectual capital that often occurs when senior employees leave the health system (Modern Healthcare, 2016). It will take the experience of baby boomers, the entrepreneurial spirit of Gen Xers, can-do attitude of Millennials, and the disruptive tech-savviness of Gen Z to address the complex health challenges of today and effectively meet the challenges of the future.


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