Framing the Issue

  • Although millennials now rule the work force, they’re not filling leadership ranks at the pace of previous generations. They also tend to turn over faster than those of previous generations.
  • In health care, roles are so specialized that it can be hard to move up. But in large health care organizations, there are nonclinical roles that offer more room for advancement. A lot of millennials with clinical backgrounds are taking on nonclinical jobs instead of traditional linear advancements to get into leadership more quickly.
  • Health systems that form strong bonds with their millennial employees stand a better chance of keeping them, or courting them back after they’ve left for the long haul.
  • Embracing millennials’ values, such as teamwork, work-life balance and social connection also can help hospitals to attract and retain this group.

Members of the millennial generation, those born between 1982 and 2004, have surpassed baby boomers as the largest segment of the workforce.

And now as millennials climb the leadership ranks in the hospital field, they expect to be managed — and to manage — much differently from those in generations past, much of that difference is centered around how they interact with colleagues and bosses.

"Millenials tend to communicate differently," says Rachel Polhemus, senior partner with Witt/Kieffer. "They want instant gratification so they are looking for answers faster."

Supporting Articles

Hospitals and health systems have been quick to realize the value in catering to this group’s distinct values and are pulling out all the stops to adapt to the generation that is poised to overtake their field.millennials-health-care-managers

To remain competitive, today’s leaders are: establishing long-term relationships with millennial employees that extend far past their initial employment tenures; promoting work-life balance and team-based approaches to problem solving; and, perhaps most shrewdly, tweaking their internal messaging to mimic the interactions of social media.

Three states, six years

Benjamin Dzialo, executive director of the Clinically Integrated Network at Boulder (Colo.) Community Health, is a millennial leader with a professional trajectory not unusual for his age group, which often includes maintaining ties with previous employers. In the past six years, he has taken jobs that include an administrative fellowship at the University of Texas Medical Branch Health at Galveston, and a consultant role at Trinity Health in Livonia, Mich., before landing at Boulder in August.

Dzialo, who was profiled by H&HN in 2013 when he worked on process excellence at Trinity, doesn’t see his recent departure from that organization as a flat-out goodbye. He maintains relationships with some of his former co-workers, and doesn’t rule out the possibility of joining them again.

ben-dzialo-millennials-health-care-managers“I’m very happy with my job right now, but there’s a chance that at some point in my life, I might be going back to Michigan,” he says. “And so, it would only make sense that I would consider Trinity at that point.”

This less-rigid approach to coming and going — and maybe coming back again — is so widespread among millennials that health systems are putting plans in place so that when they lose employees, they can possibly intercept them on the rebound from their next job. (Pictured left: Benjamin Dzialo values work/life balance, and appreciates the fitness culture in Boulder, Colo. Dzialo is shown participating in a triathlon in Zurich. He has competed in too many triathlons to count, he says.)

For example, Scripps Health in San Diego — which counts 67 percent of the staff it’s hired within the past 18 months as millennials — instituted an alumni program to court former staff. Eric Cole, corporate vice president of human capital services at Scripps Health, says it’s all about maintaining a long-term relationship with employees.

"Millennials do tend to turn over more often than other generations," says Cole. "We’ll reach back out to [former employees] and say, ‘Would you like to come back to Scripps? We have an opening.’ "

The approach appears to be working: Scripps is seeing about 20 percent of employees return within the first year of leaving.

Cole says that, sometimes there isn’t much a health system can do to prevent these exits, but there are mutually beneficial ways to respond to them. "Based on exit interviews we’ve had, sometimes you just have to let [millennial employees] go, and make sure you have enough of a relationship with them to be able to reach out to them and say, ‘You know it’s all right for you to come back,' " Cole explains.

However, Cole says, there are proven ways to keep millennials relatively happy, and it starts with the employee's direct supervisor building the foundation of that long-term relationship. This can be kick-started by communicating with millennials on their terms, such as by embracing texting, instant messaging and remote work environments. The millennial’s relationship with his or her supervisor — and their ability to communicate — is one of the biggest determinants of whether he or she will stay at the organization for a long period, Cole asserts.

Investing in their development and grooming them professionally also help to keep millennials engaged. A recent Gallup survey found that 87 percent of millennials cite professional development or career growth opportunities as "very important" to them in a job.

“Emotional attachment is really crucial for the millennials,” says Linda MacCracken, senior principal of the health and public service practice at Accenture. “They want to be able to personally connect and they want to be able to digitally connect, but they also need to feel some attachment. If you’re an executive, there is an opportunity to win the loyalty and the engagement of the millennials, but it calls for having the social attachments, and making sure that there’s a clear career ladder opportunity.”

Polhemus says that these types of efforts — alumni programs, embracing modern modes of communication and investing in millennials’ professional development — are the waves of the future when dealing with this age group.

"It’s going to be important to, as much as possible, retain and attract talent and find ways to keep [millennials] engaged in the work, recognizing that there’s always a risk of losing them," she says.

Overcoming bias

William Hartenbach, M.D., executive vice president of anesthesia services for physician staffing firm EmCare, says millennials’ list of unique needs shouldn’t blind leaders to the value of their ideas. For example, Hartenbach, who recruits and hires physicians for a living, says millennials’ preference for work-life balance is important not just because of the heft of the generation demanding it, but because it’s a good idea, especially as physicians increasingly report experiencing burnout.

“Initially, I would dismiss candidates who wanted to talk about [work-life balance] and who were concerned about how much time they were going to be in the hospital,” Hartenbach says. “But, I think it’s increasingly important to make sure that you don’t get burned out. It’s a long career and it’s fairly intense and the stakes are high.”

Hartenbach now offers potential candidates more time off than he did previously, and “adapted my expectation and changed my attitude toward immediately dismissing somebody who asked me about vacation,” he says. His compromises have paid off because the millennials he’s hired and promoted “have done a fabulous job.”

“They like being mentored and like being given responsibility to lead and direct, and they have a lot of energy,” he adds. “It’s easier to promote people when they have a lot of fire and energy in their bellies than when they’re older and tired and kind of fed up with the system."

Case in point: Nathan Bolli, a millennial who was still completing his residency when Hartenbach promoted him to chief of anesthesia at Florida Hospital Carrollwood in 2015.

When Bolli came on board, Florida Hospital was in the midst of converting paper documentation to electronic health records. Bolli’s digital acumen helped him to quickly modernize the anesthesia department, Hartenbach says, moving "that hospital forward faster than any other place I’ve ever managed or am currently managing."

Bolli says the willingness of leaders at Florida Hospital to take millennials’ concerns seriously is what keeps him there. It even led him to recruit a friend.

The hospital is “very receptive and responsive to the impressions and advice that a millennial generation has of how to grow and move forward,” Bolli says. “And [I tell others that] this is a place for growth, that we respect your opinion and we hope that you can become part of the institution and grow with us. We can take your ideas and incorporate them with our ideas and have a better product, and that has helped to recruit people to the hospital.”

Skilled at ‘Likes’ and Lean

In a direct departure from the independent-minded baby boomers, millennials grew up being rewarded with participation trophies and A's for effort and are used to receiving — and giving — constant feedback, for better and for worse.

Once again, Scripps noticed this trait and responded by implementing a rewards program that incentivizes employees to recognize each other for their work. Millennials have embraced the program and one element of it in particular: an e-button — or a virtual thank-you note. Think of it as something similar to the “Like” button popularized by Facebook. (Pictured at right: Eric Cole, corporate vice president of human capital services at Scripps Health, says millennials "want to be part of the problem solving.")eric-cole-scripps-millennials-health-care-managers

“Millennials are the highest utilizers of that component of the program," says Cole. "[The button] is interesting because it’s a really quick recognition that you don’t have to take a lot of time to use," which is consistent with millennials' compulsion for rapid modes of communication.

In addition to their propensity to need quick and regular feedback, millennials are team players to their cores, a characteristic on which Scripps has also found a way to capitalize. The health system now utilizes Six Sigma and Lean approaches to problem-solving — methodologies that are inherently team-based — and millennials have run with them.

Cole cites a team-based approach Scripps has adopted for reducing patient falls as an example. By employing diverse teams that assess possible reasons for previous patient falls, millennial employees were able to come up with effective solutions that ultimately prevented more falls, such as posting charts above patient beds that kept every person on the unit informed of the patient’s status.

These approaches “really draw on that team problem-solving, which is so strong in that millennial generation,” Cole says. “They just don’t want to pass the solution or the problem off; they want to be part of the problem-solving.” As a result, Scripps “is reaping rewards in both patient experience [perceptions] and also cost reductions,” he says. “I think it’s a win-win for both the staff and the organization.”

Unmet potential

While the health care workforce is dominated by millennials, they are still a rarity in executive leadership positions, says Polhemus. In her talks with many health system senior leadership teams, she says, “I look around the table and I can’t remember the last time a millennial was sitting at it.” 

That might explain why, unlike previous generations that tended to stay with one employer for years or even decades, millennials are job-hoppers. They oftenfeel they're not moving up quickly enough in an organization to bother sticking around.

rachel-polhemus-millennials-health-care-managersPolhemus suggests that managers adopt a straightforward, open dialogue from the outset to get a feel for millennial staff members' expectations, as well as to communicate their own. This allows managers to anticipate the internal opportunities necessary to keep a good employee or recognize that the employee may need to move on to grow professionally. (Pictured at left: Rachel Polhemus, senior partner at Witt/Kieffer, says millennials are hopping jobs to move up the career ladder.)

"It's important to have and develop a culture of transparency around communication," regarding millennials' career goals, she says. "It's also important to be open-minded, and understand that individuals aren't leaving because they don’t like the organization; they’re leaving for career advancement."

Another reason millennials are slow to move up in an organization may be that leadership roles are evolving to encompass a more complex — and more difficult to acquire — skillset. For instance, health care systems now often seek managers with both business and clinical experience.

In large health care organizations, nonclinical roles offer more room for advancement. Warner Thomas, president and CEO of Ochsner Health System in New Orleans, says that because health care organizations are becoming bigger, more competitive and more complex, this new paradigm demands “a much more capable, a much more flexible and creative leader. And that is the challenge for any health care institution, regardless of whether someone is early, mid- or late career,” he says.  

So there is enormous value in investing in this young group. In addition to health care’s inherent challenges, the volume and speed at which millennials are set to overtake health care means that hospitals and health networks that do not adapt to their needs will fall behind. “This change in terms of workforce priorities will topple those organizations that are not nimble enough to alter their strategies,” says Cindy Roark, M.D., president and CEO of Synergy Population Health, a health care consulting firm.

At Scripps, millennials with clinical backgrounds often are pursuing nonclinical opportunities to get a shot at leadership, Cole says. To encourage this, Scripps implemented simulation centers that incorporate new technology so clinicians can rapidly "upskill," or practice treating patients in a lifelike environment. Geared toward the communication preferences of millenials, these centers incorporate online learning as well as face-to-face educational sessions.

The system also has dedicated educational units for continuing education. Cole cites an example of a nurse who became a patient care manager, then moved into scheduling. She married her nursing expertise with her interest in problem-solving to move up in her career.

This is precisely the kind of work that more organizations need to be doing to attract and retain young staff, says Dzialo. "If you want to be successful in hiring and taking on my generation as a workforce, you have to look at [my employment] as an opportunity for education and mentorship. If you’re not looking at career advancement as an expected skill set as a requirement of your organization, I think your organization will fail in its work."

Executive Corner

10 Ways to manage a millennial

“The good news in terms of identifying successful millennial leaders is that they are not significantly different from successful leaders in other generations,” says Cindy Roark, M.D., president and CEO of Synergy Population Health. However, this group comes with its own quirks when it comes to managing them. Roark suggests that managers:

  1. Constantly communicate the why for any decision or project.
  2. Make an attempt to make everyone feel part of the process.
  3. Facilitate collaboration on projects that would have been autonomous in the past.
  4. Throw email edicts (such as the phrase “effective immediately”) out the window.
  5. Allow for and be a part of team building and camaraderie.
  6. Allow for flexibility to address work-life balance.
  7. Provide constant feedback.
  8. Provide constant praise.
  9. Somewhat sugarcoat the message.
  10. Develop and support (both from a scheduling and a financial perspective) a social responsibility strategy within your department and the overall organization.