It comes as no news flash that the baby boomers in health care leadership are starting to retire. I believe the generational transition in health care managers will bring profound changes. Specifically, it will bring a marked quickening in the pace of decision-making, but it is also going to pose new challenges.
A Consensus Management Style
Boomer health care managers brought a demonstrable professionalization to the field. Some early boomers remember that when they started out, there were hospital job titles like "superintendent," conveying the whiff of a prison or school district.
But boomers also brought with them a management style that drives many younger people crazy: a near obsession with consensus, along with decision cycles on major points sometimes stretching into years. At its root, the boomer obsession with consensus derived from a profound ambivalence toward authority rooted in the anarchic 1960s. To many young boomers, authority was often exercised in illegitimate ways. They vowed that when they ascended to leadership, things would be different.
Historians of health care management will look back on the previous 30 years as the "age of the meeting." Because they feared making decisions that might negatively affect anyone, many health care executives spent perhaps half of their professional lives — up to tens of millions of person years — in meetings. All too often, these meetings were badly run, with no clear goals or time limits. Avoiding accountability seemed to be the hidden agenda.
The meeting also was viewed as a way of fortifying senior managers against the steep costs of making a mistake. Hospital and health system trustees may have perpetuated this approach by punishing failure more consistently than rewarding success. Against the wrath of gun-shy boards (or discomfited physicians), health care leaders could argue that the fateful decision was thoroughly discussed (even validated by consultants!) and "everyone was on board." Of course, the costs of not deciding something could simply be floated by a relatively forgiving payment system.
The Younger Generation's Approach
Why is this destined to change under Generation X and Gen Y managers? In major part, it will change because of the Internet, and particularly social media. My Gen Y daughter is not only online literally all the time, but has been since she was 6. It was not unusual for her elementary school homework to be accompanied by a background of several simultaneous media feeds (music, TV) and as many as six simultaneous live messaging sessions with friends. Somehow, she got her work done.
The online existence of Generations X and Y has intensified with their adulthood and a wave of social media innovations. First Facebook, and rapidly after, Twitter and Instagram, accelerated the trend toward continuous horizontal communication. Social media has abolished the distinction between downtime and uptime, between vacations and work, and between personal and professional spheres.
Today's boomer leaders despair over a workforce that spends a quarter or more of their workday communicating with each other through social media, a phenomenon known as "cyberslacking."
By some estimates, cyberslacking costs the economy upward of $170 billion a year.
But, the reality is that many younger people are working via social media interaction. Social media has replaced the water cooler as the hub of informal organization and the way news and people issues are "processed." Many Gen Y workers would rather not be physically at work in any case, hence the management workaround of the results-oriented work environment, where finishing tasks takes precedence over physical presence.
Continuous horizontal communication is a necessity for tech startups, where the principals may be in different states or on different continents. The intranet and the enterprise social media it supports have been significant management tools in most tech firms for the better part of 15 years.
Meetings on Social Media
Social media-supported, continuous, horizontal communication is a potential solution to health care's "death by meeting." There is no mystery what others are thinking, because feedback is often instantaneous. A significant problem in the blogosphere, civility, is improved by requiring people to post with their real names. If consensus is essential, it can be found rapidly and impersonally through online polling tools like those offered by SurveyMonkey and others.
Social-medialike team interaction and more telepresence is almost certainly where direct patient care is headed. Most patient care is already small-T teamwork. Eventually, the gridlocked electronic health record systems we have today will evolve in the direction of "groupware" for the clinical team, as hospitalist Robert Wachter, M.D., once urged in a famous blog post, "Why the Medical Record Needs to Become More Like Facebook."
Whether this type of instantaneous horizontal collaboration is capable of scaling up to the management of billion-dollar health enterprises is unknown, highlighting a key defect of scale (e.g.,the inevitability of vertical bureaucratic hierarchy). But, present managers can assist in the transition to a more rapid-cycle, less meeting-intensive management style by embracing these new tools. They don't have to wait to retire, and can influence the succession of decision-positive younger execs.
By the time the generational transition in health care leadership has been completed, I believe we will have markedly reduced face-to-face meeting time, replaced discussion threads with polling for many in-person meetings, markedly shortened the time to make decisions, and substituted "take a few risks and fail faster" for "never fail" as a management philosophy.
Jeff Goldsmith, Ph.D., is the president of Health Futures Inc. and associate professor of public health sciences at the University of Virginia, Charlottesville. He is also a member of Speakers Express.