Millennials' Turn at the Top

Trustee talking points

Although millennials increasingly fill the workforce, they’re not filling the health care leadership ranks at the pace of previous generations. They also tend to move from job to job more than employees have done in the past.
Something similar is true at the board level: Millennials are rare on hospital boards of trustees even though they have a lot to offer other board members.
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 than clinical ones. Because of this, millennials with clinical backgrounds often are taking nontraditional career paths.
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. Embracing millennials’ values also can help.

They’ve been called coddled, helicoptered and just plain spoiled. Still, the millennial generation is a growing force that is inspiring many hospitals and health systems to find creative ways to keep their millennial managers and managers in training happy.

Members of the millennial generation, those born between 1982 and 2000, have surpassed baby boomers as the largest segment of the workforce.

As millennials climb the leadership ranks in the hospital field, they expect to be managed — and to manage — much differently than those in generations past, much of that centered on how they interact.

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

Hospitals and health systems have been quick to realize the importance of catering to this group’s distinctly different values and are pulling out all the stops to adapt to the generation that is poised to overtake their field.

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 Community Health in Colorado, is a millennial leader with a professional trajectory not unusual for his age group, a trajectory that involves 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 doesn’t see his recent departure from Trinity as a permanent goodbye. Dzialo still maintains relationships with some of his former co-workers and doesn’t rule out the possibility of joining them again.

“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 said. “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 an employee, they can possibly intercept them on the rebound from their next job.

For example, Scripps Health in San Diego — which counts 67 percent of the staff it’s hired within the past 18 months as millennials — instated an alumni program to court back 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," Cole said. "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 after 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 says.

There are, however, proven ways to keep millennials relatively happy, Cole says, and it starts with building the foundation of that long-term relationship with the employee's direct supervisor. 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 says.

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

“Emotional attachment is really crucial for the millennials,” said 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 at EmCare's anesthesia services, says that millennials’ long list of special 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 said. “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 says he “adapted my expectation and changed my attitude toward immediately dismissing somebody who asked me about vacation.”

Hartenbach says that 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 says. “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 Tampa 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’s 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 said. “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 love the program, and they especially utilize one component of it: an e-button — or a virtual thank-you note. Think of it as something similar to the “Like” button popularized by Facebook.

“Millennials are the highest utilizers of that component of the program," says Cole. "It's 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' attraction to rapid modes of communication.

In addition to their propensity to need quick and regular feedback, millennials are team players to their core, 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 taken and run with them.

As an example, Cole cites a team-based approach it has adopted for reducing patient falls. 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 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 increasingly filled with millennials, they are still a rarity in executive leadership positions, Polhemus says.

In her talks with many health system senior leadership teams, she says, “I looked 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 feel they're not moving up quickly enough in an organization to bother sticking around.

Polhemus 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.

"It's important to have and develop a culture of transparency around communication as far as [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."

Health systems also have been slow to bring millennials into the organization's very top ranks: the board. Only 21 percent of hospital and health system board members were ages 50 and younger in 2014, according to the American Hospital Association Center for Healthcare Governance's 2014 National Health Care Governance Survey Report. Part of the problem can be that finding millennials to serve as trustees can be especially difficult.

Many experts say that most health system boards don't pay enough attention to succession planning. Recruiting millennials and paying attention to their concerns would help to ensure continuity and bring fresh voices into an organization's governance.

A further 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 — skill set. 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.”

There is obvious 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 those who 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.

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" and 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, as 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."

Genevieve Diesing is digital editor of Trustee.

Bringing millennials on board

As hospitals and health systems assess how they can attract and retain millennials in their operations, hospital boards are asking the same question.

Millennial Nicholas Tejeda, CEO of the Hospitals of Providence Transmountain Campus in El Paso, Texas, says that governing boards that want to attract younger members should start by establishing a vision that strikes a chord with millennials. “Principles are what resonate with millennials,” Tejeda says. “There are a lot of things millennials care about just as much as any other generation did, such as that the organization has a noble vision and it’s based on serving a community. “

Tejeda should know. He started a millennial advisory group comprising successful young leaders. The group helps Tejeda and his team to gain perspective on the millennial generation and also to identify leaders who have the interest and aptitude to perhaps later serve on their governing board.

“It’s a pipeline of development for us that’s very deliberate and focused on that generation,” he says. Tejeda says the group has been essential in understanding how millennials view health care providers and how they make decisions.

“The insights they provide into how they evaluate health care providers was invaluable,” he said. “We read studies on how they make decisions, but when you actually sit down and talk, it is surprising the insights you can get. I think the bigger value, clearly, is just learning from them about how we should function differently for our sake, a hospital organization.”

Among the insights Tejeda has garnered:

There are strong opportunities for hospitals to develop new consumer engagement opportunities by telling more stories through the eyes of the patient.
Speed, efficiency and cost effectiveness are critical factors when millennials select a health care provider.
It is essential to contemplate the importance of work-life balance and how that applies to a millennial workforce.

Recruting millennials to serve on a health system's board isn't just a matter of career advancement and succession planning. It also gives trustees insight into how the younger generation approaches health care today. — Genevieve Diesing

Trustee takeaways

“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. Members of this group, though, do come with some of their own quirks. They often look to others — and their own leaders — to:

Communicate the "why" for any decision or project.
Make an attempt to make everyone feel part of the process.
Facilitate collaboration on projects that would have been autonomous in the past.
Allow for and be a part of team building and camaraderie.
Allow for flexibility to address work-life balance.
Provide continual feedback.
Provide praise.
Develop and support a social responsibility strategy in the organization.