understanding how health care is changing
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Understanding how health care is changing. Looking at the world through the lens of your patients, your community, and your co-workers. Eric N. Berkowitz, PhD. Would you wear Flip Flops to the White House?. Northwestern 2005 NCAA Championship Lacrosse team. - PowerPoint PPT PresentationTRANSCRIPT
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Understanding how health care is changing
Eric N. Berkowitz, PhD
Looking at the world through the lens of your patients, your community, and your co-workers
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Would you wear Flip Flops to the White House?
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Northwestern 2005 NCAA Championship Lacrosse team
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To understand your patients and how patient behavior is changing
To better work in clinical care teams more effectivelyTo recognize that the community is more demanding
of health care institutions today
The answer you have may be in understanding which cohort you belong to!
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Or have you found yourself asking these questions?
Why do the new employees not seem to want to work very hard?
How can my kids do their homework and instant message at the same time?
Doesn’t anyone read the newspaper anymore?
Do I have to go to another group meeting?
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This is the perspective of cohorts!!!!
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Cohorts…….
A new way to look at your patients, physicians, employees, colleagues….
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The concept of cohorts is actually not so new…first posed in 1928!!!
Karl Mannheim a sociologist wrote an essay
“The Problem of Generations”
Essays on the Sociology of Knowledge (1928, 1952) London: Routledge & Kegan Paul
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As we talk about cohorts, it affects…..
*patient behavior*clinical teams
*management & leadership challenges
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The Management Implications of what we talk about tonight are significant!Improving health care today means working cooperatively in teams
It is leading a symphony of varying cohorts
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Disclaimer for protection of the presenter
As we talk about cohorts and you find yours, it is not meant to imply that you hold these values, did these things, or come from these
types of families, OK???
In another words, don’t be too serious!
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What’s a cohort?
• A group bound together in history by the events that were happening as they were ‘coming of age’ : ~ 17 - 22
• Major historical events: wars, political dislocations, technological revolutions, sociological upheavals
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“Cohort” vs. “Generation”
• A ‘Generation’ is usually:– Defined by when a group is born– About 20 - 22 years in duration
• A ‘Cohort’ is:– Defined by when a group is coming of age – Can be as long, or as short, as the events that
define it
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Events Form Values
• The ‘cohort-forming’ events form similar value sets in those who come of age during those events
• The value sets tend to change little during a lifetime
• Thus the groups are bound by their similar (and unchanging) value sets*
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Cohort Definition
• Depression• World War II• Post-War• Boomers I & II• Generation X• N Gen• Millenials
Matures
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Depression Cohort:only our patients
• Born between 1912 and 1921 (89 to 98 years old)
• Defined by the Great Depression• financial security rules their thinking• preserving their homes a central concern
S & P 400 declined 69% between 1929 and 1932. Not until 1953did S & P get back to where it had been in 1929
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How do events affect cohorts?
If you have grandparents or parents who are from the depression cohort and enter their kitchen what do you
always find?
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Depression cohort kitchens have?
• (a) a rug near the stove• (b) linoleum on the floor• (c) Moxie in the refrigerator• (d) an area called a pantry• (e) a chute for the ice
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Depression cohort kitchens have?• (a) a rug near the stove• (b) linoleum on the floor• (c) bottles of Moxie in the
refrigerator• (d) an area called a pantry• (e) a chute for the ice
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Depression Cohort Patients”
Loved by Hospital CFO’s and Doctors:
Why?
They always paid their bills!
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Who are the matures?Patients, some employees, and the
communityBorn between 1922 and 1945
World War II The Post War
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World War II Cohort• Born 1922 - 1927, came of age 1940 to
1945 (age 83 to 88 today)--5% of population
• defined by World War II• defined role in war was for many highest
status achieved• common experience was a sense of
deferment and delayed gratification*
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World War II:
The Best Patient:
Why?
Defining experience of this cohort was the war Took an order, marched to it
And, you will succeed, You’re the clinician give an order, they will comply!
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Post War Cohort:patients, community, workforce
• Born between 1928 and 1945, came of age 1946 to 1963
• 22.7% of the present population• beneficiaries of a long period of economic
growth• tenor of their times conservative, seeking
comfort and security• time that promoted conformity*
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Boom Times in America
per capita income grew in the 1950s by 48 percent
• Home ownership increased by 50 percent
• Those fitting into “middle class” category reached 60 percent
Tulgan,Managing Gen X,p.42
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Post War were the first sandwich cohort!
Can’t really accept the pride of the World War II group
yetThey ain’t Boomers
?
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Post War Cohort values
--The Post Wars are more cautious and--The Post Wars are more cautious and quietly assertivequietly assertive
--value conformity--value conformity
Levittown
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Mature Values
--Accomplished their goals through hard work--Accomplished their goals through hard work
--Matures believe in hard work and sacrifice--Matures believe in hard work and sacrifice
--Matures are fiscally responsible--Matures are fiscally responsible
--self-sacrifice is a virtue--self-sacrifice is a virtue
--strong trust in authority and institutions--strong trust in authority and institutions
--delayed reward--delayed reward
--adherence to rules--adherence to rules
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Post War Key value:great trust in Institutions
A Health System Development Director’s Dream!
This is the group whose value as well as their stage in life cycle leads them to support institutions, but hold on!
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Mature Leadership is
Directive!!
Take Charge !!! Delegate !
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How do other cohorts view Matures
• Dictatorial• Rigid• Inhibited
• Too set in their ways• They’ve got all the money• Learn to use your computer
Boomers Gen Xer
•Trust•Good leaders
Gen Y
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Mature view of work:
• Inevitable duty rather than a sense of meaning and fulfillment and social interaction (Kupperschmidt, 2000)
• A good day’s pay and recognition from authority are just rewards for a day’s hard work ( Lancaster and Stillman, 2002)
• Believe in command and control leadership (Zenke et al., 2000)
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Pre-Boomers:The management challenge
• Need technology training• Use traditional perks for motivation• Personal touch—phone calls and notes• Coaching should be tactful and private
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A work environment for the Matures
• Matures like consistency and conformity• Matures are conformers• Matures are disciplined• Matures believe in law and order• Command and control leadership• Obedience over individualism
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Leading Edge boomers• Born between 1946 and 1954• 17.4% of the population, came of age between 1963-
1972• first to experience television as a pervasive influence
on culture• came of age in the 60s--Vietnam, Kennedy assassination• heavily values individualism, indulgence of self, and questioning everything
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Boomers
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The Boomer Motto
“Never trust anyone over 30”
-Abbie Hoffman
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Oh God, We’re 50 hitting 60 (and older!!!!!)
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The March to 60!Nearly 8,000,000 Boomers turned 60 in 2007
That is 330 per hour that year !
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Boomers II• Trailing edge boomers born between 1955 -
1965, came of age 1973 to 1983• external events are stopping Vietnam War,
Watergate--faith in institutions gone and idealistic fervor disappeared
• narcissistic preoccupation with self (“I’m OK, You’re OK”)
• oil crisis, S & P declined 30% between 1973 and 1975---debt was way to maintain lifestyle
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Boomer I’s and Boomer II’s
• Idealistic• Workaholics• Career first, family
second• Active participants or
aware observers of the 60s
• More cynicalBoomer I’s Boomer II’s
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Then: Long hairNow: Longing for hairThen: A kegNow: A ekgThen: Acid rockNow: Acid refluxThen: Moving to California because it's cool.Now: Moving to California because it's hot.Then: Watching John Glenn's historic flight with your parentsNow: Watching John Glenn's historic flight with your kidsThen: Trying to look like Marlon Brando or Elizabeth TaylorNow: Trying not to look like Marlon Brando or Elizabeth TaylorThen: Seeds and stemsNow: RoughageThen: Popping pills, smoking jointsNow: Popping jointsThen: The President's struggle with FidelNow: The President's struggle with fidelityThen: PaarNow: AARPThen: Killer weedNow: Weed killerThen: Hoping for a BMWNow: Hoping for a BMThen: The Grateful DeadNow: Dr. Kevorkian
What they knew,What they know!
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The Boomers
• 86% high school graduates• More than 26% have college degrees• Boomers have a sense of privilege
Highest level of education! Why?
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Boomers are aging differently• By 2010, estimated 96 million people over 50• 50 will be fashionable: ‘50 is where it’s at,
baby!’• Inner-directed focus will lead to a new
spiritualism, contemplativeness• Boomer elders will be seen as wise, reflective,
‘keepers of values’
In October 2007 the first Boomer applied
for Social Security at 62!
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Boomers are aging differently
• 2000: ‘Youth’ still holds sway (50 is still ‘bad’)– Youth-emulating– Age-denying– Activity-driven in ‘retirement’
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Boomer values
• individuality not conformity
• rule breakers
• what they get is more than what they earn, it is what they deserve
• fights are a clash of moral principles Good vs. evil
• want to be in charge
• work centered
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Trailing Boomers
Possibilities not so bright!Possibilities not so bright!
--three mile island--three mile island
--energy crisis--energy crisis
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Boomers and Work• “workaholics” with a relentless pursuit of success and
achievement (Kupperschmidt 2000 & Zemke 2002)
• Highly competitive (Foot 1998, Lancaster & Stillman 2002)
• Place great value on their careers as a central focus on their lives (Smola and Sutton, 2002)
• Career is a key to personal fulfillment (Kupperschmidt 2000 & Lancaster & Stillman 2002)
• Not technologically savy & do not like change (Raths 1999)
• Even when working in a team, want their individual contributions recognized (Weston 2001)
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The Boomer Challenge
• Let them know their experience counts• Communicate the change agent potential• Show them how they can be a star• Need to be encouraged to take advantage of
training opportunities• Give them public recognition*
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Boomers
• Motivate with personal appeal• Provide public recognition• Name recognition• Reward hours and effort• Coach tactfully• Use questions, not statements• Treat as equals
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“Kids. I don’t know what’s wrong with these kids today”
--from Bye Bye Birdie
Or what I often hear Boomers say about Gen Xers and other younger cohorts
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Generation X
• Born 1966-1976, came of age 1984-1994, 21.9% of the population
• children of divorce, latch key kids--searching for anchors
• little hope of lifestyle of parents• politically conservative*
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W. Strauss And N. Howe, (1991) Generations: The History of America’s future 1584-2069) New York:
Morrow; C.Raines,(1997) Beyond Generation X, Menlo Park, Ca. Crisp.
• In the 1960’s 75% of the families looked like these popular TV shows – “Leave It to Beaver”– “Ozzie and Harriet”
• 40% of Gen Xers were in single parent households as children
• By 1997 only 3 in 100 families looked like this!!!!!!!!!!
American College of Physician Executives 58
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Who are these Gen Xersthe most demographically diverse
• 69% Caucasian• 13% African American• 13% Hispanic• 3% Asian American• 1% Native American*
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The Boomer view of a Gen Xer
But Boomers shouldn’t look askance!
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Would you have invested in these boomers?
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Do Boomers really see themselves?
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The New Gen Xer
David Filo
Jeff Bezos
Michael Dell
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Reality Bites
And they wonder why those of us in our twenties And they wonder why those of us in our twenties refuse to work an eighty hour week just so we canrefuse to work an eighty hour week just so we canAfford to buy their BMWs. Why aren’t we interestedAfford to buy their BMWs. Why aren’t we interestedIn the counter-culture that they invented as if we didIn the counter-culture that they invented as if we didNot see them disembowel their revolution for a pairNot see them disembowel their revolution for a pairOf running shoes. But the question remains, what areOf running shoes. But the question remains, what areWe going to do now? How can we repair all the We going to do now? How can we repair all the Damage we inherited? Fellow graduates the answerDamage we inherited? Fellow graduates the answer is simple. is simple. The answer is…………I don’t know.”The answer is…………I don’t know.”
--Elaine Pierce (Winona Ryder)--Elaine Pierce (Winona Ryder)
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Generation X
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What Gen Xers Know
• 1980 Carter signs Chrysler bailout bill• 1981 Pope John Paul II shot• 1982 John Lennon shot• 1983 PCP drug rages• 1984 Bernard Goetz shoots four in NY subway• 1985 Crack street drug first appears• 1986 AIDS quilt• 1987 Gary Hart has some problems• 1989 Exxon Valdez• 1990 Bush breaks taxes promise• 1991 Dr. Kervorkian gets attention• 1992 Charles and Di separate• 1993 First World Trade Center bombing• 1994 Kurt Cobain commits suicide
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But they also know…….• Post-it notes (1980)• Pac-man (1981)• Smurfs (1982)• Teenage Mutant ninja turtles (1983)• The Cosby Show (1984)• Cds become popular (1985)• Oprah goes syndicated (1986)• Geraldo appears (1987)• Last Playboy Club closes in Lansing, Michigan (1988)• Berlin Wall Falls (1989)• Saturn launched (1990)• Anita Hill accused Clarence Thomas (1991)• Clinton elected (1992)• Michael Jackson accused of fondling a boy (1993)• Michael Jordan takes up baseball (1994)
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Gen Xers have grown up with . . .
• Only knowing color TV• PCs and microprocessors• Jobs not careers• Being pragmatic
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Xers on the Job
• of their 52 million, nearly 18 million change their full time jobs annually!
• They are not slackers– according to the U.S. Census Bureau, they work an average of 3.56 hours per week more than the national average
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The Xer Organizational Challenge Challenge
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Keys to the Xers
• Xer’s were affected by their parent’s experiences of disappointments of downsizing and being laid off (Meda 1996; Tulgan 1995)
• Reward their innovation• Want to continuously learn new things• Work in teams where they are given responsibility• Motivated in an environment that they describe as a
“culture of fun” (Ramo 1977)
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Gen Xers are . . .
• Self reliant• Want balance• Like informality• Approach to authority is casual• Technologically savvy
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Flexibility in work environment!!Work/life balance
• Augusta Medical Center• Medical College of Virginia
9 month work schedules to conicide with a child’sSchool schedule
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Gen ‘xers:most want……
(d)
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The “N - GEN” (Y)(‘Network’ or Internet)
• aged 26-32 today• “Crystallizing Event” is the Internet, 9-11• Archetypical opposite of Gen X; recurring
characteristics similar to Depression/WW II• Positive, idealistic, hard-working, stressing
team-play (not free-agency)– More modest, mannerly, civic-spirited
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A Positive Cohort
• Most studies show up to 80 percent believe they will be financially better off than their parents
• 46% in high school class of 2000 said the had an “excellent relationship with their parents up from 34% as freshman (Newsweek poll 2000)
• 1.2 million of the 3.3 million N Gen received college degrees in 2000
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The N Gen
• Less likely to gender stereotype• Less racial stereotype• Barriers of time and space are different—less
absolute meaning*
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N Gen Women
When Boomer were young women, 1 in 27 participatedin sports
In 1998 one in three young women participatein sports
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Gen Y job expectations
• Gen Y’s have been using computers since preschool
• Work enthusiastically in teams• Grown up over-supervised—now eager to
manage their own time!
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Core values of the N Gen
• Optimism• Civic Duty• Confidence• Morality• Diversity
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N’ Gen (Gen Y) on the Job
• Expect diversity• Network with others• Resilient• Multi-task• Technological savy• optimistic
• Technologically dependent
• Need supervision and structure
• Inexperienced in dealing with people issues
Assets Liabilities
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The Millenials
• Born 1983 – 1993• Consistently list their parents as their “most
admired choices”• Trust their Grandparents the most followed by
their parents• 92% place “high value” on volunteer work
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Show: All sizes - Large - Medium - Small
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Millenial Momentous Events
• Aids sweeps the world in the 1990s• Nelson Mandela released from 27 years of prison• Oklahoma City bombing April 19 1995• Dolly the sheep cloned July 5 1996• Viagra launched March 27 1998• America and Britain invade Iraq 2003• Madrid Bombings March 11 2004
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Messages for Millenials
• Be Smart—you are special --Baby Gap, Sports Illustrated for Kids, Nickelodeon (They have been appealed to , catered to)
• Leave no one behind –be inclusive• Connect 24/7 –always on, always interdependent• Achieve now—tutors in preschool, keep climbing• Serve your community
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8 Key Trends that affected Millenials
• Focus on children and family—90 percent of fathers attended birth of their children Federal Forum on Family Statistics reported national attention to children at an all-time high
• Scheduled, structured lives• Multiculturalism—UCLA’s Higher Education
Research shows that interracial interaction among college freshman has reached a record high
• Terrorism• Herorism
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• Patriotism—UCLA Freshman Survey reported renewed political interest
• Parent advocacy—Generation 2001 Survey by Harris for Northwestern Mutual. Mom and Dad often cited as “Most Admired”
• Globalism
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Understanding Millenials• Computers aren’t technology--never known life without
computers!• Internet is better than TV—recent years the number of hours
spent watching TV has declined• Reality is no longer real—digital images have/can be altered• Doing is more important than knowing—half life of
information is short actions more important than accumulation of facts
• Multi-tasking a way of life• Staying connected a way of life• Zero tolerance for delays 24x7 variety of modes
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Millenials Spend their time Differently
16.7 hours per week on-line
13.6 hours per week watching tv
12 hours per week listening to the radio
7.7 on the phone
www.clickz.com/news/articl.php/2240141
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Millenials & Work
• Define success largely in materialistic terms (Lancaster & Stillman 2002)
• Achievement-oriented, willingness to work long hours at the expense of their private lives (Zemke et al. 2000)
• View change as positive & desirable, causing them to become easily bored (Lancaster & Stillman 2002, Smola & Sutton 2002)
• Place great emphais on prestige (Lyon et al. 2005)
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Millenials
• Want committed coworkers• Need continual stimulation and challenge—
comfortable juggling many tasks • Truth detectors always on—do not give
second chances• Expect to be asked for input regarding
decisions (grew up being asked for advice about computers!)
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Millenials on the job
Assets Liabilities
Multitasking distaste for menial work
Goal orientation lack of skills for dealing with difficult people
Technical savy impatience
Positive attitude lack of experience
Collaboration confidence
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Getting the N’Gens & Millenials
• Encourage self-designated work teams• Flexible work hours• Virtual work teams• Reverse mentoring programs
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Reverse mentoring
Sentara Health System puts computers outside the cafeteria
It allows employees to email friends and surf the net and help colleagues help less techno literate colleagues!
B. Brown (2001)
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Cohorts mean different patients…..different expectations…
different behaviors
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Cohort Patient ExpectationsPre-boomer
Boomer I Boomer II Gen x’er NGens/Millenials
Service/promptness
Will wait for good bedside manner
Get me out fast
Get me out fast
Get me out fast
Now
MD personality
Marcus Welby
Academic/
ER Not important
Not important
Staff Friendly Professional
Efficient Quick Quick
Office environment
Cheerful Professional
Where’s a video
No opinion
No opinion
Quality care Means
Optimism Clear explanations
Latest technology
Latest technology
WEB based links
Reaction to prognosis
Accepting Second opinion
Second opinion
Third opinion
Check cites
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Across the CohortsMatures Boomers Xers N’gen
Millenials
Outlook Practical Optimistic Skeptical Hopeful Positive
Work ethic dedicated
Driven Balanced Determined goal oriented
View of authority
Respectful
Love/hate Unimpressed
Polite Positive
Leadership by
Hierarchy Authority Competence
Pulling Structuretogether
Relationships
PersonalSacrifice
PersonalGratification
Reluctant to commit
Inclusive friendly teams
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Don’t try to cram it all in !!!