Generational Diversity: What Practice Managers Need to Know

Grand Rapids, MI—The events and circumstances that individuals experience during their formative years contribute to a unique generational “personality.” As the approach to healthcare continues to become more personalized, it is important for practice managers to recognize what sets one generation apart from the next, and the ways in which care should be tailored to these individual groups.

In the keynote speech at the 14th annual National Organization of Rheumatology Managers (NORM) conference, Lynne Lancaster, Generational Expert and Co-founder of Bridgeworks, Wayzata, MN, shared general principles for ensuring the delivery of quality care to individual members of the 5 living generations—Traditionalists (born before 1946), Baby Boomers (1946-1964), Generation X (1965-1979), Millennials (1980-1994), and Generation Z (1995-2012)—as well as practical tips for managing employees in each of these generations.

“There are many factors that shape how we see the world and who we are—from geography to ethnicity, birth order to thinking style,” she said. “Generational personalities do seem to hold true over a lifetime, and if we can understand them a little better, it can help us manage a little better.”


Traditionalists came of age during the Great Depression, and to them, the doctor’s word is still law. As a result, patients in this group may not ask questions of their physicians or admit that a treatment is not working for them. As a result, it is even more important for providers to ask these patients questions to ensure that they know what to do when they get home and to address any potential treatment-related side effects or other issues that they may not feel comfortable bringing up on their own.

“Many Traditionalists tell us they feel invisible, so treat them with respect and interest,” Ms Lancaster said. “Schedule a bit more time to talk and to make them comfortable. You may need to coach younger employees on ways to do this.”

Regarding Traditionalists as employees, they grew up in a culture where there was a clear line of authority, and information flowed from the top down.

“If you want to think of one big concept about the Traditionalist generation, I would say it would be loyalty to institutions,” she said. “If you’re in a room full of Traditionalists and you say ‘Jump,’ they’re going to say, ‘How high?’”

Baby Boomers

Baby Boomers are currently hitting major life landmarks, such as becoming grandparents or empty nesters, losing their parents, getting divorced, experiencing their first health scare, dealing with financial crises, or thinking about retirement. As a Baby Boomer, Ms Lancaster said that these events trigger thoughts of “What’s next?”

Patients in this group often think that they are invincible. They may feel embarrassed about being ill or weak and may not want to confide in a younger healthcare provider. They are also proud, she added, so younger professionals must be careful not to act in a condescending manner.

Many Baby Boomers are still juggling career and family, even if they are sick. Providers should initiate honest and upfront conversations to help them deal with the reality and potential limitations of their illness, she advised.

Employees who are Baby Boomers often deny that they need help, particularly when it comes to using technology in the workplace. Ms Lancaster recommends using cross-­generational mentors to teach technology skills and holding employees accountable for actually mastering these skills.

“But also, be willing to speak with them privately,” she added. “Provide reassurance that they are still valued employees and that you want to help them be productive. Show appreciation for their history with you.”

Generation X

A major issue for members of Generation X is work/life balance. Patients in this group are typically strapped for time, so it is helpful if providers are respectful of this fact and can find ways to get these patients in and out of the clinic as quickly as possible. Ms Lancaster suggests texting Generation X patients with appointment updates and providing reliable Wi-Fi access so they can get work done while waiting for their appointments, or even while they are receiving an infusion.

Regarding Generation X employees, managers need to be creative with scheduling, she said. If possible, allow them to tailor their schedule to family and life-stage needs, and encourage them to actually use their vacation and personal time.

“Gen Xers value a workplace that encourages health and a balanced lifestyle,” she noted. “Managers can promote and model these behaviors.”

But at the same time, individuals in the group are concerned about their career paths, and often feel burdened with managing younger generations while being stuck under the “Gray Ceiling.” As a result, many Generation Xers are saying, “When is it my turn?” she said. Therefore, it is important for managers to provide leadership opportunities for these employees, and to invest in their future.

For members of this generation, knowing that their growth and development matters to their employers will go a long way toward motivating and retaining them in the workplace.


Millennials have been raised with instant access to information. Patients in this group can frustrate healthcare providers, as they often conduct their own health research online and tend to trust peer-generated resources, such as Reddit. They are also not afraid to challenge their physician’s advice with something they found on the Internet.

“But keep an open mind, and be willing to discuss these sources,” Ms Lancaster said. “You might find countervailing resources to share with them.”

Millennials also tend to have a significant distrust of institutions, and more than half say they distrust traditional medicine and prefer to look at alternative or natural options. One study found that Millennial adults are so frustrated with healthcare that more than half will delay seeking medical attention; they say that seeing the doctor is “too much of pain.” To address these frustrations, get them in for appointments in a timely manner, and make sure to set up next steps before they leave the clinic, Ms Lancaster told attendees.

With these individuals, assume the cell phone is the “go-to” for online browsing, so make sure that any online health resources are easy to access from a mobile device, she added.

When it comes to dealing with Millennials as employees, it is important to remember that this is a generation of collaborators. They want to have a voice, so it is impor­tant to create a participative culture. They do well in collaborative environments, so practice managers should put teams together to work on projects.

However, she warned, Millennials can be overly attached to consensus, so as leaders, they may need help to know when to make the hard calls. Keep in mind that they may also be uncomfortable giving and receiving tough feedback.

According to Ms Lancaster, the number 1 reason Millennials left their last job was because they did not feel part of the culture. To address this issue, “embrace them while they are here,” she said. “They may not stay forever but capitalize on their energy and knowledge while you have them. Show them all the ways they make a difference, and don’t be afraid to invest.”

Implement “stay interviews” for valuable employees. Sit them down and find out what is working and not working for them, long before they decide to leave. And if they do leave, create a “boomerang plan,” she said. “If a good employee is moving on to another job, make sure they know they’d be welcomed back at a future date.”

Generation Z

Raised by often skeptical Generation X parents, members of Generation Z tend to be practical and resourceful. After witnessing the crushing debt experienced by many Millennials, this generation has become extremely pragmatic about school, money, and their careers. As a result, many of them regard 4-year colleges as wasteful and want a more detailed plan for their future.

When dealing with patients in this group, Ms Lancaster suggests that providers simply ask what the best way is to communicate with them, and when.

“Invite them to tell you how much and what type of information they would like to have about their treatment, and provide printed copies of medical information,” she advised. “Remember, your secondary audience is going to be Mom and Dad.”

Generation Z employees may not be in every workplace yet, but certainly will be soon. This generation desires clear instructions on what they should learn in a certain position, said

Ms Lancaster. Show them the skills they can acquire and what training, learning, and certification options they have, and make sure they understand their employee benefits.

Help focus them when they show up at work, she added. Initiate clear discussions regarding how and how often they should check in with their manager. Teach them when they should make a decision, when they should ask permission, and discuss why certain procedures or protocols must be followed.

From a playlist to a pair of shoes, members of Generation Z are coming of age with the ability to customize anything, so be prepared for requests such as more tailored job descriptions, special learning opportunities, and ramped-up advancement.

“With onboarding and orientation, be ready for them,” Ms Lancaster said.

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