David Bartholomew, FACHE (Host): Welcome to the Healthcare Executive Podcast, providing you with insightful commentary and developments in the world of healthcare leadership. To learn more, visit ache.org. I'm David Bartholomew, Senior Vice President of Learning at ACHE, and a Fellow of the American College of Healthcare Executives. I'm here today with Dr. Katherine Meese, a researcher, author, and CEO of HuMargin Group, and Dan Collard, the co-founder and partner of Healthcare Plus Solutions Group. Welcome to you both. I know you both, and I'm excited to be here today after many years working with you both in this arena. So let's just get started.

Dan, I think let's kick it off to you. How did you get interested in this topic and why did you decide to write a book about it?

Dan Collard: Well, I think a couple reasons. We've watched folks speak about the multi-generational workforce for a long time. We've seen books that are written, but I spend an awful lot of time in the field and I sort of see the impact. I sort of see when it goes, right. That's the first thing we look for is what's it look like when leaders do it well?

And then what's it look like when there's something missing. And I think just through the course of our conversations with Dr. Meese and myself, it's like, let's actually quit talking about it and let's do something about it this time.

Host: That's great, Katherine, and I mean, you are in this arena of workforce research. Tell us about your experience and journey there.

Katherine Meese, PhD: Yeah, so one of the many hats I wear is as a university faculty member, and so I will tell you, my story's a little saltier than Dan's, but I noticed a huge difference in my students who were pre and post pandemic. So I started to notice a lot of changes in behaviors and how they approached the classroom and professionalism.

And so that got my wheels turning a little bit. And one day I was riding the elevator up to the fifth floor and it was full of professors and the dean and two students who were not mine got on and one turned to the other and said, oh my gosh, I forgot to take my Xines today. My psychiatrist was like, don't skip your meds.

And then the doors closed and I realized that we are dealing with a fundamentally different generation that not only nicknamed their Xanax, but also has a really different approach to mental health, to communication, to transparency. And as a leader and as an instructor, I could tell you, I am not seeing that we're ready to handle these changes in the workforce.

And so that got me really interested in thinking about what would it look like, not only to support these people coming into our workforce, but also to give leaders the tools to help make sure that these folks can stay engaged in the important work of healthcare.

Host: That's a great entry point, uh, to the next question, which is why is this suddenly such a hot topic in the workplace? We know there are lots of different initiatives. Katherine, you've worked with us on some CHRO studies and understanding kind of retention models, what is happening with the employee setting.

Tell us a little bit about why this became such a kind of burning topic to kind of unpack in a book.

Katherine Meese, PhD: I think we've known for a long time in healthcare that workforce is one of the most important tools that we have to accomplish the very important work of patient care. You can't do it without your humans. That said, I think with the pandemic, we saw a massive shift in workplace dynamics, not only within healthcare, but more broadly as a society.

And so with that, we're left with some lingering shortages from that time, massive shortage of physicians. It would take nearly 1.75 million years just to replace the physicians that left the workforce during COVID. So with that, we know at the same time, we have the aging of our patient population and workforce, which require more care and fewer people to do it.

And so the only way we're going to be able to make that sustainable is by having healthy, younger, flourishing generation in the workforce that can stay committed to this work and continue to provide patient care for many years. And so when I started looking into the research on this, I found that unfortunately things aren't looking as great as we would like for them to look. First of all of Gen Z individuals, 57% identify that being a social media influencer is their top career aspiration. So that's a little different than the work of being a nurse or a physician or working at the bedside. In addition to that, 22% of Gen Z individuals that are already working in healthcare are planning to leave within the next one to three years citing talk toxic corporate culture. And so with that, it gave me sort of the starting startling realization that if we don't make some changes here in how we create a great work environment to help support this younger generation in the workforce, we are going to have a very difficult time meeting the demand for care.

Dan Collard: Expand a bit on where Katherine was going there as well is, for the first time really also gives us an opportunity to attend to both the workforce and the leadership cohort. And here's a couple reasons why. As Katherine said, retention has never been more important than it is today from a cultural perspective, from a quality and safety perspective, from a financial perspective.

And yet, what we also realize is now we have this new cohort of leaders coming in who themselves are members of these newer generations. And so we have to be thinking about both the workforce and the leadership cohort at the same time. And then finally, the reality is for many of the incoming workforce, these leaders will be their very first bosses.

And what a great opportunity to best prepare these leaders to take on sort of that noble role of being someone's very first boss. It's sort of, we want to get it right the first time and that, really, I think is a neat opportunity that we explore in the book.

Host: I think that's great. I'm glad you added that Dan, because I know you both are out in the field with organizations really trying to impact their leadership styles and behaviors. So I think that's a great, compliment to Katherine. Now, staying with you, Dan, you kind of came up with this term Genfluencers. So what exactly is that and how does it relate to this book?

Dan Collard: Well, I think again, it's part of the fun of working with Katherine on writing the book, the statistic that she just shared about the percentage of Gen Zs who aspire to be a social media influencer. So let's just take that term influencer. If we drop that into a cocktail conversation, a professional conversation, we know the typical responses.

You know, you think TikTok, Instagram, clothing, you think, makeup lines, whatever the, they're influencing there. And so the question was, could we create an environment where leaders and aspiring leaders alike could become professional workplace influencers. And then right upon that is not this older tradition of that means older to younger, where older influences younger, but perhaps just the opposite. Where younger begins to learn how they can influence older. And so we took the concept of this generational observation, a professional workplace influencer, we became sort of a mashup. And that's where Genfluence came from. And it's been really fun as Katherine has sort of been out on the leading edge of the conversation that the word is almost taking on, a verb, an adjective, a pronoun.

Yet she was, recently speaking somewhere and I saw someone's first post saying, I wanna be a Genfluencer.

Host: I mean, I guess, Katherine, do you Genfluence frequently?

Katherine Meese, PhD: I'm trying to Genfluence. I think we're all trying to Genfluence. And that's the point. I think, sometimes very much building on what Dan said, we think it's like, okay, leaders have to do this work and they have to create these environments and it's their responsibility. And I think what we're advocating for is that this is everybody's responsibility.

Every single person in the organization is empowered to make a difference in how that generational harmony works well in the workforce and how we get the benefit of all of that difference in perspective and approach and skills and tools. And so we really wanted to step away from this idea that this is a leadership behavior that needs to happen, but rather something that everybody can do every day around them.

And I think, and Dan knows this, one of my favorite things about figuring out how to help and support leaders and employees is giving them tools that are doable and free, where they can make a difference within their own sphere of influence instead of having to wait for some change to come from a higher level.

So our approach in this book, and one that I think Dan and I both share, is really around what does it look like to empower each person to be a Genfluencer in their own environment?

Host: I love that. That's so important for all professionals really. I mean, we see that in our own learning at ACHE is really having practical application. If something can happen that you can give a tool to them and it has immediate impact. It's really so valuable to those individuals.

Let's stick with you, Katherine, because you've got this thing called myth busting. Now you've got a hole piece in the book on myth busting. So tell us a little bit about that.

Katherine Meese, PhD: I have to tell you, David, when I started doing the research for this book, it was, there were so many aha moments. Where I had to challenge my own thinking or stereotypes or misperceptions that I had were completely disrupted by actual evidence and data and facts. And so one of the big sort of overarching principles that we noticed and talk about in this book is that there are so many opportunities to market this concept of generational differences because it's something that everybody kind of enjoys latching onto. And so when you're seeing news articles and communications coming out around different generations, we also know that communications that get more traction, more likes and engagement in an online and digital world are ones that cause a sense of moral outrage or anger.

And so, they're very specifically designed to get at that outcome. So if you find yourself reading an article about differences among generations, you may find yourself reacting or saying something like, we would never get away with that in my generation, or I would've never gotten away with that when I was their age.

And that's exactly the point. And so then when we started digging into actual data, looking at some of these things, it really just doesn't hold up under scrutiny or you'll learn that one of these articles was a survey of 15 people. And so I think one of the things that I really enjoyed about writing this book is trying to understand what's actually causing generational change.

It's probably not world events, which is what most of us think about. And what are some of the things that we can sort of unlock in terms of understanding different generations better? Not based on what we're reading out in the media, but based on what the data actually says. So, I'll give you an example, a real example.

It is a very common narrative to sort of say that the boomer generation is very wealthy and had great economic conditions and had it easy. Therefore, they own several homes and the rest of us can't afford our rent. That is a narrative that is out there in the news, and yet millennials actually have more inflation adjusted income at the same age as their boomer counterparts.

And they're positioned for an $84 trillion wealth transfer. And so this narrative that sort of, we have it the hardest, just doesn't hold up under scrutiny. And I have to tell you, as millennial, it made me grumpy to learn that that was not true.

Host: Well, I'm sure that would make us all grumpy a little bit, you know, if we were in that scenario. Dan, anything to add on that?

Dan Collard: No, I think what that also led to is if we can take a look at the busting of these myths, it really sort of opens people's approach, it sort of opens that, that element of curiosity to say, okay, well if that's not the case, what is it then? And then finally, the last sort of, I think, myth related part of the book that I'm super excited about is not only did we focus upon the workforce, the dynamics between leaders and those whom they lead. But we also brought really neat part of the framework in, and that's the patient dynamic. What's that look like now as America ages, as the patient population ages, and perhaps the caregivers are abundantly younger? So what do those dynamics look like?

And I think if we apply the myth busting framework that Katherine talks about, it actually opens up the door to even better patient care.

Host: I love what you said about curiosity, because I think that's the number one piece that if we're curious as individuals, we forget the differences. We learn to understand others better, just with a, a sense of curiosity. So I think that's a great compliment. Let's go back to you, Katherine, and talk a little bit about skills and competencies.

I know you love this area of skills and competencies. We work a lot together on this. So tell us some of the skills that leaders really need to effectively manage in a multi-generational workforce.

Katherine Meese, PhD: I think you nailed it first, David, with curiosity. One of the things that we sort of saw, particularly in this myth busting space, is I think particularly misconceptions around Gen Z, particularly related to mental health. And so, if I'm being honest with you, when I'm out on the road, when I'm listening to leaders, there's sort of this narrative that Gen Z is maybe fragile or they don't want to work hard or they can't take hard feedback.

And yet when we look at the research on what's actually going on with Gen Z mental health and some really fundamental things and technologies that were introduced early in their adolescence that have shaped how they interact with the world and have led to some really eye-opening and sad and shocking mental health statistics. We, it allows us to reframe from are these people really weak and fragile? Or are they brave? Because despite all of these things going on with mental health in the background, they're showing up for the hard work of healthcare anyways. And so if we go into those interactions without that mindset of curiosity, let's say we have a Gen Z colleague who does not complete a project on time or accurately. Our first assumption might be they're lazy. And that's my assumption about this generation. They don't want to work hard because that's what I see all over the news. But if we adopt that attitude of curiosity, what we might understand is that over 40% of Gen Z says in 12th grade, I can't do anything right. And so when you're dealing with someone who fundamentally doesn't believe that they can do anything, right, it might be fear, it might be someone who's afraid to put their hand up and say, I don't know how to do this. And so really taking off that judgmental hat and putting on the curiosity hat helps us figure out how we support these people better and give them the tools that they need for success.

I think the other one, and Dan does this so well, is that we have to become encouragers in chief. I really thought early in my dealings with some of these students, and this was wrong thinking, that it was my job to sort of toughen these people up in the workplace, right? Like, you're not going to make it if you don't toughen up a little bit and figure out how the real world works.

And I think that is exactly the wrong approach. I think what many of these generations need is a lot of encouragement, a lot of guidance, and for us to get really detailed about explaining how we expect things to be done. One of the common points of friction I'm seeing is that leaders will say, okay, well when I was their age, I had to just figure it out and no one walked me through it step by step.

Okay, well we probably have to walk people through it step by step. We know after over 40 years of research that it is much less likely that people in the workforce now have ever held a job before. So you may not only be helping them acclimate to the role, but also to the idea of working altogether.

And so the more we can embrace that curiosity and become encouragers in chief, I think we really set these generations up to be successful contributors in healthcare.

Host: I love that. Dan, anything else to add?

Dan Collard: No, I think the phrase I see an awful lot today is replace judgment with curiosity. And you sort of see that theme all the way throughout the book. As we think about the earlier chapters and as we move towards the framework later, that ability for any of the generations as they look towards the other generations in the environment there to replace judgment with curiosity is one of the first door openers for us.

Host: I think that also goes to some of the previous work that you both have, I know, worked in is trust, building trust as a leader and really kind of helping everyone come onto the same journey together. So I think that's a really a remarkable piece. Katherine, Gen Z is here, Gen Alpha's on the way.

Maybe we need to explain to folks what those may or may not be. So you're the best person to do that, but what's the biggest misconception about either of these generations?

Katherine Meese, PhD: We've touched on it a little bit, but this idea that this younger generation doesn't want to work as hard as I did. They're having more boundaries. They're not staying late, they're not putting in discretionary effort at work. People are seeing that. I think or perceiving that as being lazy or disengaged.

And I think instead we can see that in a few different ways. One, knowing what we know about the mental health of this generation, rapidly increased rates of anxiety, depression and unfortunately suicide and self-harm, that protecting your mental health is really critical because they're not starting at the same place that everybody else is starting out at.

And so, rather than something that can be perceived as a sign of weakness, that's really just wise to be prioritizing that. And I think as organizations, we're going to have to rethink our systems and rethink how we design around it. This generation, Gen Z in particular, has been profoundly shaped by technology, and I think that shows up in almost every way that they interact with the social environment and with work.

It's also leading, unfortunately to a generation that experiences the highest rates of loneliness, and we know that loneliness and social isolation at a chronic level can actually be detected in our molecular structures, and it's about as bad for your physical health as smoking, roughly 15 cigarettes a day. So, creating areas of connection in the workforce is incredibly important. We don't exactly know what Gen Alpha will hold yet. Cutoffs are a little bit unclear, but they're probably about 15 years old right now. And so we don't have many in the workforce. But I would imagine that the way people engage with AI is going to also fundamentally shape how people approach social interaction, particularly as people develop AI companions and friends that may prevent them from sort of

in-person 3D relationships, I think we're going to see some challenges in how people might relate to patients, might relate to colleagues or, deal with interpersonal communications. And so I think all of those things are going to take really thoughtful and intentional design from leaders and a lot of support.

Host: That's pretty fascinating. Dan, anything to add on those two groups or others?

Dan Collard: In the very beginning of the book, I dedicate my part of the book to my three grandchildren who are that Gen Alpha group. And I think that it's our opportunity to learn from each other. Per Katherine's observation around the mental health and the wellbeing perspective, I think that's one of the very first points that we could say, what could the older generations learn from the younger generations instead of having that preconceived notion of weakness. Because the reality says, the data indicates that the older generations probably didn't take as good a care of themselves as they should have. Mental health approaches to wellness could have been seen as a point of weakness or, sort of that moment of suck it up and let's move on. Maybe perhaps it's that moment of learning. If we embrace curiosity that we could learn from those generations to say, gosh, how could we spend the waning years of our careers learning from them?

Host: I think there's so many pieces of truth that apply to all generations and some of what you both have just said. I mean, mental health, wellbeing, loneliness and isolation. Those are things that really impact a lot of different groups and I appreciate putting emphasis on self-care and wellbeing. Because I think that's important.

I'd like to switch topics, just a hair, and talk about your presence at our ACHE Congress on Healthcare Leadership. That's one of my favorite things that we do at ACHE. So I love talking about it period. But what is most interesting about that particular conference, which is held in Houston this year, from March 2nd to fourth?

I believe that it is, that it is so multi-generational. We have everything from students to people that are in a retired status, giving back in some kind of executive residence position, perhaps at a university. There's an entire wealth of generations at this event, and I know you're both there.

So I'm imagining we're going to touch on some of these themes at Congress. So tell us a little bit about what you're planning for that. I know you're trying to translate some of the book constructs into a actual application teaching environment, which I love and adore. So give us a little glimpse of what we're going to see in Houston at Congress.

Dan Collard: Yeah. You know, David, your team does such a good job curating all of the content for Congress. And what I would say for this one particular presentation, it truly is there's something for everyone that we're, that, that happened to get to attend our particular session. You have the early careers. What's it like as I either enter the workforce or am new to the work force and think about what's the best version of me in a year. You have the folks that are more senior in their tenure to think, okay, I've been trying to figure this out for a while. Perhaps can, are there a couple of nuggets as Katherine said, what are some things that are just doable? I could take home and I could use tomorrow?

And so I think there'll be something for everyone. Katherine, what would you add?

Katherine Meese, PhD: Well, we're going to make it fun. I think that's important. No one wants to be bored. I don't want to be bored. Dan doesn't want to be bored and neither does anyone in the audience. So we always try to keep it fun, but also fully grounded in the evidence because nobody has time to do things that aren't going to work.

And then I think for Dan and I, it was really important when we were writing this book, and I think we feel the same way about Congress that we are modeling what generational collaboration looks like. I mean, Dan and I are not coming from the same generation. I'm sure that's very shocking to everyone involved.

But, we've had to navigate our own difference and approaches and thinking and friction. And so for us to be able to model that in front of the audience and with the people that are coming to learn, I think is also really important to show in a small way that this can be better than any of us would be on our own or as individuals.

Host: Perhaps one nugget of truth you guys could share with us, in your own experiences at Congress, because I think given this environment, and one of the beauties of Congress is this networking piece, really learning and meeting and connecting with others, which is exactly what you're talking about in the book.

So is there anything from your own experience that you can say or share or say in terms of like how someone might just think of opening up a dialogue with someone that may be a little different, either generationally or some other difference at Congress?

Dan Collard: Over the last couple of years, I've shared this with many folks, my favorite part of Congress is getting to interact with early careerists, whether it's in the line going into the restaurant or the cafeteria, the lunch line, if you will. I think it was probably three years ago, I found myself at the Chicago location standing in the lunch line and a conversation struck up and they were members of Katherine's world at the University of Alabama Birmingham, and they asked if I'd come join them at their table. And I probably had not had that much fun in so long. And that really has become sort of my tradition is to seek out those conversations. But not always in a listen to this sage advice from Dan. It really is that, let me learn from them. Let me literally sort of crawl inside their space as they are entering or just have entered the healthcare world.

Katherine Meese, PhD: I think for me, I'm always, I really noticed this last year, one of the things we talk about in the book is the importance of hope and how people are missing it right now, which is not a great thing. That's a core human need that we have. And I distinctly remember last year walking down, there's sort of this big hallway and one of the large events got out and everybody started walking down the hallway.

It was sort of this flood of people and I was just sort of overcome by this sense of, oh my gosh, look at all these people who are shoulder to shoulder doing this very important work as standing between our patients and human suffering. And so for me that was just an incredibly uplifting experience.

And I think sometimes in our daily work, it's hard to feel the enormity of what we're trying to do, but it's also easy to forget that there are so many other people in the boat rowing in the same direction. And I think for me, that's just a real highlight of my year to have my energy restored.

Host: That's great. I mean, I think it's a restorative environment, so that's what's so critical is just meeting other people and getting back that hope. Dan, you have this really interesting, framework in the book and it's called Control Alt Lead. Again, I was about to say delete because it's just kind of ingrained in our nature as PC users. But tell us what that means. Tell us how that has applicability to people in the operation space and healthcare and how they can align teams and really get to strategic excellence.

Dan Collard: It's no mistake that you think control, alt, delete. I spent the first three fourths of my life as a PC guy. I'm diehard Mac now, and there is no control, alt delete on the keyboard, but PC folks are very familiar with that keystroke sequence because sometimes you just have to reboot the system. And that's exactly what we thought about this opportunity for us, is to do a reboot for leaders.

As you heard Katherine mention several times in the conversation earlier, it has to be doable, very practical, very pragmatic. And so we wanted to create a framework and we wanted it not to be 25 things to do, and we landed on about eight things to do. And so it's a very simple approach, of what we call the control alt lead framework.

There are eight elements and the elements aren't even necessarily designed to be sequential in nature. It's one of those that, as you read the book, you're probably going to find maybe three or four of the elements that fit most with your current leadership situation, which your current, with your current leadership challenges, whether it's mentorship, whether it's not just succession planning, but looking for success in that planning, looking for the success in positioning the next generation, which is part seven of the framework.

They're positioning the next generation for success. So I think it's, I think readers will find it practical, pragmatic. They will realize that they don't have to do one through eight in that order to be successful as well.

Host: Katherine, anything to add?

Katherine Meese, PhD: Well, one of the other parts of the model that I love. And I have kudos to Dan for developing it, is this idea of putting the focus on yourself. And usually we say in leadership, take the focus off yourself. But it really gets to that idea of, instead of blaming another generation for their behaviors, how can you put the focus on yourself, you know, instead of saying, oh, this younger employee didn't do

the project to my expectations. How can you ask? Did I actually give them the training and the structure and the skills that they needed to do this independently? Did I explain it well? Did I expect too much or assume too much that didn't set this person up for success. And so I also really liked that part of the model, Dan.

Dan Collard: I'd put a ribbon around it to say part eight of the framework is sort of a nod, very by design to the body of work that Katherine and my colleague Glen Studer have, have been focusing on the last couple of years, and that's building trust. And so part eight of the framework is seeing every single interaction

as a trust building opportunity, and it's just a great ribbon around that because at the basis of busting myths, identifying the nuances of generations, it's the mortar between the bricks of our organizations and that mortar is trust.

Host: I love that. And I think it's Deborah Bowen, our CEO always says building the culture of and we're in a professional society. We're clinical, nonclinical. We're multi-generational as you guys have just said, and I think this concept of and, and leading in a time like this is so important because trust really does matter.

And it does create meaningful and impactful change in the workforce and our patients and everything that you're trying to do. I know my advanced copy for your book is coming to my desk or office in the next seven to 10 days. So I'm excited about that. But it's soon on the shelves. We'll have it at Congress of course. We're thrilled that you both came to talk to us on the Healthcare Executive Podcast today about this book. It is a wonderful opportunity, I think, for people to learn, uh, about their own generation. And all those that they work alongside, in whatever setting they may be. So thank you both tremendously for joining us here, and for being a part of the Healthcare Executive Podcast from the American College of Healthcare Executives.

And for more information for our listeners, you can please visit healthcareexecutive.org. And thank you Dan, and thank you Katherine once again.