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
To understand your patients and how patient behavior is changingTo better work in clinical care teams more effectivelyTo recognize that the community is more demanding of health care institutions todayThe answer you have may be in understanding which cohort you belong to!
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?
Cohorts……. A new way to look at your patients, physicians, employees, colleagues….
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
As we talk about cohorts, it affects….. *patient behavior *clinical teams *management & leadership challenges
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
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!
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
“Cohort” vs. “Generation” • A ‘Generation’ is usually: • Defined by whena 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
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*
Cohort Definition • Depression • World War II • Post-War • Boomers I & II • Generation X • N Gen • Millenials Matures
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 1953 did S & P get back to where it had been in 1929
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?
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
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
Depression Cohort Patients”Loved by Hospital CFO’s and Doctors:Why? They always paid their bills!
Who are the matures?Patients, some employees, and the community Born between 1922 and 1945 World War II The Post War
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*
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!
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*
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
Post War were the first sandwich cohort! Can’t really accept the pride of the World War II group yet They ain’t Boomers ?
Post War Cohort values --The Post Wars are more cautious and quietly assertive --value conformity Levittown
Mature Values --Accomplished their goals through hard work --Matures believe in hard work and sacrifice --Matures are fiscally responsible --self-sacrifice is a virtue --strong trust in authority and institutions --delayed reward --adherence to rules
Post War Key value:great trust in InstitutionsA 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!
Mature Leadership is Delegate ! Take Charge !!! Directive!!
Dictatorial Rigid Inhibited Too set in their ways They’ve got all the money Learn to use your computer How do other cohorts view Matures Gen Xer Gen Y Boomers • Trust • Good leaders
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)
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
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
Boomers Born 1946 to 1964 –two distinct groups 45 % of today’s workforce
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
The Boomer Motto “Never trust anyone over 30” -Abbie Hoffman
The March to 60! Nearly 8,000,000 Boomers turned 60 in 2007 That is 330 per hour that year !
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
More cynical Boomer I’s and Boomer II’s Boomer I’s Boomer II’s • Idealistic • Workaholics • Career first, family second • Active participants or aware observers of the 60s
Then: Long hairNow: Longing for hair Then: A kegNow: A ekg Then: Acid rockNow: Acid reflux Then: 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 kids Then: Trying to look like Marlon Brando or Elizabeth TaylorNow: Trying not to look like Marlon Brando or Elizabeth Taylor Then: Seeds and stemsNow: Roughage Then: Popping pills, smoking jointsNow: Popping joints Then: The President's struggle with FidelNow: The President's struggle with fidelity Then: PaarNow: AARP Then: Killer weedNow: Weed killer Then: Hoping for a BMWNow: Hoping for a BM Then: The Grateful DeadNow: Dr. Kevorkian What they knew, What they know!
The Boomers • 86% high school graduates • More than 26% have college degrees • Boomers have a sense of privilege Highest level of education! Why?
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!
Boomers are aging differently • 2000: ‘Youth’ still holds sway (50 is still ‘bad’) • Youth-emulating • Age-denying • Activity-driven in ‘retirement’
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