1. Managing Conflict: Bridging the Generational Gap David A. Novis, MD MGMA Annual Meeting Las Vegas, NV October 2006

2. What I can share with you 30 Years Experience with Resolving Conflicts Business Managing partnerships Boards of Directors Hospital Administration Medical Director Chief of Pathology Hospital Medical Executive Committee Trustee

3. Agenda Generational Profiles: what are they are what do they mean? Getting in and out of conflict Weaving in generational considerations Problems submitted from floor

4. Practice Managers What difficulties in your practice bring you here ? Impasse in resolving conflicts? Unrelenting trans-generational friction? Placed in no win situations? Delegated responsibility w/o authority?

5. Situations Influencing Conflicts and their Resolutions Generational Gender Religious/racial Upbringing Education Experience Other

6. Generational Profiling A new phenomena? "The young people of today think of nothing but themselves. They have no reverence for parents or old age. They are impatient of all restraint. They talk as if they alone knew everything and what passes for wisdom with us is foolishness with them. As for girls, they are forward, immodest and unwomanly in speech, behaviour and dress.“ Socrates

7. Generational Profiles

8. Generational Composition of Total Workforce

9. Generational Composition of Physician Workforce

10. Matures/Traditionalists The Elders Background environment World War II, Depression Heroes MacArthur, Eisenhower, FDR Characterized by others Loyalty, patience, conformity, sacrifice Sense of Self Hard work + climbing the ladder = Success; Tenure = Authority Quote In my day, we built this practice on

11. Boomers Outgoing Leaders Background environment Civil rights, Woodstock, Viet Nam Heroes Kennedy Characterized by others Competitive, workaholic, climbers Sense of Self Personal development + teamwork = success Quote DRG’s, cook book medicine…it wasn’t supposed to be like this.

12. Generation Xers Incoming Leaders Background environment Watergate, Challenger explosion Heroes none (do not recognize authority) Characterized by others Slackers, cynical, short term goals Sense of Self Loyal to people not companies Self reliance + capre diem = success Quote I’ll need 6 weeks off when my child is born

13. Millennials/Generation Y Soccer kids Background environment Oklahoma bombing, 9/11, Internet, Laptops, cellulars Heroes Pop stars Characterized by others Coddled, aimless, need constant stimulation, communication,& reinforcement, Self Group oriented and postpone career Quote“ Like, we have to work for our money?” “Our parents told us anything is possible—but deprived us of social skills.”

14. How is profiling commonly employed? Marketing campaigns, corporate strategies Stereotypical judgments: racial profiling May promote conflict

15. Generational Profiling A shortcut to resolving conflict? Profiles characterize generations--not individuals Individuals and problems are unique People may think that the roots of their differences are generational (not unlike sexism and racism)

16. Issues that may appear to be based on generational gaps Investment portfolios Call schedules Work schedules Income requirements Retirement buyouts New member equity Succession

17. Learning from my mistakes Succession Equity Mission (Quality) Operations (POC testing)

18. Conflict…. How did we get ourselves into this mess? Fail to anticipate the inevitable Fail to perceive conflict Perceive conflict, but ignore it Try to resolve conflict but fail See Diamond, Jared. Collapse (London: Penguin, 2006).

19. Fail to anticipate a problem before it arrives New problem--No experience False assumptions Example: Equity Assumed competence in all areas Assumed entitlement of new associates See Diamond, Jared. Collapse (London: Penguin, 2006).

20. Fail to perceive it when it does arrive Slow trend—creeping normalcy Don’t want to perceive it Example: Succession Want to believe associates will grow into the job See Diamond, Jared. Collapse (London: Penguin, 2006).

21. Fail to try and solve it Denial Rational (Selfish) behavior Example: Mission (Quality) Fail to embrace common goals Fail to appreciate conflicting goals See Diamond, Jared. Collapse (London: Penguin, 2006).

22. Try to solve it and fail Values clash, vary or change Put tactics before strategy Short term vs long term goals Narrows solutions Example: POC Testing Fail to seek compromise solutions Diamond, Jared. Collapse (London: Penguin, 2006). *Tuchman, March of Folly (New York, Random House, 1984)

23. Strategies of Conflict Resolution Anticipate the inevitable Harness conflict for growth Avoidance may not be the best strategy

24. Strategies to Harness Conflict What Younger Generations May Not Know 1.Get the right people on board 2.Strategy First…. 3.…Then Tactics Collins, Good to Great (HarperCollins, New York, 2001).

25. Get the right people on board Consider ALL skill sets Understand everyone’s personal niche passion expertise skills and limits Points to areas of need Hire, Train or outsource

26. Get the right people on board Creates infrastructure Develops recognized champions Determines need for experience vs. fresh ideas

27. What skills do you need?

28. Strategy first… Strategy:Tactics=Location:Route Example: Department staff meetings Tactics first=Reluctant, narrow, short term solutions Strategy first: lasting, broad long term solutions Develop a corporate mentality Opens the door to a family of tactics

29. Strategy first… Establish a mission Fixate on outcomes (the vision) Establish a strategic plan Develop a corporate mentality Opens the door to a family of tactics

30. …then tactics Alignment Cultivate Trust

31. Alignment: Instill Corporate Culture while maintaining sensitivity to individual needs Understand everyone’s needs determine “walk aways” real vs. articulated needs

32. Cultivate Trust Require vulnerability Tolerate mistakes and shortcomings

33. Real vs Articulated Issues Don’t debate smoke ArticulatedReal Da Vinci Robotics ProImprove CareUndermine SurgiCenter ConExpensiveTie up OR Point of care testing ProFaster TATControl ConPoor QCPrecedent Double reading surgical biopsy specimens ProBetter QualityAnxiety over errors ConExpensive, ↑ TATAnxiety over being rushed

34. Consider all the possible solutions Not getting slides on time? Need more histotechs or a better work flow? Not getting reports out on time? Need more typists or a better work flow?

35. Summary Define conflict Determine needs and walk-aways Real Issues vs Articulated issues Place in context of mission, vision and outcome measurements Consider all possible solutions Action Plan with outcomes (may need more information)