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Unlike any prior time period in our history, the contemporary workplace will soon encompass five different generations, distinguished variously, but typically defined and labeled by year of birth. Here, I’m referring to Baby Boomers (1946–1964), Generation X (1965–1980), Generation Y or Millennials (1981–1995), Generation Z (1996–2010), and the forthcoming Generation Alpha (2011–2025). Largely driven by the advertising world, hoping to better target their marketing campaigns, efforts have been made to easily distinguish these groups based on social influences, generational values, behaviors, and preferences.  

I suspect that these labels may have complicated matters even further. For example, the COVID-19 pandemic-induced shift to the virtual workplace may well have exacerbated intergenerational tensions in areas where groups are supposed to differ. Think social interactions, communication preferences, work-life integration and wellness strategies, perceptions of technology usage, and willingness to change. These differences must surely have led to breakdowns in communications, team function, and clinical performance, among many others.

On one hand, these age-based delineations can be a helpful reference point, particularly when leading multigenerational teams. There are some proposed defining factors, such as cultural movements, historical milestones, technological advancements, learning preferences, and lifestyle traits for each period that can be interesting to delve into and see whether they resonate with yourself and your teams. These features can be lively conversation starters and help you glean insight into how best to manage morale and burnout, as well as create more inquiry, respect, and open-mindedness among such a diverse population. However, surely additional factors beyond age should be equally impactful; consider background experience and training, levels of maturity, tenure within an organization, and lineage in a role.

Is it possible that the COVID pandemic has influenced societal perceptions of generations, and might the pandemic influence the formation of generational identities for those still in formative years?

It seems to me that this is a very opportune time to work to address and dispel age-associated or generational stereotypes.

Dispel the Myths

That said, it’s so important that we inquire, appropriately and respectfully, about the stories of others to expand upon—and maybe even rebut—marketing matrices.

Upon reflection, I don’t think that people neatly fit into their age-based silo. As I look across the multigenerational tables as a Baby Boomer by age, I certainly have “silo creep” and span several different buckets. You might think World War II, for example, was a defining life event for me, but that wouldn’t be true. Rather, I grew up as a relatively privileged individual during the segregated South African apartheid era, which left an indelible impact on my values, philosophies, and priorities.

I know I’m not alone here. When speaking with a millennial colleague, it became clear that these categories are not cut and dried:

“I think some of these characteristics are pretty broad generalizations. I am part of the millennial category, but it has never quite resonated with me. Millennials are often painted in an unfavorable light, such as when it comes to work ethic, world views, and materialism, just as Baby Boomers can be criticized for not being tech-savvy, and seniors can be stereotyped as dependent and frail.”

“My father, a Baby Boomer, studied computer science as an undergraduate, before it became an official degree program at Boston University. My grandfather, a member of the Silent Generation, ran his final Boston Marathon in 4 hours and 30 minutes at age 72 and continued to participate in road races into his 80s. To me, labels can be tough because they don’t allow for nuance and individuality; they don’t tell the whole story.”

It’s easy to jump on the bandwagon and affirm negative generalizations, but this can be damaging when it comes to building an inclusive team. We must ensure these categories, simply based on a number, don’t serve as a detrimental springboard for misunderstandings about behaviors and preferences.

Seek Data and Understanding

It’s our responsibility as leaders to build diverse teams and foster respectful environments for every member of our workplace and beyond. We can strive to enact change at the national level, such as by communicating the importance of accommodating different learning styles for different generations at major conferences and advocating for educational material that best suits the learner (e.g., didactic talks vs. handouts vs. podcasts, etc.).

Locally, we can commit to better understanding our colleagues on a one-on-one basis. If one generation prefers frequent, regular, unvarnished feedback, provide that. If possible, be willing to adapt traditional annual reviews to meet worker preferences. Support departmental social media initiatives but be respectful of those who might not wish to expand their digital presence at this time. You’ll find that some cohorts might thrive on multitasking, while others prefer to focus on tasks linearly. Take all of these factors into consideration. 

Ask, listen, collect data, and repeat. Run a short quarterly communication survey asking how employees prefer to receive information within the department, or whether digital Grand Rounds lectures are meeting their academic needs. Sometimes, simply listening and giving people a choice can make all the difference when it comes to feeling a true sense of appreciation and belonging at work.

Not fully understanding the complexities of our multigenerational workforce has been described as a contributor to workplace stress and burnout. Challenges managing, building, and leading multigenerational teams have been recognized, yet solutions have not. We must first hear from our colleagues directly. For example, you might ask a more seasoned colleague what it was like when they first started out in radiology. How have things changed over time? In their perspective, has it generally been for the better, or have there been obstacles along the way? How has patient care evolved? Older generations might consider asking younger generations about what their highly digital academic training experiences are like today. When an opportunity presents itself, respectfully inquire and listen to build connections and understanding.

Celebrate Our Diversity of Ages 

One good aspect of the multigenerational descriptors is that they remind us of the remarkable diversity of values, preferences, and skills that we are so fortunate to have in our workforce. Understanding, embracing, welcoming, including, and being respectfully inquisitive about these differences will serve us far better. Acknowledging that differences exist and committing to learning about them is a lifelong journey.

Starting today, instead of trying to transform one generation to adjust to another, let’s:

• celebrate the diversity of ages in our workforce
• embrace all skills, expertise, and experiences
• focus on intentional inclusion activities
• shift the focus away from this single cultural descriptor (age) and build teams that are as diverse as possible
• avoid alienating labels and siloes and stereotypes

Never before have four different generations worked together in Beth Israel Deaconess Medical Center radiology, bringing different values, preferences, communication styles, strategies for work-life integration, and wellness approaches into the milieu. The list of differences is extensive and complex. What a terrific and timely opportunity to embrace! A field such as imaging is so dependent on the structure and function of high-performing teams. Therefore, it behooves us to better understand the different generations and explore how best to take advantage of these opportunities.

This post was originally featured in ARRS InPractice.

Those of you I have connected with virtually over the past year may recall that, in addition to family photos, my office (and thus my zoom background) is adorned with my old cricket bat, indigenous South African art, Khoisan necklaces, hummingbird photographs, and Shona stone sculptures. These are just a few artefacts that represent my cultural identity, on which I’ve been reflecting a lot these days.

One of the reasons I emigrated from South Africa after completing my medical and basic science training was to escape the abhorrent system of apartheid that I witnessed up close from a young age. My wife and I touched down in the U.S. in 1987 filled with hope and much anticipation. The days of watching fellow human beings suffer at the hands of systemic racism, marginalization, violence, and oppression were behind us, or so we thought. Perhaps our departure was one way of social distancing from that awful pandemic, though much guilt persists knowing that “running away” would not contribute to a solution in any lasting or meaningful way.

Demolishing Normalcy

Fast forward to the year 2020, and we find ourselves grappling with the factors that contributed to George Floyd’s death. Along with the outbreak of COVID-19, more than 15 long months ago, and the ubiquitous opioid addiction crisis, the America that we chose to move to is experiencing more than a single pervasive pandemic and finds itself in desperate and urgent need of a reckoning with structural racism.

The last year has exposed centuries-long inequities, disparities, and ignorance, which impact our employees, peers, patients, loved ones, and communities in ways big and small, seen and unseen, told and untold. Absent diversity, equity, and inclusion (DEI) strategies, combined with social distancing protocols, full-time remote work, technology and commitment overload, and skyrocketing mental health concerns have rightfully demolished what we once believed were the tenets of effective teams; the trademarks of normalcy. To return to what we as radiologists do best—providing top-quality, safe, timely, and evidence-based care—we must work together to dismantle, then to rebuild the status quo. How can we do this?

We Must Row as One

Whether based in a hospital, private practice, or academia, we need to develop and implement DEI strategies that will build high-performing teams through intentional inclusion practices. It’s the only way we can ensure the highest-quality care for our patients, eliminate care and outcome injustices, and begin to narrow the health disparity gaps. We must acknowledge that, yes, we all have biases, many of which are unconscious.

Consider the myriad of players and moving parts in our ecosystems: our technologists acquiring and managing images; our IT colleagues facilitating image interpretation, data management, and report communication; and our nurses providing compassionate, patient-centered care during minimally invasive procedures. We also have the essential contributions of our translators, transporters, schedulers, nurse navigators, medical assistants, advanced practice providers, administrators, and image repository staff. To effectively serve our patients, we must understand, respect, trust, and listen to one another. Simply put, we must row as one.

Doing the Work

As a first step, I encourage you to take Harvard University’s Implicit Aptitude Test to better understand some of your own biases. Set aside uninterrupted time, and take the test with an open and honest mind. You can also ask your employees or colleagues to do the same. Take time to discuss what everyone learned, and listen to each participant. Sit with them, either in person or virtually, and truly hear their experiences and perspectives. Make sure to create an environment of safety, compassion, and open-mindedness for each gathering. You can also consider designing a DEI survey for your team to receive anonymous or attributed feedback. In the spring of 2019, Harvard University created a three-minute “pulse survey” for its community. The executive summary, final report, and data charts and tables are available here.    

In these discussions and surveys, you can also delve deeper into topics such as cultural humility, microaggressions, and the difference between bystanders and “upstanders.” The emerging practice of cultural humility, a commitment to lifelong learning about global cultural differences, encourages us to inquire and learn about the experiences and identities of others. Ignorance can lead to an intended or unintended microaggression, which Medical News Today defines as “a comment or action that negatively targets a marginalized group of people.” Another important term to learn and practice is upstanders, or people who speak or act in support of an individual or cause, particularly on behalf of a person being attacked or bullied.

The Concept of Ubuntu

The Zulu and Xhosa concept of Ubuntu emphasizes the importance of “being oneself through others,” a form of humanism best expressed by the phrase, “I am because of who we all are.” Imagine if we realized that our best personal function was dependent on the function of our entire team?

To sustain and elevate team functionality, we must adopt this philosophy in a way that resonates with you. Perhaps it’s by remembering the Golden Rule, which instructs us to treat others the way we would like to be treated ourselves. Maybe it’s by thinking about Aristotle’s historic quote: “The whole is greater than the sum of its parts.”

At the core of our impact as imagers is a broad swath of races, cultures, ideologies, genders, religions, age groups, and much more. Over the next year, we will continue to share DEI resources and invite members of our ARRS family to volunteer, as we develop educational materials that are the building blocks for individual members and practices to rebuild their teams. To submit ideas and feedback, please email me directly at jkruskal@bidmc.harvard.edu.

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