What Makes the Generations Tick?

Anna Liotta

Get Generationally Savvy by Knowing the CODES!

Holiday celebrations are a big time for my family to gather and celebrate. When I say big time, I really mean it. I am the youngest girl of 19 children. Any time we are together involves a huge meal, because along with my siblings and their spouses come their 56 children who have 51 children of their own!

A couple years ago I spent Christmas with my Bonus Mom, now 94 years young. (I call her my Bonus Mom because my mother passed when I was 10 years old, and when she married my dad, she was a gift to our family.) One evening we were preparing lasagna for a family potluck. We covered it with tin foil and were off to the family dinner. At the end If you’re a Traditionalist or a Boomer I bet you immediately thought, “Saving it!” You’re right.

What I was witnessing was a Generational Moment™. My sweet Bonus Mom was a child of the Great Depression. The formative events and emotional responses she experienced between ages eight and 18 created deep imprints that never changed for her regarding what was right and wrong, good and bad, and “how things were done.” In fact, those experiences and connections shared by her peers provide the basis for a fascinating and powerful set of Generational CODES™ that drive the actions and reactions of her generation.


Physicians today have the unique experience of providing care to six generations at once. This dynamic reality brings opportunities, along with some challenges. To care effectively, care providers need to understand each generation’s unique attitudes, beliefs, and values that drive their expectations and perspectives.

Generational CODES™ are coming into sharp focus today, more than ever before, due to a major shift that happened in 2015. Baby Boomers (born 1946–1964), making up 32 percent of the workplace, were replaced as the once dominate force by Millennials (born 1978–1999) who now make up 45 percent of the workplace. This began to fundamentally impact the way consumers viewed and accessed health care—both for themselves and for their aging parents. Added to this shift are the different expectations and CODES held by Gen Xers (born 1965–1977) who still represent 23 percent of the workforce, and Traditionalists (born 1927–1945) who make up 1 percent.

With an overwhelmingly Millennial influence, it’s imperative that leaders understand What Makes Generations Tick and What Ticks Them OFF!™ The common-sense standard practices and policies that once seemed good enough, don’t get the same adaption or adoption now—which leads to the Generationally Savvy™ mantra: “Common Sense Is Not Common™.”

When people say “It’s just good common sense,” they are referencing a certain set of common experiences that they expect people across the generations to have. Unfortunately, this is no longer accurate. When it comes to things such as dress codes or the formality used when addressing colleagues or interacting with a patient, it is essential that we be explicit, and not implicit, about our expectations. Here is an example from one of your colleagues in the field.


Scenario One

In clinic, Maryann prefers formal and respectful communications. She is the CEO, and her husband is one of the founding physicians. While in clinic, they refer to each other as Mrs. Baker and Dr. Baker. Yet some of the younger physicians invite others to call them by a first name and prefer things to be more informal. Maryann says, “That’s not what we do here.” Overall, she believes the formality maintains a level of professionalism and respect so that issues can be handled in a manner that remains professional, not personal. She believes the takeaway to the patients is a higher level of professionalism. For her, professional delivery and a confident, authoritarian style carries over into the bedside manner, which she believes patients want. 

Scenario Two

Denise is a practice manager with a rather young patient population. She believes that with younger staff there is often a more casual communication style. For instance, using a patient’s first name versus Mr. or Miss/Mrs./Ms. Internally, however, there are some challenges around this. While management may emphasize various credentialing by referring to the MDs and DOs as Dr., some younger physicians prefer to be called by their first name, wanting to relate to their staff differently than has been done by the generations before them.

Which one is right, and which one wrong? Neither. With a multigenerational workforce and patient mix, it’s a both/and approach, not an either/or. But what is most important is that you are explicit, not implicit, with your practices.


Another very visible area where we see a codes. The term professional attire has been morphed and stretched to mean many things. In contrast to prior Generational CODES™, it’s not obvious to Millennials why it is so important that they all dress alike. Ever since they could choose their own clothing, Millennials have been encouraged to express themselves. They grew up hearing their parents say, “You’re unique, special, a snowflake. There is no one like you.” They took this right into their choice of what to wear and how to decorate their bodies.

Clinic One

This large clinic has a conservative policy on tattoos and piercings: tattoos must be covered, and jewelry in facial piercings must be removed. Yet in recruiting meetings directors wonder if they are losing good physician candidates because of this requirement. With a young patient population, they have heard some feedback that the staff is less relatable because they cover their tattoos, while the patients coming in show plenty.

Clinic Two

In the clinic, older physicians still wear ties to work each day and are frustrated by the lack of professionalism in the younger physicians. Even the nurses are beginning to wear flashier prints and patterns in their uniforms, or worse yet, are wearing regular clothes in the clinic. Whatever happened to keeping things professional by having people dress according to their roles? The younger physicians have asked for casual Friday options, and the older docs are worried about where that will eventually end up.

And, if clothing styles weren’t enough, now many young talented people are using body art to express their unique stories. Not allowing Millennials and Gen Xers to show them can have a surprising effect. As practices adapt to the new generations in the workforce, policy-making around dress codes and body art should be done by first checking in with the Generational CODES™. Ask about your patient profile and see what CODES they are bringing to your practice. Is your practice composed of a majority of Baby Boomers and Traditionalists? Do you have—or do you want to have—more Gen Xer and Millennial patients? The choice you make should be influenced by this information.


Workplace loyalty has undergone a transformation. Millennials are the first generation to enter the workplace with no expectation of retiring with the company they started with, or even with the next two or three companies they work for. Where Boomers thought of themselves as employees that got on with a company and worked their way up the ladder, Millennials consider themselves talent who look for a gig to work and learn from before they move on to the next opportunity.

Not understanding or ignoring the priorities and deal-breakers of younger staff can be very costly. The average Millennial employee’s job tenure is between six months and 18 months. It becomes very expensive for an organization to acquire and train staff and then rinse and repeat the experience all over again in a few months because they didn’t understand their Generational CODES™.

What to do? Millennials are unwilling to stay with an organization that described a Dream Job and then expected them to deal with a Nightmare Reality. So, clearly communicate the real details of what the job entails—the gritty and boring aspects, as well as the fun and fabulous. This begins with the job description and continues into the interview and throughout the onboarding process.

Also, be ready to deliver more feedback and coaching than the earlier generations needed or wanted. Gen Xers are highly independent and don’t need or want much supervision. Millennials, on the other hand, want weekly or monthly check-ins to discuss their career path. Progress toward a goal is a must if you don’t want to be doing exit interviews six months into their tenure. Millennials grew up with coaches, mentors, and advisors, and they expect their leader or manager to facilitate and foster their growth. 

Millennials in the workplace expect to be inspired, challenged, and stretched, all at the same time. The cost of not having this experience is that they will pick up their skill set and take it to another organization.


The ubiquitous smartphone is simultaneously a highlight and a pain point within the generations. Older managers feel that their employees used to be more likely to spend downtime proactively by finding more work to do or other ways to contribute at work. These managers implicitly understand that showing initiative is the way to get noticed for promotions or salary increases.

Millennials are extremely social. They spend a lot of time talking with each other. It is important for them to feel culturally connected with each other. So, they’re often on their phones and doing 800 things at once. Boomers and Gen Xers may see this as being unproductive and distracted. Millennials see this behavior as essential to their productivity and happiness.

This brings us back to the Generationally Savvy mantra: Common Sense Is Not Common.™

Older generations are frustrated that they can’t keep younger generations off their phones. Rather than doing something that is productive with their downtime, these younger generations jump to their phones to text, Instagram, or Facebook with their friends rather than doing something that needs to be done at work. How can these same people who are demanding a high income not contribute at a higher level?

Because Millennials are not planning to retire with your company, they are not looking at long-term social-capital building in the same way that Baby Boomers or even Gen Xers do. Once they have done what you asked them to do, they have fulfilled the job and see their work as completed. If you want them to look for productive ways to fill their time, you will need to coach them explicitly about this, or you’ll find yourself frustrated that they did not read your mind. (By the way, your expectation that they can read your mind is one of the Millennials’ great frustrations.)

The flaw is not in the expectation of productivity but in how you express it. Remember, be explicit, not implicit, about your expectations. After all, that’s just being Generationally Savvy™, no matter what generation you’re working with. 


Anna Liotta, CEO of Resultance, Inc., and founder of The Generational Institute is one of the nation’s top experts on multigenerational workforce and communication issues helping companies attract, grow, and retain clients and talent of all ages.