Tuesday, May 12, 2009

How to tell if you have been Studerized - or something that sounds similar

You’re a seasoned ED Nurse. You are respected by your peers. You are up to date with the latest medical advances, you treat your patients well, you’re a strong patient advocate and actively advocate for patient safety and the nursing profession even if it conflicts with some of your organizations priorities. You probably feel your operating at or near the expert level and have been evaluated that way for a number of years but I have news for you. Nurses are no longer graded on the Novice to Expert scale. They are now being categorized as Low, Medium, and High performers. So how do you know where you fit in and what’s behind this new evaluation system? Hold on, if you haven’t already you’re about to be Studerized or something that sounds similar but is much more painful, at least from what I’ve been told.

How can you tell if you’re on the road to Studerization. It starts out when your managers, CNE, CEO, ED MD Director, among others leave for a few days to a conference or management retreat. The retreats are usually held in resort places like Las Vegas, Phoenix, or Florida but have been branching out to other cities and even webinars. You are not told what it’s all about and you don’t care, you’re just happy to see them gone for a few days. When they return you notice an immediate change. They are using new lingo and talk like they have been indoctrinated into some sort of cult. They are very scripted. They use terms like “Hardwired”, “Fire Starter” “Best Practice” “Taking the organization to the next level” “Low Performers” and “Rounding.” Some of these I wrote about in a previous post titled annoying consultant speak They also talk about some charismatic character named Quint Studer. From conversations with a number of people who’ve attended the programs they sound like a combination of a Amway multilevel marketing seminar, manager training seminar, and Kool-Aid drinking cult gathering. There usually is an inspirational speaker to pump up the crowd. There are various levels and once students are immersed in the philosophy they are considered “Studerized”. A more advanced level is the “Fire Starter” which has a 15 point litmus test called “15 Sparks”. Hospitals can even win the prestigious Fire Starter Award after a visit from one of the Studer troopers.

Hospitals thought-out the nation are trying to improve their patient satisfaction scores and marketing share. I have written about that in a post on patient satisfaction scores out of balance and How has the patient satisfaction push effected your practice. They have turned to groups like Studer who give them the nuts and bolts of turning patients into customers and strategies to bump their satisfaction scores. I have listed my own strategies here.

Not long after the retreat new concepts start appearing into the work area. Some are founded in good ideas but are being done for marketing reasons and means to boost patient satisfaction scores rather than any interest in patient care. Some measures include.

Scripting: Nurses are no longer free to communicate the way that feels natural or based on the situation at hand but are given scripts to communicate with their patients. Coincidentally, or not, the scripts prompt the patient to answer their discharge surveys by injecting key phrases into the scripts that correspond with the questions on the survey. Would you like Fries with that?
Managing up: Encouraging staff to positively portray services and co-workers, doctors, ect during conversations and hand offs regardless if it is true or not. Hi, this is your Doctor, He is one of our best physicians, The patients really love him. Wink Wink
Hourly rounding: Rounding every hour and every half our for ER utilizing your best scripting language. Staff are required to fill out rounding documents and some facilities play the beach boys music “I get Around” every hour on the hour to remind staff. Even the Manager, CNE, and CEO round once a day and ask patients directly if your Nurse has been doing their rounding. I hope my patients are not sleeping when I round, I might get a write up for not performing my hourly’s.
Discharge Phone calls: Generally a good concept if done to check on patients but these calls are timed and scripted to plant answers to survey questions with the specific purpose of boosting patient satisfaction scores. Expect a call the day before your survey arrives provided you were not admitted, transferred, mental health, or someone who really needed to be in the ER.
Peer review: Having staff fill out 1 to 5 rating scales on each other in 5 different categories. Used to help classify people as low, medium, or high performers. If you dont participate your immediatly classified a low performer. Nice way of turning the staff against each other.
RME: Marketing measures disguised as ED through put measures that focus on turnover and catering to low acuity patients, oops, I mean customers. I have written on RME and similar programs here and here. The common thread it that they de-emphasize Triage and limit the practice of Nursing.

So where do you fall, Here are some characteristics of low, medium, and high performers from the Studer site. Funny thing, you could be a effective employee and Studer still recommends you be fired

“..In fact, I would even suggest that you terminate employees who get results but do not role model your organization’s standards of behavior, because they are so damaging to overall employee morale”.

One Chief Nursing officer at a Sutter Health Facility learned the hard way about the dangers of email. It exposed how managers are using groups like Studer target their staff following a quota system. She instructs each department manager to identify 3 low performers per unit “You know who they are” for moving up or out to improve Press Ganey scores. Read her leaked memo here. CNA gave a great response on the same memo.

So are you ready to be Studerized. Bend over.


JustCallMeJo said...


I will never work at Sutter Health.

I appreciate the sharing of information as a professional courtesy.
/jo, RN, BSN

p.s. I got passed that Studer book by my previous CNO. She thought of me at the time as a prime candidate for the purple kool-aid. She had less success in passing the zombification past her managers to the bedside. Not for lack of trying, though.

Anonymous said...

Our hospital is being Studerized -- with extreme prejudice. Since last year, the agenda (Hourly Rounding, AIDET, Walking Rounds) has ratcheted relentlessly upward. At first, we just got general descriptions of the policies and that we would be expected to follow them. Since then, though, the degree of specificity (the requirement to talk about "great care" and the use of behavioral management to script the patient's response to satisfaction surveys) has gotten worse, worse, and WORSE. Now every communication we get has all the stupid buzzwords ("manage up" "up to the next level") in it.

And over the past few months, their micromanagement has taken on a demeaning character beyond anything I've ever experienced in years of nursing.

Your characterization of the AIDET scripting ("Would you like fries with that?") is completely and utterly spot on. It sounds like the kind of demeaning script given to someone working the drive-through window at McDonalds or selling vacation timeshares in a telephone boiler-room.

Ten years ago the authors of the Cluetrain Manifesto wrote that customer satisfaction was actually improved by frank and honest communication with employees who sometimes even acted as advocates for customers *against* the organization. Customers were more likely to feel friendly toward an organization if staff spoke with their own real, authentic voices rather than with the fake, scripted voice of the Mission Statement and other Official Happy Talk.

AIDET and all the rest of the Studer gimmicks have done just the opposite. They're replacing honest unscripted communication with Stepford Wife robot-talk. And the worst part of it is, the people shoving this crap down our throats are too friggin' stupid to realize just how alienating and off-putting all this fakeness is to the patients. When I go into the hospital, I want to speak to a real, honest human being. When a patient hears every single mouth of every single staff member issuing forth with the voice of the Borg Collective, any sane person of at least normal intelligence will draw only one conclusion: "Danger! Danger! I can't trust anyone here! I need to get out of this place as fast as humanly possible! Danger! Danger!" When we all talk like robots regurgitating the company script, the patients will think they're in West World and start watching for Yul Brynner's face to come off.

talamaka01 said...


david said...

Your characterization of the AIDET scripting ("Would you like fries with that?") is completely and utterly spot on. It sounds like the kind of demeaning script given to someone working the drive-through window at McDonalds or selling vacation timeshares in a telephone boiler-room.

Tom said...


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