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.

Annoying Consultant Speak

In the past week I have sat through several process type meetings and must reflect on some of the most irritating consultant speak. Here are a few examples.

Rapid cycle process improvement
The model of improvement is applied in short test periods, using small samples of patients, and measures the effectiveness of the changes being tested. Based on what is learned, successful interventions are applied to other patients or other organizational activities or settings and unsuccessful ones are revised and tested again for effectiveness. You usually hear it when a new manager or director takes over from the outside or your existing manager goes to a conference. Murse’s Translation. I went to this cool seminar and heard this great idea and since I don’t really know anything about statistics or study design and we don’t have time to do a real study were going to implement this new process and if by the end of the day it works were going to do it throughout the hospital. Then were going to put it in a power point and present our great success to the CEO. I love the smell of a bonus in the morning.

Perfect is the enemy of Good Enough
The origins of this phrase are from the French Philosopher Voltaire. In modern times it seems to appear during crunch time of hospital IT projects. Go-Live is just a few months out. The team is feeling nervous and wants changes. The CIO calls a big meeting and gives a power point pep talk to get everyone "on the same page". Then it comes out, “You know, when it comes to rolling this out, Perfect is the Enemy of Good Enough. Murse’s translation: “Lets put some lipstick on this pig and roll her out. Stop you’re bitching, the users will just have to deal with the issues”. Ok, we know its never going to be perfect but can I ask: Did you use that same term when applying for your job when asked to describe yourself? How about when you proposed to your significant other, or do you say it to your kids just before finals or the big game? Doubt it. I’ve decided that at the next EMR Go Live that I support I will wear a team t-shirt that says, Perfect is the enemy of good enough! How about that on a team shirt. The users will be impressed.

Studerized
Being Studerized is similar a baptism in the Studer Group philosophy. I suspect there is Cool Aid being served at this baptism. Hospitals thought-out the country are sending their staff to various vacation resorts for $1200 a pop, not counting lodging and travel for the 2 day Studerization. By the end you are a customer service expert. Patients become Customers. You become experts in scripting the survey and how to change the patients perception of the visit. You are eager to go back to your hospital and implement the Three Levels of Studerizaiton. When you get back you will be filling out report cards on each other and identifying your departments high, middle, and low performers. Hope I’m not in the low group. Wow, I’m pumped. Pass the Cool Aid.

I'll update this list from time to time, shouldn't be hard I have more meetings this week.

Top Ten ways to raise your Emergency Department Satisfaction scores

So you’re a Hospital CEO, Emergency Physician Director, or ED Manager. Your latest patient satisfaction scores are lower than your competitor Hospital across town and your in a panic. The results are in the newspaper. Your job is on the line. Try this Nurse’s tried and true top 10 list of how to raise your scores in a hurry. Get your staff on board, here is how.

10. Prescribe Tylenol and other OTC meds: Patients love it because it will mean that their health coverage might cover the cost (at least publicly funded plans will). What’s a little ink on a prescription pad if it moves you up a notch on the survey.
9. Make the Nurses Apologize: Remember, the customer is always right. No matter how dysfunctional and disruptive their behavior apologize if anything upsets them. Smoking in the bathroom, cussing at the Nurses, no problem. If the Nurses refuse have the supervisor apologize and offer the patient a free drink voucher in the cafateria for not meeting their expectations. You can deal with this obvious case of insubordination later.
8. “MR CEO Take down these walls”: Eliminate secure entrances and relax visiting policies. They are only there because those damm Nurses are control freaks. Let the family in and make ER care a group event. Now isn’t everyone happy. More people to practice your scripts on (see #1). Besides, the odds are in your favor you wont have a security event. At least during your tenure as CEO, Director, or Manager. Here is one facility that was not so lucky.
7. Don’t spend to much energy on those excluded from the survey: Quietly leak out who is excluded from the survey (most institutional and mental health patients, and transfered patients in case you are curious) so staff can direct their energies appropriately. Hey, even a demanding CEO knows that you can only kiss so much butt per shift. The key is kissing the right butts.
6. Valet parking: If cost is an issue, lay off your ER Techs, or if you feel bad about that just change their job description, have them put on a suit and park those cars.
5. Prescribe antibiotics for every cough and ear ache: Again, the customer is always right and we dont treat patients, we treat customers. They didn’t drive all this way to get told a viral illness will not benifit from antibiodics and to take Motrin, drink lots of fluids, avoid second hand smoke, and rest. No, give them an antibiotic. Who cares about the treatment guidelines, this one is not measured. They will get better regardless in a couple of days and no doubt will attribute it to the antibiotic. And give them the good stuff, Cipro, makes them feel special and gives you bonus points come survey time. Also good for many bioterrorism events.
4. Hire Travel Nurses: The best thing about Travel Nurses is there easy to get rid of. Yes they are expensive but so is orientation, training, benefits, continuing education, step raises, and all the other stuff that your staff nurses have come to expect. Travel Nurses are not interested in the politics, problems, and shortcomings of the institution, or patient advocacy. They will come to work and not complain, generally be nice, and do as they are told. If they dont, send them packing.
3. Minimize threatening patient education: Crutch walking, wound care instructions, fever control, all great stuff but don’t let those Nurses get to proactive in educating patients. You can loose survey points if some Nurse talks to much about the dangers of smoking, obesity, shaking your child, or any other threatening subject. If the Nurses don’t comply limit their ability to give instructions by eliminating those handouts or use a electronic record that gives instruction control to the Doctor (like Tsystem). After all, Doctor does know best.
2. Provider is Triage: Replace your Triage Nurse with a Midlevel Provider. Your Midlevel can treat and street in a 1 minute Triage exam most of your common complaints as long as they do not engage in any meaningful conversation and follow items 10, 7, 5, and 3 as above. The Nurse, should you choose to keep one in Triage, can stand behind the Provider and quietly scribe the notes. You can call it "Team Triage" and tell them how importnat they are to the "Team". You’ll need a good generic checklist type H&P intake form (I recommend Tsystem or equivalent). The more complex patients will be assigned to the ER for the MD to see. But guess what, you can reduce your ER’s Door To Provider time to nearly zero on all patients by having your PA scribble down some preliminary orders before handing the patient over. Who cares if they ever get done. This is chart buffing at its finest.
1. Scripting to the Test: Teach your staff to memorize the test questions that patients get on their survey so you can have them script their conversation and prompt the patient to remember specifics when filling out their survey. “I am closing the curtain to protect your privacy Mr Jones” will score high on the question “The Nurse paid attention to my privacy needs? “Thank you for choosing Acme Medical Center for your care provider”. This one will get you a more likely to recommend. Not only does scripting guide the patient in completing their survey, it eliminates unnecessary Nurse conversation.

The sad part of this list is the items cited are becoming common practice at many Healthcare organizations.