BY JOSE ALEJANDRO, PhD, RN-BC, MBA, CCM, FACHE, FAAN
Case managers throughout the healthcare continuum often find themselves in the most complex situations. This means case managers need the necessary negotiation skills, process improvement techniques, knowledge base and skills to influence a complicated and transforming healthcare system.
How many times have we heard that it is the case manager’s fault when a patient isn’t ready for discharge when the team wants the patient discharged? For example, this might occur when a complex patient has exceeded expected length of stay due to multiple comorbidities. Influential case managers have the foresight to anticipate and respond prospectively to stakeholder needs. It means preparing for the next level of care while proactively addressing any social determinants of health which may pose barriers to transitioning care. It is imperative that influential case managers utilize formal and informal relationships to collaboratively progress care at the right time.
Case management executives often ask case managers to do more with fewer resources. The influential case manager understands the importance of developing relationships that establish partnerships with other healthcare disciplines and entities, so that patients, families and communities can receive the most appropriate support from their healthcare team. Creating successful partnerships and relationships is extremely important so that care transitions are seamless, efficient and effective. Successful patient care transitions require comprehensive hand-off and the necessary tools and resources to continue the recovery and healing process. Influential case managers recognize that all healthcare disciplines must be part of the collaborative process for transitioning patients within the healthcare delivery system.
For example, licensed clinical social workers (LCSWs) and their extensive experience in mental health and substance abuse can provide key strategies to facilitate transition of with dual diagnoses. Physical therapists (PTs) can provide therapies that can help facilitate care progression for patients with physical disabilities. LCSWs and PTs are just two of the many types of professionals who can improve the care delivery and transition of the patient populations we serve.
As front-line case managers, we often hear from the provider that a patient is ready for transition of care, but the documentation and/or discharge plan does not currently support an appropriate transition. Collecting data on transition of care issues is a great way of developing proactive approaches that will reduce the likelihood of a care transition issue. Many case management departments have utilization review data collection systems that can aggregate issues by diagnosis or demographic data elements. This data can then be used to identify at-risk populations and common transition barriers. For example, new dialysis patients may need to establish outpatient chair times with a community dialysis center prior to discharge.
Process improvement, team facilitation and negotiation skills are core skills of every case manager, but sometimes complex care coordination can push a case manager to complete tasks. This is why all front-line case managers, regardless of practice setting, should acquire negotiation skills so that they can influence their leaders, physicians and other healthcare disciplines. Patients, families and communities are dependent on their case manager being their advocate for the most appropriate timely and quality care.
In summary, influential case managers understand the importance of developing effective relationships with stakeholders within and outside of their organization. Influential case managers engage the multidisciplinary team in care progression and transition. Effective case managers anticipate needs by using performance and process improvement tools that proactively identify potential bottlenecks and barriers to care. Becoming more anticipatory and proactive will help make your practice more efficient and effective.
Finally, as we finish celebrating over the holidays and move into the new year, it is important that every case manager remembers to take care of herself. Case managers oftentimes work extra hours for our complex patients and/or provide coverage for a colleague during the holiday season. Take time to reflect on the difference you make to the individuals our profession serves. And as a gentle reminder, take time to thank your families, friends and colleagues who have supported your case management journey and are there for you. Without them, the struggle could have been harder!
Jose Alejandro, PhD, RN-BC, MBA, CCM, FACHE, FAAN
President, CMSA
2018-2020
Dr. Alejandro is the director of case management at UC Irvine Health, Orange County’s only Level 1 Trauma and Burn Center.“Successful patient care transitions require comprehensive hand-off and the necessary tools and resources to continue the recovery and healing process. Influential case managers recognize that all healthcare disciplines must be part of the collaborative process for transitioning patients within the healthcare delivery system.”
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