BY SHERRY ALIOTTA, BSN, RN-BC, CCM
The Standards of Practice for Case Management have been updated. The newly revised standards need not be a reference volume or an unrealistic ideal. They represent a philosophy, statement of beliefs, values to guide a program, its context and the role of the individual(s). They can serve as a road map to excellence and serve as a guidepost for case managers seeking environments that support the practice of case management.
As a case manager, it is our responsibility to adhere to the Standards of Practice (SoP) regardless of our practice setting. Adherence is much easier if we are practicing in an organization where the mission of case management is consistent with the SOPs. Whether you are a case management leader or a case manager evaluating a current or prospective employment opportunity, the SOPs can serve as a road map. By reviewing the case management role in the context of the SOPs, a lot can be learned about the organizational philosophy. Since job titles are often misleading, positions called “case management” may not be consistent with the SOPs, and jobs with more creative titles may be well aligned.
First, the position or job description should describe the role in a manner that is consistent with the SOPs. It should be consistent with the guiding principles. Chief among those principles is the focus on the client. This focus supports self-determination, self-management and partnership. The description should also discuss the role of navigating the client, as appropriate, to the applicable services needed to achieve the desired outcomes. While this doesn’t guarantee that the SOPs are the core of the organization’s program, the absence of such language may signal a divergence. Many case management roles describe cost savings as a primary position goal. While effective case management can result in lower healthcare costs, this is a byproduct of the process, not the goal.
In addition, the qualifications requested by the employer can also provide insight into the organizational support for standards-based practice. A recent advertisement called for licensed practical nurses (LPNs). In many states, LPNs cannot perform assessments. This would lead to questions regarding the ability to fulfil one of the primary responsibilities of a case manager – assessment.
This brings us to the actual responsibilities of the position. They should mirror the components of the case management process. There should be a focus on screening and identification of clients who may be appropriate for case management. As stated previously, client, caregiver and family engagement are required. There should be a requirement for a comprehensive assessment that serves as a basis for a case management plan of care. In addition to being foundational to the SOPs, a comprehensive assessment with identification of problems and barriers to care were found to be among the “Best Practices in Coordinated Care.”¹
A case manager who is interviewing for a position can use knowledge of the SOPs to ask questions that will help them determine if the organization supports practicing according to the current standards. This can potentially avoid future ethical dilemmas in performing their role in the organization. One interviewee was told they were expected to rein in physicians who were practicing in a way the organization felt was negatively impacting their bottom line. As a CM who was more oriented toward a client focus, they sensed future conflicts with this potential employer. Likewise, a case management leader can evaluate the degree to which a candidate’s replies coincide with the SOPs to determine the extent to which the person practices according to the SOPs. One leader was interviewing a candidate who appeared very impressive on paper. When asked about interactions with the client and their support system, the interviewee remarked that they didn’t talk to the clients. While this didn’t signal the person’s performance in their current role, it did illustrate that they would likely not fit in their client-centered environment.
Case management leaders are aware of the voluminous written documentation required to support a case management program. Documents such as policies and procedures, program descriptions and quality management are required by accreditation and regulatory bodies. The SOPs can serve as a rich source of content for such documentation. The case management definition generated by the Case Management Society of America (CMSA) has already been incorporated into numerous CM program documents. Basing program documents on the SOPs is one method of supporting case management excellence while also supporting the dissemination and adoption of the SOPs.
Aside from the practical application of evaluating the likelihood of SoP consistent environments, there are the real-world legal considerations. The professional case manager is expected to adhere to all applicable federal, state and local laws and regulations. If anything in their practice setting conflicts with applicable legal requirements, the law prevails. The case manager should seek whatever appropriate and reliable source available to resolve the conflict. The existence of SOPs also creates a standard that may well be applied to case managers should their practice become a focus of litigation.
Attorneys are aware of the existence of the SOPs and may use them to compare the practice of a case manager to the written standards. In one situation, a case manager was unable to establish a rapport with the client and their family. The case management organization refused to grant the client’s request for a new case manager. The client, with a life-altering injury requiring complex care and treatment, pursued litigation to force the change. The SOPs were used to support the client’s request. The SOPs repeatedly called for partnership, collaboration and client self-determination. It was argued that without a workable rapport, the case manager could not fulfil their role within the SOPs.
The newly revised Standards of Practice for Case Management represent the effort of dedicated case management professionals to provide a statement of beliefs and values in step with the current environment. It is hoped that the SOPs set forth principles that will guide programs, their meanings and the roles of the individual case manager. This article provides a small sample of ways the SOPs can be used to fulfil that mission.
Reference
Best Practices in Coordinated Care; Arnold Y Chen, Randall S Brown, N. Archibald, S. Aliotta, P. Fox less. Published 22 March 2000-Medicine-Mathematica Policy Research Reports.
Sherry Aliotta, BSN, RN-BC, CCM, has over 35 years of case management experience. She is an international speaker, consultant, researcher and author. Her experience includes senior leadership positions in acute care and managed care. She was a CMSA board member at the local and national level. She served as National CMSA President. She was named Case Manager of the Year in 1996. She spearheaded the development and dissemination of the Case Management Adherence Guidelines.
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