BY JANET COULTER, MSN, MS, RN, CCM, FCM
In my favorite musical, Hamilton, the lead actor sings, “I’m not throwing away my shot.” Don’t throw away YOUR shot! Share your knowledge and research with the case management community.
As case managers, we are intelligent, inquisitive and resourceful. We strive every day to help our clients navigate through the healthcare system. We are professionals who adhere to ethical standards and possess special knowledge and skills. To become more widely recognized in the healthcare arena and our communities, we, as a profession, need to have a body of learning derived from research, education and training. We have an extensive knowledge base but very limited research directly related to case management.
You may be asking yourself, “Can I do research?” You may be thinking, “I don’t know where to start.” You don’t have to be a research professional to start conducting research.
Let’s take a close look at the word “research.” The word contains the prefix “re” and the root word “search.” “Re” means regarding, and “search” means to explore or investigate. The Merriam-Webster dictionary defines research as studious inquiry or examination, the collecting of information about a particular subject or careful or diligent search.
As case managers, we do research every day, whether it is looking at readmissions, effectiveness of patient teaching and many other processes. We use the scientific process — assessment, analysis, goals, intervention and evaluation — when dealing with issues. The scientific process (or some of us know this as the nursing process or problem-solving) IS research. It is a systematic way of looking at a situation, analyzing the situation or issue, formulating a question, developing interventions and evaluating the effectiveness of those interventions. Process improvement is about asking questions, pursuing answers and using evidence to support your results. Case managers use process improvement every day. Process improvement refers to the practice of finding ways to make existing processes faster, more accurate, more efficient and more reliable. Research and process improvement have a tremendous influence on current and future case management practices.
What kind of research is meaningful to a case manager?
Patient outcomes
Patient care
Family education
Community resources
Social determinants of health
Prevention
Medication management
Throughout the 21st century, the role of the case manager has evolved significantly. Case managers work in a variety of settings, and, although each role has different responsibilities, the primary goals remain the same: to assist our clients to navigate through the healthcare system to receive the best possible outcomes, to advocate for our clients and provide optimal care based on evidence obtained through research. Case management research is vital for the practice of case management and the advancement of our profession. Research has the potential to directly impact patient care provided in a variety of healthcare settings.
The scientific process starts with defining the problem or issue. The problem could be something you are curious about or a situation you have seen several times and you think the situation could have a better outcome. Next ask yourself, “What is the purpose of this research?” “What do you want to answer?” Formulating the question or hypothesis is the next step. Brainstorming about possible interventions and outcomes will help you form the hypothesis. The question or hypothesis should be measurable, answerable and predict an outcome. A hypothesis is an educated guess that seeks to answer a question that can be systematically tested. Your hypothesis should also include your predictions that you can measure through your research. An example of a good question could be, “Does providing written materials to a client before discharge from the hospital increase medication adherence?” Remember you can always adjust your question.
Once the question has been determined, look for information about the issue or situation. You can find information through on-line searches or the health sciences library.
Now it’s time to design the research method. How will you collect the data? Be sure the conditions are the same throughout data collection. There are some things you can control or manipulate, and these are called “controlled or independent variables.” Independent variables are things you try to keep constant throughout your research. Controlled variables are things you can control or manipulate to create the effect on the dependent variable. Dependent variables are what you measure or observe — the outcome or response — due to the effect of the independent variable. They are called “dependent variables” because they DEPEND on the independent variable. They are the client outcomes.
EXAMPLE: You design a study to test whether providing written educational materials on prescribed medications at the time of hospital discharge has an effect on adherence with medication administration. The INDEPENDENT variable is providing the written educational materials or not providing the educational materials. The DEPENDENT variable is medication adherence. You would look at the medication adherence for those who did receive the educational materials and those who did not receive the educational materials to see if there is a difference. You are changing or controlling the INDEPENDENT variable and recording the effect on the DEPENDENT variable.
The next step is developing the research method or design. The research design can be surveys, interviews, observations or client participation.
Now it’s time for the fun part — data collection or intervention. The problem has been identified, a hypothesis or question has been developed, independent and dependent variables have been identified, and the research method has been designed. Observe and record everything about your research project. Include anything that strikes you as interesting or significant. That information may be useful when analyzing the data.
Once the data is collected, the next step is to analyze the results to determine if the data supports your hypothesis. You may need to perform a mathematical analysis to support or refute your hypothesis or question. Don’t let that scare you. There are many resources available to assist in this process.
Drawing a conclusion means determining what you believed would happen actually did happen. Ask yourself if your hypothesis was correct. There is no right or wrong outcome of your research.
The next step is sharing your findings with other case managers. You can communicate your research project and the findings in a written report, presentation or poster. A perfect way to share your research is to apply for the Case Management Society of America Foundation’s Award for Case Management Research or the Award for Case Management Practice Improvement. These awards are presented every year at the CMSA Annual Conference. Another way is to apply to present your research at the CMSA Annual Conference by doing a presentation or a poster. Writing an article for CMSA Today is an additional way to share your research with other case managers.
Communicating your research findings is very important! Sharing research and process improvement information with other case managers will allow case managers to advocate for their clients and provide the best possible care. And others will benefit from your research!
Research is needed to expand the body of knowledge of case management and increase the professional standing of case management. Our profession needs more research. The good news is — case managers are doing research! We just need to acknowledge it and communicate our findings!
Be proud of your work as a case manager!
Share your experiences and research!
Don’t throw away YOUR shot at improving case management through research and process improvement.
To apply for the Case Management Society of America Foundation’s Award for Case Management Research or the Award for Case Management Practice Improvement go to: https://www.cmsafoundation.org/awards.
Winners receive a cash award, and article in CMSA Today, a blog on cmsa.org, a webinar for CMSA members, recognition at the CMSA Annual Conference and the opportunity to provide a case study resource for case managers. Applications are due March 30th every year.
Plan ahead for 2024!
Janet Coulter, MSN, MS, RN, CCM, FCM, is a transplant case manager with a wide variety of experiences including educator, administrator, team leader and director of case management. Janet holds a master of science in nursing degree from West Virginia University and a master of science in adult education degree from Marshall University. She has published many articles in CMSA Today and the Professional Case Management Journal and served as a reviewer for the Core Curriculum for Case Management Third Edition. She currently serves as chair of the CMSA Today Editorial Board and Secretary of the CMSA Foundation board. Janet was the recipient of the CMSA National Award of Service Excellence and Southern Ohio Valley CMSA Case Management Leadership award and was recently inducted as a Case Management Fellow from CMSA.
REFERENCES
“Research.” Merriam-Webster.com Dictionary, Merriam-Webster, https://www.merriam-webster.com/dictionary/research. Accessed 5 Mar. 2023.
Rozakis, L, (2004) The Complete Idiot’s Guide to Research Methods, Penguin Group.
Helmenstine, Anne Marie, Ph.D. “Six Steps of the Scientific Method.” ThoughtCo, Aug. 27, 2020, thoughtco.com/steps-of-the-scientific-method-p2-606045.
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