Guest Column

Honing your role as care coordination consultant

Get your voice heard

By Patrice Spath, RHIT
Brown-Spath & Associates
Forest Grove, OR

It's common for case managers to say, "Oh, I wish I were a consultant." Yet, case managers already have jobs in which they do much of what a consultant does. Look at the list below and check off the consulting activities that you already do as part of your work responsibilities:

  • Assess what's going on in your job and in your organization.
  • Look for lessons learned and apply them to other activities.
  • Look for and assess quantitative data about the organization.
  • Measure your performance.
  • Continually learn.
  • Give advice.

Case managers are internal care coordination consultants. In this consulting role, case managers offer many long-term benefits to the organization and, ultimately, to patients. This role demands a range of skills and knowledge. It also requires that case managers seize every opportunity to build widespread understanding of care coordination issues, even during brief openings in committee meeting discussions.

Consider this scenario: You are sitting in a meeting of an ad hoc task group formed to evaluate ways of improving patient satisfaction. The group is mapping out a plan for expanding the organization's patient-centered care initiative. The charge is that by the second year of implementation, patient satisfaction scores will be greatly improved. You have been asked to participate in the task group for several reasons including your expertise in care coordination. The hospital's patient-centered initiative provides a prime opportunity for you to influence the quality of patient care services.

The second meeting of the task group is devoted to discussions of potential changes in the process for discharging patients. The group members state their likes and dislikes, horror stories, and successes. The group is in an action mode and you are concerned that they might move too quickly with some big decisions that turn out to be strategic missteps. You hear lots of discharge planning ideas around the table but you feel many of the proposed changes ultimately won't be workable or may actually reduce patient satisfaction. How do you get the attention of the group for a few minutes so that your opinions can be heard?

As with all consulting work, the challenge is figuring out how to influence decisions within a short amount of time. Meetings are often fraught with power struggles, competing priorities, and a mix of analytical styles and personal biases. Plus, there is the added pressure of limited time. Regardless of these constraints, you don't want to miss the opportunity to help the group begin thinking about patient discharges in a different way. To make your best shot in the meeting consider the following five questions:

• What information would be most useful to the group right now?

Select and prioritize your key points before beginning to speak. Don't make the mistake of launching into a mini-seminar on discharge planning models. Sometimes a well-placed sentence or short story has more impact. Avoid blurring your message by covering too many aspects of the discharge process. In your five-minute speech, you can't cover everything from "assessment" to "planning" to "plan implementation." To committee members not familiar with the discharge planning process, it can all sound like a mishmash of jargon and platitudes.

• What framework might help us move forward?

Often a discussion begs for a framework to link ideas and extend the thinking. In the meeting, committee members are advocating specific "pieces" of the discharge process — strategies for identifying patient needs, expeditious ways of arranging for services, etc. If you speak up with just one more new idea without a framework for tying all of the pieces together, you could actually add to the disagreements rather than increase everyone's understanding.

For example, a common framework for showing the three phases of a change process is initiation, implementation, and institutionalization. Use that framework to discuss how each of the new ideas — including yours — will affect outcomes and patient satisfaction. Not every idea you propose will be embraced by the committee. Avoid falling in love with your ideas. Remember that when you're a consultant, whether you're working inside or outside the organization, you are not in charge. Consultants assist, advise, add expertise and experience, diagnose, or help find solutions to problems. Your role is not to make decisions but to add knowledge and help equip a committee or leader to decide.

• What evidence or rationale might be useful?

You may or may not be called upon to give an in-depth explanation of the rationale for various changes to the discharge planning process. However, it is important to your credibility as a consultant to be prepared to do so. If you propose any paradigm-busting ideas about care coordination issues or process revisions, expect hard questions and challenges.

Before any meeting, think about why you would advocate particular case management or care coordination process changes. If you're drawing from personal experiences, be able to explain all aspects of the experience clearly. The committee will want specifics, including the chronology of the project and how you tracked its impact on patient outcomes, including satisfaction.

In addition to personal experiences, your ideas might be guided by research findings that have impressed you. If you decide to refer to research, be cautious. Health care professionals can be hard sells when it comes to knowledge derived from research and theory. Select only strong, recent studies done by respected researchers with a sample group and context similar to your facility and patient population. If you quote statistics, know how the calculations were done.

Quoting from The Joint Commission standards or Medicare Conditions of Participation can be useful; however, you need to be able to explain the rationale behind these requirements and how to design programs that will satisfy these requirements.

• What concrete examples will help emphasize my point?

Concrete examples, real stories, and illustrations are valuable tools for consultants. For example, if you're pushing for case managers in the emergency department, share examples of how this has worked at other facilities. Collect good examples, stories, and illustrations. Practice using them so you can explain them without hesitation and without rambling. The feedback you get from the group will help you determine whether the ideas are "keepers" for your facility.

• What exactly can the group do next?

Committees often need information and a plan before they can make their decisions. You might offer to bring articles or books to enhance their knowledge, arrange a field trip for them to see a particular case management model in action, or bring in a speaker who has experience in a needed area. Remember that, as a consultant, your job is to help others succeed. You succeed when you have built the capabilities of the group. If you do your job well, the group will need you less and less as the improvement project moves forward.