Where does the time go?

How CMs can successfully manage their time

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

Case managers have a lot going on every day. Phones are ringing, pagers buzzing, people you need to talk with. Coordinating care for complex patients is knowledge work that often requires deep concentration. And deep concentration requires periods of uninterrupted time. What happens when case managers don't have time to concentrate on their work? It takes longer to solve problems and accomplish the tasks. Staff members who often feel busy all the time may not notice that not much is getting done. If you find staff saying they are feeling constantly busy or they leave work wondering just what they were able to accomplish, it is time to teach them how to take control. Busy-ness may be blocking your case managers from accomplishing their work.

While people like to pride themselves on their ability to multitask, trying to do two (or more) things at once actually reduces cognitive functioning. Multitasking isn't always a bad thing. However it can take a toll if the tasks require concentration. Complex tasks that require attention to detail are poor candidates for multitasking.

The more often case managers switch between activities, the longer it will take to complete any one of them. Each switch can eat up between five and 30 minutes of their time. To change tasks, an individual must mentally close out one activity and return to the other activity and re-create their train of thought to remember exactly where he or she was. If a person has been away from a task for more than a short while, he or she may need to reorganize materials and regain concentration. The worst switches are those caused by interruptions — random events that pull case managers' attention away from the work and break their concentration. If interrupted for more than a couple of minutes, it's going to take most people some time to regain their concentration.

As director of the case management department you won't be able to eliminate the need for some multitasking among your staff or stop all interruptions, but you can help people gain more control of their workday. Good time management has always been an important skill, but for case managers it is essential. Factors such as high inpatient occupancy rates, shorter hospital stays, and information overload are putting the squeeze on case managers to get much more done each working day. Time management involves analyzing how staff time is being spent and then prioritizing different work tasks. Activities can be reorganized to concentrate on those that are most important. Various techniques can be useful for carrying out tasks more quickly and efficiently, such as information handling skills, communication skills, delegation, and daily time planning.

Be clear on priorities

Before case managers can successfully manage their time, they must be thoroughly familiar with their job description and with what they should and should not be doing. Any ambiguous responsibilities must be clarified. The precise role of case managers, their objectives, and performance targets should be clearly articulated by the manager. Everyone must know what is expected of them and these expectations should be in writing.

It may be helpful for case managers to keep a diary or log sheet for a period of at least two weeks to see how they spend their time. The manager and staff member should jointly review the log sheet entries, discussing questions such as:

  • How many of the case manager's activities were planned and how many were unplanned?
  • How accurate was the planning — did tasks get completed in the time allowed?
  • How much time was spent on routine activities that could be delegated?
  • How often did interruptions divert the case manager from his or her tasks?
  • At what time of the day does the most work get accomplished?

The manager should assist the staff in determining how to use their time more efficiently. Split problem areas into the Enemy Without and the Enemy Within. The Enemy Without includes external factors beyond the case manager's control, such as mistakes or inefficiencies in other departments, unexpected extra tasks, and complicated patient/family situations. The Enemy Within is personal inefficiency and includes poor planning, lack of assertiveness in saying "No" to people, and putting off unpleasant activities.

Confront the time enemies

Tackling the Enemy Without may require the setting of service level agreements that detail what each department expects from case managers and improving interdepartmental communication. Interpersonal tensions or inefficient work practices in other departments may need to be addressed. Tackling the Enemy Within requires that case managers are taught to make more constructive use of their time. This can include better planning techniques, such as:

  • spending five minutes each morning reviewing the day's activities and adjusting priorities as circumstances arise;
  • building slack time into the schedule so that too many tasks are not constantly competing for the case manager's time;
  • having a backup plan for contingency situations. Decide which tasks can be dropped, who can be called to help out, and who will need to be notified if the case manager is delayed by other activities.

The manager can help staff members prioritize their time by ranking tasks in order of importance. Try to be objective and avoid ranking highly those tasks that the case manager enjoys the most but are not that vital. The 80/20 Rule, also known as Pareto's Principle, has enormous meaning for the daily tasks of case managers. This rule says 80% of a person's time is spent doing things that are probably not as productive as the other 20%. Discover which of the case manager's activities are the "vital few" and separate them from "the trivial many."

In some circumstances, it may be appropriate to delegate some case management tasks to other people. The manager should be involved in determining those tasks and supporting the delegation process. Assess which tasks can be assigned to someone else. Regular routine tasks not requiring clinical expertise, such as completion of forms or report photocopying, should be handed over to clerical staff. Tasks that can be delegated to staff in other departments will require some negotiation between the case management director and other managers. Do staff members in the other department have the time and willingness to do the task? Are employees in the other department knowledgeable and competent to perform the task? Can the task be easily integrated with activities already assigned to the other department? Before beginning these discussions with other departments, the case management director should feel confident that his or her staff members are managing their time effectively.

Review how work is done

Help case managers find solutions to work inefficiencies so they can accomplish more goals. Complex tasks can be broken down into manageable bits. Arrange work to avoid task hopping. It's best to concentrate on one thing at a time. It can be more productive to batch similar tasks together rather than multitask.

Encourage case managers to avert unwanted interruptions as much as possible. Answering machines and voice mail were invented so that we wouldn't miss important calls. However the technology also can be used to protect important opportunities for concentration. Unless case managers are expecting a critical message, let voice mail pick up calls. Then staff members can choose when to return calls. Confer with payers and other facilities to establish a set time for sharing information. Most people are willing to set a mutually convenient time if they realize it's helping you help them get the information they need.

Make sure the meetings that case managers attend are really necessary and, if running one yourself, be sure it is well organized. Can some meetings be eliminated or shortened? Meetings are most productive when only the people who need to be there are there, they know what they're doing, and they leave with a clear idea of what to do next. Does the meeting need to happen at all? Can the same result be achieved with a phone call or two? If case managers are required to a attend meeting, make sure you know why their presence is needed and what's expected of them.

Case management productivity depends on good tools and effective environments and on using them both well. It can be overwhelming for case managers to get their work done. Try tackling one of the time-wasters each month. Pick one where you can make a positive change right now to keep your staff motivated.