Case Management Insider

The CM leader's role in recruitment and retention

By Toni Cesta, PhD, RN, FAAN
Senior Vice President
Lutheran Medical Center
Brooklyn, NY

The recruitment and retention of good case managers has never been more important than it is today. In the early years of hospital case management, many case managers transitioned into the role from utilization review or discharge planning positions. Those case managers coming out of utilization review picked up the discharge planning functions on the job. For the discharge planners, the opposite was true. Eventually everyone melded into case managers. Those who could not, or did not, want to take on the new functions moved on to other roles.

At this point in time, case management leaders must look to other clinical areas from which to draw the new case manager. These might include those working outside the walls of the hospital. Strong case manager candidates may come from managed care, home care, or long term care. However, it is likely that the majority of the next generation of case managers will come from the bedside.

The next generation will have to be our best and brightest clinicians, those capable of transitioning their clinical skills to incorporate the additional skills they will need to be effective hospital case managers. (For examples of Case Manager leader challenges, see box, below) They will be staff nurse and social workers who can take their clinical skills and enhance them with an additional skill set that will transform them beyond the bedside to a broader and deeper scope of care. For the case management leader, this change brings an additional set of new and exciting challenges.

Case Management Leader hallenges

  • Hiring the right clinicians
  • Educating and orienting the new staff
  • Retaining the best staff
  • Keeping the staff and the department moving forward

Recruitment is only the first step. Retention is equally important and should be given as much emphasis as recruitment. Unfortunately, due to time constraints and other resource limitations, it is sometimes forgotten or over looked.

The first element of retention is an accurate and up-to-date job description. Review your job descriptions annually to ensure that they match with the ever-changing roles and functions associated with case management. Also be sure that the departmental policies and procedures are also in sync with the job description and expectations of the department and the roles of the staff.

As the staff transition to higher levels of competence, consider challenging them with more complex projects. Give them more challenging and/or long-term assignments that will help them grow professionally and apply their knowledge and expertise. Expect more from them, and you probably will receive more from them.

Also consider a clinical ladder if that is a possibility in your organization. If possible, create one or more higher level positions that might include some supervisory responsibilities. The position should also include more financial compensation and be seen as a reward for the best performers in the department.

Data and feedback

Conduct regularly scheduled staff meetings. Use these meetings as an opportunity to provide written reports to the staff that reflect the outcomes of their work.

If your department uses case management report cards, these should be shared with the staff. Specific opportunities for improvement should be identified based on the data presented. Set departmental goals based on the information presented in the report cards, and then develop action items that the entire staff can agree on. This time is also great for soliciting feedback from the staff regarding their thoughts and ideas on specific topics and how the processes can be improved.

During staff meetings, review and discuss regulatory changes and updates. In the constantly changing world of case management, the staff members need to understand why they are asked to perform certain roles and functions. Compliance is always enhanced when employees understand the rationale behind functions they are asked to perform. As roles are added, assess what tasks can be taken away. Sometimes tasks become outdated, redundant, or unnecessary, but we forget to remove them from the daily work of the staff. These tasks can be a great dissatisfier for the staff.

Include your clerical staff in these discussions as they may have great suggestions for removing barriers or improving processes. After all, you want to retain them as well as the professional staff.

Another significant dissatisfier can be the expectation that the professional staff perform routine clerical tasks as part of their daily work. Clerical staff as well as software programs are necessities in today's case management department. Not only are they time savers for the professional staff, they also improve staff satisfaction by allowing the staff to spend more time in direct patient and family contact.

Encourage the staff to attend outside conferences and educational programs. These programs can be stimulating and provide a supportive network for the staff. Also encourage them to become members of case management professional organizations and to attend these meetings as well. All of these activities provide a professional environment that provides a positive work environment. Having the entire department participate in case management webinars as a group can provide a learning as well as a bonding opportunity.

Encourage the staff to read professional journals. Consider starting a journal club. Provide articles that you find particularly helpful. These might come from financial, The Joint Commission, or other sources in paper as well as electronic format.

Keeping the department moving forward

As the leader of your department, stay informed and aware of the barriers your case managers are facing on a daily basis. Help them address these barriers and frustrations so that they can remain focused on their work. You, as the leader of the department, are in a better position to address serious concerns that might have political or hierarchal ramifications.

Be sure that your staff understands the "chain of command." They should never feel as though they do not have administrative support every step of the way. Review what issues should be escalated on a regular basis so that they feel comfortable doing that as needed. If the staff members do not escalate appropriately, then they should be held accountable when a problem is not resolved. If you have a physician advisor, then consider having them attend meetings so that they can hear the frustrations that the staff are facing and can help be part of the solution. Even informal lunches or after-work gatherings can set the framework for a cohesive and productive department.

One thing is true for sure, case management's day has come: value-based purchasing, the Affordable Care Act, readmission payment penalties, coordination of care across the continuum, and the list goes on. Work is not going to get easier. Keeping your staff motivated and moving forward is the best strategy for achieving excellent outcomes for your department and your organization.