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Case managers do their best work when they use leadership skills to keep all stakeholders on track with care coordination.
Case managers might think of themselves as care coordinators and the enzyme that keeps a healthcare continuum flowing, but the truth is they also are leaders, according to several case management professionals.
“Leadership skills are important whether or not the case manager is in a titled position of management,” says Christine Tedeschi, MS, RN, CDE, manager of ambulatory disease management programs at Sharp Rees-Stealy Medical Group in San Diego.
“Case managers have to have some leadership skills because, for the most part, they work autonomously,” Tedeschi says. “They have to manage a workload and work through a whole burden of work independently and help others as needed.”
Leaders, like case managers, need skills of emotional intelligence, self-awareness, and the ability to develop relationships, says Julie Mirkin, MA, RN, corporate vice president of care coordination at New York-Presbyterian Health System in New York City.
“A big part of being an effective case manager is having credibility,” Mirkin says. “It starts with clinical competence in the area.”
Other necessary leadership skills include the ability to negotiate and understanding other people’s interests and how overlapping interests can meet the needs of patients, she adds.
When nurses and other healthcare professionals begin their careers, or when they move into case management, they likely are not thinking about leadership skills building, notes Chriss Wheeler, RN, MSN, CCM, a partner with Innovative Care Consultants in Independence, MO.
For instance, when Wheeler was a new nursing graduate, she probably was an informal leader even though she never saw herself that way, she says. “I was trying to solve problems and identify areas where I needed growth,” she adds. “I think self-reflection is needed to move into leadership roles.”
Effective leadership can improve care management teams, staff engagement, and patient outcomes. Tedeschi, Mirkin, and Wheeler provide the following best practice strategies for how case managers can improve their own leadership skills and help to develop these same skills in others:
• Build emotional intelligence. At New York-Presbyterian, case management teams review cases and talk about what could have been done better, Mirkin says.
“We look at the opportunities to improve and share best practices over and over again,” she says. “Engaging staff to participate in ongoing learning opportunities and reviewing individual performance is key to improving emotional intelligence.”
Care manager leaders can build emotional intelligence — a critical skill — in their teams. “They can set an expectation for the staff, hardwire accountability, and give positive feedback in formal and informal ways,” Mirkin says.
• Find a mentor/become a mentor. For Wheeler, her first leadership-building moments were ones she didn’t initiate: “I had someone who came to me and said, ‘You need to join this organization called CMSA [Case Management Society of America],’” she recalls. “It was at a time in my life when I was busy with young children and middle-school children.”
At her boss’ urging, Wheeler joined CMSA and then attended a local meeting.
“It was close to the local chapter’s election time, and my boss said, ‘There’s a treasurer position open. I think you should run for that,’” Wheeler says.
Wheeler took the advice and found a mentor through CMSA, and her involvement with the organization helped her develop leadership skills.
“All along the way, the professional organization and the mentors I’ve had in my life have brought me to this point,” says Wheeler, who is the public policy co-chair for the Kansas City Chapter of CMSA and is the vice chair of CMSA’s national public policy committee.
Case managers who have experience and connections with local and national organizations can become mentors for the next generation of case managers.
“We can nurture those other potential leaders and give them opportunities to lead,” Wheeler says. “Nurturing and mentoring are absolutely important to develop leadership skills.”
• Hire people with leadership potential. “I look for people who had some previous experience making a contribution to wherever they are coming from,” Tedeschi says. “Maybe they’ve been on a committee elsewhere or developed a safety [program] on their prior unit.”
Tedeschi also looks for people with good communication skills and the ability to handle issues that arise in a logical manner.
“We have leaders who are quiet, and we have leaders who are really vivacious, so there’s not one general [personality type],” she adds. “For me, potential leaders have communication skills, some experience, and demonstrated excellence in the work we’re asking them to do.”
Attitude also can make a difference, Wheeler says.
“Our formal leaders and informal leaders can either break a team or help a team excel, depending on the attitude they bring into the environment,” Wheeler says.
“Also, case managers who work in workers’ compensation have to be self-starters who are self-motivated and understand how to get all the people on the same page,” she says.
• Implement goals, realize organizational vision. Case managers are expert in more than care management. They’re also expected to see a department’s vision and develop processes within their own group, Tedeschi says.
For example, when a telehealth program involving texting for patients was implemented, the group’s leader had to understand how it would fit into staff and team workflows, she explains.
“That’s what a leader would be doing: understanding what the department wants and understanding how they’re a team and creating processes so the team can be clear on what the steps are and what needs to be done,” Tedeschi says. “The leader understood the technology from the beginning because she was in the meeting when we were considering bringing on this technology.”
The leader had done additional homework, as well. She knew the organization’s patient population focus was the new technology that would help enhance case management. “There were very general messages about how patients could manage their diabetes, and our staff nurses and case managers were expected to enroll patients in this activity,” Tedeschi says.
There were multiple steps case managers had to take, and the leader was able to audit nursing charts to make sure those steps were followed. For instance, if a patient indicated interest in the technology, but was never enrolled, the leader would have someone call the patient and get the person enrolled, she adds.
• Grease the wheels that keep care coordination rolling. Effective patient advocacy and positive outcomes require leadership skills. Care managers work with physicians and others who might have their own ideas of what needs to be done for patients and who might not be interested in collaboration, Mirkin notes.
“When I talk with physicians, I discuss my staff’s ability to provide patient advocacy,” she says.
“We’ll grease those wheels to get testing done and to make sure patients don’t have to wait for things,” she adds. “We’ll work with admitting, and we’ll be the grease on the wheels to navigate the patient and serve as an advocate.”
“After explaining all that case managers can do for patients, but also to help physicians with their challenges, a case manager might say, ‘This is why the care coordinator is important, because you’ll tell me everything you want done with your patient and I’ll make sure it happens,’” Mirkin says.
Once case managers exhibit this type of leadership skill, other healthcare professionals will begin to trust them, and collaboration will be easier. Then there will be positive outcomes that will further improve trust, she says.
“As long as you advocate for the patient, physicians are very much on board with this,” Mirkin says. “We all want the same thing.”
• If it’s broken, fix it. “If you’re an on-the-ground case manager, when you see something that is broken don’t just go to your manager to complain,” Wheeler suggests. “The person who identifies the issue probably has the solution.”
This is one way to demonstrate leadership. Another way is to influence others to be the solution.
“There are leaders, managers, and transformational managers,” Wheeler says. “A manager will manage things from day to day, and if something needs to be fixed, the manager will show people what they’re doing wrong.”
A leader, by contrast, will influence staff to set goals and accomplish tasks. “Transformational leaders will share their vision and lead the way and challenge the process,” Wheeler says.