By Toni Cesta, PhD, RN, FAAN

Introduction

In my opinion, the role of the case management leader is one of the hardest roles in any healthcare setting. The attractive things about a leadership position in case management also make it one of the most challenging. Case management leaders are expected to have a skill set that ranges from clinical knowledge and expertise, to knowledge of healthcare finances, to leadership and management skills. The case management leader also must possess strong leadership and management skills, as they are responsible for managing the staff, the departmental budget, and staff development.

Most case management department leaders have the title “director.” While some leaders may have other titles, “director” is the one most commonly used. The role of a director is considered middle management, and success in the role requires that the director cultivate good working relationships with staff and senior leaders of the organization. Most directors, if asked, would admit they simply don’t have enough staff to get the job done. Other resources they may lack include data support staff, clerical staff, office space, space on the nursing units, and laptops or similar devices.

The combination of limited resources with a middle management role and a requirement of a wide range of skills and knowledge adds up to a complex and often difficult job. The director also must stay current in all issues related to case management, and often works for senior leaders who do not completely understand the roles of case management or the value that it brings to the organization. It is no wonder that directors are difficult to find — and that there often is a great amount of turnover. This month, we will discuss why case management leaders continue to be so challenged and how they can cope with this ever-growing and demanding job.

What Is Leadership?

Titles aside, it often is said that we lead others but manage ourselves. So, what is the difference then between a leader and a manager? It certainly is more than just a title. The differences often can mean success or failure for the director of a case management department.

According to author Warren Bennis, the following list of examples illustrate the differences. As you read through the list, consider whether you fit into one or the other. If you fall more often on the manager side, that may just mean that you are still growing in your position. Be as honest with yourself as you can be.

• A leader continually develops; a manager stays consistent.

• The manager’s eye is on the system; a leader is focused on people.

• A leader creates trust; a manager controls.

• The manager sees things in the short-term, while a leader has far-seeing perspective.

• Leaders question why; managers ask how and when.

• The manager’s eye is on the bottom line; the leader watches the horizon.

• A manager imitates ideas; leaders are original.

• Leaders challenge the status quo while managers simply accept it.

• A leader is his or her own person; a manager is a soldier.

• A manager can do things correctly; the leader can do the right thing.

There may have been a time and place where leadership and management might have been interchanged. For example, if a supervisor worked in a car factory, he might be managing the processes of car-making in the factory but not have much concern for the product being made or who might be buying it. In this case, he is truly a manager — he wanted things to be efficient, but that is all.

No Longer Cogs in a Wheel

Times have changed and in today’s economic climate, this approach does not always achieve desired outcomes. Employees are no longer considered cogs in a wheel, but rather, they are important in the quality management and improvement processes. Managers also must lead their teams to improve their skills, inspire results, and identify areas for improvement whenever they arise.

The question for case management leaders is: Are you are really leading, or are you strictly managing your staff and your department? The answer to this question may be affected by myriad issues that are common in many case management departments.

For example, you may want to manage your data and share it with your staff, but you simply don’t have the resources or the time to do so. Sharing the data with your staff will help to improve the outcomes of the case management department, but most days you are swamped with work and higher-level activities fall to the side.

If you have been called a “status quo” leader, you are probably actually functioning as a manager. You may not want to rock the boat or make any significant changes. You may actually fear change. Your fear of change may be due to a lack of knowledge or confidence. It might be because your boss has made it clear that things need to stay as they are.

Whatever the reason, today’s case management department cannot stay stagnant. As the healthcare environment evolves, so must the case management department. This evolution includes the staff, the departmental resources, and the expected outcomes.

You may want to give some staff development lectures, but you don’t have the time to create the lecture, never mind give the lecture. You spend time with budgets, meetings, and other management activities that leave little time for staff development. You understand your need to lead the staff, but leadership activities just don’t fit into your day as other priorities prevail.

You may not have enough staff, but also quite common is a lack of leadership staff needed to manage today’s case management departments. Departments have become much more complicated as they attempt to integrate many roles and functions, including utilization and resource management, discharge planning, patient flow, denials and appeals, and psychosocial management and support, among others.

Under these circumstances, your challenges will be many. However, running a case management department isn’t what it used to be. The pace is quicker and there are many more demands. It is well understood that the most successful leaders possess certain traits. If you can integrate these traits into your daily routine, they will provide you with a firm leadership foundation and a higher probability of success. Let’s begin our review of these top 10 major leadership traits.

Trait 1: Be Results-oriented

As a leader of a department in today’s healthcare world, you must be results-oriented. I often am amazed by how many case management leaders do not have any sort of tracking system, such as a case management report card or dashboard, that can show where the department is doing well and where it needs to improve. The old phrase “work smarter, not harder” applies here. If you are leading your department, you must exert the department’s resources and energy in ways that improve the outcomes for the staff, the department, and the organization. By monitoring and managing your data, you will know where to exert the most energy.

While certain core activities must always be accomplished, how will you best know if the staff are functioning optimally if you are not outcomes-oriented? For case management departments, this means more than just completing those clinical reviews or getting those discharges out the door. What are the outcomes of those activities? Are you reducing denials? Is your length of stay down? Do you have fewer avoidable days? The difference between tasks and outcomes is huge for a case management department and for a leader. The best strategy is to be action-oriented, but don’t be just busy — be effective. You also may need these data to demonstrate your value to the organization and to justify additional resources when needed.

To use data to your advantage, be sure to have some form of a case management scorecard. Select the outcomes you want to track and identify the benchmarks. From there, determine the metrics you want to achieve in each of these for your own department and track them monthly. The data will help you understand where you are doing well and where you may need improvement.

Trait 2: Be Customer-focused

To be customer-oriented is a broad challenge for case management department leaders. If you are in a middle-management position, you are accountable to those above you as well those who report to you. You probably have additional responsibilities to the patients and families, physician staff, the finance department, the department of nursing, and others. The list encompasses most of the departments and disciplines in the hospital. Your customers extend to those external to the hospital, including post-acute care providers, patients and families post-discharge, and primary care providers. There is a lot to navigate.

Your job as a leader is to ensure that you are meeting the needs of your customers. This requires constant vigilance in looking past your own department walls so that you don’t ever assume you know what your customers need. The only way to truly know is to ask your customers. You can do this via a questionnaire or in person, such as during a committee meeting. For example, while you are meeting with your post-acute providers, you can ask them if the transfer process is smooth and efficient on their end. These actions can do a lot to forge great working relationships, and they will serve you well as department leader.

Trait 3: Have a Vision

Having a vision means looking beyond today’s work. It means looking toward next month, next year, and maybe even five years ahead. To have a vision, you must understand what your goals are and be able to create a vision for the future that is clear to you, your staff, and the organization. You may want to consider writing a ‘vision’ statement for your department.

A vision statement is one sentence that describes the clear and inspirational long-term desired change resulting from your department’s work. Design your vision statement to clearly communicate what you are doing to positively achieve in a way that people within and outside your department can remember and communicate to others.

In your statement, succinctly describe your vision as a guide to action for your department and ensure that each and every staff member embraces it as their guide and personal call to action. The best vision statements are inspirational, clear, memorable, and concise. They don’t need to be long — they can be as short as 10 or 15 words. It is likely that your organization has a vision statement, so be sure that yours complements it but is strictly focused on what is unique about case management and its contributions to the hospital’s outcomes, both financially and clinically. Finally, don’t keep your vision statement a secret. Be proud of it and share it whenever possible.

Trait 4: Strategic Focus

It was once said to me that one should never go into a meeting without knowing what the outcome will be. This means that before you attend any meeting where an important decision has to be made, you should negotiate for what you want. You shouldn’t even hold the meeting until you are sure that the outcome will be in the direction that you are looking for.

To be a strategic leader means that you must think carefully and thoughtfully about what you do and how you do it. Being strategic is defined as relating to the identification of long-term or overall aims and interests and the means of achieving them. You may think of this as being political, but it is much more than that.

As you navigate through issues with other departments and disciplines, you will need to be able to articulate that vision to them and engage with them in ways that ensure that you get what you need and want for your department. Being strategic means being able to negotiate and advocate for your department’s needs. You need to think at a higher level in order to be strategically successful.

You should look to the future and be able to adjust as things change. The future might be tomorrow, next week, or next year. You should cultivate good negotiation skills as you work with other disciplines, your boss, and outside agencies in pursuit of attaining all the best you can for the department and organization. It is said that a good leader spends at least 15% of his or her time strategizing. While this may seem like a lot, it will be an investment in the future of your department and save time down the road.

Trait 5: Delegate Effectively

Some directors may try to do everything themselves, seeing delegation as a form of weakness or incompetence. In fact, the opposite is true.

A good leader must use the human resources of his or her department optimally and to the department’s advantage. If you try to do everything yourself, you will never get it all done nor will you ever make improvements. You will always be stuck in the minutia of the work and lose sight of the big picture.

Start off by understanding what you must do versus what can be done by others in the department. Be sure that each and every staff member is working at the top of their skill sets, not at the bottom — and that includes you. Delegating doesn’t mean dumping on others.

If you are thinking that it would not be done right unless you do it yourself, stop and think. Look at the work you are doing objectively and ask yourself: “Is this something I can ask another person to do? Can I teach him or her how to do it? Is it within his or her scope of practice and/or job description?” If the answer is yes, then it is well worth the time to teach the task and hold him or her accountable for it going forward.

Manage the process by setting deadlines and meeting with the person to review the work completed. You will become more effective in your role, and the employee probably will value the faith that you have put in him or her. This is leadership at its best.

Summary

This month, we began our discussion of leadership and the role of the case management leader and reviewed some of the most successful traits. Next month will complete our discussion on leadership by continuing our review of leadership traits and how to apply them to your daily practice.