Hospital case managers are leaders, whether they realize it or not. Their role in standing up for patients and speaking with other healthcare professionals about patients’ needs provides case managers with leadership skills.

“You can hold a really powerful, even maybe subtle leadership to be able to help your patient,” says Lisa Lobdell, RN, MSN, CCM, lead case manager at VA Long Beach Healthcare in Long Beach, CA. Lobdell speaks about case management leadership and patient navigation at national case management conferences.

“A good example is how you might not be able to fight for yourself, but if you see something that your patients need, then you are able to speak up for them and advocate for them,” she explains. “To me, that’s leadership, being able to have people who are not in a direct authoritarian leadership role coach people on how to do the right thing.”

Case managers might not consider themselves leaders because it is not a role they sought. There is a difference between being a leader and being a supervisor, she notes.

“Some supervisors have very good leadership skills, but you don’t have to be a supervisor to be a leader,” she says. “It’s often the people down in the trenches, so to speak, who are the leaders who can get people to do things that even someone at a much higher level couldn’t get someone to do.”

Nurses are able to lead physicians, residents, and fellows to what patients need because they are a stable source of information and experience. But it takes fortitude and persistence. For example, Lobdell once had to call a physician at home late at night. The doctor hung up on her.

“I called back to make sure he did what was needed for my patient,” she says. “Often times, in the middle of the night, your patients still have needs and you’re with them while they’re dying and taking their last breath, and to get what you need for your patient takes a level of creativity.”

Lobdell offers these suggestions for how case managers can exhibit and improve leadership skills:

• Be a mentor or trainer. Each case manager should aspire to be a mentor for others, being the kind of patient advocate they would like others to be, Lobdell says.

“If people see that you are a really good, caring case manager who knows your resources and works well with others, then you are a role model,” she says.

“When I have an employee who shadows me and asks questions, and if I want them to be able to work with and communicate with different doctors and different staff members, then I model what good communication looks like,” Lobdell explains. “It’s being respectful, direct.”

For example, Lobdell will not tell a doctor, “You didn’t order this.” Instead, she will wait until the physician is finished discussing the patient, and she recaps, saying, “These are the things I think you wanted.”

The doctor might say “yes” or “no,” but the point is to learn how to communicate with people in respectful ways so it is much more likely the case manager will achieve the best outcome for patients.

“It’s all about, at the end of the day, serving our best,” Lobdell says. “We work in different kinds of areas and work with different personalities and temperaments and people who are at different stages of learning.”

• Lead for patients. Working with patients in their most vulnerable state requires subtle leadership.

“You’re trying to direct them to resources and be a leader for your patients,” Lobdell says. “You have to find out what their values are and what’s important to them and how you can get them to stop smoking to align with their values.”

Ask patients questions about what they want and need, including the following:

- What would you like to do?

- Have you heard of that resource?

- Are you ready for a change?

“I’ve had people come back to me and say, ‘I’m ready now.’ They weren’t ready before,” she says.

“For me, it’s always been about building trust, doing what you said you’d do, and doing it when you said you’d do it,” Lobdell adds. “If you tell patients you’ll call at 3 o’clock, and you don’t call them, they’re probably sitting at home waiting for that call.”

The goal for case managers is to empower and educate patients, working with them until they do not need case management anymore, she adds.

• Supervise others in case management. Case managers sometimes will be asked to move into the role of a supervisor. When this happens, they could embrace those leadership qualities that helped them land this responsibility.

As a supervisor, make communication a priority.

“When you’re supervising people, they don’t always know why you make decisions the way you do,” Lobdell says. “I’m big on communication.”

Supervisors cannot always share their decisions with people, for a variety of reasons. But they can engage in nudging people to an understanding of the supervisor’s and other organizational leaders’ goals and actions.

“As a supervisor, you have the authority to tell people what to do, but that doesn’t mean they’ll do it or do it at their best,” Lobdell says. “Being a supervisor doesn’t necessarily mean you are a leader; a leader is an informal authority.”

Supervisors who have good leadership qualities and traits make for the best leaders, she adds. “Good leaders are people who know who you are and are in the trenches with you.”

• Engage in self-examination. Case managers who aspire to be better leaders might start with self-examination.

“Look at what your own biases are,” Lobdell suggests. “We each have areas where maybe we think we’re better at doing than we are.”

Aspiring leaders also can explore their potential through a leadership program. Lobdell attended a leadership program in which one of her peers answered questions about her.

“I found that very enlightening,” Lobdell says. “One of the ways to develop your leadership style is to look at the person you are and take constructive criticism from people, so you know where your blinders and weak spots are.”

Public speaking and building support networks with other leaders also are ways to improve leadership skills.

Case managers can think of leadership skills development as similar to nursing or other training.

“I’ve had to learn how to speak with data, be heard, and take the emotion out of my voice,” Lobdell explains.

“I’ve learned how to put together a presentation. You may have great ideas, but if you don’t know how to do those things, you won’t get very far getting your point across with people in higher positions.”

A case management program also could go through a self-examination process. For instance, the program could bring new and experienced case managers together to discuss what they think should be included in training.

“We got input from case managers about what they would have liked to learn when they first came there, but that no one showed them,” Lobdell says.

• Learn people management skills. As a supervisor, case management professionals might learn how to listen to employees and see circumstances from their perspective.

Staff will seek out a good leader, looking for help with their problems. When they stop knocking on the supervisor’s door, it might be time to find out why they have decided they no longer need the supervisor’s help, Lobdell says.

When an employee is performing a task incorrectly, the supervisor’s role is to sit down with the person, listen, find out what the person is trying to accomplish, and then lay things out step by step to help the employee succeed, she says.

“If someone is going down the wrong path, you sit down and say, ‘Where are you trying to go? What do you think would be best?’” she says. “A lot of times, people can figure it out for themselves if you give them the right tools.”

Creating a team and soliciting ideas, input, and creativity is how to get the best out of everybody, she adds.

The roles of manager and leader both are important, Lobdell says. “But when we lead or focus on leading, you really get greater results.”