By Melinda Young
Developing team engagement in case management departments can improve staff retention and efficiency.
• The first step is to focus on resource allocation and the size of the department.
• Case management leaders should think proactively and seek team input and collaboration in any process changes.
• Forming a case management council could help leaders obtain buy-in.
Case management leaders can improve their departments by focusing on team engagement, outcomes, and developing optimal leadership.
“Case management is not for everyone,” says Pamela Andrews, RN, MSW, MBA, assistant vice president, case management at Inova Health System in Fairfax, VA. Andrews also is the president-elect for the American Case Management Association National Board.
There is not one specific way to improve case management and develop the best teams. But a good first step is to identify team members and to focus on the correlation between their skill sets, engagement, and outcomes, Andrews explains.
After about two decades as a case management director at various hospitals, Andrews worked in population health and regulatory strategy for a managed Medicaid program before returning to leading hospital case management across five hospitals.
“We had a staff vacancy of more than 30% in the whole system,” Andrews says.
Something had to change. Andrews began to investigate: “I needed to physically position myself in those spaces to understand the culture of the team and what kind of support and leadership was needed to build that success,” she explains. “Coming into new space as a new director, you have great ideas and want to implement them. But sometimes there is a failure to pause and take the pulse of people who were never asked for help before.”
The process improvement project to reduce staff turnover was successful. “We cut our vacancy rate in half,” Andrews says. “We’ve been able to retain those new hires.” In one hospital, staff increased from 93 full-time equivalents (FTEs) to 105 FTEs, she adds.
At the beginning of the improvement process, Andrews met with hospital case management directors. She learned where they were missing staff and what additional support was needed.
“I worked in each of the buildings, doing basics, including rounding, getting to know the team, looking at processes, and observing day-to-day management,” she says. “I came in and talked to each team to understand where they were, and I didn’t make assumptions around what I thought of where they were.”
Leaders often know what needs to be done to fix organizational problems. But they make a mistake if they jump into solving issues based on their own ideas without doing their homework, Andrews notes. “I had all of these great ideas that I wanted to start working on, moving forward, but I couldn’t do this because I needed to take the time to really do the groundwork and reacquaint myself with the team,” she explains.
Instead, Andrews met with case management teams to find out what they thought of the current processes and what opportunities they identified.
“I had to slow down and listen to the team and get their perspective,” she says. “Then, I’d say, ‘Based on what you’re saying and where we need to be, here are some of the elements we need to incorporate into what you’re already doing, and here’s how we’re going to do it.’”
Andrews describes how leaders can improve case management programs, following these tips:
• Focus on resource allocation. “We always need more; we can’t do it all,” Andrews says.
Case management team discussions should center around how to size existing operations. Teams need support that might relieve their burden. For example, if a hospital is lean with limited resources, the case management leader might see where there are resources that could be reallocated.
In hospitals where there are case management vacancies, including director roles, the goal might be to learn why there is staff turnover or why jobs remain vacant. If the answer is the case management staff is overworked and lacks support, a solution might be to hire case management assistants.
Another issue could be related to employees’ workflow or job descriptions. For instance, some hospitals might employ case managers who perform both utilization review and discharge planning. Sometimes, these roles are difficult to reconcile within a case manager’s workflow.
Case managers who have to focus on both jobs might have to spend more time on utilization review, and then find it difficult to manage patients’ length of stay. The solution would be to divide the two roles, assigning some case managers to focus solely on utilization review and others on discharge planning, Andrews says.
“One person communicates with insurance companies and provides clinical evidence to validate patients’ hospitalizations,” she says. The other case manager provides transitional planning, offering discharge support and helping patients obtain necessary social resources, she adds.
“There is a lot of time spent with the patient, supporting a quality transition and setting up the patient to manage outside of the hospital, reducing the potential for patients being readmitted,” Andrews explains.
• Manage proactively. Case management leaders need to anticipate potential issues and consistently watch operations, Andrews says.
Case management teams that work best often have experience together and have learned the rhythm of the group. They work within their boundaries and with the resources they have in place, she says.
Well-managed teams have better-defined priorities, so they can use resources efficiently. For example, well-managed teams will not leave gaps in case management, such as patients being admitted on Friday evenings and leaving on Sundays without ever seeing a case manager, Andrews says. One solution to this is to employ weekend case managers, shifting resources so there are fewer gaps.
Also, regulatory requirements govern communication with patients and families, and case managers need enough resources to handle these well. “Anytime you make changes, try to keep your pulse on the team,” Andrews suggests. “You have to be careful in providing feedback — that’s why it’s so important to come in and just listen and watch.”
• Create a case management council. “The biggest thing I did to move the needle is to form a case management council,” Andrews says.
The case management council was formed by the five hospitals and their programs. Each hospital sent one to three representatives, based on the hospital’s size. Representatives included discharge planning, utilization review, and administrative support/case management assistance, she says.
“We had each building vote for a representative to be part of the council and meet with me every month to review processes,” she says. “They look at policies and talk about levels of engagement.”
The goal was to create champions in each hospital. These were fully engaged case managers who were part of the process and ready to help the health system achieve its goals, she adds.
“We had a lot of great ideas that came from the council,” Andrews says.
The council also helped solve communication problems. They would learn about new initiatives and share these with their case management teams. “This was a piece of the puzzle that helped support all of the work we were doing,” Andrews says.
The meetings were phone calls at lunch time. “Because of the nature of the work, it’s hard to pull them out of their buildings,” Andrews says. “We decided the best way for us to successfully implement this and be consistent was to have noon calls, monthly, and always on a Thursday.”
Each council member calls into a conference line. The meeting is called to order, and the members review discussions from previous meetings. “The first thing we talk about are system updates, and we ask if they have any questions,” Andrews says. “I wanted them to be comfortable with asking any questions about something they heard or thought was coming or had any anxiety about.”
• Offer work-life balance options. “We gave our utilization review people the option of working out of a home office,” Andrews says. “We’ve been looking at things across the board, the work-life balance, which is an employee satisfier for some people.”
Certain employees chose not to take advantage of the home office option, but making that choice available was a big win for the organization, she notes.
Paying attention to work-life balance shows employees that the organization is looking out for their interests and is flexible on how it defines productivity. The council debated this issue, looking at how to clearly measure productivity when employees work outside the office.
“All of those things were discussed and worked out prior to the transition,” Andrews says.