By Toni Cesta, PhD, RN, FAAN

Introduction

This month, we will end our discussion on case management skills, tools, and techniques with an in-depth review of the concept of communication, particularly in the role of the case management professional.

Communicating with Diverse Groups

Today’s case managers and social workers face the challenge of communicating with diverse groups, including patients, families, physicians, and insurance companies. Case managers should use communication techniques and skills we reviewed in previous issues. Our lines of communication go well beyond the walls of the hospital and include post-acute providers, primary care providers, community-based case managers, navigators, and others.

For example, case managers must listen closely to what the payer is requesting and clarify any vague information as soon as possible. Do not assume the third-party payer receiving the necessary information about the discharge plan. As educator and advocate, case managers must clearly communicate the patient’s needs to the third-party payer. Remember, you are a problem-solver and should not simply accept a “No” or “We don’t do that.” Take risks when advocating for patients. Sometimes, these conversations can be difficult or unpleasant. However, communication with external members of the interdisciplinary team (e.g., payers, community resources, family members) becomes just as important to the success of the patient’s outcomes as the communication with internal members.

Well-managed conflict can increase the effectiveness of an organization. The assertive style of communication can work best when applied to the case management process, but psychological, physical, and structural barriers can interrupt the flow of communication. Case managers must work to overcome these barriers to make high-quality care decisions.

Communication Styles and Characteristics

1. Assertive

  • Pushing hard without attacking;
  • Expressive and self-enhancing;
  • Influencing results/outcomes.

2. Aggressive

  • Taking advantage of others;
  • Self-enhancing at others’ expense;
  • Intimidating.

3. Nonassertive

  • Inhibited;
  • Self-denying;
  • Passive.

Data Management

High-quality data are important for case managers to make care decisions. We identify, collect, and analyze data when assessing patients; creating and implementing the care plan; and monitoring the outcomes. Case managers should know how to manage and interpret data using tracking and collection tools, such as:

  • administrative logs and databases;
  • documentation tools;
  • variance data collection;
  • quality assessment, insurance, and improvement tools;
  • managed care review;
  • information systems and electronic medical records.

It is critical to learn and understand methods of data collection and management (retrospective, prospective, and concurrent) and appropriate use of these methods, including advantages and disadvantages. It also is important to understand data analysis measures, including:

  • Numbers: Descriptive statistics;
  • Rates: Incidence and occurrence;
  • Attributes: Demographics;
  • Perceptions: Patient and staff satisfaction;
  • Composites: Case mix index.

With automation and technology becoming increasingly ubiquitous, case managers must know how to access databases, run special reports, prepare graphic reports, conduct statistical analyses, and export or download data. Case managers with these skills are the most desirable and successful. The ability to write succinctly, clearly, and concisely is another crucial skill. Know how to accurately summarize important findings in reports, and understand when to seek out more data for better decision-making or to draw more accurate conclusions.

Do not focus solely on reading, writing, listening, and speaking. Case managers also can practice effective communication by withholding judgment, avoiding inconsistencies, and valuing all members of the team, including the patient and family.

Big Picture/Systems Thinking

Systems thinking can be defined as a problem-solving language that guides the understanding of complex issues within organizations that include parts of interaction. The complexity of case management models requires a systems approach to care delivery because of its interdependence on the various disciplines involved in care processes. Pay careful attention to the work environment and its many inputs, throughputs, and outputs, and the degree to which they interact. Inputs, throughputs, and outputs comprise the various functions of case management such as resource utilization, discharge planning, transitional planning, roles and job descriptions, goals, objectives, performance, productivity, and outcomes.

It is important to understand the services provided in the varied settings across the continuum of care. If we are not systems-focused in our thinking and approach to care delivery and management, communication will be ineffective if we are not systems-focused in our approach to care delivery. Case management requires understanding the patient’s level of care. We also must coordinate, facilitate, and arrange post-discharge services and transitions to the next level of care, which requires communication with community agencies or managed care organizations for authorization of services. Regardless of the setting, case managers are expected to employ a systems-thinking framework and approach to case management care delivery. This framework ensures success and improved outcomes.

Think of hospitals and healthcare organizations as systems in which staff members interact and function in interdependent teams to accomplish common goals. This includes case management systems. Case managers must be able to work in teams to achieve cost-effective, quality outcomes. Systems-thinking is the desired approach for achieving such results.

Systems-thinking is a powerful problem-solving technique that focuses on the essential interrelationships of the case management model. It helps case managers see the big picture and the interconnectedness of the system or organization. Systems-thinking can help case managers by:

  • managing multiple tasks and functions;
  • managing change;
  • managing decision-making;
  • motivating others;
  • handling conflict;
  • facilitating negotiations.

Emotional Intelligence

Emotional intelligence has emerged as a necessary leadership skill, particularly in healthcare.

Emotions serve as information in decision-making and communication. They also influence how case managers may connect with others and establish relationships, using:

  • awareness of one’s emotions;
  • awareness of other people’s emotions;
  • the effects of emotions on the situation or event.

Well-managed emotions can act as a source of power, motivation, feedback, information, influence, innovation, creativity, success, and freedom. Emotional intelligence can improve a case managers’ abilities by:

  • making careful decisions;
  • resolving conflict effectively;
  • communicating openly and honestly;
  • establishing trust with patients; families, and co-workers;
  • building rapport with patients and families;
  • creating a patient-centered, teamwork-focused environment of care.

The desired qualities of case managers are not limited to their technical, clinical, and interpersonal skills. These qualities are most effective when case managers can recognize, understand, manage, and appropriately respond to emotions. Responsibilities and services require case managers who are astute and emotionally intelligent; otherwise, they cannot provide efficient, effective, safe, cost-effective, ethical, quality care.

Qualities of Emotional Intelligence

Successful leaders possess extensive skills. This is especially true of case management leaders. These skills include:

1. Know your emotions

  • Identify the information influencing your perception.
  • Recognize what influences your moods.
  • Know when you are thinking negatively.
  • Recognize when you are becoming angry or feel frustrated.
  • Know when you are becoming defensive.
  • Recognize when your verbal and nonverbal communications are conflicting.
  • Know which senses you are using.
  • Communicate your feelings.

2. Managing emotions

  • Learn to de-stress when under pressure.
  • Act productively, especially when angry, frustrated, or anxious.
  • Take a moment to calm thoughts before making decisions or responding to unpleasant situations.
  • Understand the relationship between your physiological and emotional states.
  • Remain calm when you are the target of anger or criticism from others.
  • Take some time out.
  • Resort to humor.

3. Motivating oneself

  • Regroup quickly after a setback or stressful experience.
  • Change or break ineffective habits.
  • Develop productive, rewarding habits.
  • Follow words with actions.
  • Keep your promises.
  • Be persistent.
  • Do not give up.
  • Always do your best.
  • Finish your responsibilities/duties within the designated time frames.

4. Recognizing others’ emotions

  • Clarify misunderstandings.
  • Ask others how they feel.
  • Validate your perceptions of others.
  • Validate your perceptions of how others think of you.
  • Recognize when people are distressed, anxious, or distraught.
  • Engage in meaningful conversations with others.
  • Manage group emotions appropriately.
  • Help others manage their emotions.
  • Show empathy.
  • Let others express their feelings honestly.
  • Establish common goals.

5. Handling relationships

  • Resolve conflicts.
  • Approach problem resolution as a group.
  • Encourage team-building behaviors.
  • Exhibit effective communication skills.
  • Be honest and sincere.
  • Build trust.
  • Build a sense of community.
  • Influence others and allow others to influence you.
  • Make people feel welcome.
  • Seek support and advice.
  • Avail yourself to others when they need you.
  • Be approachable.

Successful case managers excel in areas such as peer relationships, leading subordinates, resolving conflicts, making complex decisions, resource allocation (including their own time), and innovation. Successful case managers are leaders, not managers. Leadership skills are more desired in case managers than management skills. Management is more narrowly focused (“How can I accomplish certain things?”), while leadership is broader (“What do I need to accomplish?”) In other words, management is doing things right, while leadership is doing the right things.

Management is efficiency in climbing the ladder of success; leadership determines whether the ladder is leaning against the correct wall.

Imagine a group of new graduate nurses cutting their way through a jungle. The workers will be clearing the path in the front. The potential managers will be behind them, sharpening their machetes, creating policies and procedures, and setting work schedules. The potential leader will climb the tree, assess the situation, and say, “Wrong jungle!”

Changes in the healthcare industry require professional leadership first and management second. Although the title generally is associated with management, leadership more fully and accurately defines the role of the case manager. Efficient management without effective leadership is “like straightening deck chairs on the Titanic.”

Effectiveness depends on whether energy is expended in the right place on the right things. It is irrelevant if a case manager spends days on a discharge plan only to discover the plan was not right for the patient due to poor vision.

The pressure for change within our healthcare industry will intensify in the coming years. This pressure will require case management professionals to respond with new dynamic transformational leadership to cope with future changes. The transformational leader approaches leadership from an entirely different perspective or level of awareness. The transformational leader:

  • draws attention to important goals or actions;
  • encourages team members to forgo self-interests for the good of the team.

Transformational leaders:

  • are role models;
  • build an image;
  • set goals;
  • set high expectations.

The case manager of the twenty-first century characteristically has all of these qualities. Any organization interested in building a solid case management program should consider them.

Summary

When other professionals study the work of case managers and social workers, they may not recognize its complexities and challenges. So much of what we do is invisible to others, and may not be appreciated. We may help eliminate problems or barriers affecting our patients before others even know such barriers exist. Because our work is so complex, we must continuously grow and hone all the skills we have discussed during this series. Pick two or three skills that you want to work on for your own professional growth and development. Evaluate your effectiveness as you deal with real-life situations. The more skills in your toolbox, the better your work as a case manager will be.