EXECUTIVE SUMMARY

Crisis management is important to case management leaders and their teams as the COVID-19 pandemic continues. COVID-19 cases and hospitalizations sharply increased through the end of 2020.

  • One way to cope with the uncertainty and disruptions is to focus on staff and individual resilience.
  • Case managers find it challenging to provide follow-up for patients as more care occurs via telehealth. Some patients are difficult to reach.
  • Proactive case management leaders and staff learn how to shape their jobs in ways that make them comfortable, while handling the crisis as effectively as possible.

The COVID-19 pandemic began a dangerous phase in the fall of 2020, continuing into the winter as case rates skyrocketed and hospitals reached saturation levels of infected patients.

Even with potential vaccines on the horizon and better treatments than when the pandemic began in early 2020, the healthcare world prepared for shutdowns and disruptions in care transitions.

Case management leaders can best handle the crisis by focusing on their staff’s and their own resilience, as well helping patients safely and successfully navigate the continuum of care.

One thing case managers learned during the past year is COVID-19 patients need post-acute help that is individualized for their needs after experiencing the devastating disease.

“There were a significant number of COVID-positive patients who went to the emergency department (ED), but did not meet criteria for admitting,” says Gary Rogg, MD, FACP, co-director of WMCHealth’s COVID-19 Recovery Program at Westchester Medical Center, the flagship of WMCHealth Network in Valhalla, NY. “They did not have primary care doctors. They’d have ongoing symptoms, and would keep coming back to the ED. We started an outreach program and with video visits and televisits to take on these patients and provide ongoing care to them.”

The pandemic reinforced the idea that providing follow-up care is crucial for successful case management, notes David Wilkinson, BSW, director of case management services at Central Behavioral Health in Norristown, PA. “Everyone has a caseload, so they need to look through their notes and charts, using basic technologies, and look for gaps in care.”

Case managers should know if it is unusual for a patient to go two weeks without a call or visit to a provider. “In those two weeks, maybe they missed an appointment,” Wilkinson says. “Missing an appointment [is important], even in telehealth. I’ve heard there has been a higher show rate in people seeing a psychologist or therapist on telehealth because they don’t have to get physically to the agency.”

It should be concerning any time patients miss a visit or are unavailable when called. Case managers need to make the follow-up call. If that fails, they should reach out physically to check on patients, Wilkinson says. (See story on case management follow-up during the pandemic in this issue.)

As the pandemic wears down everyone in the healthcare world, fatigue, stress, and burnout increase. “One of the things I talk about is this concept of collective occupational trauma,” says Ellen Fink-Samnick, LCSW, CCM, CRP, principal with EFS Supervision Strategies in Burke, VA.

Case management leaders need to care for and nurture their staff through this challenging period. “If there was ever a time we needed to stop looking at mental health as a stigma for the healthcare workforce, it’s now,” she adds. “You must pay attention to your own self-care so you can be attentive to the care of others. It’s an occupational hazard that the healthcare workforce takes care of everyone else before themselves. We can’t afford to do that anymore.”

To combat the repercussions of the pandemic, case management leaders should identify staff members who are resilient and can proactively help improve the team’s ability to handle the crisis.

“I created this idea of proactive personality,” says Mike Crant, PhD, MBA, professor of management and organization at the University of Notre Dame. “I’d expect more proactive people to be more likely to raise their hands and volunteer. Proactive people tend to look at things, which other people see strictly as threats, as opportunities to learn new things and to make a difference.”

People with proactive personalities shape their jobs in ways that make them comfortable and capitalize on what they like to do. “They create a situation that they’re satisfied in. This makes them less susceptible to stress,” Crant explains. “Reactive people, who don’t like changing anything, might be totally stressed out in a crisis because there isn’t a policy manual for them to follow.”

Crant recently co-authored a study that showed healthcare professionals with proactive personalities redesigned their jobs, making them more flexible and effective in combatting an emerging new virus when SARS-CoV-2 first struck Wuhan, China, and overwhelmed the healthcare infrastructure.1

“Doctors in Wuhan, in the early stages of the pandemic, were better able to cope with this crazy, uncertain situation if they were more proactive,” Crant says.

In days before the viral infection had a name, a hospital in Wuhan changed to a strictly respiratory hospital. There was no roadmap for how to handle an unknown and rapidly spreading disease and overflowing patient load.

“It was a difficult situation for frontline healthcare workers. There was no policy, and no one knew how to treat it,” Crant explains. “Those who were more active and self-directive were better able to come up with effective ways to do their work.”

Physicians and other staff were given 24 hours to adjust to complete changes in their jobs, and they had to be self-directed in figuring out how to make that change, he adds.

Proactive personality is associated with resilience and thriving. It also is at the heart of effective leadership. “What we showed in the study was it’s really important to encourage and at least give permission to people to act without waiting to be told what to do,” Crant says. “It’s OK in a crisis to go after what you need and to craft your job in a way that works for you.”

Healthcare organizations need people to be more self-directed — not just sitting and waiting to be told what to do, he adds.

Crant’s study outlined a 10-item proactive personality tool. Participants indicated on a seven-point Likert scale whether they strongly disagree (1) to strongly agree (7). Here are a few of the 10 items:

  • “I am constantly on the lookout for new ways to improve my life.”
  • “Wherever I have been, I have been a powerful force for constructive change.”
  • “I excel at identifying opportunities.”
  • “I can spot a good opportunity long before others can.”1

A five-item resilience scale includes:

  • “I am getting better at my work because I learn from my mistakes.”
  • “I find ways to handle unexpected situations.”
  • “I bounce back when I confront setbacks at work.”1

Case management leaders can make changes that will enable their staff to better cope with crises, Wilkinson says. For example, case management teams can hold meetings more frequently to go over changes and cover new knowledge during the crisis.

“One thing we do is each team holds a brief morning meeting,” Wilkinson says. “It could be for half an hour to an hour, and we look at the case situations and immediate follow-up of the day. We also talk about how things are going that day. This is a way to connect and feel connected.”

Connecting with colleagues is especially important when staff work from home. “If you’re working from home, that can have its own worker isolation feel,” Wilkinson says. “Staying connected and client-related is important.”

The daily conversations among team members also improves patient care by letting more people hear about patients’ struggles and chime in with potential solutions. “If someone is feeling frustrated about something, someone might say, ‘Yes, I’ve had this similar situation, and this just happened yesterday,’” Wilkinson says. “It’s a daily check-in to hear what’s going on.”

Daily meetings also enhance resilience and self-care. If someone appears to be under the weather, the team can encourage him or her to take the afternoon off and someone else on the team would cover their cases, he adds.

At the beginning of the pandemic in Wuhan, proactive physicians would come into work early to talk about the new things they had learned about the virus. Then, they would meet again at the end of the shift, Crant says.

“They created a situation that allowed them to succeed, and they were learning more than peers who were not proactive,” he adds.

REFERENCE

  1. Chen N Yi-Chen, Crant M, Wang N, et al. When there is a will there is a way: The role of proactive personality in combating COVID-19. 2020. Article in pre-print. https://www.dropbox.com/s/l639jt2nltnr5x2/Proactive%20Personality%20and%20COVID-19%20preprint%20version.pdf?dl=0