Phone communications jumped in importance over the past year of the pandemic, but there are tactics case managers can use to improve their technique and build rapport with patients or clients over the phone.
- One tip is to listen for audible clues about the person’s mood and energy level.
- It helps if case managers share a little about their own lives to build rapport.
- Sometimes, the call, even if scheduled, comes at a bad time. Case managers should be alert to possible roadblocks to a successful conversation and do their best to reschedule or otherwise overcome those barriers.
As many case managers have learned during the COVID-19 pandemic, switching from in-person meetings with patients to phone sessions is challenging.
Case managers could miss certain cues, such as evidence of nutritional status, environmental cues, and body language that may indicate resistance or discomfort.
There are ways case managers can improve their phone relationships with patients/clients. These center around becoming better and more attentive listeners.
“Hone your listening skills,” suggests Eric Bergman, RN, CCM, past president of Case Management Society of America Chicago. “You have to be able to hear better over the phone and be more focused than you would be in person. You don’t get any visual cues, no body language, and you can’t even see what the client looks like.”
Bergman offers these tips:
• Listen for audible clues and cues. “Over the telephone, you’re listening to a lot of breaths and pauses, and you need to be extremely attentive to what makes someone laugh,” Bergman says. “As you practice, you can hear a smile over the phone. Those are the skills.”
Case managers need to be sensitive to what makes a relationship work between relative strangers. “How are you connecting with somebody in a way that allows them to trust you and be comfortable with you so you can ask uncomfortable questions,” he says. “You have to build a personal relationship, and a lot of practitioners are hesitant.”
Listening for cues can help build trust, and it helps as case managers work with the same people over weeks or months. “The other day I heard a patient’s voice, and I knew she was tired and depressed,” Bergman shares. “My immediate response was, ‘I can hear it’s not a good morning; you sound a little bit down today.’”
The patient laughed and joked about how Bergman was not her therapist. But she was pleased that he was paying attention to her, and she used that as an opportunity to talk and vent her frustration.
“I could just hear it in her voice,” Bergman adds. “I think that if you are prepared to listen, you will hear their emotions.”
• Share a little to help build the relationship. “One of the important aspects of that is learning to carefully share some personal information so you are building a relationship with somebody,” Bergman says. “One thing I do is I have a little bit of personal information that I have carefully considered that I am willing to share. It’s a careful line you have to walk.”
For instance, every case manager will have little aspects of their life that they would be willing to share with patients to help build trust and rapport. “I know from personal experience that if you’re only a voice over the phone, and you don’t share something a little personal, you can’t gain the trust of the patient,” Berman says. “But if you can find those little aspects of your life that are not personal enough to give them too much insight into your life, but allow them to see you as a caring person, who has three dimensions, you’re a little better off.”
One such tidbit would be about where the case manager lives. It would be fine to mention a general area or a city, without naming the specific subdivision or street, he says.
“I tell people I have children, and then they will talk about their children,” Bergman says. “I can reveal that I relate because I have children of similar age, or I have experienced that with my kids. There’s acknowledgement that we share something.”
• Be aware of roadblocks. The case manager might know a call might not happen at the best time. It could be the case manager is tired and has just this one last call to make after a busy day, and wants it to be over quickly, or the patient is tired and disinterested.
“Ask, ‘Is this a good time for you?’” Bergman suggests.
If a patient arrives late to a case manager’s office and looks disheveled and weary, the case manager has visual clues that something is off. But it is more challenging to identify these roadblocks over the phone.
“You have to be listening to hear whether they sound rushed and whether it took 10 rings for someone to answer the phone,” he says. “Maybe there’s a child crying, or you hear something else going on.”
If the case manager launches into the agenda without paying attention, there will be a roadblock. “Depending on the person’s personality, some people may just be polite and they won’t say it’s a bad time for them,” he explains. “Others will say, ‘Forget it — I’ll talk to you another time.’”
The key is to be sensitive to the patient’s mood and find a way to navigate around any problem with the timing. “You can say, ‘It sounds like this is not so good a time for you. Do you want me to call you back later?” Bergman suggests.
• Learn relationship-salvaging skills. Bergman worked as a flight attendant for 27 years, learning every type of creative way to salvage encounters with customers. He has applied these skills to his work as a case manager.
“The thing about being a flight attendant is you’re not only with people at a stressful moment, but you’re locked up with people in a stressful moment,” he says.
For example, Bergman recalls a major snowstorm at a Northeastern airport. The plane sat for hours on the tarmac for de-icing. Finally, the pilot received word the plane could take off, but it was unable to land in the destination city and had to land in another state.
“The flight took eight hours, and we ended up in the wrong place,” Bergman says. “I was the one who led the crew and took care of people for eight hours, and when they got off the plane, they all said, ‘Thank you.’”
The key to landing that kind of success in service and provider relationships is to be completely genuine and honest with people. “In that flight circumstance, we didn’t know what would happen, but I knew it would be bad. I said that, and I encouraged the captain to be brutally honest,” he says. “We said, ‘We’re going to try to get you there, and we’ll let you know what’s going on.’” Even if nothing changed, they spoke with passengers every 30 minutes to let them know they weren’t forgotten.
As a case manager, it is OK to tell a patient who needs help or is in a crisis that it will take some time to figure out the next step and to make arrangements. “You can say, ‘I’ll still call you in two hours if I haven’t figured it out yet,’” he adds. “Most people want to know that you’re really helping them and that you care and that you get it.”
The other lesson Bergman learned from his flight attendant days to his case management role is to not take the other person’s bad mood personally. “My experience as a flight attendant getting screamed at by somebody taught me to not take anything personally,” Bergman explains. “People are frustrated, including people who are genuinely polite and would be mortified if they let something nasty slip.”
When patients are unreasonable or angry, the case manager can de-escalate them by saying, “I understand. I want to do whatever I can do to help you. What can I do right now to make things better?” he suggests.