Practical tips help you master telephonic CM

Learning how to listen leads to success

Whether it's the way you establish your initial client contact or it's your only form of client interaction, the telephone is part of your case management tool chest. And learning some simple rules for effective telephone communication will make you a more effective case manager.

"The first step is to realize the impact your own personality and experiences have on how you hear what your client is saying over the telephone," notes Sheila Messina, MA, RN, an independent education and training specialist and former case management specialist for NMH Homecare in San Jose, CA. "For example, I myself have been a home care patient. If I talk to a patient who is receiving home care, I bring with me a different understanding of the experience than a case manager who has never received home care. It influences the questions I ask and my response to the answers my client makes to those questions."

For example, another case manager recently asked Messina to speak to a client for her. "The client was on home care, and the case manager felt that the client was being noncompliant without good reason. The case manager asked me to speak to the client and persuade her to be more compliant with her home therapy," explains Messina.

"When I spoke to the client, I found out she had some valid reasons for not complying with her home therapy," she continues. "I understood the client's reasons for not following her treatment plan because, as a home care patient myself, I had a better understanding than the other case manager of some of the barriers to compliance. We were able to work out a plan that improved some of the compliance issues."

To help make yourself aware of how your own experiences affect your perceptions, Messina suggests case managers try asking themselves the following questions:

• How soon into the conversation do I make a judgment about my client?

• How willing am I to allow my client to participate in this conversation?

• How much value do I place on the information I receive from my client?

• Do I begin the conversation with the assumption that I already have all the information about the client that I really need?

• Do I ask open-ended questions and explore the answers I receive from my client?

Skip 'yes' and 'no'

Case managers must ask open-ended questions to create a clear picture of their clients, stresses Messina. "Close-ended questions that get a 'yes' or 'no' response mean that you aren't exploring the whole situation, and you won't get the accurate assessment of the client you need to develop an effective treatment plan," she notes. In addition, even when case managers ask open-ended questions, they must pursue the responses until they can create an accurate picture.

The conversation below is a typical case manager-client exchange. The first conversation is how not to conduct a telephonic client assessment. The second conversation is a much more effective approach, notes Messina.

Conversation A:

Case manager: "How is your therapy going?"

Client: "It's OK."

Case manager: "That's good."

Conversation B:

Case manager: "How is your therapy going?"

Client: "It's going pretty good."

Case manager: "Pretty good? What does that mean? Are you having any problems with your therapy?"

The case manager must pursue the line of questioning to a logical conclusion before making an assumption about the client or the treatment plan, says Messina. "Always explore your client's responses until you are satisfied that you have a complete understanding of the situation."

Of course, this approach to telephonic case management takes time, notes Messina. "You can't adequately do your job as a telephonic case manager if you are in a hurry or if your client is under stress or in pain," she says. "If it's not a good time for you to speak with your client for any reason, schedule a time in the near future to continue the conversation rather than trying to fit it in under less-than-ideal conditions."

Case managers also may have to use their clinical skills to get the client past the current situation before continuing to explore other issues, notes Messina. "For example, if your client is in pain, you must deal with that situation and improve it before your client can work with you on other treatment issues," she says. "Look into the client's diagnosis and treatment and make sure that something is being done for the pain. Or, if the patient seems particularly anxious, ask what is causing the anxiety and see if there is something you can do to alleviate it."

Finally, if your client presents you with a situation outside your own experience, always try to find a way to address it fairly, she says. "If you are a single woman with no children, and you have a married woman client with six children having a difficult time complying with her treatment plan, look for another professional with children who is willing to talk with her for you. Don't try to fake an understanding you don't have," Messina cautions.

Similarly, if your client asks a question you don't know the correct answer to, admit it, she says. "Tell your client, 'I don't have that information, but I can find out and call you back, or have the appropriate person call you with that information.'"