Indicator instrument panels: A key to survival?

How to communicate with stakeholders

By Alan Cudney

Premier, Inc.

Charlotte, NC

A hospital chief executive officer was recently overheard saying, "Let’s eliminate some case managers. They don’t do anything anyway." Unwittingly, the leader of this troubled hospital was about to make a mistake that could jeopardize the financial viability of his organization. The impact case managers can have has been well-documented, but those who make judgments about program funding and success often misunderstand this impact.

The situation outlined above probably has been repeated in many hospitals across the country. However, it is often avoidable if the case management program director is properly trained and educated. Leaders of case management programs — many of them registered nurses and social workers — often do not communicate on the same wavelength as their physician and health system executive customers. Too many case management leaders expect their administration and physicians to hold the same interests and opinions they do about the importance of their work.

While their training equips them well for their jobs, case management leaders may not understand the business side of health care. The result may be a communication breakdown between case management directors and their stakeholders.

Case management directors can bridge this communication gap by not only identifying their stakeholders but also by working with them to develop a shared vision of desired program results. When asked, "Who is your customer?" most case managers will reply, "the patient and family members." Sometimes a case manager will add, "the physicians." Rarely will a case manager include hospital executives and payers in the list of stakeholders.

To understand all their customers’ expectations regarding case management, program directors must take the first step by familiarizing themselves with current health care business issues, as well as the environments and issues their customers face. Program directors also need to cultivate such an understanding and customer focus among their own staff members.

"I don’t care about the money issues; I just want to make sure the patients get what they need," a case management staff member recently stated. While this may seem admirable, hospitals are responsible for performing like businesses. At the same time, they are expected to act as stewards of the resources at their disposal in order to produce positive health outcomes. This dichotomy of purpose in the health care industry should prompt case managers to regard physician and hospital executives as business partners and their own departments as independent case management consulting firms.

The logical next step in developing an understanding of customers’ environments, challenges, and expectations is to develop a system for monitoring the case management department’s progress in meeting those expectations. Many departments struggle with documenting their achievements because some staff members may not have strong analytical skills. In any case, a small set of indicators (an instrument panel) that reflects stakeholder expectations should be developed and monitored regularly and consistently. Clear, readable reports that track these indicators should be provided to stakeholders.

Create operational definitions

A first step in developing a departmental instrument panel or report is to create an operational definition or description of each indicator. The operational definition should be detailed enough to show which data are needed and where the data must come from. This detail justifies use of the indicator by ruling out the possibility that the data are not available and ensuring that the data are easy to obtain.

Two levels of indicators are needed for proper management of the program. The first level is identified by a high-level summary of program results. This summary is suitable for communicating with key customer groups such as health system executives, physicians, and payers. The second level comprises basic operational indicators such as budget variances and staff absenteeism. This level is useful for monitoring or improving departmental performance but not for communicating with customers.

For a broad set of indicators, data are generally needed from a number of disparate sources. For example, a separate hospital department or third party may be the best source for patient satisfaction information, and the business office may be the best source for length-of-stay data. The manager should develop agreements with the necessary departments to obtain these data regularly. The task may be easy if the organization has a computerized data repository or if the department has a case management information system.

Generate easy-to-read reports

Once the indicators are selected and defined and a process is put in place to obtain data regularly, a report format should be generated. If a marketing or communications department exists, it should be asked to help develop a concise, easy-to-read report format. It is helpful if a small space is left for bulleted text comments about key milestones or exceptions to the graphic report. The comments should be short; if they cover more than 20% of the page, the audience may skip over the content. (For a sample report template, see p. 95.)

Customers or key stakeholders should have an opportunity to comment on the selection of indicators, report format, and, in some cases, operational definitions. This ensures that the instrument panel report will be both accepted by and familiar to the stakeholders. Discussion of the report also can create a common understanding of the challenges and barriers the case management department faces and the resources it needs.

The case management instrument panel (report) also can be used to engage the support and teamwork of staff members. The panel should be prominently displayed in the department and discussed at staff meetings, and staff should be encouraged to work as a team to make progress in all indicators targeted for improvement. In addition to challenging staff members, the report can be used to evaluate staff performance. Specific performance levels can be incorporated into evaluation tools to further motivate support for these customer-focused goals. Finally, the graphic report template can be linked to the data so any updates are automatically reflected in the graphs.

The case management instrument panel is a powerful tool for documenting the value that case managers bring to the organization. Not only can it be used to express the shared vision between customers and case managers regarding what the case management function is supposed to achieve, but it also can clearly show measurable progress toward shared objectives. Finally, the case management instrument panel can be used to strengthen both the case management department and the hospital or health system by focusing staff on common goals.