Do your CMs have the skills they need to do their jobs well?

Use an assessment tool to keep case managers sharp

Accountability is the catch phrase for case management on the eve of the new millennium. Case management supervisors need comprehensive assessment tools to determine whether their case managers consistently meet the high standards in today's competitive health care marketplace and to help those case managers continue to develop new skills.

"As a manager, having a comprehensive case management skills and competencies checklist helps me measure the ability of each case manager to carry out the duties of the job and improve the quality and financial strength of the institution," says Monica Hamilton, MHA, RN, BSN, director of clinical resource management for Florida Medical Center in Ft. Lauderdale. "An assessment tool must go beyond areas normally covered on a basic job description and provide case managers with opportunities for growth."

A good director of case management will use an assessment tool to encourage case managers by pointing out strengths, Hamilton says. "I look at a skills checklist as a tool for pointing out opportunities for growth rather than a way of pointing out all the things that a case manager does wrong." (For more on the power of positive reinforcement, see p. 61. For a sample of a case management skills checklist, see p. 59.)

A case management skills checklist also provides a good training tool for new case managers. "Case managers come into an organization with a variety of backgrounds. Even case managers who have a good core set of knowledge still need to know goals, philosophies, and objectives specific to your organization," says Barbara Luttrell, RN, BSN, ABQUAR, CDMS, nurse consultant and former director of Workplace Health Services for Cerulean Workplace Health in Atlanta.

"It's important to have an evaluation tool that enables you to look at whether your case managers handle different aspects of cases in the same manner," says Anne Van Genderen, RN, CDMS, CCM, manager of case management and nurse consultants for PRO-WEST in Seattle. "We're working on an evaluation tool right now that we hope will help us measure whether we are including everything we need to from the time we open a case until closure."

Making a list

What you include on your case management skills and competencies checklist will vary depending on your specific organizational needs. However, there are certain basic standards that directors of case management agree belong on a good case management checklist regardless of your practice setting or case management model. (For more on how to develop a case management skills list, see p. 60.)

1.Personnel policies. These policies might address job description, work hours, vacation requests, evaluations, and corporate mission statement. Although these policies are most important for case managers new to the organization, other personnel policies are regularly updated and important even for case managers who have been on the job a long time, Hamilton says. "For example, policies regarding patients' rights are ongoing, and all case managers must keep up with any changes in these policies."

2.Physical environment. "This is basically orientation for new hires, but it's important that you have an orientation checklist that covers things like where to find the policies and procedures manual," Van Genderen says.

You also will want to determine that your case managers are familiar with the workings of all the necessary office equipment, Hamilton says. "It's an orientation to the department and equipment credentialing process. Nurses are quite familiar with equipment credentialing," she adds.

3.Communication. Communication is absolutely essential for all case managers, Luttrell says. Communication skills include:

· building rapport with the client and family;

· contacting physicians, nurses, and other members of the health team;

· coordinating resources;

· report writing;

· service or equipment negotiation;

· computer skills.

"Case managers today must know a lot about computer systems and software," Luttrell says. "I think it helps to set up a buddy system. Use your experienced case managers to sit next to new hires and watch them work through your computer program."

4.Financial skills. Case managers should understand coordination of benefits, managed care plans and plan benefits, and issues such as cost analysis and the difference between expenses and charges, says Hussein A. Tahan, MS, RN, CNA, clinical pathway manager at Mt. Sinai Medical Center in New York City and adjunct professor at the College of Mt. St. Vincent in Riverdale, NY. "Case managers must have a good grasp of prospective payment systems, capitation, and other managed care issues and terms," he says.

Case managers also must develop skills such as how to issue notices of non-coverage and advocate for out-of-plan coverage, Hamilton adds.

5.Leadership skills. "Case managers must develop leadership skills in order to manage and facilitate a patient care plan," Tahan says. Leadership skills include decision-making, creative problem solving, and conflict resolution.

6.Case management process. This section covers the basic skills needed for the case management process, including monitoring and prioritizing caseloads, reviewing medical records, and evaluating patient and family needs, Hamilton says.

"You also want to review cases to see if case managers can develop a plan of care that is relevant to the patient," Tahan says.

7.Professional development. Growth and development are important to maintaining high standards, Hussein says. "Case managers should be encouraged to pursue advanced degrees, participate in continuing education programs, and seek certification," he says.

Case management directors agree that it's important to keep a list of resources on hand to help case managers strengthen areas they need to improve.

"I always kept a file of articles I wanted each case manager to read," Luttrell says. "Those articles included historical information on managed care, clinical issues, anything I felt was necessary to get us all on the same page."

A resource also could be another case manager, organization resource person, or a continuing education program, Hamilton says.

When using the case management skills and competencies checklist to train new case managers, Luttrell always conducted a pretest to measure what case managers already knew about each section of the checklist. "I used the test to customize training of new case managers. If a case manager seemed strong clinically, but weak on computers, I would customize their program accordingly."

Rather than trying to evaluate each case manager on a skills and competencies checklist once a year, Hamilton keeps a file of notes year-round instead.

"Evaluating case managers is an accumulative process," she says. "Every time I speak with a case manager about a case, or receive feedback about a case manager's performance from a physician, patient, or family, I file it away. I try to establish patterns in their work. Are there areas they don't understand? When I finally sit down to fill out a checklist or assessment tool, it's based on documentation kept all year long."

[Editor's note: The case management department at PRO-WEST in Seattle turned its case management training manual, which covers many of the areas discussed above, into a book other organizations can use to train new case managers. Fundamentals of Case Management: Guidelines for Practicing Case Managers is available through Mosby Year Book in St. Louis for a no-risk 30-day approval. The cost is $33.95. Contact Mosby at (800) 426-4545 and request #QS9152.]