Productivity tool measures CM success
It’s used for evaluations, to justify more staff
When the case management leadership at Northwestern-Lake Forest Hospital in Lake Forest, IL, wanted to add a position on the acute care unit, they used the productivity/capacity tool they developed to show management how hard the staff on the 44-bed unit were working.
Using the tool, the case management leadership determined that the case managers on the 44-bed acute care unit had a 157% productivity rate when the department target was 95% to 125%.
"We were able to show the data to the chief financial officer and justify hiring a social worker to help address the complex discharge planning needs of patients on the unit. We hired a full-time social worker, and suddenly the overtime we were paying one of the case managers who is an hourly employee dropped. That, plus avoiding the risk of losing experienced but exhausted case managers more than paid for the social worker’s salary," says Denise Majeski, MSN, RN ACM, NE-BC, interim chief nurse executive for the 201-bed community hospital.
Developing a capacity and productivity tool is an essential part of proving the value of case management, Majeski says. "The tool assists in staffing budget decisions, supports the FTEs needed for the department, and defends the need for new staff. It justifies the work of the department to the organizational leadership," she adds.
To create a tool, make a detailed list of case management tasks and assign a time to each, says Jenny Prescia, MSN, RN, ACM, CCDS, interim director of case management. Prescia shadowed multiple case managers with a stopwatch and measured how long each task took each case manager, then came up with an average time for each task. "Some tasks were cut-and-dried and took about the same time every time but others, such as discharge planning, had varying times depending on the complexity," she says.
To determine the productivity of an individual case manager, tabulate the number of times the case manager completes each task each day and multiply by the time it takes to complete the task to get a total time spent, and multiply it by the days the tasks were performed. Add the total time for all tasks to determine how many hours the case manager spent working. Divide the number of scheduled hours into the total hours worked to show productivity.
At Northwestern-Lake Forest Hospital, every time case managers complete a task, they enter it into the case management software. Prescia uses the data to create reports that show the productivity of the individual, a unit, or the entire department. "I can run a report that shows how much time each case manager spent on discharge planning or how much the entire department spent and come up with the percentage of the day spent on discharge planning," Prescia says.
When several case managers complained that a per diem social worker wasn’t doing her job, an analysis showed that she was operating at only 25% efficiency. When she didn’t change after she was put on a performance improvement plan, management suggested that she look elsewhere for a job.
"This tool is objective, not subjective. The staff all know that they are being held to the same standards and there is no favoritism," Majeski says.
The management team uses the tool as part of each employee’s annual performance evaluation. "It helps them feel successful. If they aren’t meeting their performance goals, instead of saying you’re not doing your job,’ we can ask if they are satisfied with their metrics and suggest that we work together on improving them," Prescia says.
Case managers at Northwestern-Lake Forest are responsible for utilization review, coding and documentation, denials management, discharge planning, and care coordination. "Our model works in a small hospital, but it may seem overwhelming in a larger organization. We’ve observed that job enjoyment decreases when case managers concentrate on just one job function all day long," she says. In staff satisfaction surveys, 98% of case managers report high job satisfaction and 100% answer "yes" to "I know what is expected of me in my job."
The average caseload, depending on the unit, is 20 to 25. Case managers on the orthopedics unit have an average caseload of 13. On the intensive care unit, it’s 15. The surgical case managers have a caseload of 22 to 25.