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Perhaps better than anyone else in the hospital, case managers know that getting things done depends on establishing and maintaining effective relationships — with decision makers at your facility, with insurance companies, and perhaps most importantly, with patients.
Many health care leaders claim the national health system is in crisis. At the least, it’s clear the system can be confusing and complicated for the average patient, says Connie Burgess, MS, RN, president of Connie Burgess & Associates and Health Inter Connexions in Long Beach, CA, who spoke recently at the Hospital Case Management Conference in Orlando, FL. Burgess says that although improvements are being made, it’s not enough. "We know we have done an awful lot to streamline technology, but most consumers today do not have a personal relationship with a health care professional. That is our job. That is what [case managers] uniquely bring," she says.
Not only should case managers be willing to develop those kinds of personal relationships with their patients, they should encourage patients to do so with their physicians as well. Of course, consumers also must play a role in improving the health system. "If we are to succeed in healing health care, consumers must assume more responsibility for their well-being," Burgess says. Case managers are uniquely skilled to aid them in that endeavor. "We must empower and educate our consumers and patients to increase their self-care capacity and their health," she says.
How do case managers do that? They contribute to the system with new programs and ideas such as:
"Case managers are the group that have and will continue to positively impact the future and well-being of health care," Burgess says. The profession, she adds, is the "single most important thing that has happened in the last 15 years to health care. It is positive; it is making the difference. We just need to pay attention and acknowledge to ourselves how it’s working."
"It is our job to empower our consumer," Burgess says. "In order to do that, we must maximize our own abilities and contributions" to the health care system. By that she means taking the initiative to champion new programs within your department, or simply expressing your ideas to administrators. Do so with confidence, she encourages, citing one of her mottos: "You gotta wanna. If you want to do some different things, if you want to impact your practice or your business, you will. But you gotta wanna."
Sometimes that means developing a better working relationship with your hospital’s administration. Larry Strassner, MS, RN, manager at Cap Gemini Ernst & Young in Philadelphia, agrees that this is imperative. "By far, directors of case management should be consistently monitoring and demonstrating the effectiveness of case management in their organization and reporting this to senior management," he notes. "Most directors of case management also should be part of the strategic planning and budget process, and if nothing else, be clear about how their department fits into achieving the hospital’s business imperatives."
Showing what case management means in relation to the overall fiscal health of the facility can be difficult if case managers don’t have the data to support their claims. It’s a common problem in the industry, Burgess says. "We don’t have the data to show that what we do brings the added value to the organization. . . . So, you are the greatest case manager in the world; prove it." Only then, she adds, will your executive team begin to understand you.
Of course, you have to show them in their language. First of all, know what they want to do. "Not all CEOs are interested in reducing [length of stay] or cutting their costs. It is not always in their best interest." Managed care has blurred those lines a bit, she explains. You have to think in terms of what drives your organization as it relates to the different payment systems. Fee for service and per-diem rates are revenue-producing systems, while capitated, case-rate, and DRG systems are cost-based models, Burgess says.
Case managers must understand which systems operate in their environment before even getting started talking about new incentives, according to Burgess. "To complicate it, the doctor may be capitated and the hospital is cost-based, and guess who’s in the middle, besides the patient? You are! You’re supposed to figure it out."
Once you have a handle on the goals of your organization and can show how you fit in with solid outcomes measurement data, you can begin to communicate your ideas, Burgess says. This should be a deliberate process, using the following tactics:
1. Send a memo or a newsletter. "Don’t just talk about [your idea]," she says. To show on paper that you’re taking some initiative is very effective.
2. Rehearse your presentation. This is also a way to engage and use your relationships with your co-workers. If you’re planning to meet with your executive team about a new program you’d like to start, Burgess stresses, "Don’t go in cold. Rehearse it with someone you trust, who will give you feedback. And be rehearsed enough to be relaxed . . . regardless of the facts." Your including them and your enthusiasm might also bring them in as supporters of the project.
3. Choose people who understand the subject and the importance. "Your executive team is the group that tends to make most of the decisions that go on. Some are better informed than others. . . . Choose someone who can understand the concept and champion it," she explains.
4. Know your listeners and speak their language. It’s important to tailor your presentation to the person who’s hearing it. You have to understand, Burgess explains, whether this is a person who likes the "Q & D" (quick and dirty), or who needs the details spelled out for them. In addition, you have to use "the language of good business." Tell them how they’ll get a return on their investment, for example. Using that kind of money language can really get their attention.
The good news, Strassner says, is that most CEOs understand the importance of engaging and empowering the clinical staff to effect change, when it "improves patient clinical outcomes and the cost of care." Through healthy relationships with CEOs and chief financial officers, you can get what you need to have a successful department, which benefits everyone — patient, case manager, and the hospital as a whole.
There’s another piece about relationships, Burgess adds: your relationship with outside case management. "We’re all in this together," she says. "When I say to [the outside CM], I will commit to not utilize any more resources than are absolutely necessary . . . and the outside CM says, I will not ration care’ . . . it’s about trust."
[For more information, contact:
• Connie Burgess, MS, RN, President, Connie Burgess & Associates and Health Inter Connexions, 3155 Claremore Ave., Long Beach, CA 90808. Tele-phone: (562) 493-8188.
• Larry Strassner, MS, RN, Manager, Cap Gemini Ernst & Young, LLC, Philadelphia. Telephone: (215) 448-5625.]