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One of the most significant challenges facing case management departments is how to hire a team of effective case managers to meet ever-changing demands. Vicki Alexander, RN, CCM, a team leader in the case management department at Community Hospitals in Indianapolis, says two key criteria that she looks for are recent clinical experience and a global viewpoint of the managed care industry.
"We have not had good luck hiring people who have been in only one venue their entire career," she reports.
Alexander, who is responsible for case management operations in the hospital’s inpatient services, says it is also important to find case managers who can communicate effectively with a variety of audiences. For example, some case managers are reluctant to challenge physicians. Some applicants even indicate that if a physician writes an order, they won’t challenge it. "That doesn’t work very well in our business," she contends.
On the other hand, some case managers may be able to communicate effectively with physicians as well as the multidisciplinary team but do a poor job at the patient’s bedside or with families facing a crisis situation. Alexander also seeks case managers who have appropriate delegation skills. "The workload ebbs and flows," she points out. "You have to be someone who is able to delegate to individuals."
In order to identify the right type of case manager, Community has developed a structured interview process. "No matter who performs the first-round interview, they use the same format," says Alexander. The hospital uses a scoring system to help assess résumés of qualified applicants, because if two dozen applicants are interviewed, it is very difficult to recall the specifics of each applicant, she notes.
Community then uses a ranking system of 1 to 4. A 4 indicates there is something obviously wrong with that candidate, while a 3 indicates at least a serious flaw. A 2 is used for someone who reveals positive attributes and can be trained, while a 1 is the ideal candidate.
The hospital then uses a team evaluation process after the first round of interviews to develop initial impressions and pinpoint areas to explore on the second round of interviews. Alexander says she tries to perform the first round of interviews herself, along with managers from various hospitals.
The hospital often uses team interviews as well. For example, if a general case management RN is being interviewed, several managers may sit in on the initial interview. If it is a specialty position for an area such as cardiac or rehabilitation, the hospital frequently will add someone on staff from that area. Social workers typically are interviewed by several other social workers.
According to Alexander, it is also important to present an honest portrayal of the position. "Sometimes, you feel like you are selling the job to the employee," she explains. To avoid that problem, Community sometimes uses what it calls "employee shadowing" where selected applicants are asked to spend a full day with the case manager to see firsthand what that case manager does.
"We have found shadowing to be very beneficial for the applicant," she says. "But we only do this when we are down to the final applicants and can’t make a decision."
The hospital uses standard interview questions as well as customized questions for each position. It also differentiates the questions it uses based on the facility. Alexander says that is because some facilities have a more rural flavor and very different culture than the larger urban tertiary facilities that are more specialized and have a different type of patient and physician.
Here is a sample of questions and discussion points that Community poses to applicants:
Community also asks applicants about their ideal working environment and poses several ethical scenarios. "We find it very important to give them a scenario and have them kind of work the case," Alexander explains.
"Not only does it give us an idea of the employee, but it also helps us to understand the baseline that they are coming in at," she says.