Want patients to follow a treatment plan? Engage them
Want patients to follow a treatment plan? Engage them
Building relationships is key to success
As payers and providers alike begin to recognize the value of care coordination, case managers are being given more and more responsibility. But often, case managers have so many tasks to complete in a day that they don't have time to build the kind of relationships that help them engage their patients in following their discharge plan or treatment regimen.
It's not enough to make a quick phone call to patients or pop in and out of their hospital room. To be effective, case managers need to take the time to get to know their patients and build a relationship with them.
"We all went into case management to make a difference, and we have to spend more time with patients rather than spending time in the chart or compiling statistics. Building a relationship doesn't happen quickly, especially when people don't feel well and are worried about their health," says Joanna Malcolm, RN, CCM, BSN, consulting manager, clinical advisory services for Pershing, Yoakley & Associates in Atlanta.
Organizations need to give their case managers time to get to know their patients instead of loading them down with tasks that could be done by other people, she says. "I hear over and over that case managers are too busy to spend time with their patients. Organizations need to look at whether case managers are the most appropriate people to do clerical or administrative tasks," she adds.
In order to provide the best possible care coordination for their patients, case managers need to establish a level of trust and build rapport with their patients, and they can't do that by just reading a chart, or calling patients on the phone or stopping by their hospital room and going over a checklist, adds B.K. Kizziar, RNC, CCM, CLCP, a case management consultant based in Southlake, TX.
The trust factor is important in building relationships, and to develop trust, case managers need to take time to get to know their patients. "Patients are in the hospital such a short period of time and have so many different people coming in and out of their room. Often the only consistent person is the case manager," she says.
Case managers need to take the time to get to know their patients, their culture, their level of understanding about their condition, their financial situation, and their emotional status, all of which impact their abilities to be compliant with ongoing care plans, Kizziar says. It's essential to know the patient's living situation and support system in order to develop a workable treatment plan, Kizziar points out. For instance, the patient may be the family breadwinner who is more concerned about getting back to work than in keeping diabetes or another chronic condition in control. "You can't find this out by just reading the chart or doing a short assessment, and it's crucial information that case managers need to determine the best way to engage a patient in following the treatment plan," she says.
Whether you introduce yourself in person or on the telephone, take time to really listen to your patients. Set aside time just for them and don't let your beeper or someone trying to get your attention distract them, Kizziar says.
When you introduce yourself to patients, whether it's in person or on the telephone, make sure they have a clear understanding of the role of case management and that you have the expertise to coordinate their care, says LuRae Ahrendt, RN, CRRN, CCM, nurse consultant at Ahrendt Rehabilitation in Norcross, GA. Tell patients what you know of their medical history and their treatment team. Without bragging, let patients know that you have the expertise to help them optimize their medical and rehabilitation potential.
"I find it's hard for people to say no to the message of a competent, expert, and caring professional as a partner who will help them get as good as they can get," Ahrendt says. "Giving them a message of expertise and hope and letting them know that they're not in it alone provides an early foundation for a good relationship, even in the midst of tragic circumstances.
"It's really important early on to help people understand that two big roles of the case manager are to empower the client or family to direct their own care and understand their own care as well as to provide the education that allows them to do it," she says.
The wrong approach is to try to exert power and force people to do things. Saying "I represent the insurance company and this is what they want you to do," is often met with resistance, she says.
Sometimes, case managers mistakenly perceive that their patients/clients have had adequate education about what happened and why they need to do certain things, Ahrendt says. "They may have had extensive education, but if it was shortly after their diagnosis, because of their own shock about their condition, it may not have registered," she says. It helps you move forward if you take time to learn what they understand happened to them and fill in the gaps or correct mistakes, she says.
Keep in mind that progress may not occur as fast as you'd like, particularly in the beginning. Take time to let the relationship evolve and don't try to change everything immediately. "As trust builds, things start moving faster," Ahrendt says.
After the initial assessment and treatment plan are in place, recognize that there are patients who can be monitored with follow-up phone calls but there are others who need extra assistance, Kizziar adds. "You can't lump all patients into one category and interact with them in the same way. There are patients who will do well if they just get a phone call once a month to check on them and remind them of what they're supposed to be doing, but there are others who may need help face-to-face at least for a while until compliance improves," she says.
Recognize that the success of follow-up phone calls depends on the questions and the way they are asked. Don't ask questions that can be answered with a yes or no, Kizziar advises. For instance, if you ask patients if they are weighing themselves every day, they may say yes because they don't want you to push them to do so. Or, they may not be weighing themselves but assume their weight is under control because their jeans don't feel tight.
As payers and providers alike begin to recognize the value of care coordination, case managers are being given more and more responsibility.Subscribe Now for Access
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