Pioneer: Case managers are ‘guardian angels’
Pioneer: Case managers are guardian angels’
Gambosh receives Lifetime Achievement Award
During a career that spanned four decades and began at a time when selling case management services "was like selling ice cubes to an Eskimo," Mary Gambosh, RN, CCM, was truly a pioneer in case management, says Jeanne Boling, MSN, CRRN, CDSM, CCM, executive director of the Case Management Society of American (CMSA), based in Little Rock, AR.
CMSA has given Gambosh, one of the organization’s co-founders, its Lifetime Achievement Award.
"She is a case management pioneer in the true sense of the word. The scope of her work is amazing, the impact of her ideas, incalculable, and the extent of her influence, enormous. . . . There is little that today’s case managers do, think, or face that she has not pioneered, taught, or written about," Boling said as she presented the award at the CMSA annual conference this summer.
Gambosh reminisced about her work in the fledgling field, the origins of CMSA, and offered advice for today’s case managers in this interview with Case Management Advisor.
Q: How has case management changed since you began your career?
A: Case management has changed dramatically, but only in the delivery. The process hasn’t really changed over time. If you think about it, in each and every case, you have to assess what the patient’s physical and emotional state is, develop a plan of care, and change the current plan of care if it isn’t working.
When I started out, I used my common sense to bring all the parties to the table, and I think case management is still common sense. Patients need a guardian angel who will oversee them to make sure they can still function on their own after the incident. That’s what case management is all about.
A lot of people think case management started with hospitals in the 1980s. We need to go back further than that. That was only the evolution of case management, not the beginning. However, over the years, case management has transitioned from going to see one person and managing their care to managing the care of clients by telephone. While you can do a lot on the telephone, you can’t do it to the same extent you can in person.
Q: You were one of the pioneers of case management. How did you get into the field?
A: I worked as a psychiatric nurse for three years and a hospital nurse taking care of children, many of whom were indigent, for 10 years. While playing tennis, I leaned over to pick up the ball and ruptured a disc. Surgery was very successful, but I couldn’t lift so I had to look for another way to use my skills as a nurse.
I saw an advertisement in the paper for someone to help injured workers get back to work and decided this was an interesting field. I spent a week at hearings for injured workers with problems with their insurance carriers. It seemed like it would be so easy to resolve these problems if somebody could sort them out. That’s when I got the idea for my business.
When I first started out, I would bring all the parties to the table one by one. I would visit insurance adjusters and tell them that I am a nurse and can talk with physicians not only about disability but what the patient still can do. I told them that if we do certain things, I can help this person go back to work and save hundreds and thousands and sometimes millions of dollars. I saw such a need for the service. The idea caught on, and my business grew from one case to hundreds. When I sold the business in 1999, I had 340 people working for me.
Q: What advice do you have for today’s case managers?
A: The most important thing is for case managers to become computer literate and to become comfortable using computers. Too many nurses are still falling behind in using the computer. There is so much good information out there about diseases, centers of excellence, and other topics that can put case managers way ahead of the curve. If you’re not comfortable using computers, take a class or get your children or grandchildren to teach you. My family says I learned all my four-letter words when I learned to use the computer, but I did learn and it’s been invaluable to me.
Case managers shouldn’t be afraid to say they don’t know something and to find someone who does know. Nobody can expect case managers to know everything, but they should be expected to know where to get the information they need.
Join the association of your choice and volunteer to assist wherever your talents lie. Don’t leave it to someone else. Your future may be at stake.
Q: What advice do you have for case management directors?
A: Today’s case managers are young, and they come into the field not knowing a lot but are eager to learn. A lot of companies don’t spend a lot of money on training because it’s not a profit center. I urge every company to spend a little money on training, even if the case managers they hire say they are trained. When I ran my business, I made sure every person working for me had the same training.
I see case managers who are so dedicated and want to do the right thing, but they just don’t know how to do it. Unless there is a training course and some guidance, there’s no way they can do their best for the patient.
I used to train my professionals in my kitchen while I made chicken soup. Each nurse I hired the first few years helped me build the training manual.
Q: You were involved in the creation of the Case Management Society of America. How did that happen?
A: In 1989, 12 of us from around the country agreed to meet in Chicago to exchange information about what case management is all about and begin an organization. We knew each other’s names, but we didn’t know each other at the time. We built this little organization that didn’t grow a lot in the first couple of years. The management company we hired didn’t understand case management and what we needed to do. Just as I became president of CMSA, Jeanne Boling left the company she was working for, and I knew we needed her to run CMSA. She became our executive director, and because she knows what case management is all about, the organization grew to what it is today.
During a career that spanned four decades and began at a time when selling case management services was like selling ice cubes to an Eskimo, Mary Gambosh, RN, CCM, was truly a pioneer in case management, says Jeanne Boling, MSN, CRRN, CDSM, CCM, executive director of the Case Management Society of American (CMSA), based in Little Rock, AR.Subscribe Now for Access
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