What is Case Management? I have tried to answer this question many times over the span of my career. Due to the ever-changing healthcare environment in which we live, the answer seems to get more complex every year. How can something so complex with so many moving pieces be explained? If you are a leader in a case management department and interviewing candidates for a case management position, how do you explain what case management is without scaring people away? I am the Director of Case Management in an acute care hospital setting with close to 10 years of experience, and I still have trouble answering this question.
Let me start by explaining what case management is not. Case management is not always a Monday through Friday job. The hours are not always 8 am-4:30 pm. Depending on the organization the case manager chooses to work for, an acute care hospital, for example, they may be required to work on weekends and holidays. And if you are a leader in your department, you may even get a phone call for guidance on cases after hours. Case managers are not only nurses; they are social workers, therapists, or other licensed personnel. But wait, there’s more!
Time for the good stuff. Case Management is advocating for a patient when they are most vulnerable and cannot advocate for themselves. It is calling the local sheriff’s office to fingerprint a John Doe trauma patient with hopes of being able to identify the patient so their loved ones are able to be notified. Case Management is helping a patient and their caregiver understand how to better manage their illness by providing education and connecting them to resources in their community. It is knowing you can spend an extra ten minutes talking to your patient who may be lonely because some of the things on your to-do list can wait until tomorrow. Case management is taking a few extra minutes to help your patient use the bedside phone to call their family because they keep forgetting to press “9” before dialing the number. It is honoring the patient’s right to refuse the most perfect discharge plan, even though they were agreeable to it two hours ago and you worked really hard on it. Case Management is listening with your ears and assessing with your eyes. It is knowing when to recognize when something is not right and taking the time to dig a little deeper until you get to the root of the problem. Case Management is giving patients and their caregivers the tools they need to maintain or improve their health so they may manage their health in the outpatient setting rather than coming to the emergency room and waiting for hours.
Case Management is knowing how to communicate effectively. It is recognizing complex discharges with barriers. It is coordinating meetings, sooner than later, for the family and the treatment team to sit down together to discuss goals of care and options. Case management is having difficult conversations, happy conversations, celebratory conversations, and tearful conversations. It is communicating risks and benefits of adherence to a recommended treatment plan truthfully while still being compassionate and empathetic all while recognizing the patient’s right to self-determination.
Case Management is knowing how to collaborate with others on the treatment team. It is helping physicians transition patients to the lowest level of care that safely meets their patient’s needs. It is helping the treatment team be good stewards of healthcare dollars spent. Case Management is helping providers prevent duplication of services, diagnostics, and treatments. It is knowing how to become partners in healthcare and being able to build valuable relationships with post-acute providers in the community. Case Management is often not revenue generating, but it is revenue saving when done effectively. It is knowing when to use your voice and knowing when to observe and listen.
Lastly, Case Management is continuing education and never-ending opportunity for professional growth. It is being innovative and thinking “outside the box”. It is not being afraid to share a crazy idea that may improve a patient outcome, because a case manager knows something great might grow from that seed. Case Management is an important part of patient care and patient outcomes. It is rewarding in so many ways. Case Management is here to stay, and I am honored to be a part of it.
Guest post from Angela Gottschalk, BSN, RN, CCM, submitted as part of our “Case Management Is… Contest” and selected as one of two Third Place Winners!
Angela Gottschalk is the Director of Care Coordination at St. Tammany Heath System in Covington, LA. She has been a registered nurse for over 13 years, 9 of which have been dedicated to the field of Case Management. Gottschalk obtained her CCM certification in 2018 and is a current member of the Case Management Society of America, American Nurses Association, and Louisiana State Nurses Association. She received her BSN from Southeastern Louisiana University in Hammond, LA and is currently working on her Masters of Nursing in Healthcare Administration through Chamberlain University.