How one new case manager turned her department around
Everyone wants to hire a case manager with experience. Experience is very valuable, but with a large number of case managers reaching retirement age and the demand for case managers increasing, organizations will be forced to hire people who lack previous case management experience. And that’s not necessarily a bad thing. Bringing a fresh set of eyes into a department can have an incredible impact.
We are going to look at one new case manager who had a major impact on her patients, department, and organization. We will look at the keys to her success and discover how this can be replicated in other organizations.
Karen began her nursing career in 2007 working in a Level 1 Trauma setting. In 2017 she became sick and could not continue to work in trauma. She began researching her options and found case management. She studied case management independently by taking a course to be sure it was something she was interested in doing. In August of 2017, she began her career in case management at a small hospital.
She had excellent one-on-one training by the then director of case management to build on the knowledge she gained from the course she took. When her Director transferred to a larger facility, a new director came on board, but she only lasted 3 months. Impressed by her ability to case manage her clients, the CFO reached out to Karen to offer the Interim Director position. Karen attended some leadership training and began her position as interim director of case management in August of 2018, with only one year of case management experience.
The situation Karen was walking into was far from ideal. There was room for improvement in several metrics, and the department needed structure. She also faced resistance from her team. She had been there for the least amount of time, and yet she was asked to lead them. Some case managers had been there for decades. It’s not easy to change the way things have always been done. And it’s even more difficult for a newbie. Several of her staff quit.
Karen was tasked with improving metrics in several key areas. She started with the Medicare observation form known as the MOON. These forms are supposed to be given to every Medicare beneficiary within 24 -36 hours of admission. She talked with the case managers in her department to discover how they were handling these forms. She discovered a knowledge gap as to who was to receive the forms, and the time frame and which they were to be given. Karen was able to re-educate the department and within a month they were hitting 100% of their goal!
Karen emailed everybody in the department and showed them the results that they, as a team, had achieved. The staff had never seen the Case Management Scorecard, to see where they stood with compliance metrics, so the ability to see the results of their hard work excited the team and helped to begin to soften the resistance to change.
Next, she worked on the Important Message from Medicare or IMM Form. This form is supposed to be given within 48 hours of discharge of all Medicare beneficiaries to let them know their right to appeal the discharge. That one was difficult due to restrictions on timing. Karen decided to improve on this she would need to track it daily. This improved the numbers but also revealed that discharges over the weekend were falling through the cracks. So she started having her Discharge Planner deliver the forms on Friday to cover any weekend discharges. Once this was implemented they quickly reached 100% of their goal!
With success in these two areas, she was asked to tackle the corporate goal of 30% of patients with discharge orders discharged before noon. As Karen explains, “Corporate had a really big problem with why we had such a low percentage of patients discharged home with no case management needs not leaving the hospital on time. Even though I felt that wasn’t on case management, as there were no needs, the discharge always falls on case management. It came to be part of my metrics too. It was so challenging because there were so many barriers in the discharge process and it required multiple disciplines of the hospital, including the doctors and nurses.”
Karen started attending morning rounds, with her staff. During these rounds, case management meets with the patient’s nurse, physical therapist, house supervisor, physician supervisor and when possible a physician. In short, the goal length of stay is given and attendees are asked what is needed from case management to help the patient discharge. “We just discuss any barriers that might delay discharges such as equipment, pending tests, lack of insurance, or any social needs. Since Case Management starts discharge planning upon admission, I need to know where this patient came from, and what kind of support they have at home. With this information, we can start early on a discharge plan. We identify barriers early on, and are not scrambling at the last minute which can delay the discharge.”
Although they have not met goal, since being active in morning rounds and discussing all discharge barriers with her staff and the multidisciplinary team, discharges before noon percentage has significantly increased. “I’m really proud of my department.”
Karen credits the support she received from the Case Managers Community Facebook Group as one of the keys to her success. “I still post questions in there. I don’t know everything. Like I said I’ve only been in case management now for a year and a half and some of those case managers are very seasoned. I still ask questions on there.”
She also credits the Case Managers Community for giving her the encouragement to accept the interim Director role. “Back in August of 2018 I posted about them offering me the job, I was so in shock. I’ve never seen myself in leadership. Everybody in the group was so supportive and they are the reason why I accepted the interim job. Every single person has told me they wished they had the opportunity and that I had to do it. That is the reason why I accepted the interim job, because of the support I got from our Facebook group.”
In 2019 Karen accepted the permanent position of Director of Case management. “I really debated over this because I don’t have leadership skills. I didn’t learn leadership skills like dealing with the staff. I was able to fix metrics but it takes a lot more than that to run a department. So I was a little hesitant about actually taking on the role but I have a really supportive administration. I also have a really supportive Corporate Case Manager Director who I can email and text with anything.”
So what can we learn from Karen? Don’t be afraid to push yourself beyond your comfort zone. Even though she did not feel prepared to lead her team she took a leap of faith knowing she had the support of her organization and the Case Managers Community behind her.
Invest in yourself. Karen invested her time and money to learn about case management to make sure she was making the right career move.
Never stop learning. Karen continued to learn. She identified that leadership was a subject she needed to learn about and took advantage of additional training on that subject.
Communication is key. Karen listens to her team, her organization, and hospital staff. She also effectively communicates to them so that everyone understands expectations.
Share the wins. Karen credits her team with the success that has been achieved and shares the wins with them. The sign of a true leader.
Takeaways for Organizations
Any organization would love to have someone like Karen on their team. And the good news is you can. But how do you find a diamond in the rough? You look for clues.
Clue #1: Karen was willing to invest in herself. She invested her own time and money into a course on something she was interested in. Those who are willing to invest in themselves are a good bet for you to invest in.
Clue #2: She took the time to research and make sure she was moving her career in the right direction. She wasn’t just looking for a job, she was looking for a career she was interested in and would excel in.
Clue #3: She showed she was a lifelong learner and committed to self-improvement by taking a class on her own.
Karen’s success was a combination of her drive to succeed as well as the support she received from her organization. Karen had excellent one on one training. When you find someone eager to learn and succeed, make sure you give them the tools they need. She was told what success would look like and given the authority to institute the change needed to deliver the desired results.
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Karen Wilkerson is a Registered Nurse Case Manager and is currently the Director of Case Management at Placentia-Linda Hospital in Placentia-Linda California. She has been a Registered Nurse for 13 years with a focus on Trauma when in 2017 she changed career paths to Case Management.
She graduated from Mount St Mary University with her Bachelor of Science in Nursing and is an active member of the American Case Management Association. She is currently studying for her ACM certification that she will take in April.
In 2018 she was asked to lead the Case Management department as the Interim Director of Case Management. In December of 2018, she awarded the Turn Around of the Year Award, for her increase in hospital-wide metrics, leadership and positive changes implemented in her department. Karen Wilkerson resides in Los Angeles, California.