Question

1. Discuss an example in which case management was done poorly.

2. Describe how you would have managed these circumstances and provided a high level of quality care.

Answer 1

Case Management Department poorly manage:

“1)Role Confusion or Who is Doing What?”

You may be wondering what I mean by “who is doing what?” This is probably the biggest mistake a case management department can make and has to do with something we call role blurring or role confusion. This means that the roles and functions of the staff members are undefined and blurry around the edges. Not only do the staff members themselves not know exactly what they are or are not supposed to do, neither do the other members of the interdisciplinary care team!

2) Inadequate Staffing Ratios”

Once the case management department has determined its roles for the nurse case manager and the social worker, the next important area of clarification is the staffing ratio for each discipline. No department in any hospital can function adequately if the workload exceeds the staff member’s capacity. The case management department is no different than the nursing department, the hospitalists, or the physical therapists. Even residents and interns have maximum caseloads. For some reason, case management has been slow to catch on to the fact that excessive caseloads result in poor outcomes for the patients and the organization. They result in dissatisfaction for the case management staff and personnel turnover. So this is mistake number two: giving the staff more work than they can effectively accomplish in the course of a work day.

2)As a case manager or social worker, you play an integral role in ensuring your patients receive the highest level of care possible. You do this when you assess them, conduct a clinical review, prepare a discharge plan, or expedite a delay in delivery of care. While you may not have the primary responsibility of monitoring quality, you and every member of the healthcare team have a responsibility to ensure that care is timely, appropriate, and meets a minimal standard of quality. In addition, as case managers, we also must ensure that the care to be provided at the next level following the inpatient stay is timely, appropriate, and meets a minimal standard of quality.