COLLABORATIVE CASE MANAGEMENT
A Peer-Reviewed Journal for Case Management and Transitions of Care Professionals I S S U E
7 0
•
J U LY
2 019
•
ISSN
2328-448X
In This Issue:
Recruitment, orientation, training and retention… everything you need to be successful
T H E O F F I C I A L P U B L I C AT I O N O F T H E A M E R I C A N C A S E M A N A G E M E N T A S S O C I AT I O N
PUBLISHER
L. Greg Cunningham, MHA
ISSUE 70
COLLABORATIVE CASE MANAGEMENT
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Training for Success: A New Model for Orientation Peg Albrets, RN, BSN, ACM
8 Bridging the Gap between Theory and Practice: How Advanced Care Transition Simulation Can Help Debra McElroy, RN, MPH and Kathleen Ferket, MSN, APRN-BC
14 Progression of Care Rounds Dani Hackner, MD, MBA; Marc Adler, MD; Stephen Crouch, MD
CEO ACMA • Little Rock, AR lgcunningham@acmaweb.org
EDITOR
Tina Richardson
ACMA • Little Rock, AR trichardson@acmaweb.org
EDITORIAL BOARD Paul Arias, RN, BSN, MIS Executive Director, Case Management Loma Linda University Medical Center Loma Linda, CA Reggie Allen, MBA, RN Vice President, Clinical/Business Operations Transformation Clinical Operations Excellence CHRISTUS Health • Irving, TX Joan Brueggeman, RN, BSN, ACM, CRCR Director of Utilization Management and Care Coordination Gundersen Health System • La Crosse, WI Dani Hackner, MD, MBA, FACP, FCCP Physician in Chief, Medicine Hospital-Based Services, Ambulatory Specialty Clinics, Emergency Medicine, Urgent Care Services and Cancer Center Southcoast Health • New Bedford, MA Ann Scotti, MSW, LCSW, ACM Director, Care Coordination St. Peter’s University Hospital • New Brunswick, NJ Article Submission Guidelines:
17 Case Management Leadership Recruitment and Retention Patrick O’Boyle, RN, BSN, ACM
“Case management in hospital and health care systems is a collaborative practice model including patients, nurses, social workers, physicians, other practitioners, caregivers and the community. The case management process encompasses communication and facilitates care along a continuum through effective resource coordination. The goals of case management include the achievement of optimal health, access to care, and appropriate utilization of resources, balanced with the patient’s right to self-determination.” Approved by ACMA membership, November 2002
Are You Interested in Submitting an Article to Collaborative Case Management?
If so, send an email to trichardson@acmaweb.org for guidelines and information.
Earn a Free CE Today! COLLABORATIVE CASE MANAGEMENT
A Peer-Reviewed Journal for Case Management and Transitions of Care Professionals I SSU E
7 0
•
J U LY
2 019
•
ISSN
2328-448X
In This Issue:
Recruitment, orientation, training and retention… everything you need to be successful
ACMA members can earn a free CE by reading this issue of Collaborative Case Management and passing the online quiz by 80%. To get started, login to your ACMA Membership Account here, go to Resources, scroll down to Collaborative Case Management and select “View latest issue and earn CE.”
T H E O F F I C I A L P U B L I C AT I O N O F T H E A M E R I C A N C A S E M A N A G E M E N T A S S O C I AT I O N
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Article proposals may be submitted to trichardson@ acmaweb.org in one of the following formats: completed article/manuscript, article abstract or article proposal. Submissions should include three learning objectives for your proposed article; outcomes information as applicable to the model/program/intervention described in the article; author(s) bio information: name, contact information, organization, position, education/ credentials; and statistical data and outcomes (including p-values) whenever applicable. All article submissions are reviewed and published at the approval of the Editorial Board. Collaborative Case Management is a peer-reviewed journal published quarterly by the American Case Management Association (ACMA) 11701 West 36th Street, Little Rock, AR 72211 Telephone: 501-907-ACMA (2262). Subscription is a benefit of membership in ACMA. Memberships are available at $135 per year. Student membership is open to individuals enrolled in a full-time academic program at $60 per year. More detail about membership categories is available at the ACMA website, www.acmaweb.org or by calling 501-907-2262. Photocopying: No part of this publication may be reproduced in any form or incorporated into any information retrieval system without the written permission of the copyright owner. For reprint permission, please contact ACMA, 11701 West 36th Street, Little Rock, AR 72211. The statements and opinions contained in the articles of Collaborative Case Management are solely those of the individual authors and contributors and not of the American Case Management Association. The Publisher and Editor disclaim responsibility for any injury to persons or property resulting from any ideas or products referred to in the articles or advertisements. Copyright © 2019. American Case Management Association. All rights reserved.
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Training for Success: A New Model for Orientation Peg Albrets, RN, BSN, ACM
Stanford is a 480-bed quaternary care academic medical center in Palo Alto, California, with a mission to provide complex patient care for both local patients as well as patients from the state of California and beyond. Case managers, social workers and complex care managers serve in an advanced practice role. They work with large multi-disciplinary teams, patients and families to optimize patient care, provide support and interventions for psychosocial issues, and manage safe transitions to the next level of care after hospitalization. Staff members need to be clinically knowledgeable, effective communicators, highly organized and able to navigate the complex healthcare and payer environment. LEARNING OBJECTIVES 1. Articulate three tools used as standard work for orientation of new case management staff. 2. Identify three metrics used to measure success of the new orientation program. 3. Describe three modifications that can be made to orientation program following metric analysis and feedback.
INTRODUCTION Stanford’s goal is to provide the right level of care at the right time with a focus on high quality care, patient and family satisfaction and best outcomes. We need well-trained case managers, social workers and complex case managers to ensure effective transitions to the next level of care, manage throughput in a busy academic medical center with an active transfer center, and to function as responsible financial stewards for both patients and Stanford Health Care. Case management and social work practice at Stanford are a stimulating mix of individual practice and autonomy, while at the same time functioning as core members of the multidisciplinary team. Our staff members need to be able to think critically, solve complex patient care issues and thrive in a fast-paced environment. Stanford Health Care was also expanding further into ambulatory care and building a new state of the art hospital that needed to hire many additional staff in anticipation of a much larger inpatient bed capacity. To meet our goals, we determined that we needed to develop a robust orientation process to meet current and future staffing needs and to ensure optimal preparation of new staff members. We focused on ensuring that professional staff members
have the knowledge they need to be successful. This included clinical knowledge, communication and organizational skills, and an understanding of insurance, regulatory requirements, documentation standards and community resources. In addition, they needed to be able to follow national practice standards for case management and social work. We believe that investing time, attention, support and training during orientation will increase success and satisfaction for new staff, as well as allow the department to build and maintain a high-functioning team. In late 2014, Stanford implemented a new management role titled manager for education/compliance for the Department of Social Work and Case Management. One of the first projects for the new manager was to conduct a thorough review and revision of the department orientation program. This review included informal interviews with senior staff members, who had served as preceptors, as well as interviews with newer staff members for feedback regarding the existing orientation process. A consistent theme was uncovered. Staff did not understand that expectations around orientation were clear for either preceptors or new staff, and there was not enough follow up after orientation to assist new staff on
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the often-steep learning curve of the advanced practice role. The management team met to review the feedback, further define issues and concerns regarding orientation from both a management and a staff perspective, and to focus on ultimate goals. Using an integrated approach and LEAN management tools (a set of operating philosophies and methods to minimize waste), we developed standard work around orientation, and clarified the roles and responsibilities of the managers and preceptors as well as the expectations for new hires. We also identified key metrics to evaluate our program, which included: • Effectiveness of orientation from staff perspective • Effectiveness of preceptor teaching method from staff perspective • Staff assessment of readiness to take on assignment at end of orientation • Staff assessment of support during orientation • Management tracking of performance issues and concerns PROGRAM IMPLEMENTATION The manager of education/compliance, with input from the management team and staff, developed standard work and tools for orientation. The manager of education/ compliance also continues to play a key role in orientation of all new department staff, as the manager reviews overall orientation plans and goals, provides general department orientation, completes hands-on Epic training, reviews competencies, and begins the education for new staff on the culture and ethical framework for decision-making, as defined at Stanford, during the first week. The focus for the first week is on hospital orientation, general department orientation, completion of Healthstream and Epic training, resource review, meeting essential staff in the department and competencies. Beginning the second week, the new hire is out on the unit or in the clinic with the preceptor for the remainder of the orientation time for hands on training in patient assessment, medical record review, documentation, team rounds, collaboration with the multi-disciplinary team and referrals.
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ORIENTATION TOOLS AND PLANS:
• Hands-on training with Epic, Stanford’s electronic medical record
Standard work pre-arrival includes:
• Review of department documentation standards and regulatory requirements pertaining to documentation
• Standard work for managers regarding new hire process • Welcome email template to new hires
• Survey readiness review
• Objective and specific expectations for orientation and probation period for each discipline, given to new staff members and to the preceptors
• Regular weekly check-ins for manager, preceptor and new staff member during orientation Standard work after orientation:
• Standard master orientation calendar for new staff members
• Monthly check-in for manager and new staff member during six-month probation period with standard tool to assess progress against goals
Standard work during orientation: • Master department orientation checklists • Discipline-specific orientation checklists that include all aspects of practice
Additional tools we have used: • Baseline and follow up postorientation surveys
• Master orientation binder for new hires with essential information
• Preceptor training class with a focus on learning styles, generational differences in learning, teaching tools, holding staff accountable and giving constructive feedback
• Hands-on training for new hires • Building blocks approach to skill building followed by integration into practice • Standard competencies for new hires: communication, ethics/end of life, SBAR (situation/background/assessment/ recommendation), 2 midnight rule, risk assessment, grief, SBIRT (screening/ brief intervention/referral for treatment), health care reform, team care rounds
METRICS • New staff satisfaction with orientation process • Performance issues during orientation/probation • Staff satisfaction with preceptors
ORIENTATION METRICS
5 4.5 4 3.5 3 2.5 2 1.5 1 0.5
Orientation was effective overall
Preceptor methods to teach were effective n December 2014
which includes group review and discussion led by the manager of education/compliance • Completion of Stanford-specific Healthstream online training
I felt prepared to handle my assignments I felt supported following orientation
n March 2015
n March 2016
n October 2016
NEXT STEPS Based on feedback from managers, preceptors and new staff over the past few years, we have continued to modify our orientation program to make further improvements.
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We have moved all systems training to week one to minimize disruptions to their time with the preceptors in weeks 2-4. We have set a time during the first week for the new staff to meet their preceptors for coffee so they can get to know one another before orientation starts. We have instituted a new hire selfassessment tool and learning style assessment, completed by the new hire prior to arrival, and the results are shared with the managers and preceptors to assist us in creating an individualized orientation plan. We continue to offer a class twice a year, or as needed, to train staff to function as preceptors, to increase the pool of staff who can precept new staff members, and to solicit new ideas for improvement. We have created a visibility wall for the managers to track new hire progress against the discipline-specific monthly goals so they can see status at a glance and focus their attention on staff members who need additional assistance or coaching. We are also working on improvements to the handoff from one preceptor to the next. We have been setting up a loaner laptop at the end of week one so the new hire will be ready to go on their first day with the preceptor. We also offer a meeting with the manager of education/compliance in week 4 for Epic refresh training, as we have found many new staff members need that extra support. We continue to reassess the competencies annually to ensure they are necessary and up to date, and reflect best practices. In addition, we offer twice a year SBIRT for our new social workers. Our department director has lunch with the new hires to welcome them to their new career at Stanford, and to set out clear expectations for professional practice and communication. We have found it is more efficient for the manager of education/ compliance to orient several new hires at the same time, and that the larger group also facilitates more robust discussions for the competencies. Stanford is also implementing a new training program from ACMA entitled Advanced Care Transitions Simulation (ACTS). This will enable the department to provide new staff with an opportunity to participate in scenarios, using actors to portray patients and families with real-time post scenario feedback on their performance. Our goal is to enhance their communication, listening and motivational interviewing skills.
We plan to provide this training after orientation during the probationary period so that the staff have some experience and context under their belts in order to gain maximum benefit. CONCLUSION The management team continues to meet regularly to assess effectiveness of the orientation plan, review staff feedback from the check-ins, discuss preceptor feedback, and update orientation tools and plans as needed. The manager of education/ compliance is primarily responsible for this process as well as implementation of any
modifications. Regular surveys of recent hires have been done to assess the metrics relating to staff feedback. Through institutional leadership and the concerted efforts of multiple disciplines, we have achieved the following: • Increased staff satisfaction with the orientation process • Increased staff comfort level in taking on new assignment • Increased preceptor satisfaction with the orientation processes • Earlier identification, intervention and monitoring of any performance issues
EXAMPLES OF TOOLS/STANDARD WORK Welcome email for new hire:
Hello, We are so excited to have you join our department, and hope you will find your Stanford career to be rewarding and fulfilling! We have arranged an orientation plan for you with a calendar attached to this email. This orientation will consist of an all-day standard hospital orientation, computerbased training time and time spent with our experienced staff for hands-on training, as well as time with our manager for education and compliance and/or social work supervisor for one-on-one training. We have also attached an outline of weekly orientation goals/expectations to this email. Our goal is to provide you with the foundation, training and tools that you need to be successful here. The plan may change a bit to accommodate schedules and needs during orientation. For your reference, here is the list of your preceptors during orientation and their contact information. Please complete the attached new hire self-assessment form and return it to me via email, as it will assist us in tailoring your orientation to your needs. The first day of orientation you will report to Stanford’s facility at 7600 Gateway Boulevard, Newark 94560 at 7:30am for an all-day hospital orientation. Our human resources department will reach out to you with the details of time and location. During orientation, human resources will discuss parking options. The second day of orientation you can park in the Hoover lot, off Campus Drive, and walk or take the shuttle to the main hospital building. You should report to our main office by 8:30am. We are located in the main hospital building at 300 Pasteur Dr., ground floor, room HC029, phone 650-723-5091. At that time, you will receive a packet of information, and our admin will get you set up to do your computer-based training. Your manager will greet you at some point during your day and will introduce you to our office staff. Please bring a pair of ear buds to use during the computer-based training. Please contact me if you have any questions. We’re looking forward to seeing you soon! Manager of Care Coordination (This email includes attachments for master orientation calendar, new hire self-assessment, learning style assessment tool and discipline-specific weekly goals.)
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WEEKLY GOALS FOR SOCIAL WORK WEEK 1:
WEEK 1:
Staff: completes new hire competencies, completes Healthstream, completes Epic training, and understands CM & SW roles
Staff: completes new hire competencies, completes Healthstream, understands CM & SW roles, completes Epic training
MGR Education/Compliance: review dept. and SHC roles, ensure systems access, trains on Epic and sets up for new hire, review organization and reports, provide opportunity for hands on practice with tasks, reviews competencies, documentation standards, and survey readiness and regulatory guidelines for practice WEEK 2: Preceptor: staff shadow first day, then focus on building blocks: daily workflow/organization, team rounds, patient assessment, Epic assessment documentation tools, handoffs, referrals, documentation, team rounds/CHR, weekend handoff, assign patients to new staff by end of week, comfort level assessment for skills/tasks Staff: shadow first day, able to print patient lists and reports, attends team rounds, completes 2 SWATs and documents in Epic, completes handoff in Epic; completes 2-5 referrals, documents in Epic, attends CHR, takes caseload of 15-20 patients by end of week MGR: check-in, review regulatory issues, reviews any concerns/gaps, review CHR, SW standard work WEEK 3: Preceptor: focus on putting it all together, standard daily work, team rounds participation, assign more patients, comfort level assessment for skills/tasks
 Staff: takes full caseload by end of week with assistance of preceptor, completes CRM, and presents case at CHR MGR: check-in, review regulatory issues, reviews any concerns/gaps, and set up on-going plan for mentoring
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WEEKLY GOALS FOR CASE MANAGEMENT
MGR Education/Compliance: reviews dept. and SHC roles, ensures systems access, trains on Epic and sets up for new hire, reviews organization and reports, provides opportunity for hands on practice with tasks, reviews competencies, documentation standards, and survey readiness and regulatory guidelines for practice WEEK 2: Preceptor: staff shadow first day, then focuses on building blocks: daily workflow/organization, team rounds, patient assessment, CMA, handoff, referrals, documentation, IQ reviews, team rounds/CHR, weekend handoff, assign patients to new staff by end of week Staff: shadow first day, able to print patient lists and reports, attends team rounds, completes 2 CMAs and documents in Epic, completes handoff in Epic, completes home care, SNF, hospice, home infusion, and acute rehab referrals, documents in Epic, completes 5+ IQ reviews, attends CHR, takes case-load of 3-5 patients by end of week MGR: check-in, review regulatory issues, reviews any concerns/gaps review CHR, CM standard work WEEK 3: Preceptor: focus on putting it all together, standard daily work, integrating DCP and UR, team rounds participation, assign more patients, comfort level assessment for skills/tasks Staff: takes caseload of 10-12 patients by end of week with assistance of preceptor, completes CRM, completes 10+ IQ reviews, completes LOC assessments with IQ, presents case at CHR MGR: check-in, review regulatory issues, reviews any concerns/gaps WEEK 4: Preceptor: assigns entire caseload to new staff, guides and continues education comfort level assessment for skills/tasks Staff: takes entire caseload all week with assistance of preceptor, completes COMPASS and InterQual MGR: check-in, review regulatory issues, reviews any concerns/gaps and set up on-going plan for mentoring
COLLABORATIVE CASE MANAGEMENT | ACMAWEB.ORG
MASTER ORIENTATION CALENDAR: WEEK 1 MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
7:30-3:00
8:30-8:35
8:30-12:00
8:30-9:00
8:00-9:00
Hospital Orientation: 7600 Gateway Boulevard Newark, CA 94560
Meet manager in main office
Meet Manager of Education & Compliance in bullpen HC004. IT access and set up, share drive, intranet, LEAN, department orientation, employee sign documents, hospital and office tour
Check email, complete ACA competency HC004
Complete any Healthstream or competencies, resource review, Compass
Manager: Schedule for SBIRT-given quarterly (SW only) Schedule for lunch with director
8:35-8:45 Meet admin in new bullpen for computer set up 9:00-12:00 Healthstream all day in new bullpen HC004 12:00-12:30 Lunch Break 12:30-5:00 Complete Healthstream
12:00-12:30 Lunch Break 12:30-2:30 Meet Manager of Education & Compliance in new bullpen for competencies: SBAR, communication, ethics, end of life (all) 2:30-4:30 Reading for competencies, finishing HealthStream
9:00-10:00 Meet with Utilization Manager, for IWork training HC004 10:00-12:00 Meet UM team for IQ review at their desk HC029 (CM and CCM only): Time to finish resource review (SW) 12:00-12:30 Lunch break 1:00-3:00 Meet with housing coordinators at 900 Welch Rd (SW only) 1:00-3:00 Work on Compass (CM and CCM only) 3:00:3:30 Meet with DME SL (all)
9:00-12:00 Meet with Manager of Education & Compliance in new bullpen HC004 bullpen for Epic training 12:00-12:30 Lunch break 12:30-3:30 Meet with Manager of Education & Compliance in new bullpen HC004 bullpen to continue Epic training 3:30-5:00 Explore share drive/ intranet/Compass Laptop set up with Business Operations Manager
3:30-5:00 Meet preceptors, finish HealthStream, COMPASS
AUTHOR BIO Peg Albrets, RN, BSN, ACM, is a graduate of Michigan State University. She has over 40 years of nursing experience and has devoted her career to case management for most of that time. She has been at Stanford since 1990 as a case manager on the oncology/hematology service for many years before moving into management in 2006. She spent several years as the case management supervisor before becoming manager of care coordination. She was the department lead for the implementation of Epic as the electronic medical record for Stanford. She then took on the role of the first manager education/compliance for the department of social work and case management and enjoyed further defining and developing that role for three years before her retirement in 2017. One of her proudest moments came when Stanford was the first hospital in California to implement the case management module in Epic, a huge leap forward for case management and social work practice and documentation. Peg came out of retirement in 2018 to serve as manager of special projects for the department of social work and case management, and currently works on a per diem basis to assist the director and department as needed.
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Bridging the Gap Between Theory and Practice: How Advanced Care Transition Simulation Can Help Debra McElroy, RN, MPH and Kathleen Ferket, MSN, APRN-BC
The healthcare environment is in a dynamic state of change, and case management is at the center of value-based care initiatives. Care managers must be knowledgeable about clinical, regulatory and payer requirements, all while developing rapport, building relationships and coordinating the care of complex patients. As health systems continue to expand, the case manager requires a working knowledge of the organization’s care continuum to plan the most optimal care transition for the patient. As a recognized leader in case management education, the American Case Management Association (ACMA) introduces Advanced Care Transition Simulation (ACTS), the first nationally recognized simulation training program for
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case managers. ACTS is focused on improving care transitions through simulation. ACTS uses a Learning Map© exercise with participants to ensure there is a solid, working knowledge of their own system of care. Nationally, inadequate care coordination and care transitions are responsible for $30-45 billion in wasteful spending.¹ Value-based payment (VBP) programs are increasing and promote the delivery of the right care, in the right setting, providing financial incentives for achieving quality standards and eliminating unproductive costs from the system. Valuebased payment models, like BPCI (bundled payment clinical improvement) and Accountable Care Organizations (ACO) align incentives to encourage collaboration
among disparate providers to achieve objectives. High-cost, complex patients often have suboptimal outcomes because of inadequate coordination. Improved hand-offs and coordination as patient’s transition from one provider to the next are key strategies in VBP programs. A well-structured VBP model draws attention to the full continuum of healthcare services. The ACTS program enhances understanding of care transitions and introduces the concept of longitudinal care coordination for complex patients. An exercise using the Transition of Care Standards© with the Learning Map, guides discussion about opportunities or solutions to improve communication regarding care transitions within their own system of care.
COLLABORATIVE CASE MANAGEMENT | ACMAWEB.ORG
LEARNING OBJECTIVES 1. Describe how simulation bridges the gap between theory and practice. 2. Review the mission and goals of the Advanced Care Transitions Simulation program and how you can apply it to your setting. 3. Identify how Transition of Care Standards can provide opportunities or solutions to improve communication within your system of care. BRIDGING THE GAP Simulation is an important methodology in bridging the gap between theory and practice in healthcare education and is now available for the case management field. The Advanced Care Transition Simulation (ACTS) program is focused on improving care transitions by assessing the performance of care management professionals in realistic patient scenarios, using standardized patients (SP). The ACTS program leverages unique, team-based simulations of patient scenarios to enhance care coordination and critical thinking. Participants are evaluated throughout the simulation on assessment skills, communication skills, transition planning, and documentation of the plan of care and collaboration. Traditional orientation and education in the acute care case management environment has been centralized within a department. Orientation may include shadowing opportunities with experienced case managers to observe their practice in the clinical setting with patients/families. Cross continuum roles for care managers have proliferated in ambulatory, community, and post-acute settings, but vary widely in preparation and skill sets. ACTS is tailored to address professional development and offers simulation experiences targeted toward care managers across the continuum. SIMULATION IN HEALTHCARE Healthcare simulation programs have spread to many parts of the country, including hospitals, medical and nursing schools, community college programs and clinics. Both high and low fidelity simulation have been used extensively within the domains of medicine, robotic surgery, dentistry and nursing education for the past 15 years.
Healthcare simulation is a technique that creates a situation or environment to allow persons to experience a representation of the real healthcare event for the purposes of practice, learning, evaluation, testing to gain understanding of human actions and systems.² Simulation is meant to replicate aspects of the real world in an interactive manner that allows learners to be immersed in the learning environment. In healthcare, we simulate to improve both the practitioner skill set but also to improve patient safety. Use of simulation continues to grow and high-tech simulation labs are becoming a standard of care at many academic centers. The American Case Management Association (ACMA) explored the concept of using simulation in case management education in a 2016 workshop and received positive feedback and suggestions from the over 200 participants. Subsequently, ACMA continued to refine the ACTS program, which was tested in five beta sites throughout 2018. We are indebted to the case management leaders and organizations who assisted ACMA in refining the ACTS program (see Table A). The ACTS program launched in 2019 and offers a turnkey approach to delivering case management education, using low fidelity simulation with standard patients representing realistic patient scenarios. Low fidelity simulation-use requires a patient care setting and minimal props to replicate the environment, but does not use monitors or high-tech equipment, mannequins or recordings which are fundamental to high fidelity simulation. The ACTS web-based portal offers a variety of resources (see Table B) and is designed to support implementation of the ACTS program at their organization. ACTS is a complimentary program to the Compass educational module program. Compass modules enhance case management
understanding of theory and knowledge, while ACTS fosters critical thinking, integration and the application of the case management skills into practice. ACMA’s cross modality of educational resources prepares today’s case manager, no matter their practice setting, to achieve the best patient outcomes in today’s value-based care environment. TABLE A: ACTS Beta Site Participants Baycare Health Inova Health Ohio State University Medical Center & The James Cancer Center Stanford University Medical Center Vanderbilt University Medical Center
TABLE B: ACTS Portal Resources Ten patient scenarios, which cross care setting: ambulatory, acute care, skilled nursing, acute rehab and pediatric Pre-simulation videos Educational resources: motivational interviewing, Teach Back, Longitudinal case management Pre and post test Links to CMS conditions of participation Glossary of terms Documentation samples Learning map, system of care sample
TABLE C: ACTS Anticipated Outcomes Staff engagement Improved relationships across care settings Staff retention or reduced voluntary turnover
Competency measures by participant, facility or system Potential for reduced orientation time Readmission reduction
Longitudinal care management practices
Improved understanding of care continuum
Improved patient experience with care transition questions
Improved patient safety associated with care transitions
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Patient safety is a key concept within the simulation environment. Simulation-based learning has demonstrated effectiveness in improving safety competencies in all healthrelated disciplines.⁴ Debriefing is an essential component of simulation that is used in
goals and the patient felt safe. In an actual patient encounter, case managers do not have the luxury to be able to say to the patient, “How do you think I did with your plan of care?” In ACTS, participants do have the ability to ask about their effectiveness
and experienced care management professionals and result in performance anxiety. The ACTS program reinforces a safe learning environment in the pre-simulation resources. Optimally, an ACTS assessor is positioned behind a two-way viewing area to lessen any concerns about observation throughout the simulation. CARE ACROSS THE CONTINUUM
nursing education. It can be defined as an activity that follows a simulation experience that is led by a facilitator where feedback is provided on the participants’ performance, all aspects of the simulation activities are discussed, and reflective thinking is encouraged. The review of the literature identifies significant learning occurs through discussion and reflection during debriefing.⁵ Fifty percent of hospital-related medical errors are attributed to poor communication during transitions of care.⁶ Debriefing with standard patients after the simulation allows for two-way feedback to determine if communication was clear, the care transition plan was understandable, met the patient’s
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and style. The ACTS educator/facilitator ensures all feedback is professional and respectful in accordance with the International Association for Clinical Simulation and Learning guidelines (INACSL). Any individual-directed coaching or review regarding opportunities noted in the simulation is completed in a private discussion setting. Maintaining a safe and supportive learning environment is key to a successful simulation experience. Clinical simulation experiences are associated with high levels of stress and anxiety that can leave learners unable to perform or inhibit learning.⁷ Being observed during a simulation may affect both new
Healthcare professionals who practice in one particular care setting may be unfamiliar with the requirements and nuances of care delivery in other settings, and this may contribute to fragmentation and poorly planned care transitions. The scenarios within the ACTS portal of resources include transitions from one care setting to another and offer the case manager the experience of coordinating care in an alternate care setting. A commitment to improve care transitions requires the case manager to adjust their viewpoint from an episodic to a longitudinal view. Patients transition across multiple settings, and it is necessary to ensure these transitions are as safe and coordinated as possible. This commitment also demands better communication, recognition of differences in staffing and resources, and the identification of information necessary to deliver optimal care in each setting. Expanding the case manager’s understanding of the care continuum is necessary for developing a longitudinal view of care management. This knowledge is essential for the case manager who coordinates care for complex patients, regardless of their practice settings.
COLLABORATIVE CASE MANAGEMENT | ACMAWEB.ORG
ACMA addresses this learning opportunity by using the Transition of Care standards and an ACMA Learning Map© during the ACTS program. Bringing care managers from across the care continuum to engage in simulation may enhance the skills needed to excel in a value-based model of care. ACTS TESTIMONY “Our organization embarked on this opportunity with the expectation that we would be providing a safe learning environment promoting the importance of quality care transitions,” said Pamela E. Andrews, RN, MSW, MBA, CCM, ACM at Inova Health System Case Management in Fairfax, Virginia. “The opportunity for our case management teams, home health nurses, transition case managers and subacute care partners to participate as one team further validates communication and drives the patient experience and the quality of care transitions. The program has exceeded our expectations. The ACTS experience has invigorated our practice and partnerships. As a case management leader, it has magnified the boxes/barriers we have inherently placed in the way of best practice, these ‘ah-ha’ moments are contributing to redefining how we practice, and our team members response has been priceless!” ACTS PROGRAM OPTIONS ACTS training options include either a train the trainer model, where an organization designated trainer can conduct ACTS training on site, or an ACMA-led ACTS program at their organization. Individuals designated to be ACTS trainers will participant in a full day of training at an ACMA designated simulation center to prepare them for conducting the ACTS program at their organization. Participants (trainees) enrolled in the program will receive ACTS portal access, which includes a pre-simulation video, review materials and a pre-test. Participants are required to complete all pre-simulation materials prior to attending the simulation workshop. Evaluation is based on pre and post testing, assessment of practice during the simulation, and documentation associated with the plan of care. The simulation assessment tool evaluates observed behavior and performance in the following categories: education,
professionalism, assessment, care coordination, transition management, compliance/documentation, and utilization and resource management. Reports are automatically generated within the ACTS portal. Scoring is available for review by overall organization, individual facility or individual participant. These reports are useful in identifying additional
for a case manager, it is documented that it may cost anywhere from $97,216 to $104,440 to replace a nurse.⁹ This cost does not account for the clinical experience, regulatory and payer knowledge required of a case manager. It is more difficult to reference the cost of a social worker in the case manager role, although estimates about training a new social worker costs about $54,000,
educational needs and will meet requirements of regulatory agencies requesting ongoing educational records to demonstrate competency.
according to the Texas State Committee on Finance.¹⁰ This may vary based on years of experience and geographic location. Case managers are aging with nearly 44% over the age of 55.¹¹ This may contribute to additional vacancies and the need to focus on both recruiting and retention in a now very competitive case management environment. Investments in educational and professional development may foster staff satisfaction and promote organizational retention.
ACTS PROGRAM OUTCOMES There are many studies that demonstrate the effectiveness of healthcare simulation for professionals and patients alike.⁸ Currently, there are no studies specific to outcomes associated with case management simulation education. The ACTS program anticipated outcomes are based on applicability to related research in the healthcare simulation field. Data will be collected as organizations implement ACTS to further identify the impact on patient safety, improved care transitions, reduced readmissions, improved patient experience and improved healthcare relationships across the care continuum. It is postulated that enhancing longitudinal care management practice/knowledge will positively impact value-based programs, such as Bundled Payment Clinical Improvement and ACO models of care. While there is little evidence in the literature to estimate the cost of turnover
CONCLUSION The use of simulation as a required component of case management training has the potential to transform orientation, professional development and patient outcomes. ACMA is collecting pre and post ACTS implementation data to identify and monitor select outcomes associated with the ACTS program. Future publications will continue to highlight the return on investment in case management education and development programs. Additional information on the ACTS program can be obtained here.
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ISSUE 70
ABOUT THE AUTHOR Debra McElroy, RN, MPH, is Senior Vice President for Practice Development and Education at the American Case Management Association. Kathleen Ferket, MSN, APRN-BC, is Senior Consultant of Transitions of Care and Simulation Programs at the American Case Management Association. REFERENCES 1. Health Policy Brief: Care Transitions, Health Affairs, September 13, 2012. Numbers adjusted to 2018 dollars using Consumer Price Index for Medical Care, https://fred. stlouisfed.org/series/CPIMEDNS. 2. Lopreiato JO, Downing D, Garmmon W, et al; Terminology & Concepts Working Group. Healthcare Simulation Dictionary. Rockville, MD: Agency for Healthcare Research and Quality; 2016. AHRQ Publication No. 16(17)-0043.
3. Harder, N (2018) The Value of Simulation in Health Care: the obvious, the tangential, and the obscure. Clinical Simulation in Nursing, editorial. Elsevier, 15, 73-74. 4. Boet S., Bould D., Fung L., et al; (2014) Transfer of learning and patient outcome in simulated crisis resource management: a systematic review. Canadian Journal of Anesthesia, 61, 571-582. 5. Pivec, C., (2011) Debriefing After Simulation: Guidelines for faculty and students. Scholarly project, St. Paul, Minnesota. 6. Improving Care Transitions: Optimizing Medication Reconciliation, March 2012, American Pharmacists Association & American Society of Health System Pharmacists. 7. Tyerman, J., Luctkar-Flude, M., Graham, L., et al; (2019) A Systematic Review of Health Care Pre-simulation
Preparation and Briefing Effectiveness. Clinical Simulation in Nursing, 27, 12-25; Elsevier, Inc. 8. Walsh, C, Lydon, S, Byrne, D, et al; The 100 Most Cited Articles on Healthcare Simulation. Society for Simulation in Healthcare. 2018, 13, 3, 211-220. 9. https://www.beckershospital review.com/finance/will-2018-be-the-yearhealthcare-addresses-its-turnoverproblem.html 10. h ttps://www.governing.com/ columns/smart-mgmt/gov-social-workersturnover.html 11. https://www.reliasmedia.com/ articles/134694-experts-market-casemanagement-to-younger-hc-professionals Jones, C. (2008) Revisiting Nurse Turnover Costs. Journal of Nursing Administration, Wolters Kluwer Health; 38: 1, 11-18.
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ISSUE 70
GRAND ROUNDS
Progression of Care Rounds Dani Hackner, MD, MBA; Marc Adler, MD; Stephen Crouch, MD This article is a discussion regarding a case scenario on a topical issue involving care management, population health and physician advising. Discussion questions asked of physician advisors regarding rounds design and rounds content include: 1. What is your impression on how progression of care rounds is organized, and how can it be improved? 2. What is your impression of the scenario? Are there any red flags that may need to be addressed in rounds? Are there any utilization, clinical or documentation issues of concern? BACKGROUND Dr. Erin Smith, CMO for Progressions Hospital System (PHS), joins the multidisciplinary rounds on the respiratory step-down unit (RCU) as an executive observer. PHS is attempting to improve length of stay and quality of care through enhanced progressions of care rounds. For intermediate level of care, the unit has telemetry, pulse oximetry, noninvasive positive pressure, and tracheostomy care capabilities. Jim Vasquez is one of five
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rotating charge nurses for the area and runs rounds one day a week. He maintains a white board with action items and other data. On rounds, hospitalists present their cases with occasional input from respiratory and speech therapy, and social work. Specialty services made up of doctors and advanced practitioners do not participate in rounds. Case management reports on plans for the way including skilled nursing and home health but does not see patients with routine discharges. For bedding status and level of care, utilization managers electronically contact hospitalists out of rounds through the health record inbox. Due to a standing meeting, the unit manager, Susan Emma, is not typically present for rounds but touches base with the rotating charge nurse later in the afternoon. CASE SCENARIO A hospitalist presents an 80-year-old patient observed with community acquired pneumonia and altered mental status. The patient has received antibiotics (piperacillin/ tazobactam and azithromycin). The hospitalist is reluctant to give fluids due to a history of mild heart failure and fluids are monitored with a urinary catheter. A consult is pending with the cardiologist who knows the patient from a prior visit. The charge nurse is concerned about the vitals, a respiratory rate
of 20, a pulse of 135 and a blood pressure of 155/78. The pulse oximetry is 95% on 3L. Telemetry shows no arrhythmias. The chest x-ray shows an upper lobe pneumonia. Case management wants an anticipated discharge date. Respiratory therapy is having difficulty obtaining a sputum for culture. George Yang, the respiratory therapist indicates that the patient has had the cough for several months. The working diagnosis is simple pneumonia. The patient is in a double room. WHAT IS YOUR IMPRESSION ON HOW PROGRESSION OF CARE ROUNDS IS ORGANIZED? HOW CAN IT BE IMPROVED? Dr. Steve Crouch: There should be more involvement by all members of the care team. It should be multidisciplinary. Everyone should be there at the same time and provide whatever information they have and present their barriers to care, progression of care and ultimately to discharge. They all should be encouraged to speak up. Having the conversations with all players is more efficient and the entire care team is aware of the responses, barriers and needs. Dr. Marc Adler: This exemplifies the risk of having rounds just for the sake of having rounds; they should be meaningful and task
COLLABORATIVE CASE MANAGEMENT | ACMAWEB.ORG
the right people at the right time to affect the right outcomes. I have found that trying to secure every clinical and administrative stakeholders’ needs at one rounding huddle ends up unsuccessful for everyone, mostly
and receive appropriate hand-offs from their overnight teammates. Owners of safety issues should have “run the list” before rounds. Care managers, physical therapy, respiratory therapy, etc., should be prepared with the latest information before the meeting.
upper lobe infiltrate. Sometimes clinicians get sidetracked by alternate diagnoses, and it is helpful for team members to raise a red flag when a patient’s condition seems unusual or unstable.
Establish a rounds leader who takes the helm and runs the list. Every stakeholder should provide relevant information about changes in status and any unanswered questions requested by team members. If a member is unable to attend, they should provide their information to someone on the team before rounds. the patient. In fact, some walk away with misinformation and confusion leading to longer lengths of stay and possibly poorer care. First, this CMO should identify the goals of the rounding team. Typically, administration wants to ensure progression of care (patient flow) and high-quality care with cost efficiency. Care management needs to ensure proper utilization and level of care decisions. Clinical staff seek appropriate care and outcomes through evidence-based medicine with patient satisfaction. Attending physicians want all this and an efficient day, and students want an educational experience. We usually allocate 15 minutes (what just happened?) or 2 hours (are we there yet?) Consider regularly scheduled brief rounds that are consistent in content, structure and attendees. Residents may not realize part of their education is learning the art of
formulating and using concise data, but they are often frustrated if rounds are not presented in traditional didactic formats. Consider separating formal education from these rounds. Stakeholders should be expected to attend rounds promptly, at the same time every day, with up-to-date information specific to their profession. Clinical staff need to pre-round
A working DRG helps the team establish a target date of discharge. While this is often in flux, the multidisciplinary team is best suited to have a realistic target based on all the issues influencing a patient’s stay. The duration of these rounds should be limited so stakeholders can get to work on the necessary tasks. The key message to the team is that these rounds do not take the place of continuous updates and ongoing communication throughout the day; they serve as a connection point for all to communicate together to ensure efficiencies and clear understanding among team members. WHAT IS YOUR IMPRESSION OF THE SCENARIO? ARE THERE ANY RED FLAGS THAT MAY NEED TO BE ADDRESSED IN ROUNDS? ARE THERE ANY UTILIZATION, CLINICAL OR DOCUMENTATION ISSUES OF CONCERN? Dr. Steve Crouch: It should be considered that this patient may need isolation until communicable process has been ruled. Tuberculosis could be a possibility. What is being done about the heart rate? Primary rhythm disturbance? Secondary to fever or dehydration? Is there a delay in the cardiologist rounding? Has anyone inquired as to the need of fluids or addressed the hesitancy to give fluids by the attending? Dr. Marc Adler: This is an opportunity for several members of the care team to raise a voice without criticism. Clearly this patient’s clinical status and history raise concerns for himself, staff members and other patients. Active tuberculosis should be considered given complaints of chronic cough with an
Escalation of both clinical instability (tachycardia, tachypnea, hypoxia, etc.) and possible delays in consultation can be problematic in busy inpatient settings with many specialists and testing. It is important to create a culture of safety where all hospital staff feel empowered to seek help and raise concerns without negative consequences. When testing or consultation are not progressing as expected, a meaningful escalation hierarchy can help. Individuals who can assist in progression of care need to be identified before crises occur. These may be clinical leaders, physician advisors, medical directors, department chairs or CMOs depending on your institution. No one should feel that a concern can’t be addressed by going up the ladder. High quality and efficient care require this. Mindfulness of patient and staff safety issues should be encouraged. If appropriately empowered, this patient would likely not have an indwelling urinary catheter and might have been placed in a respiratory isolation room with respiratory contact precautions. ABOUT THE AUTHORS Dani Hackner, MD, MBA is pulmonary/critical care, chief clinical officer of Southcoast Health/SHG in Massachusetts. Marc Adler, MD, is a physician advisor in internal medicine, and medical director/physician advisor at NYU Langone Medical Center. Stephen Crouch, MD, is medical director of care management at Advocate Aurora Health System.
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Did You Know?
Do You Know The Nation’s First Hospital and Medical School? Pennsylvania Hospital, part of Penn Medicine, is the nation’s first hospital, and was founded in 1751. The University of Pennsylvania opened its School of Medicine, the nation’s first, in 1765. Also, the Hospital of the University of Pennsylvania was established in 1874 as the nation’s first teaching hospital. Penn Medicine has pioneered medical frontiers with a staff comprised of innovators who have dedicated their lives to advancing medicine through excellence in education, research and patient care. Penn Medicine physicians and scientists have participated in many important discoveries, including: • The first general vaccine against pneumonia • The introduction of total intravenous feeding • The development of magnetic resonance imaging (MRI) and other imaging technologies • The discovery of the Philadelphia chromosome, which revolutionized cancer research by making the connection between genetic abnormalities and cancer.
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ISSUE 70
Leadership of the case management department in today’s acute hospital setting is a demanding, 24/7 position. Vacancies in case management leadership positions are rampant. This article examines some causes and solutions to this problem.
LEARNING OBJECTIVES 1. Identify differences between unit-based director and case management director positions 2. Identify opportunities to improve the case management leader role 3. Identify rationale supporting elevation of case management leadership to the C-suite A recent review of open positions posted on Indeed for case management director positions revealed 1,773 open positions across the United States. The open positions were across the spectrum of healthcare settings (acute hospital, LTAC, SNF, home health, insurance companies, etc.). The same search on LinkedIn revealed 911 new listings in the past week. Sign on bonuses of up to $20,000, relocation assistance, and other incentives are found across the listings. Why is it so hard to attract candidates to this position? We’ve all been there and seen the same scenario many times. There is a vacancy in the case management department. You know a great floor nurse and suggest that he/she apply. What’s the usual response? “No way!!! You all work too hard.” “No way, I’ve seen what you have to deal with every day. Why would I want to do that?” The responses could go on and on with the same message. It isn’t just staff level case management positions that are hard to fill, management level (manager and director positions) are often even more difficult to attract qualified candidates. The director of case management role is a challenging one. The case management director and a nursing unit director share similar responsibilities. These include, but are not limited to, staffing, compliance, quality, patient/ family concerns and budget. In addition, case management is charged with management of LOS, readmission reduction, observation management, denial management and more. The case management staff is assigned to all
Case Management Leadership Recruitment and Retention Patrick O’Boyle, RN, BSN, ACM units of the hospital, including the emergency room. Transitions of care, BPCI and BPCI-A are new additions to the director of management’s growing list of responsibilities. As case management grows beyond the walls of the hospital, the case management director will need expanded authority and autonomy. The reporting structure for case management directors is often different as compared to other director level positions in the hospital setting. Nursing unit directors typically report to the Responsibility
chief nursing officer. The case management director may report to the chief nursing officer but may also report to the chief financial officer. In addition, the case management director often has a system-level leadership at hospitals that are part of a healthcare system. This dichotomy of leadership often creates challenges for the case management leader. Below is a comparison of [some] of the duties of a nursing unit vs a case management director: Nursing Unit Director
Case Management Director
Staff schedule
•
•
Staff evaluations
•
•
Staff licensure/certification Staff discipline
• •
• •
Compliance with Quality JCAHO, etc. Patient/family issues 24/7 accessibility/responsibility
• • •
• • •
Patient care quality Clinical expertise/bedside competence
• •
• •
Observation Management
•
•
Readmission(s) • Length of Stay (LOS) Denial Management Utilization Committee leadership Important Message from Medicare (IMM) compliance Medicare Outpatient Observation Notice (MOON) compliance
• • • • •
Staff in all units
•
Bundled Payment Initiatives (BPCI, BPCI-A)
•
Post-Acute Vendor management
•
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COLLABORATIVE CASE MANAGEMENT | ACMAWEB.ORG
COMPENSATION According to the 2019 American Case Management Association (ACMA) Hospital Survey, directors of case management appear well compensated. The data from the survey shows the average salary is $122, 860. Salary ranges across the country vary with the West Coast showing the highest salary. The salary range was $115,798 to $136,072. Indeed reflects similar data, reporting a base nationwide salary of $114,000. Using data from the ACMA, based on a 40-hour work week, the average per hour rate is $59, but a director level position is 24/7. Assuming a work week of 50 hours, the average per hour rate drops to $47 for a director level position! This simple computation shows the inadequacy of case management leadership compensation. The non-exempt staff case managers that a director oversees are often making more per hour than the salaried director (depending on the area). TURNOVER AND TENURE Case managers must have a strong clinical background. The current nursing shortage and turn over in nursing limits the qualified applicants for a case management position. According to the American Nursing Association (ANA) (2018), by 2022 there will
“27.7% of all new registered nurses hired left within one year” be more registered nurse positions available in the United States than any other profession. A 2018 Bureau of Labor report estimates an additional 1.1 million nurses are needed to avoid a worsening of the nursing shortage. Unfortunately, turnover and tenure in nursing are a significant problem. Per a 2019 National Health Care Retention report, 27.7% of all new registered nurses hired left within one year; 48.2% left within two years; and 73.2% left within five years. The report goes on to address hospital turnover, stating the average turnover rate in hospitals has increased by nearly 5% over the last ten years. Since 2013 the average hospital has turned over a staggering 85.2% of its workforce. The
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2019 report shows an average hospital turnover rate of 19.1%, the highest turnover rate in nearly a decade and an increase of 0.9% from 2017 data. Data from the ACMA 2017 Survey shows 40% of case managers have less than 5 years of tenure. Twenty-eight percent have greater than 12 years. Only 6% of responders to the survey report a tenure of 5-7 years. These numbers demonstrate a similar trend to nursing. Many registered nurses become a case manager but 60% leave the position before the five-year mark. This directly effects the “pool” of qualified case managers for leadership roles. OPPORTUNITIES/FILLING THE VOID What can be done to improve this situation? Every hospital has opportunities. C-suite intervention and support of the case management department is vital. A strong relationship with the C-suite can assist the case management director with opportunities/ obstacles to success. A few examples of this are: • Chief Medical Officer (CMO) intervention when needed to address physician practice • CMO intervention to address emergency room physician admission/patient status opportunities • Chief Nursing Officer (CNO) intervention to improve nursing unit discharge practices
• Ancillary department support to improve patient flow (ex. expediting observation patient testing) • Pre-admission cooperation to assist with IMM/MOON administration, patient status, inpatient-only procedures, etc. • BPCI coordinator assistance to improve post-acute care/reduce readmissions • Chief Financial Officer (CFO) assistance to address revenue cycle concerns
“…we have to support our care providers— physicians, nurses, nurse practitioners and others on the front line—in a way that ensures professional vitality.” According to an article by Jeff Lagasse in Healthcare Finance (July 14, 2017), Paul Esselman, senior executive vice president and managing director of Cejka Executive Search, states that adding new C-suite titles will emerge “as hospitals, health systems and medical groups become more linked, there will be a greater need to ensure patient care and experience is consistent across the continuum. Healthcare leaders will work more
ISSUE 70
with leaders outside the organization and in the communities, they serve.” The article goes on to quote Mark Solazzo, Northwell Health system executive vice president and chief operating officer, “Healthcare is changing rapidly. If you look at the wave of consumerism or the wave of regulatory oversight, those didn’t exist at the level they exist at today. An organization that says, ‘We can handle this with the people we have now,’ they’re not going to survive.” A re-evaluation of the case management director within the hierarchy of hospital leadership is warranted. The responsibilities of the case management director reach all clinical areas of the hospital and beyond. Elevation of the position to the c-suite is justified. An officer level role for case management will enable the department leader to enact change, act with greater autonomy, and address case management priorities efficiently. In an interview published in the Journal of Healthcare Management, Kenneth R. White, PhD, RN, FACHE, FAAN, associate dean, University of Virginia School of Nursing, brings up an interesting concept regarding “burnout.” He states: “…we have to support our care providers—physicians, nurses, nurse practitioners and others on the front line—in a way that ensures professional vitality. I choose the term ‘professional vitality’ as the opposite of ‘burnout.’ I see burnout a lot in my clinician colleagues, and I understand why it happens. The pace of care delivery and the requirements of electronic health record documentation and regulatory compliance can be overwhelming. The situation is not sustainable. We need to care for our frontline care providers.” “We also need to partner with providers and other stakeholders in the community to improve population health. It is no longer enough for a large health system to have a mission to provide acute care. We have to prevent people from needing to go to the hospital in the first place. We have to take better care of our patients who have multiple problems and comorbidities. It is not uncommon now for people to have 10 or 12 major medical comorbidities when they are admitted. The situation has become extremely complex.”
Dr. White’s comments reflect a change in thought process. Instead of trying to avoid burnout, we need to support our healthcare leaders and promote vitality. A focus on the positive things, what we are doing right, instead of missed opportunities and lack of resources. Dr. White goes on in the interview to discuss what can be done to improve healthcare professionals roles. He states, “We provide our care interprofessionally, but we do not teach it interprofessionally. We have made some strides in undergraduate medicine and nursing programs, but continuing education needs to become truly interprofessional. For example, nurses learn how to take care of patients at the end of life; physicians also learn how to deal with patients at the end of life—but they do not learn together: and they must practice as a team.
involved and supported. The patient experience will be affected by the culture of interpersonal support. The lack of qualified case management applicants has created career opportunities for experienced case managers and case management leaders. Travel nursing has been around for decades. But travel case management is a relatively new niche that is growing. The need for qualified case management staff is growing. As any attendee to the annual ACMA conference has seen, there are numerous companies actively seeking case managers to fill interim director, manager and case manager opportunities. Initially, small staffing agencies specializing in case management, health information management and coding worked at filling the void.
A team approach to healthcare supports all members. All levels of providers in a hospital need to adopt the team approach and
As the demand has grown, these (relatively) small agencies have been joined by other large staffing agencies who focused on bedside staffing. The expertise of these specialized agencies is valuable. Nursing staffing agencies are acquiring staffing firms which specialize in case management. In June of this year, General Healthcare Resources (GHR), a healthcare recruitment company, entered into an agreement to acquire HCTec, a case management/coding/CDI recruitment
care interpersonally. The results would be cyclic. Entry level positions recognize the support of senior leadership. Senior leadership sees the results of entry level positions feeling
company. The acquisition of HCTec’s expertise in case management, coding and CDI gives GHR an instant well-tuned tool to tap into the case management market. Also, American
To advance that practice, a much bigger emphasis needs to be placed on team science— the collaborative effort that leverages the strengths and expertise of healthcare professionals to address clinical challenges in patient care management.”
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COLLABORATIVE CASE MANAGEMENT | ACMAWEB.ORG
Mobile Nurses (AMN) recently purchased another case management staffing company to supplement their staffing options to include case management. These types of mergers will enable these companies to offer case management staffing solutions to their existing clients, as well as expand their bedside nurse staffing to the clients brought from the case management staffing firms. The interim leader role can be challenging. Hospitals requiring interim director or manager assistance have a case management
• Admit your mistakes. You are in a new environment, and you will make mistakes. Own them. • Meet with your leadership. Learn what their priorities are and the chain of command. • Visibility: Though the workload of the case management director is heavy, the interim director should round on the staff, be available to assist when they have difficulties. Attend multidisciplinary rounds.
• Full medical dental coverage • 401k options • Housing, travel (including air and rental car) • A daily per diem rate to cover meals, expenses, etc. • Flexible scheduling - you decide when you want to work. (i.e. you can take a week or a month off after completing a contract) • Valuable experience from practicing case management at various areas around the country • Paid time off • Travel points (the staffing company pays for travel expenses, but the traveling case manager earns and retains the points from air, hotel and rental car expenditures) CONCLUSION
department in crisis. The interim leader arriving into this situation must have confidence and skills. Success as interim is dependent on the interim leader having: • Extensive knowledge of case management • Transparency: the staff you are now leading need to see that you are committed to their success. They may have working without leadership for some time. Demonstrate you are part of the team but are also now in charge. Think of kids in school with a substitute teacher, you need to show that you are not just a “place-filler.” • Confidence: You are coming into a position where you don’t know the hospital, its politics or the players involved. You won’t know who to contact for issues and questions. Don’t be afraid to ask questions and solicit assistance from your staff and other hospital leaders for assistance.
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• Learn about your staff, meet with them to introduce yourself and learn a little about them. • Celebrate Success: As quoted earlier in this article by Dr. White, we need to act interprofessionally and support all the members of our team. Celebrate small success (an improvement in LOS, IMM compliance, decrease in call-outs, etc.) The travel case manager/case management leader can reap many benefits. The career of an interim case manager “consultant/traveler” can be very rewarding. It is an opportunity to explore our country. Assignments are typically a minimum of 13 weeks for a case manager. Leadership role minimums are usually longer, six months or more. The opportunity to spend months in a city/region gives the case manager a rare chance to truly learn and enjoy the local area(s). Benefits can include: • Higher pay rates as compared to full-time staff positions
Case management is a fulfilling, dynamic and exciting career choice. As case managers, we need to promote our staff, ourselves, our successes and our challenges. We need to support each other and help the new, inexperienced case manager. Adopting a culture of support is essential. The narrative we tell will be repeated by all our customers. By changing our point of view to one of celebrating success instead of dwelling on challenges and failure, we can impact the image of case management. A case manager can impact so many lives. The patient, their spouse, their children, their family, the community and the case manager’s coworkers. A positive approach to our career will improve the interaction and outcome with all the lives we touch. ABOUT THE AUTHOR Patrick O’Boyle, RN, BSN, ACM has been a case manager for over 20 years. He has been a unit-based case manager in all settings, a manager of case management and a director of case management. He has spent the last six years traveling as a case management consultant, providing interim staffing solutions at both case manager and management level positions. Most recently he is employed by HCTec, a case management consulting and staffing firm, as the corporate compliance officer for case management.
DRIVE PERFORMANCE IMPROVEMENT THROUGH EDUCATION The Transitions of Care Standards (TOC) provides a framework for organizations to assess their current care transition processes, review the current outcomes, and apply the new TOC consensus measures. The standards apply across all care settings and will identify opportunities to improve care transitions systemwide. ACMA has developed a suite of services to help systems better align with changes brought about by TOC. transitionsofcare.org
COMPETENCY VALIDATION Keeping People on the Right Path
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COLLABORATIVE CASE MANAGEMENT
A Peer-Reviewed Journal for Case Management and Transitions of Care Professionals ISSUE
70
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JULY
2019
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ISSN
2328-448X
In This Issue:
Recruitment, orientation, training and retention… everything you need to be successful
T H E O F F I C I A L P U B L I C AT I O N O F T H E A M E R I C A N C A S E M A N A G E M E N T A S S O C I AT I O N
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November 15-17, 2019 | Miami, FL | Loews Miami Beach Hotel
Spark innovation. Learn from the experts. Share strategies with the very best minds in case management and physician leadership. Learn about the vital role case management leaders and physicians play to improve patient care. - 38 Speakers - 16 Breakout Sessions - 16 CEs/CMEs - 4 Keynote Sessions - 1 Affordable Price Save $75: Register before September 15. Register Today: acmaweb.org/leadership #ACMAleadership