DorlandHealth

Richard Scott

In this inaugural edition of The CM Insider section of Case In Point Weekly—a section that will bring readers face to face with thought leaders across case management settings—we sit down with Marcia Colone, Ph.D., ACM, the director of UCLA Health System’s Care Coordination Department, to talk about her department’s guiding principles and key concepts, including advancing the plan of care and escalation.

Richard Scott: First of all, congratulations on your new role with UCLA Health System. How has your transition been so far?

Marcia Colone: My new role as director of care coordination at UCLA Health System started in May 2008 when I crossed the threshold of the new hospital due to open in June. UCLA Health System is rated by World News and Report as third in the nation. Its reputation is well earned as a world class medical facility. The opening of the long-awaited new building heralded a new beginning for the organization and for me as I began my new role as director.

The Department of Care Coordination was formed in 2005 and experienced many changes in leadership and focus. With nearly 100 staff, comprised of RN case managers, social workers and discharge planners on two hospital campuses, the respective roles were clarified and the vision was renewed upon my arrival.

RS: I understand you have a guiding principle at your organization. Can you talk about this principle and what it means.

MC: The department’s new guiding principle is that of “advancing the care plan.” The premise of this principle is that a patient’s care plan is constantly in motion, ever-changing and in need of being managed. The central question is—what needs to happen today so that the care plan can be advanced?

RS: How do you incorporate the principle into your daily practice?

MC: This question is raised at our twice-daily rounds and each team member answers the questions from their respective role. The care plan is shepherded by the RN case manager who ensures that the plan is reviewed, updated and communicated to the team to ensure its progression.

The care plan is the “source of truth” for the patient/family and health care team. When the team is in alignment, the plan’s progression can be monitored and adjusted as appropriate. Our RN case managers have a clear understanding of the patient’s clinical status and a primary focus on efficiently moving the patient through the hospital stay to a safe-discharge using a newly developed process called “high intensity escalation”.

RS: You see the concept of escalation of prime importance to case management. Can you describe escalation?

MC: High intensity escalation defines the concept of escalation as an interventional process. The process is used to anticipate, identify and eliminate barriers associated with the care and discharge plans. Case managers makes an assessment of the level of escalation needed based upon criteria such as the nature of the barrier, what interventions have already been attempted or failed and what are the next steps needed to ensure resolution.

The case manager decides whether to escalate the issue/barrier or coach the team member on how to further escalate the issue. Either way, there remains an expertise and tenacity which requires judgment to initiate the process and follow through to its completion.

RS: Can you provide an example of escalation protocol and how it pays off.

MC: An example of high intensity escalation is the patient who needs a final physical therapy visit before the physician will discharge. The physical therapist is uncertain what time she will be able to conduct the final assessment so the case manager pages the therapist and asks whether another therapist is available to ensure that the discharge occurs today. If the case manager had accepted the initial response from the case manager, the patient’s discharge would have been uncertain.

RS: How do you see case management progressing in the near future?

MC: Contemporary case management practice requires breakthrough innovations that facilitate patient flow and team development. Steady improvement in practice is no longer acceptable. As leaders, we must advance practices that are bold, provocative and lead to operational innovation in the hospitals we serve. UCLA’s Care Coordination Department is clearly on its way.