Amidst all the talk about how to improve quality, efficiency and efficacy in healthcare these days, case management sometimes feels like the best kept secret. Those of us in the field know without question the difference that case management makes to those for whom we advocate, in particular patients with complex cases or multiple co-morbidities. Yet at times case management seems to occupy an understated position while newer and sometimes nearly synonymous terms such as care coordination take the spotlight.
To understand why, we need not look beyond ourselves.
Clarity in Definition
Across the spectrum of health and human services, case management is made up of professionals who, by their nature and vocation, are nurturers and caregivers. We expend so much emotional energy giving to others that self-promotion seems both unnatural and too much work. Few of us have the extra energy it takes even to contemplate the difference we make to our patients, employers, profession and community.
That, however, is precisely what we need to do. As case managers we need to “toot our own horn” individually and collectively to promote our practice to our patients/clients, our employers, the healthcare teams with which we collaborate, and within the broader community of healthcare practitioners. Case managers from every discipline and background must capitalize on the ongoing healthcare reform discussion and become informed and empowered participants in the debate. Unless we make our voices heard, we run the risk of getting lost in the ever-widening chorus of job titles and roles, such as care managers, care coordinators, patient navigators, guided care nurses and the like. We need to draw attention to the important roles that case managers fulfill as patient advocates and stewards of scarce and costly care and treatment resources.
The 2009 Case Manager Role and Functions Study conducted by the Commission for Case Manager Certification (CCMC) revealed the essential activities and knowledge areas that define the practice of case management. Essential activities are identified as case management process and services, resource utilization and management, psychosocial and economic support, rehabilitation, outcomes, and ethical and legal practices. Knowledge domains determined by the study are case management concepts, healthcare management and delivery, principles of practice, psychosocial aspects, healthcare reimbursement, and rehabilitation.
As the role and function study findings reveal, case managers contribute their knowledge and expertise in meaningful ways in the pursuit of desired clinical, financial and patient-satisfaction outcomes. Moreover, those who are certified case managers go the extra step to attest to their professionalism, commitment to continuing education, and adherence to a strict ethical code. These are the qualities that case managers should showcase in order to differentiate the practice against an increasingly confusing backdrop in which nonclinical people in largely administrative roles are sometimes called “case managers.”
Respect Through Professionalism
At the same time, case managers need to take a close look at their professionalism to ensure that we hold ourselves accountable to the highest degree of professional and ethical behavior. Because of our roles as advocates and our natural inclination to take care of others we may be tempted to “cross the line” when it comes to human relationships.
Even with the best of intentions, it is very easy to blur professional boundaries, such as giving a patient/client a ride in one’s own car, inviting that person to a worship service at our church, or adding the person’s name to the prayer list. In order to command the respect of others, particularly members of the healthcare team, we need to present ourselves in a professional manner in how we dress, interact with patients, and explain the scope of case management services and our role as the case manager. Furthermore, we are not just clinicians, we are also businesspeople who must be accountable for the full scope of our responsibilities, including submitting complete and accurate reports, communicating in a timely fashion and even billing on time.
Beyond individual accountability, there are other ways for case managers to become involved for the good of the practice. Through professional organizations case managers can attend professional conferences to keep abreast of the latest developments in the field. For certified case managers, for example, CCMC offers opportunities to volunteer one’s time and talent in a variety of capacities, such as item-writing workshops to support the certification examination.
Receiving the credibility that case management deserves will not happen if we fail to recognize and communicate our value. In the midst of critical debate around healthcare delivery, case managers cannot afford to stay silent. We must speak up and let our voices be heard.
Jolynne Carter, BSN, RN, CCM, is a past chair of the Commission for Case Manager Certification (www.ccmcertification.org). She is also Associate Vice President, Network Services, Paradigm Management Services, LLC. (firstname.lastname@example.org)