I was part of a team contracted to train a group of individuals working under the job title of case manager. A majority of attendees were registered nurses but there were a few social workers sprinkled in the mix. I had been looking forward to the experience for a couple of months and the day had finally arrived.
As we entered the classroom, the first thing that was apparent was that it was crowded. People were milling around trying to find seats and the technical staff was attempting to string together power strips to accommodate the need for plugging in laptops. Despite log ins having been sent out weeks ahead of time, instructors were quickly immersed in looking up numerous usernames and passwords. That was kind of the first red flag that there might be problems because people were supposed to have been practicing with the tools by that point. Well, despite all of the frenzy class began within about fifteen minutes of the scheduled start time. Though a bit of a rough start, things were still looking good for a very productive day.
Introductions complete, the first instructor launched into the process of transitioning previously taught theory into applied skill. Basic content was reviewed and a video vignette was played on the screen at the front of the auditorium. It was a large screen and rather hard to miss yet it was obvious that quite a few people were not paying attention. There was a large group sitting in the back who were blatantly talking throughout the presentation and video, others were responding to email, some were texting on their smartphones or browsing the internet…. but a handful of individuals managed to stay focused despite their colleagues’ extracurricular activities.
After the video was wrapped up, there was an interactive exercise that required people to work in pairs. That was when the muttering started… “This is stupid”, “This is a waste of my time”, “I can’t believe this”, “I know how to do my job”, and so on. As an educator, I am used to a certain level of resistance. I don’t take it personally; it is a normal reaction to change. To the credit of a few, there were individuals who were engaged, clearly grasping the principles, and attempting to work through the case example with the support and encouragement of the instructors. Efforts were made to help steer participants toward resolutions when they seemed to hit a barrier, but frequently the advice was met with an argument or my personal favorite, “I’m just going to do this may way”. And so day one followed along the agenda and we wrapped up within a reasonable period of the anticipated end time. The reader’s digest version of day 2 … pretty much a replay of day 1 minus the initial computer problems.
I have spent considerable time thinking about the events of both days trying to determine where disconnects could have been bridged, how material might have been delivered differently, how geo-cultural influences may have had a hand in the situation, and how the class could have been better prepared. What really bothered me was that tens of thousands of dollars seem to have been wasted by an organization that was trying to provide a learning opportunity to their staff. But the content was dismissed in a rather offhanded manner by quite a few people because they simply could not (or perhaps did not want to) see an immediate applicability of the approach for the patients with whom they worked.
What I saw those two days raised the bar on the level of resistance and obstinacy that I previously experienced as an educator. Even with the benefit of time passing since the experience, I still find myself comparing the behavior encountered to that of stubborn, spoiled children not getting their own way. Though it was discouraging to see a group of reportedly educated clinical professionals conduct themselves in such a manner, the subsequent thoughts gave me even more cause for concern. These individuals, working under the title of case manager, interact with complexly ill, high risk patients. i have to wonder what quality of interaction they experience. I shudder to think of it being anything close to what I saw. It is sad to think that for some people, that is the face of case management. That is a real shame.
I firmly believe this group was a minority and not representative of professional case managers in general. I have the pleasure of knowing hundreds of case managers and they are extremely caring people who are compassionate and poised in all of their interactions. Perhaps the most important characteristic common to those I know is that none of them are foolish enough to believe that they know everything. They keep their minds and their ears open to new concepts and are forever finding better ways of doing things to make their patients’ experiences better than they would be without case management support.
This is a heads up to anyone who feels they are at risk of sinking into complacency in their approach to work. Health care is always changing… consumers expectations are on the rise… and case managers are being viewed by many as a critical factor of successful patient-centered care coordination. I believe that an overwhelming number of case managers are up to the challenge being placed before them. The essential element that we must remain mindful of is to never fall into the pit of thinking that we know it all or that do not need to consistently and continuously improve the quality of the service we bring to the health care team.
Now get out there and creatively collaborate!