Resistance is futile: The case manager as a change agent

Years of training and education experiences have given me (I hope) a broad view of the case management landscape. Regardless of whether we work in the provider or payor sector, there are themes that appear to be common across the spectrum of our practice. Collectively, my experiences contribute to the editorials I have (and will continue to) post here.  Hopefully, these will focus more on the positive aspects of our practice. However, there are the less than glowing issues that we must recognize, evaluate, and correct if we truly hope to see case management continue it’s maturity into a profession of widespread acceptance.  Sure it would be nice to post happy stories about the wonderful work we do week after week but will that approach help us to advance if we are only willing to look at the smiley face of WIIWD? In that spirit, if a topic hits close to home my hope is that it might result in someone taking a look inward to consider if his/her walls are made of glass or perhaps a deck of cards.

Last time, I discussed the issue of complacency. Today’s post pertains to another scourge in our midst, Resistance.  Resistance is that next step on the scale pretty close to complacency in that complacency is more a passive acceptance of the status quo and resistance is an active refusal to accept change.

We have to stop overlooking resistance as a problem in our ranks because it hurts us in multiple ways. The resistor is perceived by his/her contemporaries in a negative light and s/he does harm to the face of case management as a whole because those who look to us to take the lead in coordination of care and resource management are sorely disappointed when confronted by the individual who resists collaboration simply for the sake of not wanting to change. You know the type…

  • The person who begrudgingly completes an urgent task and makes sure everyone know that s/he is doing them a favor
  • The person who mutters about a workflow change and quietly sticks to doing something the way s/he has always done it because that is the right way that it is supposed to be done
  • The person who obstructs rather than facilitates a transition of care because they did not get a form filled out perfectly so puts the request aside and neglects to just pick up the phone to ask a clarifying question
  • The person who skips a team meeting because they are “too busy” and sees their time as more valuable than that of the team
  • The person who enters a patient’s room and announces him/herself as a “case manager” whose job it is to get the hospital paid and the person out the door
  • The person who seems more put upon than flattered when a less experienced case manager turns to them for help with a complicated situation
  • The person who hoards their knowledge and experience and holds it over everyone else’s head to be sure s/he is recognized as the smartest person in the room
  • The person who won’t just come out and speak directly to a colleague about something that is on their mind but rather attributes their feedback to the amorphous collective we often refer to as “they”

Know the type?  Sure you do.  We all have someone we work with that is represented by at least one of those portrayals. Heck, I knew at least one personification of each of those vignettes at every single company I have been an employee of in my thirty odd years working in healthcare. Well folks, that is the person who is killing us slowly in the eyes of colleagues and patients alike. They are a pimple on the face of case management progress and if we hope to grow our ranks with new blood, we need to lance and drain the pustule rather than continue to place warm moist clothes on it waiting for the spontaneous burst.

Resistance is something that we as case managers address with our clients on a day-to-day basis but do we take a close look at ourselves to evaluate how we handle change?  By and large, I believe we do a good job of integrating change but not without grumbling. Don’t get me wrong. I am not saying that we should just lie down and allow the tractor to plow over us unquestioningly. Resistance is normal, but i believe  we can reframe the reason for our resistance into more constructive terms and end up with an even better outcome.

Instead of change being a personal inconvenience, take a step back and think about whether the change is a better, albeit a different way of doing something. Whatever the change impacts, we need to methodically look at the way something is and imagine the way it could be better because two things are for sure 1. nothing in healthcare is perfect and 2. everything in healthcare is changing so resistance is futile.

Sometimes I think that the professional case manager may have been a circus performer in a previous life because the really good ones seem to magically maintain balance on a unicycle perched on an inclined treadmill while keeping porcelain plates spinning all the while. We all know people like this, perhaps we are a person who possesses that amazing amalgam of gifts including (but not limited to) intellect, perspective, reasoning, clarity of communication,  organizational skill, grace-under-pressure patience, roll-with-the punches composure, and compassion for one’s fellow human beings that is brought out in the persona of the honest-to-goodness professional case manager. As I have said before, case management is a symphony of skills, not a solo performance. We have to curtail the diva impulse and keep our eyes on the real priority of our work – our clients.

Be it a change in a workflow process or a change in ourselves, the barrage of competing priorities that have to be juggled will continue unabated. Let’s make a promise to ourselves to always frame our resistance with a reason rather than react and rebuff the revolution at our doorstep.  Case managers are change agents so be the positive light that shines through brilliantly on our practice rather than the negative taste that lingers in one’s mouth like garlic after a big meal.

Until next time… get out there and creatively collaborate!

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