Welcome to 2016

Technology and the Internet are wonderful tools for communication and interaction. However, both can grow to be masters instead of servants of those seeking to leverage their power. Recognizing that its Internet presence had grown beyond its usefulness and become more burdensome than valuable, Ascent Care Management, LLC is consolidating to a single site here at WordPress.

This exciting development kicks off 2016 allowing a more focused effort to grow CM World into a more regularly published editorial feature blog. More importantly, this site serves as a central point of communication about COLLABORATE® for Professional Case Management: A Universal Competency-Based Paradigm (Treiger and Fink-Samnick)  which is available at Wolters Kluwer, Amazon, Barnes & Noble, and other fine resellers.

Please take a moment to peruse the expanded web pages and watch for more news about the COLLABORATE® for Professional Case Management paradigm soon.

Do Health Care Consumers and Caregivers Understand The Difference Between Support and Abuse?

Recently, I witnessed a rather disturbing chain of events while on vacation with my spouse.   As I previously shared, my husband is disabled following a stroke in 2014. After a year of rehabilitation we resumed traveling, mostly cruising. We purchased a collapsible scooter to make getting around the ship and some of the ports a bit easier.  In all honesty more often than not he walks around the ship using a quad cane and enjoying his independence.

A big part of cruising revolves around taking excursions upon reaching port cities. We’ve applied a measured approach as to our activity. If either of us is not up to it, we simply cancel a tour rather than grit our teeth and soldier on through it. We don’t prod each other into overdoing something. This approach has worked well for us because we exercise good judgment and respect our physical tolerances. But just the other day, we witnessed two gentlemen join one of our excursions; one of whom should have been in a hospital or skilled nursing facility.  Even the untrained eye saw how much he struggled and more than a handful of fellow passengers were distressed with what was going on. However, his traveling companion (be him friend or relative) appeared to be oblivious or unaffected by the situation and continued to push him…. literally.

He pushed him up the stairs of the bus, pushed him into the seat (which was directly behind us), and pushed him out of the bus once we arrived at our tour destination. Mutterances such as “come on, do it” or “just keep going” were clear enough to hear. As the older man passed our seat, a number of us saw that he was incontinent and his blue jeans wet and the zipper left down.  Another gentleman traveler pointed this out to the companion who only responded with “yeah, it’s a bit too late for that”.  It was not a matter of misunderstanding what had been pointed out, he spoke clear, unaccented English. It broke my heart that the man just did not appear to be mindful of his companion’s physical state, nor that his dignity was suffering a massive blow… even if he may have been too confused to realize it.

Once seated in the row behind us, the older man’s labored breathing, congested cough, and incontinence were cause enough for me to alert the tour guide of my concern. She made an inquiry prior to departing the terminal but the companion insisted he was doing the right thing because he was told “he needed to get out and keep active”.

So what does this have to do with case management?

Granted, I was not privy to any of the clinical facts regarding the man’s health nor the context in which the instructions were given. Basically, it is impossible to know what was said or not said but in the back of my mind I could hear the voice of a well-meaning health care professional dispensing a generalized recommendation of increasing physical activity  at an office visit or as part of transition plan instructions. Case managers participate in countless team meetings to discuss client status and progress. We espouse the importance of caregiver involvement in recovery from illness. We urge caregivers to allow their loved ones time and space to make their own efforts and to praise  attempts to regain self-sufficiency. However, are we being clear enough and is that lack of clarity increasing the risk of unintentional abuse and/or neglect by caregivers?

In this instance, if taken at face value it occurred to me that the companion may have misinterpreted fairly common instructions which are given and intended to relieve caregiver anxiety as to what they should and should not do for the recovering patient. Additional study into what we think we are telling our clients versus what they are hearing may prove quite illuminating and serve as a gateway to meaningful change in our we teach and coach. Does it mean we need to change our entire approach to providing care instructions? No, but we probably need to make a few adjustments.

So the next time you are care planning or explaining discharge instructions with a caregiver and client, consider the following…

  • Assess – Ask a few questions as to what are the usual activities in which the individual participates and if there are any upcoming events such as travel, etc. which might be out of the ordinary.
  • Provide context – When providing instructions, place them into contexts that the client and caregiver understand. For example, if the client normally climbs down a flight of stairs to get to the mailbox, make sure the physical therapist weighs in on whether this is something the person should resume doing straightaway.  In the case of international travel, this requires a bit more discussion with the care team, treating provider, family, etc. Travel plans can be postponed. In this case, a letter from the provider could help in getting a postponement on the trip and perhaps a full refund.
  • Verify understanding – Be sure to apply “teach back” methodology to ascertain if the receiver of your message understands your meaning. If you do not verify understanding, you may as well have not bothered to provide any instructions.

As with any situation, there are exceptions. In spite of our best efforts, we cannot force our will upon others; people will do whatever they want to do. I do not know what became of the gentleman, nor his traveling companion but I certainly hope that they both made it back home safely.

Best to you,
T.

Conscious Case Management©

In today’s harried health care environment, every participant of the patient care team seems to be rushing from one situation to the next, simply trying to put out proverbial fires. Often, there is someone associated with the care team whose job title is case manager, care coordinator or something similar. Actually, there are probably two or three people working in a similar capacity who has some level of interaction with the care team.

The sad thing is that no one seems focused on the big picture. Instead each struggles to keep up with their job’s demands. BUT through the miracle of the Electronic Health Record as long as every box is checked or drop down menu is selected from, people feel a false sense of reassurance that the work is done.

Well, I beg to differ with this conclusion.

Professional case management is about more than simply checking off boxes in the medical record or whatever information system one is working in. The Commission for Case Management Certification (CCMC) defines case management as “a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet the client’s health and human service needs. It is characterized by advocacy, communication, and resource management and promotes quality and cost-effective interventions and outcomes” (2015).

Frankly, none of these actions can be encapsulated by a check list. Each require a qualified clinical profession to take a step back and objectively assess each patient’s situation in order to formulate clear recommendations for patient-centered care coordination. The patient with special needs requires a case manager able to sensitively advocate on his/her behalf, to logically discuss pros and cons of each option, and to collaboratively reach consensus as to the most appropriate interventions as part of the patient’s care plan.

Professional case management process requires one to practice in a mindful manner. In other words, effective, professional case management is Conscious Case Management©. Conscious Case Management© is fairly easy to recognize but difficult to embody. It requires a clinical profession who is committed to practice excellence as evidenced by continuing education, certification, and advancement of professional case management practice. While we are not all driven to author articles and books or speak in public or participate in a professional organization, we must take personal responsibility to contribute to the practice by striving for day-to-day excellence and quality care. We must look beyond medical record and room number and diagnosis code to see the face of a human being who needs our very best in order to become his/her very best through as full a recovery as is possible.

Avoid falling into the pit of being a case management-bot. Instead, strive to become a Conscious Case Manager©.

___

Definition of Case Management found at http://ccmcertification.org/about-us/about-case-management/definition-and-philosophy-case-management on April 15, 2015.

The Leadership Competency

The competency of leadership is integral to the COLLABORATE© model. But I wonder if how we define or perceive leadership impacts the way in which each of us, as case managers, embody it.

Chemers defines leadership as “a process of social influence in which one person can enlist the aid and support of others in the accomplishment of a common task” (1997). Peter Drucker wrote that “management is doing things right; leadership is doing the right things”. Having worked within a number of large corporations, I can honestly say I subscribe to Drucker’s view because I have worked under many managers but can count the number of real leaders on one hand.

Earlier this year, I read an article in Psychology Today and this excerpt about being a leader stuck with me, “being the leader does not always mean you deserve to be the leader. And just because you are the leader does not mean you have a right to lead others. You have been granted the privilege to lead others. Being the leader means that you have been placed in a position to serve others—your customers, investors, your team…” (Sindell & Sindell, 2013).

This got me to thinking about leadership as it relates to being a case manager. My clients place me in various leadership positions. A patient-client confers on me the right to foster them (or their loved one) through the maze of complex health care. As a consultant, clients compensate me to lead through education and behavioral example.  As a public figure, I was (and still am) expected to represent the concerns of the many, as opposed to the interests of a few, in order to further the recognition of case management. But how do I personify leadership internally? How does the leadership competency exhibit itself in my day-to-day interactions? And subsequently, am I worthy of the privilege of leadership? I believe those to be essential questions that every case manager must consider for themselves.

For those reading this who do not consider themselves a “leader”, perhaps that is because you are confining your definition to a more bureaucratic construct. Leadership has nothing to do with an organizational chart. That’s simply a management structure. In COLLABORATE©, it is recognized that “When addressing the leadership competency, it is essential to remember that case management leadership happens in every aspect of practice and professional identity—from academia and professional associations where formal education and training provide the theoretical and practice foundation to supervision and management where policy and procedure reflect practice standards and evidence-based research to the front-line where effective and efficient hands-on coordination of care is based on skill strengths and abilities guided by client goals in partnership with a professional case manager and health care team” (Treiger & Fink-Samnick, 2013).

We need to start deconstructing our beliefs about what authentic leadership is all about. It isn’t being the president or the manager or the director.  For those who rely on those titles as a conference of power, think again.  People will not follow you if you do not demonstrate a reason why they should do so. Perhaps if we look at followership, it may help us to identify critical needs for case management leadership. Bersin (2013) identifies three points of followership:
1. We follow people with character because they have a moral compass.
2. We follow people who help us grow because they respect and bring out the best in each of us, help us do great things, and help us understand how to overcome our own weaknesses.
3. We follow people who have their own unique strengths and weaknesses, which make them real.

For a long while, I did not spend much time analyzing the qualities of why I found some people worthy of following. In retrospect, it seems that it was more an issue of personal influence and charisma.  If I heard or read something that struck a chord in the context of my experience or beliefs, I tended to becoming a disciple (more or less) of that person’s doctrine.  But if experience has taught me anything, it is to take the time to scratch beneath the veneer of what gets pushed out for public consumption to make sure my eyes are wide open. When I have blindly followed, I have regretted it, more often than not.

So with that in mind, I consider the approach that I utilize with any patient-client because I have the expectation that they will initially follow me as we proceed down the case management process path inclusive of assessing, planning, implementing, coordinating, monitoring, evaluating, and eventually disengaging. As we scratch below the surface and establish our relationship, I understand more of what each person needs, what their barriers are, how best to leverage their strengths, and most importantly how to build their self-confidence to take the reins in the hope that they will eventually manage their own health care, or at least take a more invested role in their care. I tell each person what I plan on doing, and do what I said I would.  I negotiate with each as to what they are going to do, and expect them to do what they agree upon.

So what does this come down to? Well for me, it means maintaining a level of professional integrity so that it is worth the time and effort of followership, be it a peer, a patient-client or an institutional engagement. If you believe that people will buy into something you say (or write) simply because of who you are or that you tell them to do it… think again! Today’s “client” seeks a reason to follow; some evidence of you being worthy of their loyalty and commitment. If I do not display character, do not demonstrate respect for others, ignore my own personal weaknesses or consider myself invulnerable simply because of who I am or a position I occupy, it is a recipe for my ultimate failure.

So turn this around and consider this… Instead of thinking that you are a good “leader”… ponder a while on the question, are you worthy of being followed?

Now get out there an COLLABORATE©!

_____

Bersin , J. ( 2013 ). To understand leadership, study “Followership.”
Retrieved April 23, 2013, from http://www .bersin.com/blog/post.aspx?id=cd24d918-3848-4223-96ee-b01de41d5eec.

Chemers M. (1997) An integrative theory of leadership. Lawrence Erlbaum Associates, Publishers. ISBN 978-0-8058-2679-1.

Sindell, M and Sindell, T.H., (2013). The Golden Rule of Leadership.  http://www.psychologytoday.com/blog/the-end-work-you-know-it/201306/the-golden-rule-leadership

Treiger, T.M. and Fink-Samnick, E. (2013). COLLABORATE©: A Universal, Competency-Based Paradigm for Professional Case Management Practice, Part II; Professional Case Management, 18(5), 219-243.

Devotion to Lifelong Learning

Over the past year my valued colleague, Ellen Fink-Samnick and I have launched a new competency-based model of professional case management practice. COLLABORATE © (2013). Our first article was published in the May/June issue of Professional Case Management and the second was just published in the September/October issue. While there are eleven (11) competencies, the one I wish to highlight in this post is that of Lifelong Learning.

While I do not often support the use of absolutes (e.g., always, never), I firmly believe that professional case managers should engage in a continual pursuit of intellectual enrichment. A case manager who considers him/herself a professional should adhere to the long-established and accepted Case Management Society of America’s Standards of Practice for Case Management which so strongly supports the importance of maintaining one’s competence that an entire Standard is devoted to Research and Research Utilization, “The case manager should maintain familiarity with current research findings and be able to apply them, as appropriate, in his/her practice” (2010).

This fall, I returned to the world of formal higher education and enrolled at the University of Alabama’s Capstone College of Nursing. It seems only appropriate as I devote my career to advancing case management. The first class I enrolled in is Nursing Informatics which focuses on the management and use of information for advancing nursing practice.  It is a fundamental and important course to begin with as it lays the foundation on which I plan to build ongoing study… but back to the COLLABORATE model and Lifelong Learning.  The key elements of this competency are:

• Academia and advanced degrees
• Professional development
• Evolution of knowledge requirements for new and emerging trends (e.g., technology, innovation, reimbursement)
• Practice at top of licensure and/or certification
• Acknowledgment that no one case manager can and does know all

(Treiger and Fink-Samnick, 2013)

It is certainly true that given the variation of our work environment, we find ourselves in places of learning every day. I challenge colleagues who do not feel as if they learn something new each day at work that it may be time to find a new job. Whenever I found myself in a position where I was less than satisfied with any aspect of the job, I looked for something that had more promise of helping me advance my personal goals.  The reasons for dissatisfaction could be a lack of managerial support or simply lack of understanding as to what case management really was. Whatever the case, I did not allow someone else’s shortsightedness to impact my long-term goals.

But what if the issue is more that our place of work does not value our pursuit of knowledge in order to improve ourselves? I often wondered why such a disconnect existed because whatever I learned found its way into practice, ultimately benefiting my clients (their members) and hopefully my fellow case managers and care coordinators. This may present a bit of a conundrum to some but it is a personal commitment to professional growth that overrides the downside of a less than supportive employer… and so I continue my academic quest and strive to embody a competency that is essential to professionalism in case management.

Perhaps that is why I now work for myself?

___

Case Management Society of America. (2010). Standards of Practice for Case Management. Retrieved from http://www.cmsa.org/SOP

Treiger , T. M., & Fink-Samnick , E. ( 2013 ). Collaborate © : A Universal, Competency-based Paradigm for Professional Case Management Practice, Part II: Competency Clarification. Professional Case Management, 18 ( 3 ), 122 – 135.

Case Managing Ourselves© Update

Greetings and salutations,

It is coming up on a month since the CMSA National Conference held in New Orleans. The initial post-conference frenzy has subsided and most everyone I know who attended has returned to the reality of our “regular” lives. I say regular but in no way are our lives ho-hum. We case management professionals make a difference in the lives the people we work with each and every day. The annual pilgrimage to case management mecca is an opportunity to renew ourselves in the healing waters of shared spirit, knowledge, and understanding that our work is essential to the success of health care. Anyone who takes issue with that or who fails to give credit where it is due is sadly misguided and uninformed as to what authentic professional case management is really about.

One of my concurrent session presentations at the conference was entitled, Case Managing Ourselves: When You Are Caring for Others, Who is Caring for You? A Goal-Driven Self-Care Plan. I reported the results of surveys conducted through Ascent Care Management early in 2013 and shared some personal perspectives as to how I undertook the challenging work of Visionary Self-leadership© to improve my own health and wellness. The session was extremely well received. As a matter of fact, it was the most frequent reason people stopped me to chat during the course of the conference! Personally, I was gratified that others understood my personal struggle, as well as validated what I suspected for so long – I am not alone in facing challenges to a more healthful way of living. Regardless of the issue one faces, it is clearly more difficult to care for ourselves than it is to serve the needs of countless strangers.

Let me share some of the survey results…

Respondents were overwhelmingly female and over the age of 45 yrs. I suspect that is not a surprise to anyone reading this. Over 66% of respondents worked in acute hospitals, health insurance companies/health maintenance organizations, or for a worker’s compensation company.

How much continuous sedentary time do you spend at work (e.g., desk work with only activity being to retrieve a fax, restroom break)?
Answer Options Response Percent
0-1 hour 4.9%
1.1-2 hours 7.3%
2.1-3 hours 4.9%
3.1-4 hours 0.0%
4.1-5 hours 17.1%
5.1-6 hours 9.8%
6.1-7 hours 24.4%
7.1-8 hours 12.2%
More than 8 hours 19.5%
Do you take time to exercise every week, optimally for at least 30 minutes?
Answer Options Response Percent
Yes, I exercise 7 days a week. 2.4%
Yes, I exercise 5-6 days a week. 17.1%
Yes, I exercise 3-4 days a week. 24.4%
Yes, I exercise less than 3 days a week. 9.8%
No, I do not exercise regularly. 43.9%
Other 2.4%
Does your company have an onsite exercise program, gym, or fitness benefit (e.g., gym membership, incentive discount, access to wellness coaching)?
Answer Options Response Percent
Yes, and I participate/use it regularly. 17.5%
Yes, but I do not participate/use it regularly. 2.5%
Yes, but I do not participate/use it. 20.0%
No 47.5%
Other 12.5%

These are just three (3) of the questions posed in this informal survey, but perhaps you are picking up on the alarming themes of non-engagement.

  1. A majority of respondents are sedentary for at least 4 hours at work.
  2. All respondents work in the health care industry.
  3. Almost half of respondents’ employers do not provide a fitness benefit or access to wellness coaching.

Future articles that I have authored/co-authored on this topic are slated to appear in Professional Case Management and Case in Point. These all speak to the growing un-wellness within the ranks of case managers in the United States. From what I see, it is safe to say that if we do not start to address our own lifestyle issues, there won’t be many of us left to care for those countless strangers. Couple that with the fact that there is a recognized shortage of incoming case managers and the field of case management is facing the dire consequence of extinction.

It is time to take action.

It is time to start Case Managing Ourselves©

Will you join me?

Best of health,
Teri

The current top reason cited as affecting professional Case Management practice is…

“The variation among individuals working under the case manager job title who are not  actually performing the full scope of case management roles, functions, and activities (as defined by the Standards of Practice offered by the Case Management Society of America).”

This is not surprising to me. There is a massive problem with misuse of the “case manager” job title and it is worsening as more organizations start to apply it to positions seeking non-clinical and unlicensed administrative staff who coordinate services for their clients. While it may sound “cool” and market more effectively, this practice does a grave disservice to the consumer.

Consider this… as a patient, the consumer is greeted by a steady stream of new faces throughout the care continuum. From the hospital to their insurance company to any other care setting, there will invariably be someone identifying him/herself as a “case manager”. But what does this really mean to that consumer?  If the interaction is positive, it probably means a favorable impression of what a case manager is and does.  But what of the less than positive experiences?

As I discovered at a visit to a Senior Center where I spoke about case management, for many it resulted in creating a negative opinion about ALL case managers without a real understanding of what authentic case management means. Interestingly, when I attempted to share information as to the definition, qualifications, and activities of case management, many in the room were not willing to accept that as truth.  Their personal experience overrode anything I said.  Unfortunately, many of the attendees had stories to share regarding negative experiences of a family member or friend with a case manager. More than once, I heard accounts where case managers described their work responsibility as being “to get them out of the hospital and to make sure the hospital gets paid”. Can you picture me falling over backwards at that revelation?  I almost did!

In 2011, an article I penned for the Remington Report included the point that “In order to establish and maintain a consistent definition of case management, it is necessary to codify it in such a way as to prevent the continued misuse of its title and functions. This begins with a standard definition, originating from subject matter experts, to be used as a common point of reference. The most widely accepted definition was approved by the Case Management Society of America in 2009 as  “a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality cost effective outcomes”. Despite attempts to redefine the term for a specific purpose or use by companies, organizations, agencies, and other entities, this definition remains the gold standard.”

This definition, in conjunction with Standards of Practice, must set the foundation for establishing a clinical professional practice track of education, work experience, and accreditation/certification, all of which are necessary for case management title recognition. Until those of us who dedicate ourselves to the professional practice of case management unite and make enough noise about this, we risk continuously treading water in a vortex that will eventually suck us under the waterline.

Now get out there and collaborate!