1. Section Editor(s): Powell, Suzanne K. MBA, RN, CCM, CPHQ

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It started out as a fairly innocent question to the PCM Journal Editorial Board Members: What is the ONE "holy grail" of case management that you deem to be non-negotiable? Some answered by alluding to ROLES:

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* Advocating for the patient


* Owning the discharge/transition process


* Resisting the Dark Side


* We must not give away our CORE functions


* Facilitating patient empowerment


* Deliver client-centric care



Others answered by alluding to NEEDS, both now and in the near future:


* Title Protection


* Independent Practice


* Using the Standards of Practice and Code of Ethics as our framework


* Role of CM recognized as a distinct area of expertise


* Staying 'in the game' as the national agenda shifts



It turns out that finding the essential characteristics of a case manager is quite messy, given the evolution of health care and confusing array of titles and models. There is a difference between case management roles, functions, and activities (tasks). But does that mean that each role, function, activity, or task should have its own "TITLE"? Among the many titles that occur in current literature encompass (various aspects of) "case manager" roles, responsibilities, characteristics, skill sets, characteristics, and activities. Here are some of the more well cited:


* Care Coordinator


* Case Manager


* Care Manager


* Clinical Resource Coordinator


* Guided Care Nurse


* Health Coach


* Medical Home Care Coordinator


* Patient Navigator


* Patient Motivators


* Resource Coordinator


* Resource Manager


* Transition Coach


* Utilization Manager



And these are just a handful of those being used in current literature. Here I must interject the concept of "Gestalt," which is described as the "essence or shape of an entity's complete form." It is a structure, configuration, or pattern of physical, biological, or psychological phenomena so integrated, as to constitute a functional unit with properties not derivable by summation of its parts; or, more commonly described with the phrase "The whole is greater than the sum of the parts."


When I was a child, we had little tests in books where we were instructed to connect lines from List "A" to List "B." In that fashion, I made a list of some of the new "titles" (List "A"). List "B" include some of the tasks that case manager performs and I connected lines. You can see that it appears a new title emerges with each new task! Has the whole of case management's gestalt been fragmented? If so, I submit that a primary vulnerability to case management may be the plethora of functions-turned-titles.


In its second annual "Managing Care Transitions Across Sites" e-survey, conducted in May 2010, the Healthcare Intelligence Network captured the essentials of care transition management from 87 health care organizations. The survey identified the top coordinators of care transitions.


Survey Highlights include: Nearly 52% of respondents use case managers as their care transition coordinators.


* About 28% of respondents have discharge planners as their coordinators.

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* Almost 27% have nurse practitioners.


* Of the 22% of responding organizations who answered "Other," some are using RNs as their coordinators.


* According to 15% of respondents, a transition coach or social worker is their care transition coordinator of choice.





There are "essential" characteristics that case management must never, ever give up or negotiate away. Further, we must recognize and proclaim that the gestalt of case management is more than the sum of its parts. Teri Treiger, President CMSA 2010-2011, sums these Editorial thoughts up completely and eloquently.


Efforts to fragment the unified skill set of case management into individual elements and turn them into stand-alone "professions" is one of the biggest threats to building recognition of, and consistency in, the professional practice of case management.


The strength and value of case management is in the holistic and comprehensive approach to working with each individual person (and caregiver). Similar to a symphony, each individual instrument contributes to the whole. While I love the beauty of a solo, it is the sum of all instruments that packs the power in a piece such as, Ode to Joy. Case management is a symphony of skills, not a solo.


During this special week that nationally recognizes case management, let it be known that whatever we are called, "Case management is a symphony of skills, not a solo."


Suzanne K. Powell, MBA, RN, CCM, CPHQ, is Editor-in-Chief, Professional


Case Management.