1. Powell, Suzanne K. RN, MBA, CCM, CPHQ


Disengagement causes a host of problematic behaviors that can lead to poor staff performance and patient safety or quality issues. There are 2 broad kinds of engagement: individual and organizational; this Editorial is about individual engagement.


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The end of each year is a time when we reflect on our lives and consider making changes (also known as new year's resolutions). The joy of the holidays may be mixed with sadness or burnout, and this can be a reliable cause of disengagement. Disengagement can lead anyone down the slippery slope of bad behaviors, up to and including (but not limited to) depression, absenteeism, poor quality of work, forgetfulness, and ornery-ness. For our patients/clients, the case manager may be less productive and this may even lead to quality and patient safety issues. Almost as important, life is just no fun in this disengaged state.


Being "motivated" and being "engaged" may be two very different states. "What is your motivation for working?" would seem like a good starting question, and it can lead you to valuable insights. But being motivated does not necessarily translate into being engaged. For example, one answer to this question may be, "I am motivated to get a paycheck and have health care for my family, so I come to work every day." This is an important motivation, but, in-and-of-itself, it will not bring job satisfaction and engagement; if this is the only motivation, you may feel like something is missing.


What if-in addition to health care and a paycheck-you hold other reason(s) for coming to work every day ... reasons that will not just keep you motivated, but engaged in case management? This, however, is sometimes more difficult to find and connect to (especially during a stressful day when everyone wants a piece of you).


Most of us got into nursing, or social work, or health care because we wanted to make a difference in others' lives. With this "making a difference" comes much angst and frustration along the way. I remember the first time my passion went over the top and I realized that case management was what I needed-as much as case management needed me.


It was in the late 1980s and I was working for a Medicaid plan in Arizona. The young man's name was Chuck, but the nursing staff affectionately called him "Chuckles." Chuck had leukemia and had just celebrated his 19th birthday (on the oncology unit). The oncologist told me that Chuck needed a bone marrow transplant in order to survive. After investigating the benefits, I was stunned to find out that bone marrow transplants were only "allowed" for children up to 18 years old. Being a new case manager, and not knowing my "limits," I made phone calls and wrote letters, persistently badgering Arizona Medicaid at the highest levels of the department. Finally, I learned that starting October of that year, autologous bone marrow transplants would be added to the adult's benefits. So in August, I started the process of getting authorization, collating medical records (they were not electronic at that time), getting the patient and family educated, and coordinating the doctors between Phoenix (where Chuck was located) and Tucson (where the procedures would take place). However, by September, Chuck was deteriorating. It remained unclear whether my dozens of letters and phone calls made an impact for future 19-year-olds with leukemia, and Chuck did not live long enough to have the transplant, but he left a lasting footprint in my case management heart.


One of my favorite Hollywood scenes is in the movie, City Slickers, where Billy Crystal's character (Mitch) is alone with Curly, played by Jack Palance-a scary, crusty cowboy who looked like he sleeps in the saddle. Mitch is trying to find out what is important in his life and goes to a Dude Ranch to "find himself." In this scene, Curly is giving Mitch some life advice.


Curly: Do you know what the secret of life is? (Curly holds up one finger) This.


Mitch: Your finger?


Curly: One thing. Just one thing. You stick to that and the rest don't mean s***.


Mitch: But, what is the "one thing?"


Curly: That's what you have to find out.


My "one thing" was then-and still is now-"to make a difference." What's your "one thing?" I wish for you to find this, and focus on it; you may be surprised at what a great 2016 this may bring.


disengagement; engagement; motivation