1. Treiger, Teresa M. RN-BC, MA, CCM, CHCQM, FABQUARP
  2. Powell, Suzanne K. RN, MBA, CCM, CPHQ


As in everything, case management has an evolutionary trajectory. Perhaps, the latest in case management is Conscious Case Management. In today's harried health care environment and with multiple "productivity" criteria to measure usefulness, case managers should not move to just finishing your daily responsibilities or trying to close the most cases; rather, a mindful approach, whether in listening or doing, will yield the best outcome. Instead of mindlessly completing tasks and checking off boxes, practice in-the-moment-and do so consciously.


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As in everything, case management has an evolutionary trajectory. First, the need for case management was recognized. Then decades were spent trying to find the best practices for the greatest good in each level of care; we are still working on how to find data to assess that. Perhaps, our next evolutionary step is the most important, when it comes to the human advocacy facet of case management: Conscious Case Management. Here is a short blog found on the subject, by Teri Treiger:


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 have some level of interaction with the care team.


The sad thing is that few seem 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" (CCMC, 2015).


Frankly, none of these actions can be encapsulated by a checklist. Each requires a qualified clinical professional 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.


A 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 quite difficult to embody. It requires a clinical professional 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 the medical record, 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.


Applying conscious case management is a bigger challenge than expected: It may be simple, but it is not easy. There are some challenges.


Challenge 1: Getting one's mind-set away from the "I checked off all the boxes so my work is done" mentality. Your organization's case management computer program is a tool; it is not case management, care coordination, or transition of care. When a case manager believes that being a good case manager means closing more cases than anyone else, he/she is missing the foundational point of the work. Sadder still are organizations that perpetuate the myth by using productivity targets on case closure volume as criteria of meeting performance management goals. Sometimes, fast versus good do not live in peaceful coexistence and do not always work for the "conscious case manager."


Challenge 2: Do unto others as you would have done unto you. How would you want your loved one to be treated. Far too often, we have horror stories about how our own loved ones were mismanaged. Case management colleagues have compared horror stories on care given to our loved ones (or ourselves). It is far too easy for people to see the patient in room 305 as a series of tasks, rather than the human being, Mr. Jones in room 305, who needs compassion and support during a difficult time.


Perhaps, the most critical task during these times is for health care professionals, including case manager, to practice mindful listening: hearing beneath the words, to the essence of the meaning. Moving past the anger and hurt because their life has dramatically changed and not "sparking" with our own emotion. It is worth the effort to shuffle our emotional priorities.


Challenge 3: Call out colleagues doing a disservice to professional case management. There are those in our midst acting as if performing their job is doing a favor for each client. As Homeland Security says, "If you see something, say something". Turning a blind eye to individuals who fail to personify professionalism in everything they do hurts us all. When that client shares their bad experience, that one encounter becomes a belief that forever taints the light in which case managers are perceived.


Challenge 4: See each other as colleagues, not as obstacles. When working in managed care, I remember the negative things said about hospital case managers. When working in a rehabilitation center, I experienced less than satisfactory encounters with both payer and hospital case managers. It was frustrating both then and now when I see the same issues taking place. We need to collaborate across the aisle with our colleagues and stop seeing case managers in other care settings as the enemy. We must stop blaming other case managers if a determination does not go the way we expect. Turning to a client and saying "the case manager at your insurance company denied the authorization" or "the hospital case manager isn't sending us the information we need to make a determination" is playing a blame game. Rather than point a finger, we must assume collective accountability across the continuum rather than only in our limited part.


Our most important pursuit should be changing public perception about who case managers are and our role in care coordination. When I asked, most of my mother's neighbors have negative things to say about case management. We need to do a better job of raising awareness that what we do is positive and contributes to the well-being of every client and caregiver.


Avoid falling into the pit of being a case management-bot. Instead, strive to become a conscious case manager. Instead of mindlessly completing tasks and checking off boxes, practice in-the-moment-and do so consciously.




Commission for Case Manager Certification. (2015, April 15). Definition of case management. Retrieved from [Context Link]


advocacy; mindfulness; professional case management