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


Case managers' days are hectic and unpredictable. This Editorial describes why multitasking may not be the best choice and identifies techniques and attitudes for smoothing out hectic days.


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Do you often feel overwhelmed by the many tasks you juggle throughout your workday? The balls start falling around your ears and the moving parts are not always moving in a logical trajectory. The first thing most case managers try to "control" the raging tide is multitasking: getting two or three things done at the same time. Will multitasking help? Or not?


Probably not. Research has demonstrated that multitasking actually increases stress. More specifically, research shows that multitasking lowers IQ, shrinks the gray matter, and reduces productivity by 40%. Some go so far as to say that multitasking is a myth. What we are actually doing is switching back and forth between tasks rather quickly. Unfortunately, neuroscientists believe that because it takes time to "reset" between tasks, we actually lose time when we switch from one task to another (Powell, 2016).


So, if multitasking is not the answer, what can a busy case manager do? Actually, before we talk about what can be done, a bit of further explanation and research may help convince you to consider alternatives to multitasking.


Mindfulness has been a well-discussed technique for several years now. In a longitudinal study (Holzel et al., 2011; Powell, 2014), pre-post changes in the brain gray matter were studied via magnetic resonance images before and after an 8-week "Mindfulness-Based Stress Reduction" (MBSR) program. Here is what was found:


* Whole-brain analyses identified increases in gray matter concentration in the several parts of the brain in the MBSR group when compared with the control group; for those who like specifics, the parts of the brain with increased concentration were the posterior cingulate cortex, the temporoparietal junction, and the cerebellum.


* In layman's terms, the aforementioned says that mindfulness improves regions involved with learning and memory processes, modulation of emotional control, and the process of awareness.


* This supports the concept of "neuroplasticity," which has replaced the formerly held position that the brain is a physiologically static organ. Scientists now realize that the adult nervous system has the capacity for plasticity and can change in response to training. So don't believe that one can't teach old dogs new tricks!


Amit Sood, MD, MSc, FACP, Professor of Medicine at Mayo Clinic, writes a lot about resilient living and sharpening your focus. You may know the feeling; some call it the "zone"-when you're so absorbed in an activity that nothing else seems to intrude. You will not only get more done but may enjoy yourself more as well.


Here is Dr. Sood's breakdown of a typical human working brain: When we are in a waking state, our brain seesaws between two modes:


a. A focused mode of intentional presence, or


b. The default mode of mind wandering (which I have always called my "monkey mind").


According to Sood and Jones (2013), the average person spends half to two thirds of the day with a wandering attention (the "b" mode). Furthermore, the majority of this time is spent with negative thoughts, discounting the good, inflating the bad, and making unhappy comparisons ... which all leads to excessive stress (Sood & Jones, 2013).


What if we could spent more time in mode "a" and emphasize focus and intentionality in choosing the direction of our attention, thus remaining in the present moment (a mindful practice)? As opposed to multitasking (which slurps up the brain volume), mindfulness has been shown to increase gray matter, as researched earlier.


Emotional resilience-another important technique to make it through a stressful day-includes experiencing positive emotions and recovering relatively quickly from negative emotions. Dr. Sood prescribes five principles to develop emotional resilience: gratitude, compassion, acceptance, meaning, and forgiveness. All important, without a doubt, but for the purposes of releasing the need to multitask, we focus on acceptance and meaning.


Acceptance is about flowing with adversity, creatively working with what is, and being open to possibilities. Acceptance isn't apathy. It is empowered engagement, where one wisely lets go of the uncontrollable to save energy for the controllable.


Early in my case management career, I was told by a wise physician that "sometimes the dragon wins." Over the decades, I have learned to accept many things that cannot, or will not, be changed. This, alone, can ease the stress and increase your resilience on a daily basis.


Meaning: Why are you here and what does this world mean to you? At the core, no matter what you do, you're an agent of service and love. You touch a part of the world, however small, and leave it a little better than you found it. This goes back to why we became health care workers in the first place. Whether your reason was to ease suffering, be an advocate in a convoluted health care world, or just to earn a living, know why you are a case manager: The reason and the outcome may surprise you.


For a summary, here are a few techniques that can assist you to be more focused, less stressed, and generally happier. These techniques have been written about in the Professional Case Management (PCM) journal in many articles and editorials on resilience, mindfulness, multitasking, and stress reduction.


1. First, SINGLE TASK! As opposed to multitasking, single tasking, involves focus and uses the tools and processes developed by "mindfulness" practitioners: Working on the task or focusing on the person in front of you;Committing to your choices; andLiving in the present.


2. Next, read the Editorial written in the PCM journal in March/April 2016 about "Mindfulness, Multitasking, and You." It may convince you that multitasking is not the "badge of honor" many case managers wore for decades (Powell, 2016).


3. Plan your day according to when you are most alert. Plan for peaks and valleys. Are you a morning person? Then don't squander that time on e-mail. Instead, use it to tackle projects that require your full concentration. Save the afternoon for going through your inbox or catching up on your filing.


4. Assess distractions and make every attempt to reduce them. Do you have sound notifications for every e-mail, text, and news flash? Perhaps, just phone calls are enough. Can you check e-mails at specific intervals during the day and focus in between those intervals? Another common way to get distracted (for managers especially) is the open door policy where anyone can come to your door and lay his or her complaint at your feet. I am in favor of an open door policy; however, some parameters-rules of engagement-may be needed and must be adhered to.


5. Too many mental notes will clutter your mind. All of that unfinished business can sap your mental energy. Put whatever is on your mind on paper or capture it digitally. Dr. Sood says to "think of it as off-site storage." I love Post-it notes.


I realize that sometimes you are trying to single task, doing one thing, when-beyond your control-your phone rings, someone makes an in-person request, and you may have to quickly triage all of this. Knowing we (case managers) are human and not good for others until we have taken care of ourselves (resilience), do what you CAN. You can practice focus/mindfulness. You can turn off the excess alarms on your phones and e-mails. You can keep the patient front and center. You can remain peaceful when others (who are not practicing these techniques) are demanding and complaining. You can practice acceptance that not every day will be smooth sailing. And, most of all, you can remember why you chose to be a case manager.




Holzel B. K., Carmody J., Vangel M., Congleton C., Yerramsetti S. M., Lazar S. W. (2011). Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Research: Neuroimaging, 191(1), 36-43. [Context Link]


Powell S. P. (2014, July-August). Mindfulness: Another tool in the case manager's toolbox. Professional Case Management, 19(4), 159-160. [Context Link]


Powell S. P. (2016, March-April). Mindfulness, multitasking, and you. Professional Case Management, 21(2), 61-66. [Context Link]


Sood A., Jones D. T. (2013). On mind wandering, attention, brain networks, and meditation. Explore (NY), 9(3), 136-141. Retrieved January 27, 2017, from [Context Link]


case manager stress; multitasking; resilience; single tasking