1. Owen, Mindy Susan RN, CRRN, CCM

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Case management has a long history of providing support, guidance, and information to patients and families within our communities as they go down the path of making informed decisions regarding their plan of care. Case managers have been challenged with being the "touchpoint" in the middle of confusion: both the catalyst for a comprehensive plan of care and the advocate for a patient and his or her family. We have also been the "ear" that listens to the health care team and formulates as well as facilitates an individualized plan and transition-of-care plan as we also become responsible for the implementation of these plans. The health care arena that we work within has always presented as a complex environment and today that environment continues to evolve. This evolution of health care, which we experience daily, has challenged case managers to their core, making many of us question, at times, who are we, what is our role, and how do we provide our unique professional expertise through the complexities and unknowns of the health care system? Are we still the catalyst? Do we still lead the team in individualized care planning? Is our approach focused on the whole patient and his or her family as we work within our standards of practice?


Today, many of us are told to improve our efficiency, reduce the inpatient length of stay for your caseload, "move patients through the system expeditiously," all the while keeping an eye on, and managing medically complex patients who may potentially be readmitted. It is not a surprise that with these conflicting directives and the focus on efficient "throughput," the assumption becomes case management equates to discharge planning.


In many organizations, case management has grown as a critical department and a valued member of the hospital health care team over the last several decades. However, I challenge all of us that as we have grown, we have not "owned" our value or provided strong direction and consistent leadership to support what we bring to the organization in revenue and quality. Today, there is a wide variance as to where case management should be structured within an organizational chart. Some organizations have the case management department report up to the chief financial officer through the revenue cycle team, others have the department report to the chief executive of nursing, and still others have case management reporting to the director of quality. These various placements add to the lack of clarity and beg the question: "Where does case management fit within a health care system?"


Through the work I do today, I have been privileged to travel and see the innovations that case managers bring to their practice, as well as viewing the limitations that are regularly imposed. I am often asked for recommendations in regard to hiring "good case managers." As I reflect on the scope of practice, the experience a case manager needs and the impact case managers have as a patient advocate, my response has not been much different than it was years ago.


Case managers must be clinically mature, have a solid clinical background to support their peer position, and be ready to function with confidence as part of the health care team. They must understand their value and be able to collaborate and communicate clearly with patients, families, and all the health care team members with whom they interact. Case managers must be adult learners, ready to be open to new resources that may enhance the plan of care. Case managers walk the tightrope between clinical accountability and fiscal sustainability for their organization. Effective case managers will need to gain the knowledge and expertise to manage these responsibilities in an ever-changing and dynamic environment. All of this, and so much more, leads me today to truly believe that case management is in our DNA.


Over the years, I have worked with colleagues who would tell me, "Case management is an advanced practice." Yes, the standards of practice, techniques, and tools may be taught ... but a "good case manager" takes those tools, embraces the standards as a foundation, and grows his or her expertise in a way that exemplifies the practice in all they do. The most effective case managers understand this. It is not about this being a job, it is a passion, a profession, and a commitment to all the stake holders that case managers serve.


I have been fortunate to see firsthand what good case management is and what it can do. And although it may be hard to describe or "put a finger on," we all know it when we see it. Case management is a reflection of doing "the right thing at the right time and for the right reason." First and foremost, as the patient advocate, constructing the care plan in an objective and respectful manner and honoring and supporting patient choice along with cultural diversity are paramount to "good case management." No matter how complex the environment is, or difficult developing the plan of care may be, the case manager is always guided by asking; "In this situation how would I want myself or my family treated?" Teachable? I am not sure. Innate to the practice: essential.


A dear friend and colleague of mine practiced case management for more than 35 years. She and I worked together in the beginning of our case management journey when we were challenged to define case management for the organization we represented. We were asked to develop the process and lead a team that would provide case management services to the high-risk, high dollar payer population. Looking back on that time, I believe that the organization saw us as two nurses who were passionate about being advocates for those we served, with leadership qualities that would be essential to forge the path and be valued. Although we did not complete our careers together, we never stopped supporting or learning from each other. Maureen (Moe) was a case manager's case manager-It was in her DNA. She would be there for her family, her friends, and anyone who needed her expertise and caring support. She led by example, always giving of her time and knowledge to help patients develop the best care plan for themselves. No task was too small or too complex for her to embrace. No patient or family was ever undeserving of her time and her "listening ear." She would demand quality in everything she did while always being open to new and innovative ways to enhance her practice.


But she always viewed case management in its purest form, connecting a patient/family who was in need of a case manager who she believed could make a difference: case management was in her DNA. The last care plan she developed was her own. She led her care team and family on her journey: Doing the right thing at the right time and in the right way ... for herself. She lead by example and taught those who surrounded her the importance of patient choice and the value of good case management.


As we honor friends and colleagues who have helped establish the foundation of "good case management," let's always remember why we do what we do.... And that as professionals, it's in our DNA.