1. Chapter 13 Case Management
Ann H. Cary
Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

2. Introduction
Case management is a strategy that is used in an overarching process called care management
Care management is an enduring process in which a population manager establishes systems and monitors the health status, resources, and outcomes for an aggregate
Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

3. Building Blocks Used by Case Managers
Risk analysis
Data mapping
Data monitoring for health processes, indicators, and unexpected illnesses
Epidemiologic investigation of unexpected illnesses
Multidisciplinary development of action plans and programs
Identifying case management triggers or events that promote earlier referrals of high-risk clients when prevention can have dramatic results
Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

4. Definitions of Case Management
Care management: a program or process that establishes systems; monitors the health status of individuals, families, and/or groups; and develops planning and intervention activities and targeted evaluation outcomes for the client and program
Strategies: use management; critical paths; disease management; demand management; and case management
Case management: includes the activities implemented with individual clients in the system
Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

5. Definitions of Case Management, cont’d.
Case manager builds on the basic functions of the traditional role and adapts new competencies for managing transition from one part of system to another or to home
Coordinating: conscious activity of assembling and directing the work efforts of a group of health providers so that they can function harmoniously in the attainment of the objective of client care
Advocacy: activities for the purpose of protecting the rights of others while supporting the client’s responsibility for self-determination; involves informing, supporting, and affirming a client’s self-determination in health care decisions
Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

6. Case Management and the Nursing Process
Case management is complex because of the coordinating activities of multiple providers, payers, and settings throughout a client’s continuum of care
More complex in rural settings
Healthy People 2010
Through a nurse’s case management activities, general community weaknesses in quality and quantity of health services are often discovered
Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

7. Case Managers: Characteristics, Roles, Knowledge, Skill Requirements
Characteristics and roles
Can be labor intensive, time consuming, and costly
Knowledge and skill requirements
Knowledge of community resources and financing methods
Written and oral communication and documentation skills
Negotiation and conflict-resolution skills
Critical-thinking processes to identify and prioritize problems for the provider and client views
Identification of best resources for the desired outcomes
Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

8. Tools of Case Managers Case management plans
Core foundations of the plans include:
Standards of client care
Standards of nursing practice
Standards of practice for case management
CareMaps
Tool developed by Zander showing cause and effect and identifying expected client/family and staff behaviors against a timeline
Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

9. Advocacy Skills for Case Management
Nurse advocates make the client’s rights the priority
Aim to promote self-determination in a client group
Process of advocacy
Informing
Supporting
Affirming
Systematic problem solving
Illuminating values
Generating alternatives
Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

10. Conflict Management Skills for Case Management
Case managers help clients manage conflicting needs and scarce resources
“Mutual benefit with limited loss for everyone” is the goal of conflict management
Techniques
Using a range of active communication skills directed toward learning all parties’ needs and desires
Detecting areas of agreement and disagreement
Determining abilities to collaborate
Assisting in discovering alternatives and valuable activities for reaching a goal
Negotiating, assertiveness, and cooperation
Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

11. Collaboration Skills for Case Management
Goal: promote respect, understanding, and accuracy of communication of all team members’ points of view
Need knowledge and skills about:
Clients
Health status
Resources
Treatments
Community providers
Clients’ and families’ complex needs
Intra-/interpersonal, medical, nursing, and social dimensions
Team member and leadership skills
Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

12. Issues in Case Management
Legal issues
Liability concerns of case managers exist when the following conditions are met:
The provider had a duty to provide reasonable care
A breach occurred through an act or omission to act
The act or omission caused injury or damage to the client
Ethical issues
Autonomy, beneficence, and justice
Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.