By Sandra Zawalski, MSN Ed, RN, CRRN, CCM, ABDA, MSCC

How many times a day do we have conversations with other people? And how many times do you find your mind drifting during these conversations? Currently, it can be difficult to really talk to someone and hear what they are saying. It is normal for us to think about all the work that needs to be done, and what needs action at home, and wonder if what the other person says is necessary. Today, we are bombarded by multiple communication tools, social media, email and, of course, the old-fashioned phone, which, according to my millennial children, no one uses anymore except us old people!

Believe it or not, there is an art to listening. This art is to find out what the speaker thinks about something. This allows each person to truly learn from one another. When we are “in the mode,” ideas, questions and actions will fall into place. Multiple articles, training sessions and lectures have been devoted to the art of listening; however, if you are not ready to try the methods, none of the tips or exercises will help you.

When a case manager is meeting with a client to complete the initial assessment, what is the client not saying to you? If you are listening, you may pick up on it. Verbal and non-verbal language is important, and you must assess if the two match. If the client says, ”Great, I am going to love working with you” as they sit with their arms crossed, eyes looking around the room, you could assess the client is actually not interested and just there because case management may be mandatory for them or they are just trying to fulfill an action.

Case managers should be focusing not only on what is being said but how it is being said. If the case manager is under stress and perhaps dealing with their own anxiety, they may have difficulties focusing in on the conversation. You may need to limit the time you spend talking with a person. This is where motivational interviewing can really empower the case manager and their client. Let the client set the tone, and lead the conversation with the case manager redirecting them to the goal that has been established.

I frequently tell the story of my mother-in-law. She was not book-smart, only finished high school, but there were times that I would put her against anyone. When you talked with her, not to her, but with her, she made you feel like you were the only person in the room. Her eye contact, body language and art of using reflection, redirection and confirmation were some of the best I had ever seen. This would even occur in a crowded, noisy room.

Case managers also need to ensure their client understands what is being said, and can they hear you? Based on the age of your client, they may be embarrassed to state they are unable to hear you or they don’t understand what is being said. Another great example I talk about is my dad. He was very hard of hearing and refused hearing aids. Due to cancer, he also had the pinna (the ear) removed, which made his difficult hearing even worse. I walked into his hospital room just as the case manager explained the treatment and discharge plan. My dad shook his head as if he understood what she was saying. Knowing my dad and hearing how soft the case manager was talking, I knew he did not hear her or understand her. I asked him to repeat what the case manager said, and he was incorrect in all aspects. The case manager indicated that was not what was said. It was explained to the case manager that he was extremely hard of hearing and, as she could see, missing an ear. She continued to talk with him in the same tone. Several times, I had to repeat to her that she needed to speak up. Finally, I repeated what she was saying to my dad in almost a yelling voice; however, when asked to repeat what was said, my dad was able to understand and explain what the treatment and discharge plan was. The case manager became upset and said I was yelling at him. I said no, I wasn’t yelling, but I was speaking in a volume and tone that he could hear. This conversation about tone and volume continued for several minutes until I asked to speak to her manager. This led to a great conversation about how to talk and listen to our clients.

I have found myself being more aware of what is being said to me and what I am saying. It can be difficult in this stressful, busy world of ours, but it can be done. You may need to have the person you are talking to repeat what was said, you may have to employ methods of validation during your conversation. You may have to tell a family member that the conversation needs to be put on hold until you can find a quieter space to talk and you may find yourself having to write down specific points to remember. None of this is a negative reflection on you. These are tools that can encourage a more meaningful and productive conversation.

So, the next time someone asks you, “Are you listening”? You can say, why yes, I am!


CMSA  Annual Conference Featured Keynote Speaker is Dr. Bruce Berger, communication expert and Motivational Interviewing pioneer! Find out how to maintain a patient-centered approach by walking through common scenarios of self-deception in practice and everyday life. Join us in Vegas, June 27-30 to experience this motivating session LIVE: Early Bird Registration closes May 1st!

Bio: Sandra is a registered nurse with almost 40 years of experience in a variety of clinical settings that includes orthopedics, brain injury rehab and neonatal intensive care. There is extensive experience in case management for payers and providers holding leadership positions in each, as well as owning her own consulting business. She has a Master’s in Nursing with a focus on education, is a board-certified case manager, certified rehabilitation nurse, certified as a Medicare Set Aside Consultant, a member of the American Board of Disability Analysts and a designated ATD Master Trainer. Sandra has published numerous articles in case management professional journals and is a regular contributor for Just Begin magazine. Sandra is a former commissioner for CCMC, a former chair and has had the privilege of speaking at national conferences including CMSA and CCMC’s New World Symposium as well as a certified Cert 360 facilitator for CCMC.