To me, great case management is all about achieving a fine balance between the art of case management (the way we communicate and interact with patients) and the science (the evidence and technology we use to carry out the case management process).
Those of you who know me have heard me say that a million times, right? That’s because it’s one of three guiding principles or mantras that have served as a framework for my professional growth for many years. I realize we live in a rapidly changing world (especially from a technological point of view), but there are always some things that seem to remain steadfast and this is one of them. So, I’d like to dig into my “balance the art and science of case management” mantra a little deeper in today’s blog. (I promise to cover the other two mantras in future blogs!)
Here’s how I see it: The science of case management involves using data and other inputs to anticipate an event or outcome, and then applying the knowledge of what we know works. For example, we rely on sophisticated data and analytics to help predict which people within a population are most likely to benefit from case management. We anticipate what interventions are most likely to help a patient by using evidence-based care, which includes both clinical practice guidelines and your clinical expertise to guide our assessment and care planning efforts. We use medical management software and integrated system applications that capture assessment and care planning data so that outcomes can be effectively measured and analyzed.
The art of case management is all about the way we communicate and interact with our patients. The art of case management requires caring, compassion, empathy, mindfulness and being “in the moment” with the person. The tools we use to advance the art of case management are active listening and meaningful conversations. When you think about it, case management is about building relationships, and building relationships is all about having meaningful and personal conversations!
The art of case management also involves seeing the “big picture” of the patient’s current situation including strengths, barriers to adherence, psychosocial support, social determinants of health, family dynamics and many other factors. These, of course, will be different for every individual, and thus we can’t rely on science or technology to present the person’s individual “big picture” for us. This is where critical thinking—the art of active listening, thinking out of the box and “connecting the dots”—comes into play.
The art and science aspects of case management truly work hand-in-hand. For example, conducting an effective assessment requires a perfect balance of art and science. We certainly need to use technology to drive a comprehensive, evidence-based assessment (the “science” part). But there needs to be time spent on establishing rapport and trust, which happens through relationship-building conversations with the person (the “art” part). In fact, asking open-ended questions and actively listening to the patient’s answers can provide most of the information needed for any assessment!
In the spirit of advocating for balancing the art and science of assessment, I’m going to take this opportunity to air one of my pet peeves. I’ve sadly seen case managers fall into the trap of just reading an endless list of questions to the patient and recording their answers. This is not an assessment; it’s an interrogation. (There’s no way that patient is going to meaningfully engage with the case manager after that!) The art of assessment (in other words, relationship-based conversation) quickly becomes a lost art when a case manager is focused on how quickly all the boxes and fields in an assessment tool can be clicked on and checked off. An organization that measures case management “productivity” or “quality” on this basis is missing the mark, undermining the value that personal conversation plays in achieving meaningful patient-centered outcomes.
I hope I’ve shed some light into why great case management involves both art and science. Let’s take it a step further: Envision critical thinking as the fulcrum upon which this balance is supported. Critical thinking truly is the bridge between the art and science of case management! As I’ve already suggested, an effective case manager is one who is flexible, creative, caring, open-minded, has good active listening skills, is outcomes-focused and is able to see and respond to the “big picture” of each patient. Interestingly enough, these are exactly the characteristics of critical thinkers! (Isn’t that simply amazing to think about?)
I hope I’ve provided some inspiration to help you think about this question: How can YOU best achieve balancing the art and science of case management in YOUR everyday practice?
CMSA’s ICM program provides multiple strategies to engage clients, stratify risk, and develop care plans to mitigate risk and help clients achieve improved health and well-being.
Join the Spring ICM training, April 4-6: A virtual face-to-face training. Addressing the whole person and their physical, behavioral, and social health and needs is essential for positive health outcomes and cost-effective care. This course will provide out-of-box strategies to reduce the risks contributing to complexity. Deadline to register is March 3: https://www.pathlms.com/cmsa/courses/7005
AUTHOR: Mary Beth Newman, MSN, RN, BC-CMGT, CCM, is a past president of CMSA. She has 35 years of professional experience with a focus on building best practice, quality-driven care management programs. Mary Beth is currently a Senior Assistant Vice President at EXL Health where she supports clinical product development, including digital transformation solutions for clinical operations.