By Janet Coulter, MSN, MS, RN, CCM, FCM
At first glance, letterboxing may seem far removed from healthcare. It is an outdoor treasure-hunting activity where participants follow clues to hidden boxes tucked away in parks, trails, forests, and cities. Inside each letterbox is usually a logbook and a unique hand-carved stamp. Participants stamp the logbook with their personal stamp and use the letterbox stamp in their own journal as proof they found it.
Look a little closer. Letterboxing begins to resemble something very familiar to professional case managers: a journey of navigation, problem-solving, persistence, and discovery. Case managers are experts at putting pieces together. Rarely is the path straightforward. Patients and families often enter healthcare systems overwhelmed, confused, and uncertain about what comes next. The case manager becomes the guide, interpreting information, identifying barriers, coordinating resources, and helping patients move toward safer, healthier outcomes.
Letterboxing works much the same way.
Participants receive clues instead of a GPS location. Sometimes the clues are simple. Other times they are layered, complex, or intentionally challenging. Success depends on observation, patience, adaptability, and the ability to think critically when the path becomes unclear.
Professional case managers do this every day.
We assess medical, behavioral, financial, and social factors. We anticipate challenges before they arise. We reroute plans when obstacles appear. We continue searching for solutions even when the answers are not immediately visible.
The Importance of Persistence
Not every letterbox is easy to find. Sometimes weather changes the landscape. Trails shift. Clues become outdated. Participants may need to retrace steps and start over.
Healthcare can feel similar.
Case managers frequently encounter delays, denials, limited resources, staffing shortages, fragmented systems, and complicated transitions of care. Plans may need revision multiple times before the desired outcome is achieved. Progress can feel slow, and the path forward may not always be obvious.
Yet we persist.
That persistence matters. It is often the difference between a patient falling through the cracks and a patient successfully navigating recovery, treatment, rehabilitation, or long-term support. Letterboxing reminds us that meaningful outcomes rarely happen without determination. Sometimes success comes from continuing forward one clue, one step, and one solution at a time.
Hobbies like letterboxing offer something important: balance.
Letterboxing encourages participants to disconnect from constant notifications and reconnect with nature, movement, creativity, and curiosity. It invites people to slow down, observe their surroundings, and experience the satisfaction of discovery.
For case managers, that type of renewal matters.
Stepping away from work responsibilities even briefly can improve resilience, sharpen focus, and restore emotional energy. Activities that combine physical movement, problem-solving, and exploration can support both mental wellness and professional longevity. In many ways, letterboxing reminds case managers that we also need opportunities to explore, recharge, and rediscover joy outside of work.
Every Journey Leaves a Mark
One of the most meaningful aspects of letterboxing is the exchange of stamps. Every person who finds a letterbox leaves behind a mark in the logbook, creating a record of shared journeys and experiences.
Professional case managers leave marks too.
Every patient interaction matters. Every difficult conversation, coordinated service, discharge plan, advocacy effort, and supportive moment leaves an impact that may last far beyond a single episode of care. Case managers may not always see the full outcome of their work, but their influence is often deeply woven into the patient’s healthcare journey. We help individuals navigate some of life’s most vulnerable moments with dignity, compassion, and support.
That is meaningful work.
Letterboxing may appear to be a simple outdoor hobby, but its lessons resonate deeply with professional case managers. Both require patience and problem-solving. Both remind us that success is not always about speed, but about continuing forward with purpose. It reflects the importance of perseverance, critical thinking, adaptability, curiosity, and human connection. These are qualities that define outstanding case managers every day. And in both letterboxing and case management, sometimes the greatest reward is found not only in reaching the destination, but in the lives touched along the way.
Perhaps that is why the comparison feels so fitting.
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Bio: Janet Coulter, MSN, MS, RN, CCM, FCM is President of CMSA. She is a transplant case manager with a wide variety of experiences including educator, administrator, team leader, and Director of Case Management. Janet holds a Master of Science in Nursing from West Virginia University and a Master of Science in Adult Education from Marshall University. She has published many articles in CMSA Today and the Professional Case Management Journal and served as a reviewer for the Core Curriculum for Case Management Third Edition. She has served as President-Elect of CMSA, Chair of the CMSA Today Editorial Board, Chair of the Nominations Committee, and Vice-President of the CMSA Foundation board. Janet was the recipient of the CMSA National Award of Service Excellence and Southern Ohio Valley CMSA Case Management Leadership award and was recently inducted as a Case Management Fellow from CMSA