Understanding the keys to effective case management training
Community Hospitals takes module-based approach
Whatever the goals of your case management department, your success depends largely on the quality of the training given to new as well as existing case managers.
At Community Hospitals in Indianapolis, training is rigorous and very individualized. "We have some people who are really almost ready to be independent at six weeks and other employees where it is going to take a lot longer," says Vicki Alexander, RN, BS, CCM, a team leader in the case management department at Community.
"We want to bring everyone onto our team at the same level, with the same exposure to case management and the same competencies," she says.
Community has a minimum six-week orientation that takes place in a training room at its main site, where administration is located. That area also includes the library and multimedia tools. It uses a multimedia presentation that is structured around training modules.
"The way we are set up is that you go through a module and then the manager comes in and discusses that module with you and then relates that back to our policies and procedures," she explains.
"Everyone who comes into our case management department, be it RN or social worker, goes through every module," Alexander says. She adds that, in order to work together as a cohesive team, everyone must be introduced to the same utilization review principles and InterQual.
"We really approach everything from a team function," Alexander says. For example, Community trains its RNs in pre-admission screening and crisis intervention. While these may be areas where they do not regularly practice, staff must understand everything that is taking place in the system, she explains.
"If you understand family dynamics, you can understand what it takes to get a nursing home bed for a new placement," she explains.
"Then our RNs are really working in tandem with the social worker and they have an understanding," Alexander says.
Here are some of the specific modules Community uses to train its case managers:
• Module I: Core issues.
The first module is made up of core case management items, including screening assessments, coordination, discharge planning, and listening skills. Community has a library that includes numerous books and magazines. "We subscribe to a lot of magazines, and we will reference magazine articles that they need to pull out and read," Alexander says.
Much of the information also comes from peer review organizations and the Joint Commission on Accreditation of Healthcare Organizations. "We will beg, borrow, and steal everything that we can get that we think is pertinent to our case managers’ knowledge base," she asserts.
• Module II: Financial issues.
Financial issues are very important, Alexander says. "Our RNs do appeals for all the patients who have denials." Community has a denial management team in place. Alexander says she and her case managers meet with the vice president of denial management every two weeks. "We are very integrated, and we look at denials very specifically. That helps drive the case managers’ work. They know which payers we have had difficulty with."
• Module III: Pathways, outcomes management.
"Our system is probably not as pathway-driven as it should be," Alexander says. In the past, Community has been very pathway-driven and invested a lot of time in this area. But some of the pathways became cumbersome and proved unworkable. "That is not always something that we spend a lot of time on anymore," she says.
According to Alexander, Community reviews its model with trainees, including what the model looks like and acuity levels so that everyone understands what the RN, social worker, and others on the multidisciplinary team can do to help meet the objectives.
• Module IV: Service line initiatives.
These are mainly quality initiatives, she says. Orthopedics case managers actually go to an evening meeting where they bring people in before their orthopedic surgery, Alexander explains. "We do our discharge planning up front before they come in."
• Module VI: DRGs.
Alexander says it is important that every case manager understand what DRGs mean and how they are reported.
"Our department is responsible for going to the medical service line physicians section meetings and giving the financials," she reports. "We are targeting about 12 DRGs very specifically right now, so every section meeting, I go over that with the physicians."
• Module VII: Software training.
Community uses case management software, which takes about two to 2½ days depending on the experience level of the individual, Alexander says.
Adapting training to employee’s experience
"We interface the TQ or the transition for quality training all through the training session of six weeks and give the basics," says Elizabeth Panayides, site coordinator at Community.
"Again, that is modified toward the experience of the person," Panayides adds. On occasion, trainees have actually used that system before, she says.
• Module VIII: Physicians and communication barriers.
"Dealing with physicians is one of the biggest challenges case managers have," Alexander explains. Every level of care in Community’s system, including subacute, rehab, home care, and cardiac have specific admission criteria, she says. Case managers must understand these various levels of care as well as the specifics to the different units.
Community also has many different home care, durable medical equipment, disease management, and outpatient programs, and case managers are exposed to all of those areas. "Either someone comes in, or we send [that person] to the site," she says.
Trainees also get firsthand exposure to Community’s asthma, cardiac, wellness, and diabetes programs. "We want our case managers to hear it from them so that training is one-on-one with them," she says.
Another area that is important is grief intervention, Alexander says. Community has very useful articles on how to approach terminal patients and their families, she adds. "It shows how to support people who are getting bad news. That is an important area."
Regulatory issues are yet another heavy focus, Alexander says. This area deserves a lot of attention, including Joint Commission requirements, the Emergency Medical Treatment and Active Labor Act (EMTALA) as well as the Health Insurance Portability and Accountability Act (HIPAA), she points out. While the latter area is being modified, trainees receive at least an overview.
According to Alexander, Community also devotes attention to behavioral care issues, abuse and neglect, and other legal issues. "There are so many things pertinent to legal issues now, so that is something that we try to spend a lot of time on," she says.
Once case managers complete the training modules, there is a competency assessment. Community has documentation that shows when staff were instructed, when the assessment was validated by the preceptor, and when it was validated in the work area, Alexander says.
"To really make sure that our people are competent, we want to make sure that they are able to apply [what they have learned] to the work area," she explains.
To that end, trainees receive not only a job description, but a performance evaluation so that there are no surprises on how they will be evaluated regarding performance.
Assessing policies
According to Alexander, Community also wants its trainees to demonstrate knowledge of its policies as well as the roles and expectations of its departments.
"We look at the competencies of the review process — financial, regulatory, and ethical," she says.
Community also reviews how to access network policies, which all are on an intranet and easy to retrieve. Case managers then are asked to sign a form indicating that they are accountable for ongoing professional development and utilizing resources as needed.
Alexander says this sets the tone for the expectation of employees. "They understand that in our profession, it is constant change and constant learning, and we hold them responsible for that," she explains.
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