By Jeni Miller
As case managers go about their days, they are constantly discovering and solving problems, often without even realizing it. Part of the role is to troubleshoot issues with discharge, utilization management, and more — but once the issue is resolved, that often is the end of it.
However, when case managers seek solutions for their problems, they are engaging in research.
“Case managers work in a variety of settings. Although each role has different responsibilities, the primary goals remain the same: to assist our clients to navigate through the healthcare system, to receive the best possible outcomes, to advocate for our clients, and provide optimal care based on evidence obtained through research,” explains Janet Coulter, MSN, CCM, FCM, a transplant case manager in Ohio. “As case managers, we do research every day, but we don’t always realize it. Whether the case manager is analyzing readmissions trends or the effectiveness of patient teaching, research is being conducted.”
What Research?
Mark Evans, MA, CCM, CLCP, CRC, CBIS, who recently partnered with Coulter on case management research presentation on behalf of the Case Management Society of America (CMSA), notes most case managers do not engage in official research, although he would like to see that change.
“From my experience working in this field, people in this career just don’t always see the professional development opportunities for research,” says Evans, director of case management at Encompass Health Rehabilitation Hospital in Toledo, OH. “They get that deer-in-the-headlights look. ‘Oh, we don’t do research,’ they’ll say. But we want them to promote what they’re doing, benefit discharge outcomes, family education. It’s so important to let the world know about the value of case management.”
It is important for case managers to shift their mindset into thinking about how their work truly is research, Evans adds.
Ask Good Questions
Like any discipline, genuine curiosity and formulating appropriate questions can go a long way in pursuing research opportunities. Asking why a problem exists and what the case manager is contributing is the first step. Next, they can ask what is needed to solve the problem, or who can help provide a solution for it. Finally, ask about how effectively an intervention worked and for how long, as well as whether the solution can be replicated in other places.
Again, this is what case managers are already doing, but it is part of the research process to ask these kinds of questions.
“In my practice, we have such a quick turnaround time with patients that we’re constantly asking and engaging families and communities,” Evans shares. “Every level of care has challenges and issues, but it’s the nature of case management to ask questions and solve problems.”
Identify Problems
At every level of care, case managers must meet a set of metrics. These are places where problems can occur. This is where the case manager can begin to look for chances to provide research and lasting solutions to common case management issues.
“Discharge disposition, family education — we report on these things constantly,” Evans says. “For every metric that is underperforming, there is an opportunity for research. We do this all day, every day, looking at ways to provide better and more efficient care.”
One example of a metric that can be more closely examined is limiting the number of discharges to skilled nursing facilities. If you are missing the mark on that metric, you can find out why it is happening and put a plan in place to fix it, Evans says. Next, measure and report how well the plan worked, whether fewer people were sent to skilled nursing, and then share the results.
Step By Step
Where should case managers begin? What steps should they take after they have identified a problem? It is a process closely related to the scientific method.
“Case managers use the scientific process: assessment, diagnosis, goals, intervention, analysis, and evaluation when dealing with issues,” Coulter explains. “The scientific process is research.”
This process can be adapted for research that is meaningful to case managers in areas like patient outcomes, patient care, family education, community resources, social determinates of health, prevention, and medication management.
Evans says case managers should take the following steps:
- Start with identifying the problem. What are you trying to solve, fix, or change?
- Ask why this needs to change. What is the current performance?
- Set your goals. Where do you want to go?
- Plan a process or intervention. What are you going to do about it? What change can be made?
- Detail the method. How should you record what you are implementing?
- Measure the results. Did this intervention work? How does it compare to before?
- Report your work.
“At the end of the day, it’s about where you start, finish, and what changed along the way,” Evans says. “We also want to ask, what were the challenges? What would we do differently? Talk about the process — what worked, what didn’t work. Share your intervention and show how it makes a difference.”
Search for Opportunities
Most case managers do not have to look far to find process that can be improved, and metrics can be met to a greater extent.
“Case managers are always really looking for those opportunities in their practice, but they just haven’t yet turned it into research,” Evans says. “As a group, case managers by and large are creative and passionate about what they do, and they’re always working to solve problems. That’s the essence of research — finding solutions to things that need to be better, taking it to the next level, and turning it into a project you can share in the healthcare community.”
Why Research?
Formalizing the research already taking place every day in case management will boost the profession and provide far-reaching solutions to problems other case managers are facing.
“Case managers use process improvement every day to find ways to make existing processes faster, more accurate, more efficient, and more reliable,” Coulter notes. “Research and process improvement both involve research that can have a tremendous influence on current and future case management practices.”
Evans notes taking on a research project is extra work for an already-busy case management professional, but he agrees with Coulter that it is “such a powerful tool to promote the profession.” He reiterates case managers already are performing the research work — it is just not formalized.
“They [case managers] are doing the work already, but we just have to structure it in a way that lines up with the traditional research model, and then get it published,” Evans says. “The questions are being asked and the problems are being solved, but we need to get to the point of designing the project, writing the research paper, and just reporting on what they’re already doing — and doing well.”
The idea of research can be intimidating, Evans notes. For many people, it was not enjoyable when they took on research projects in school. “But in the profession, it’s far more satisfying and doesn’t have to be a really complicated, huge, double-blind study with thousands of participants,” he adds. “It can be simple. It will really just take a few people doing it to show to others that this is possible. We’re not starting with a blank slate. Case managers are just a wealth of experience, and have such knowledge on so many topics, day in and day out.”
It is a worthy undertaking, Coulter says. “Case management research is vital for the practice of case management and the advancement of the profession,” she explains. “Evidence-based practice is the best practice. Research has the potential to directly impact patient care provided in a variety of healthcare settings. More formal research is needed to expand the body of knowledge of case management and increase the professional standing of case management.”
Taking on a Research Project
Evans and Coulter serve on the CMSA Foundation, the organization’s nonprofit arm that promotes and supports grants for research projects. They noticed submissions for research projects had declined, and the board wondered if case managers were reluctant to conduct research.
“Perhaps it seems different in other disciplines in healthcare, but case managers take on evidence-based practice,” Evans says. “They don’t always look at themselves as clinicians driven by outcomes and metrics. But what it’s going to take is someone to develop a project and go through all the steps to develop research and produce a product for people to see. That may spur some interest and ideas.”
Evans believes case managers could begin by taking on projects that are illness-specific or that help with family education, like instructions for families whose loved ones are coming home from the hospital or rehabilitation facility. His advice for case managers who want to begin a project is to contact the CMSA Foundation to discuss their options. Evans also encourages them not to worry about stepping outside their comfort zone.
“Don’t be afraid of research,” Evans emphasizes. “Look for opportunities in your individual setting and come up with creative ideas. Perhaps a project surrounding process improvement would work well. At the end of the day, ask what it’s going to take to get you to that next level. You can’t accidentally fall into a research project. You have to go into it with eyes wide open, so ask — what are your barriers? What is keeping you from doing this? The benefits outweigh the challenges that people have, like time or lack of confidence. There are lots of people willing to support research projects.”
Those engaged in everyday case management should be encouraged because there are so many opportunities out there, and case managers already are well-equipped. “Case managers are [performing] research,” Coulter says. “We just need to acknowledge it and communicate our findings.”
As case managers go about their days, they are constantly discovering and solving problems, often without even realizing it. Part of the role is to troubleshoot issues with discharge, utilization management, and more — but once the issue is resolved, that often is the end of it. However, when case managers seek solutions for their problems, they are engaging in research.
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