Effective Case Management

As much as 50% of hospital emergency department visits may be due to untreated illnesses or situations for patients with multiple, complex, "co-occurring" conditions such as someone who is an addict, mentally ill and homeless. Case management has emerged to guide the development and management of comprehensive, integrated treatment plans that significantly reduce these demands on emergency departments. However, there are not yet standards or training classes offered to enable hospitals and social service agencies to develop great case managers so each healthcare organization has to reinvent case management.

Fortunately, recent scientific breakthroughs about human behavior and the importance of modeling best practices after star case managers are changing this scenario for hospitals and social service organizations big and small. Instead of implementing new case management programs only to find very few organizations adopt the desired behavior, hospitals and social service organizations can leverage their best case managers to drive the development of critical attitudinal and behavior development in new personnel. Using this approach, patients get better treatment while hospitals reduce their costs.

This approach has four distinct stages.

Stage 1: Set the Bar - Identify Your Stars Use your and your partner organizations' top performing case managers to define the desired attitude and behavior. These star players (i.e. the "positive deviants") are often the most influential leaders in the local healthcare system because they are highly respected for their history of success and positive attitudes. A critical element of their performance is a commitment to achieving a "greater social good" for their patients, medical staff, social service agencies and hospitals in ways that invariably align all of their objectives.

Stage 2: Motivate Change Utilize a concise, high-energy statement of the positive deviant's greater social good created by focusing on excellent patient outcomes as the catalyst to engage prospective case managers in the change process. When presented in a particular way, this statement causes these case managers to feel honored to be part of providing patients with extraordinary care experiences and see themselves as critical contributors to the overall success of their local healthcare system. In turn, by generating and writing down personalized, positive images of the statement, case managers are more open to innovative ideas and learn them more quickly even while their natural resistance to change is suppressed. Case managers feel that a profound commitment to their own, the patient's and the hospitals' success is their idea, which generates a perception that they are critical for the entire healthcare system.

Stage 3: Sustain the Change Motivating employees is a huge success, but sustaining this motivation is key because human tendency is almost always to quickly resume past attitudes and behaviors.

Intense practice of ideal case manager attitudes and behaviors, particularly when this practice includes frequent application to real situations, causes pathways in the brain to "rewire" and the desired functions to rapidly and fully internalize. Because the new capabilities are so completely a part of normal work, everyone quickly comes to perceive that the new way is actually the norm and the change looks and feels grassroots.

Stage 4: Scale the Change How does this work if you have a large hospital or healthcare system? You must engage enough people in the shortest amount of time to generate a "buzz" and ensures others accept the new program.

An emerging technology called "persuasive technology" -- which is defined as technology designed to "change what people believe and do" - enables rapid scaling. The best persuasive technologies create the perception for every user that they have a caring personal mentor, even though it is done with many people at once. This sense of caring makes people feel that the change is uniquely theirs; that it, the change is grassroots.

A Departure from Traditional Sales Practices: Notice that neither executive support nor assessments are a part of this approach. These steps require minimum of support since its very premise is to drive change from within the people most engaged in ensuring excellent case management.