team case management: how to get your staff out of ‘jail’

PERSPECTIVES

Team Case Management: How to Get YourStaff Out of 'Jail'Jane Hammond, RN CRRN

Case management or team­work-nursing model

Teamwork is important to all of us.Through teamwork, it is possible to ac­complish more positive outcomes for ourpatients.

The model of nursing that we use onour IS-bed acute rehabilitation unit in acommunity hospital in northern Ohio isthe nursing case management model (orwhat I like to call the teamwork-nursingmodel). Our unit does not have a casemanager; it has 20. How can a IS-bedunit afford 20 case managers? We haveaccomplished this by dividing our unitinto five case management teams withrepresentatives from all shifts. Each teamis assigned three patients to follow fromadmission to discharge. The team func­tions as case manager and patient advo­cate for each of its charges and makessure that nothing "falls through thecracks" (i.e., that no mistakes are madeand that no details go unnoticed).This model has several advantages:• Patients and their families are provid­

ed with bedside case management 24hours a day by case managers whohave a working, hands-on knowledgeof the patient.

• Patients and their families are provid­ed greater patient advocacy by staff.Patient issues and concerns are iden­tified and dealt with quickly, resultingin greater consumer satisfaction.

• There is increased communicationamong staff, the patient, and the pa­tient's family.

• All nursing staff has input into teamconference and discharge planning,because all case managers see that theteam conference report sheets arefilled out by all three shifts.

• Third-party payers are provided amore detailed report of the patient'sprogress.

• Because the staff is held accountablefor the patient's progress from admis­sion to discharge, nurses are less like­ly to take the attitude that "it's not myjob." Consequently, there is an in­crease in staff pride and satisfaction.

• Because teams are composed of mem­bers from each shift, there is a declinein intershift tension.

• Most importantly, fewer issues fallthrough the cracks, thus resulting inbetter patient outcomes.However, this model also has a disad­

vantage: It requires teamwork in order tobe effective.

Gold for the GoalsOur unit director, Cyndia Schreiner,

BS CRRN LNHA, and I initiated a team­building program we call "Gold for theGoals" in order to improve patient out­comes, coordination of service and care,and teamwork. We wanted each staffmember to think beyond routine dailynursing tasks and become more centeredon how to help our patients achieve theirrehabilitation goals.

Through this program, teams competeto be "Case Management Team of theMonth." The winning team is awarded agift certificate to a local restaurant, andthe team's picture is displayed in the unit.

Each team earns points based on howwell it meets the criteria for successfulcase management we established at thebeginning of the program. The criteria in­clude• communicating with one another• completing team conference report

sheets

• establishing and monitoring the bow­el and bladder program

• identifying patient education and dis­charge needs

• observing the patient continually• assisting the patient toward his or her

goals.One of these criteria is chosen each

day, and each team is given points if itsuccessfully meets the day's criteria. Theteam with the most points at the end ofthe month wins.

We also have initiated a "bonus" sys­tem. Each team can submit its successstories describing methods that have beeneffective for its members as case man­agers. One of these submissions is pulledout of a hat each day and e-mailed to theentire staff. This program has functionedas a mentoring system for our case man­agers, because they are constantly ex­changing ideas and experiences. It also"catches the staff doing something right"and gives them a pat on the back.

Team identityTo foster team identity, each team has

chosen a name for themselves such as"Guardian Angels," "Caring Hands,""Tender Loving Care," "Nurses that Careand Give" and the "Nightingales." A pic­ture of the appropriate case managementteam is placed at the patient's bedsidewith an explanation of the case manage­ment process to help each patient (andhis or her family) identify the case man­agers easily.

Success of Gold for the GoalsThe Gold for the Goals program has

been extremely successful. Since we haveinitiated this program, communicationand teamwork have improved among all

46 Rehabilitation Nursing » Volume 26, Number 2 • MarlApr 2001

staff members. For example, suppose thata Nightingale, while working with a pa­tient, identified a concern with the dis­charge plan. She would be able to com­municate this to the member of thepatient's case management team on hershift, who in tum would review the con­cem with the therapies and social servicesdepartments and adjust the discharge planas needed.

Success has been measured not onlyby improvements in our patient out­comes, but also by the increased staffmorale as demonstrated by the ownershipthey have taken of the program. Further­more, the program serves as a way formanagement to perform quality assur­ance on the unit, and it makes the staff ac­.countable if something were to fallthrough the cracks.

The "jail" sceneIn preparationfor a visit from CARF...

The Rehabilitation Accreditation Com­mission, each Case management team

made a storyboard describing one of thefunctions of case management.

The Caring Hands storyboard featuredour Gold for the Goals program. Theytook a picture of themselves behind bars.The caption explained that before Goldfor the Goals, they were in the ''jail'' ofpoor case management. Trying to do casemanagement alone, rather than workingas a team, had been overwhelming forthem. Comments that members of vari­ous teams made on the improvements incase management in our unit since we ini­tiated Gold for the Goals include the fol­lowing:

"The Gold for the Goals awards are alittle extra bonus; the real bonus is see­ing our unit pull together as a group."

"No one on our team works alone nowand the case management is the core ofhow we function as a group."

"Being on a team of case managershas greatly improved communicationwith staff members."

"We love being nurses on a unit where

we focus on the patient and their needs,not only to fix what is physically broken,but work on fixing the whole patient."

SummaryOur patients have not only a "guardian

angel" to see that their needs are beingmet, but also an entire team of "GuardianAngels" to watch over them. I am veryproud of our unit and pleased to be ableto provide this service to our communi­ty.We have been able to accomplish thisthrough teamwork!

Jane Hammond is a clinical coordinator intheCenterfor Rehabilitation atAlliance Com­munityHospital inAlliance, OH. Addresscor­respondence to Jane Hammond, RN CRRN,Centerfor Rehabilitation, Alliance Commu­nity Hospital, Alliance, OH 44601.

Editor's noteThe author took second place in the

2000 Rehabilitation Nursing Writers'Contest for this article. Rules for the 2001contest are on page 65.

Rehabilitation Nursing> Volume 26, Number 2· Mar/Apr 2001 47