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