Q&A: Improving case manager and physician communication

Q: My case management staff is having trouble communicating with the physicians at our facility. What skills can I teach my staff to improve communication? 

A: Physicians think and work in algorithms: “If this, then this.” Case managers and social workers in case management also work in algorithms, which is a hopeful concept, because it might be possible to put those algorithms together in some fashion.

“Physicians account for approximately 80% of all health care expenditures through doctor’s orders” (Goodman and Norbeck, 2013). While these orders are generally appropriate, there are  times when other treatment options can meet the patient’s needs and be more cost effective. Case managers, through utilization management, can help physicians understand both the treatment and financial impacts of various levels of care. Physicians usually have no preference as to how their patient is bedded, just that their patients is receiving the best and most appropriate care possible.

Essential steps to effectively engage physicians in the utilization review (UR) process: 

1. Explain the why.
2. Influence through the art of negotiation. Accept that anger is often the first step in negotiation on the way to reaching an agreement. Avoid an emotional response. Know when to disengage. 
3. Effective communication. Be present and fully engaged in the conversation through active listening and making eye contact. Be curious rather than judgmental. Respect what the other person has to say. Be authentic and humble, but say what you mean. Ensure reasoning is as transparent as possible.
4. Conflict resolution. “The key to successful conflict resolution lies in understanding the motivations and challenges of the other party” (Patterson, Grenny, McMillan, and Switzler, 2002). “Case managers need to understand that many doctors are not well versed in managing others, driving performance, building alignments, resolving conflict and collaboration as part of a team. They are small, independent business owners whose primary income source is their patients. Any task that pulls them away from their practice diminishes their productivity and wealth” (Smothers, 2015).

For more information, see Case Management Models: Best Practices for Health Systems and ACOs, Second Edition.

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