Q&A: Holding case management staff accountable

Q: How can you best hold case management professionals accountable for deliverables?

A: The last step in connecting the boardroom to the bedside, regardless of model design, is to decentralize the goals to each individual case manager, social worker, and other specialists on the staff. Although this step sounds logical enough, it is the final frontier in leading a case management service. Perhaps this reluctance to hold case management professionals individually accountable is due to the fact that a case manager or social worker has no staff for themselves— unless they are fortunate enough to have case aides—and must influence others through natural authority and lateral leadership skills. It takes almost a year for a case manager or social worker to gain the knowledge, relationships, and exquisite timing that is required for their roles. A manager or director of case management tends to feel some guilt asking for accomplishment of targets on top of the day-to-day stress, conflict, and problem-solving they perform. And yet, goals give some direction to that daily grind and a way for each individual to see progress. 

Here are some suggestions: 

• Have staff members help you with the original draft of the CM data dashboard; use it as a topic of discussion in staff meetings
• If the hospital already has a data dashboard, present it to the staff and ask them to describe how they could bring about some of the goals
• As much as possible, have the data diced and sliced to each piece’s practice assignments, whether by units, services, MDs, or patient populations
• Meet with each dyad, triad, or individual staff member to discuss what they might be able to do to improve their processes to get closer to the goal
• Write down the agreement(s) in a contract
• Use the contract in annual performance appraisals, but discuss it all the time
• Revise the model based on which approaches get better results over time

For more information, see Case Management Models: Best Practices for Health Systems and ACOs, 2nd edition.

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