CMSA Today - Issue 3, 2012 - (Page 6)
Integrated Case Management
The Art and Science of
BY DEBORAH GUTTERIDGE, MS, CBIS
he passionate profession of case management is an art and science in and of itself. The “art” of case management can metaphorically be likened to the case manager as an artist, synthesizing a multitude of colors and hues on a large canvas to achieve the desired painting. The patient is represented by the canvas, while the many colors used represent the physicians, nurses, therapists, pharmacists, family, and signiﬁcant others coordinated by the case manager to paint the perfect picture, or rather, optimal outcome for the health of the patient. The “science” of case management is representative of the skills and attributes possessed by the case manager to achieve successful collaboration of those “colors” toward that perfect painting. The tools of an artist consist of such items as a palette knife, multiple brushes of various sizes and textures, assorted tubes of paint, and a painter’s palette. Case managers are also dependent on a variety of tools in their profession, and one of the most comprehensive and useful tools is that of CMSA’s Integrated Case Management (ICM).
Integrated Case Management
case management is the development of a mutually respectful relationship and dialogue between case manager and patient. Regardless of the patient’s health complexities – made up of physical, mental, or substance use disorders, or combination thereof – the case manager is committed to address all barriers to health improvement without cross-disciplinary handoﬀs. In other words, traditional practice has resulted in the case manager with physical illness expertise handing a patient oﬀ to a case manager with more expertise in the mental health arena because the patient has overarching challenges with mental health (such as depression). Integrated case management means that same case manager with physical illness expertise retains the patient’s case; addressing both the physical illness and the role the depression plays as a barrier toward health improvement. ICM can be used with all populations, ages and demographics, and all acuity levels of health complexity and illness. ICM focuses on the patient as a whole, and assesses his or her biological, psychological, social, and health services domains, and the role each plays as a potential barrier to health improvement. This assessment uses open-ended questions by the case manager to elicit the most comprehensive information from the patient, which can then be ‘scored’ using a color-coded assessment tool, known as the ICM-CAG (Integrated Case Management Complexity Assessment Grid). Scores are derived from objective anchor points, which subsequently drive the development of actionable goals and care plan.
The most critical component of integrated case management is the development of a mutually respectful relationship and dialogue between case manager and patient.
TOOLS INHERENT IN ICM
ICM as a comprehensive skill set can be utilized by case managers in a variety of practice settings. As stated earlier, the successful practice of ICM is directly related to the establishment of a trusting, respectful, open relationship. The ability of case managers to achieve this relationship with their patients is dependent upon the mastery and use of additional tools inherent in the ICM process. These tools include active listening, the use of openended questions, and motivational interviewing. The eﬀective use of these skills can lead to a relationship based on mutual respect, trust, genuine caring and concern, empathy, and openness, which will in turn yield an improvement in patient health and outcomes through barrier removal.
Today’s case manager is continually honing necessary skills and knowledge base through networking and continued educational experiences, many of which are aﬀorded through both national and chapter level CMSA opportunities. “CMSA’s ICM is a new approach to case management – one with the potential to reduce overall patient-care costs while helping to improve physical and mental health” (Gutteridge, Perez, Kathol, 2011). The most critical component of integrated
Most case managers would consider themselves “active listeners,” however the art of active listening is a skill that is polished through repeated and purposeful use. Active listening is more than merely hearing what the patient says, but being an active participant in the process by being quiet, curious, encouraging, asking open-ended questions, seeking clariﬁcation, and to
Issue 3 • 2012 • DIGITAL
Table of Contents for the Digital Edition of CMSA Today - Issue 3, 2012
The Art and Science of Integrated Case Management
Evidence-Based Practice Is an Art, Not Just a Science
Facilitating Change When Change is Hard-The Work of Professional Health & Wellness Coaches
Does Discharge Planning Really Begin at Admission? (Part 3 of 3)
The Massachusetts Revolution for a Resolution to Obtain MSL
CMSA Corporate Partners
Index of Advertisers
CMSA Today - Issue 3, 2012