Identifying and Reducing Variation within Case Management Department

As Case Managers and leaders of Case Management, we are charged with being good stewards for the patients and hospital.  While there are numerous areas to consider, one aspect of being a good steward is minding the finances for both parties.  We can achieve that by examining our processes and reducing variation to promote best practices within the department.

A particular area I would like to focus on is the initial case management assessment or initial discharge assessment.  The name really doesn’t matter.  It is the process and the manner in which it is performed that counts.  For instance, we have scorecards and collect metrics.  We take those underperforming metrics and develop action plans to improve the results.  However, how often do we collect data on the actual process?  Meaning, do we observe the process and report back on the quality of the process? 

Think about that for a moment as it relates to the initial assessment.  Is it an assessment or is it a triage? What is the policy?  If it is an assessment, it needs to be completed as such and not a triage.  We’ve all witnessed it being whipped through like a triage process.  Whereas others write a book.  There’s a happy medium in there.  Regardless, that is evidence of variation.  Something important was unintentionally overlooked or missed in the first example.  In the second example, the lack of focus may indicate not understanding the role or an inability to identify pressing issues. 

Variability in processes will impact the patient’s hospital course and transition of care.

Ultimately, these two examples have a monetary impact on the patient and hospital.  Data suggests that identifying and reducing clinical and operational variation can reduce the overall cost of care by 30%.  Clearly, Case Management cannot accomplish this alone, but the department can make a significant contribution.  Therefore, I would encourage looking beyond the metric of “percentage of initial assessments completed in X timeframe” or some facsimile to observing the process to foster quality assessments.  Consider changing the indicator to something like “percentage of team members following the initial assessment process”.  Make the quality of the process the metric. 

There’s one more important factor to consider before implementing the changes (observing the process and new metric) ---educating the team on the appropriate process (in a non-punitive manner) of conducting an initial assessment.  So critical to success.  Develop a plan to share the changes with the team.  It is important to explain the rationale for the changes, i.e., the importance of reducing variability.   Using patient-oriented and hospital revenue examples is central to helping the team understand.  Try to use examples where and when the initial assessment was not completed appropriately and there was an unfortunate or adverse outcome.  Tie those specific incidents to the hospital revenue whether through a longer length of stay, payor denial, avoidable days, readmission, etc.   Those are good starting points.  This change could yield rich results.  It may indicate that the initial assessment process needs revision.  Irrespective, as good stewards, we will have accomplished our due diligence toward reducing variability.

Good luck in identifying and reducing variability within your departments.  Share your thoughts and ideas.

Reference

Health Catalyst Editors. (2019, December 17).  Three Key Strategies for Healthcare Financial Transformation.  Retrieved from https://www.healthcatalyst.com/insights/3-strategies-healthcare-financial-transformation