PHOENIX MEDICAL MANAGEMENT, INC.

Designing and executing a clinical resource management program is not easy.  It’s not so much that any one part of the program is difficult to design and implement.  Rather, it’s the combination of all the parts that becomes untenable.

To begin with, we are plagued by a lack of understanding among hospital leaders of just what constitutes a hospital case management program.  This makes case management design or improvement efforts difficult, or at best, highly painful for many provider organizations.  Too often we try to piece together the various components of a program as envisioned by the executive group without having created in our minds – or theirs - from the outset, a solid conceptual model of the various strategies needed and how these strategies will interrelate to achieve the desired outcomes.

We came across an article that had a great analogy that can be applied to the  process of “visioning.”  Take the home stereo system, the article suggested.  “Most of us can purchase a home stereo system, install it, then use it regularly.  We can also expand an existing stereo system without difficulty by purchasing add-on components.  We can even buy a single remote control that enables us to control all the equipment at the push of a button.  The reason why we are able to do this is because we inherently understand a number of the key components that reflect the stereo’s operations.  For example, we know that ‘volume’ means how loud the sound is, and that every stereo system provides a way to boost or decrease sound.  No matter what the volume control looks like or how it is operated, for any receiver from every manufacturer, the volume control provides the same function.  Along with such functions as ‘on’ or ‘off’ right speaker or left speaker, we seem to inherently know what to expect from any stereo system.  This is because we carry in our heads, gained from life experience, a model for stereo systems, that we can apply to any specific system we see.  The designers and manufacturers as well as the salesmen who sell it to us all share the basic model with us.  This reference model enables us to map the specific stereo systems we see to a general model we already understand."

Unfortunately, when it comes to hospital case management programs, a common reference model does not yet exist.  Instead we are left to evaluate each component on its own merits and guess how each strategy might fit with other elements of the program.  This is a tedious and often error-prone approach, as our model may not jibe with the expectations of our various customers.  Too often, we are left with a bundle of disjointed activities and tasks that struggle to be an integrated program.

And so, in the absence of a consistent and complete framework to represent all we know or need to know about hospital case management, the process of conceiving a clinical resource management program has tended to be more like an unplanned journey – and we hope we recognize the destination when we get there – as opposed to a methodically planned trip with an itinerary and map.

It’s never too late to construct a reference model for your hospital case management program.  The demands on the case manager are only compounding, and the number and complexity of initiatives to choose from will probably increase.  Taking the time now to conceptualize and characterize a case management model will save tremendous time and headaches down the road.  Most importantly it will arm the case manager with the ability to critically evaluate current strengths and weaknesses of an existing case management infrastructure and identify exactly which activities are still value-added and will continue to generate bottom-line outcomes.