One thing that is not possible anymore is to stay the same.
Dr. Donald Berwick, Administrator, CMS (March 28, 2011)
Changes. Even the word conjures up anxiety in some. In others, it looks, smells, and feels exciting. Which are you? I hope the second, because there is little choice. Of course, not all changes are frightening. For example, our journal has a wonderful new column: "Case Management Down Under," as we welcome the Australian case managers and strengthen our international case management ties. Scott Trueman, Chair of the Case Management Society of Australia (CMSA, Australia) writes that the professional profile of CMSA (Australia) members' practice is diverse, embracing acute care, aged care, brain injury, community care, criminal justice, disability, education, homeless people, immigration, insurance, mental health, rehabilitation, palliative care, and residential care: not unlike case management in other parts of the world.
In this journal, we constantly attempt to prepare you, the reader, for changes; change is only scary because of the "unknowns." Part of this journal's mission is to keep you abreast of what will (or may) happen in the near future, or those lessons learned from demonstration projects and proprietary attempts to streamline, improve care, reduce readmissions, or increase patient self-determination and satisfaction.
Some changes are a double-edged sword, encompassing both opportunities and challenges. The Healthcare Reform, with its significant regulatory changes, comes to mind. In a lunch conversation with a hospital Director of case management, it became clear that case managers today are spending more time supervising regulatory issues than I did in the 1980s and 1990s. Sometimes, responsibilities may be assigned to case management that may be better indicated for other professionals (pharmacy, for example). And many health care reform challenges remain to be seen as they unfold in the coming years. However, Healthcare Reform has also given case management a grand opportunity, as so much of what case management has been perfecting for decades has been brought in the limelight.
Much of the health care reform will be, in many ways, orchestrated by each state's Quality Improvement Organizations (QIO). Serendipitously, my other major health care "hat" is as a Director of quality improvement at Arizona's QIO. And it is also a time of change for QIOs-not only because it is time to merge from the Ninth Scope of Work (SoW) to the Tenth SoW, but because there is a culture shift afoot in the Centers for Medicare & Medicaid Services (CMS). From the CMS leadership, it is a time of being open, seeking partnership, assuming positive intent, being leaders in transforming health care, bringing in the stories of patients, and being bold.
Incorporated into 10th SOW are the Aims of the Health and Human Services' National Quality Strategies, which can be found at http://www.ahrq.gov/workingforquality. Essentially, their aims are, much like case management, increasing national efforts to promote better care, build healthier people and communities, and facilitate affordable care. The National Quality Strategy principles include the following:
1. person-centeredness and family engagement;
2. specific health considerations;
3. eliminating disparities in care;
4. aligning the efforts of public and private sectors;
5. quality improvement;
6. consistent national standards;
7. primary care will become a bigger focus;
8. coordination will be enhanced;
9. integration of care delivery;
10. and providing clear information.
More details about these 10 Principles can be found at http://www.ahrq.gov/workingforquality/nqs/principles.htm#principle10. But the interesting issue to note is how clearly these crosswalk with the Case Management Society of America's 2010 Standards of Practice. Case management guiding principles and strategies are targeted at the achievement of patient/client stability, wellness, and autonomy. Included in these guiding principles are supports that are in total alignment with the National Quality Strategies:
1. Use a patient/client-centric, collaborative partnership approach.
2. Promote the right to self-determination through the tenets of advocacy.
3. Facilitate informed choice, consent, and decision making.
4. Promote the patient/client's self-care management.
5. Focus on facilitating patient/client self-advocacy, education, and anticipatory guidance.
6. Promote the use of evidence-based care, as available and promote optimal patient/client safety.
7. Assist with navigating the health care system to achieve successful care transitions.
Looking further into some of the primary "work" of the 10th SoW, QIOs will be charged with:
* Making Care Safer: CMS makes this more specific with explicit goals: reduce health care acquired conditions by 40% (both hospitals and nursing homes)
* Promoting effective coordination of care: CMS' strategic aims include "Care transitions that reduce readmissions by 20%."
* Assuring care is person and family-centered: CMS' strategic aims include "Patient and family engagement."
There were certainly too many examples of alignment between the CMSA Standards of Practice and the work of CMS and the National Quality Strategy to put them all in a short Editorial. However, I think case managers can relate to the principles, aims, and cultural attributes of the "new" CMS. According to Dr. Donald Berwick, Administrator of CMS (Town Hall Meeting, Baltimore, MD, March 28, 2011), change cannot be avoided. There is a changing concept of medicine occurring, which is demanding more attention to teamwork, patient-centeredness, and seamlessness. Certainly, since our parents time, there is a changing concept of society, where patients and caregivers want more transparency and more accountability. And, the squeakiest wheel is the changing economy. According to Dr. Berwick, health care is linked to the economic well-being of nations and we must use health care more economically.
One thing I know for sure: without the ability to change, we will not stay relevant. As Alvin Toffler the American writer and futurist, says, "The illiterate of the 21st century will not be those who cannot read and write, but those who cannot learn, unlearn, and relearn." Look out for the constantly changing landscape, but note that some things are nonnegotiable and should not be changed: keep your skills sharp, assume positive intent, and most important, always keep the patient at the center.