Keep away from those who try to belittle your ambitions. Small people always do that, but the really great make you believe that you too can become great. - -Mark Twain

Everyone has a distinct idea about how they describe or talk about ambition. Often people turn it into an ugly connotation, giving the word a bad reputation. I however, think the word "ambition" is fabulous. In my mind it has a lot to do with leadership, and we need a new kind of leadership in many areas of health care which govern case management. It is time for case managers to step into these leadership positions without being asked or cajoled into leading. I do not mean necessarily only leading as executives, but also as leaders in how we case manage our patients. We are very thoughtful about things and rarely say "Oh, me first," but we must start thinking that way a bit more; otherwise, nothing will change. Not our systems, our transitions of care (or lack thereof) and/or patient education.

Ambition can instead be defined as or looked upon as an eager or strong desire to accomplish something. These are leadership skills a lot of people don't even recognize. According to Webster, "Here for good" has dual meanings: both "here to do good" and "here for the long term." These definitions fit perfectly with case management's desire to create both economic (as financial stewards) and social (as patient advocates) values for our patients. A good case manager's nature, and quite frankly, job, is to have an expansive view and a shared purpose. It should also be marked by high levels of emotional connection, trust, and respect with not only our patients and their families but also our own counterparts and other health care stakeholders. Higher-ambition case management leaders, unlike many executives in other fields, are not content with achieving only strong fiscal returns. Rather, they strive to generate high performance on three fronts at once: creating a long-term economic or fiscal value, producing significant benefits for the wider community and building a robust social capital within their own organizations. We have all worked with leaders who do well in one of these areas. However, a higher-ambition leader unlocks the true value of their organization's full human and business potential to excel in all three.

Any case manager who has direct contact with his or her patients, either in person or telephonically, has changed lives. This gives their world, and therefore our world, value. In my eyes it is simple: case managers, who truly aspire to raise those they touch to greater heights, had to have a certain ambitious quality in their personality. Frank Tyger states, "Ambition is enthusiasm with a purpose." At times we all feel we don't really know what we are doing or what our purpose is. However, if we keep our enthusiasm and realize that everyone feels this way at times, our confidence grows in our own leadership skills. As leaders and as case managers, we must feel comfortable working directly with others outside traditional lines of command, so that decisions don't continually get bumped up the hierarchy. We need to be able to appreciate different points of view, working styles and cultures, and to build relationships within our environment that are strong enough to transcend those differences. We have done that with our patients, and as leaders, we need to do the same with our counterparts and those we lead.

I used to be a ruminator in my 20s and it got me nowhere. I worried all the time, and it was pointless. I recently read a great Maya Angelou quote where she said, "If you don't like something, change it. If you can't change it, change your attitude." When I began looking at the word "ambition" in a different way and how we can equate it with leadership, I felt like a door opened and I never went back the other way. To be able to express on such a deep level, have joy on such a high level and celebrate each other pulled it all together for me. It has made me even more determined and yes, ambitious, to work with case managers who haven't been given the opportunities they deserve. It has reinforced the idea that whatever concept lights this burning desire inside of me is worth pursuing, and it has made me even more ambitious in my quest to bring in all generations into case management.

Case management has not been multigenerational historically, but we are slowly moving in that direction and we need to change our attitude to make that occur. What I am seeing is how much more powerful we become as case managers and as leaders, when we partner with all genres and generations of case managers and work together. Mutual respect allows both case management and our workplaces to capitalize on diversity and resolve conflicts productively-it is critical to making the high-ambition leadership strategy work. We are all colleagues, whether we happen to be new case managers, seasoned or counting down to retirement. It is important to talk about each one just as brilliant case managers. We create a bigger impact together and raise each other up so we can raise up our patients who do not have the opportunities or abilities to do so.

Great ambition is the passion of a great character. It is hard to imagine a more energizing or meaningful way to spend your professional life than to play a central role in building a higher-ambition profession. Do not be afraid or become discouraged in your own role. Let me remind you of my opinion that ambition is a fabulous word. As Mildred Mcafee said, "If you have a great ambition, take as big a step as possible in the direction of fulfilling it. The step may only be a tiny one, but trust that it may be the largest one possible for now."

Kathleen Fraser, MSN, MHA, RN-BC, CCM, CRRN, FAAN

CMSA National Executive Director