The System is Broken – A Call to Action for Nurse Case Managers 

Case Management Focus

I have been involved in some complex and challenging cases lately. As I reflect on my role, I realize that I am a disruptor.  

Yes, case managers are disrupters. Yes, we are in place to disrupt the status quo. If you have not experienced the healthcare system firsthand, it is fragmented, uncoordinated, complex, and sometimes downright mean, and it is getting worse.  

I am writing this post to remind all case managers to take their roles seriously. You are needed now more than ever to be a disruptor!  

The system is in trouble—not because the professionals who make up the system practice poorly, are poorly trained, or are uncaring. On the contrary, they are well-trained and caring, which is viewed as the main reason we are seeing burnout among so many healthcare professionals.  

The issue is how the system is built. As Don Berwick said many years ago, the system is perfectly designed to achieve the results it achieves. Look at your outcomes. How are your systems performing? Look deep to discover the root cause of the challenges that hold you back.  

As a long-time workers’ compensation nurse case manager, I identify problems when I find them. I also improve communication, decrease fragmentation, and bring all the stakeholders together to create a coordinated and streamlined plan for my patients.  

Whether you are an on-site or telephonic case manager or work in a doctor's office or clinic, it is your role to humanize the system so that it works for all stakeholders.  

I know our jobs are not easy. We are working with decreased resources and are pressed to move people through a complex and costly healthcare system that is not well.  

The system works in silos. People sometimes don't communicate, so as the saying goes, the right-hand does not know what the left hand is doing; even as case managers, we don't use each other to transition our patients through the system.  

One of our most important roles is to help improve communication between all stakeholders, including the injured worker and his/her family. Another is to educate and empower the consumer to speak up, ask questions, and know their role as a patient. Helping them set realistic expectations is so important that they realize how important it is for them to be involved. Improving these two areas would make a huge difference.  

If you want a reminder about your role, I suggest you read the Case Management Standards of Practice. This is the one document everyone who calls themselves a case manager is responsible for upholding.  

If you are called into a count of law, the attorneys will use the Standards of Practice to hold you accountable for your work and documentation. I hope you are never called into a court of law, but if you are, I want you to be prepared and know that these Standards exist and how they shape your role.   

Reading Material on Systems 

When a System is Not a System: https://deming.org/when-is-a-system-not-a-system  

Healing Healthcare: https://healbrokenhealthcare.com (note I am a contributing author to this book)  

3D Problem-Solving means listening, tearing down silos, and sending people home happy file:///C:/Users/Owner/Downloads/Article%20-%20UAB%20Reporter%20-%203D%20Problem-Solving%20%20(6).pdf  

Dr. Don Berwick: Why is every system perfectly designed to get the results it gets? https://ihimedia.podbean.com/e/dr-don-berwick-why-every-system-is-perfectly-designed-to-get-the-results-it-gets  

Case Management Standards of Practice: If you are a member of CMSA, you can download a copy for free. If you are not a member, you can purchase a copy  at https://cmsa.org/about/standards-of-case-management-practice 

Case Managers are leaders in our healthcare system; I urge you to use your voice and work to be a disruptor! Don’t settle for a broken healthcare system for your patients or yourself. Work to make it better for all.  

I hope you will take this post to your next staff meeting and discuss the challenges faced due to the broken healthcare system we all share. Remind them about their roles and the value they bring to the healthcare system and the people who use it!  

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