Complex Case Management
BY JOSE ALEJANDRO, PhD, RN-BC, MBA, CCM, FACHE, FAAN
Effective complex case management requires collaboration. Complex case management provides a perfect opportunity for a multi-disciplinary team to engage in patient-centered care. As a professional case manager, you have a unique opportunity to lead the charge in developing an individualized and comprehensive care transition plan that meets the needs of the individual across the continuum of care.
Evidence-based practice suggests that it is helpful to consider complex case management from the perspective of: (1) medical and mental health complexity, (2) system complexity and (3) situational complexity (Watson, 2018).
A key attribute of complex case management is patient advocacy. Understanding and embracing an individual’s medical and mental health needs and wishes requires a holistic or whole-person approach in the development of a comprehensive care and transition plan. An effective plan is longitudinal, meaning that the complex case management multi-disciplinary team considers the long-term needs of the individual and how community resources will be incorporated as the individual transitions across the continuum of care. Professional case managers have an ethical responsibility to address the social determinants of health throughout the healthcare continuum. Oftentimes, we tend to focus on the acute care perspective as a symptom but do not look at developing a care plan from a holistic global perspective. Most patients and their caregivers want to maintain their quality of life and do the right things, but in order to do that, they must have the education and resources to be adherent.
From a system complexity standpoint, professional case managers require a comprehensive understanding of the care delivery system and available resources within the current organization and the subsequent transition point(s). This requires professional case managers to have a broad understanding of network, community and care partner resources and how to access those resources. In other words, how can we cut through bureaucracy and other red tape to efficiently create a care and transition plan that works? Building and maintaining long-term relationships with community and regional stakeholders is a key to building an effective plan.
When considering situational complexity, the complex case management team needs to have a comprehensive understanding of the impact of the social determinants of health on the complex case management plan. For example, upon care transition, will the individual have reliable access to transportation, accessible and safe housing, and other community social support and advocacy services? Oftentimes, we need to step back and reconsider the complex case management plan in terms of Maslow’s hierarchy of needs.
This edition of CMSA Today™ explores complex case management and the impact that professional case managers can have in the design and implementation of care and transition plans. I hope this edition expands your mental models and engages you in further discussion and collaborative practice. The time when a single healthcare discipline was responsible for development of a discharge plan has morphed into transdisciplinary approaches in care transition planning, evidence-based practice, research and advocacy.
Watson, S. (2018). HIV complex care and care coordination: the nurse’s role. HIV Nursing, 18(2), 38-47.
Jose Alejandro, PhD, RN-BC, MBA, CCM, FACHE, FAAN
Dr. Alejandro is the Director of Case Management at UC Irvine Health, Orange County’s only Level 1 Trauma and Burn Center.
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