# Case Management Content - What is Case Management? - What's involved in Case Management? - How to do Case Management? - What is "Good" case management? - Worker - #therapist - #therapeutic-relationship - Self Reflection - #Burnt-out [[Burnt Out]] - [[Book - The End of Burnout by Johnathan Malesic]] - [[Article Your work is not your god - welcome to the age of the burnout epidemic]] [[Systemic group supervision]] [[20220310 Solution Focused Group Supervision]] --- ## Definition of Case Management [[1_What is case management?]] ## Different use of Case Management? ## Characteristics of Case Management ^3c87c4 Source: [[Case Management Combining Knowledge With Process]] 1. Managing complexity and involvement of multiple stakeholders 1. Case workers need to manage a complex set of steps from the start of a case through to its completion, usually involving interaction with others in their organization and with external agencies, and requiring the generation of correspondence, documents and records. 2. Knowledge-intensive: 1. Typically case management processes require the intervention of skilled and knowledgeable personnel. Staff acquire their knowledge through their experience of working on similar cases and through collaboration with more experienced colleagues, becoming thoroughly familiar with the tacit and explicit rules governing how cases should be managed. These staff have to deal with issues that can be ambiguous and uncertain and that require judgment and creativity. Managing knowledge so it stays within the organization and is passed quickly to new members of staff is a challenge. 3. Variability (Manage the uncertainty) 1. While a particular type of case will share a general structure (e.g. handling benefits applications), it is not possible to predetermine the path that a particular instance of a case will takeii. A case can change in unpredictable, dynamic and ad hoc ways as it is progressed through an organization. Certain elements may be fixed (e.g. the end-to- end duration for completing a case may be set to 18 months, or a fixed budget may be allocated to each case) but there can be considerable variation in how steps are executed, based on the particular circumstances of the case. 4. Long Running: 1. cases can run for months or years, and are generally much longer running than the shorter interaction cycles handled by standard customer relationship management (CRM) systems. Because a case is long running, it changes hands over time, different people work on different aspects and no single individual has an accurate view of the case as a whole. This drives the need for a supporting case management system that can provide a single consolidated picture of the case. 5. Information Complexity 1. Case management almost always entails the collection and presentation of a diverse set of documents and records. Emails, meeting notes, case documents and correspondence related to a case must be easily accessible to the appropriate case worker at the right time. This is often difficult for case managers to organize and manage efficiently, with the danger that an important record, note or file will be unavailable, lost or overlooked when it is needed. Retrieving the correct information required at a particular decision point usually depends on the knowledge of the case worker and an adequate physical filing system. 6. Collaboration and Coordination 1. case workers usually need to co-ordinate interviews and meetings among interested parties, e.g., scheduling an interview with an applicant, with other staff in the organization, with legal representatives. Many cases require a team-based approach, with different specialists working on different aspects of a case or acting as consultants to their colleagues. These team members need to be able to access case information and discuss it with each other. Collaboration is particularly important in knowledge-based case management because workers rely on each other’s advice and experience when making decisions on a case. 7. Multiple Participants, Multiple Roles 1. There are often a range of involved parties, either directly or indirectly related to a case, who play different roles during the lifetime of the case – e.g. applicant, witness, claimant, injured party, appellant etc. There can also be a large range of staff roles required to complete a case end-to-end. And case workers can fulfill different roles in different types of cases. 8. Cases Can Be Interrelated 1. The outcome of separate cases may have an impact on each other. For example, an application for citizenship by an individual may be affected by the success or failure of an application by a spouse or immediate relative. Cases can be explicitly linked or they may be linked by inference and conducted with this inferred link in mind. 9. Critical Nature of Timescales 1. While cases may have great variability in how they are completed, very often there are inflexible requirements for end-to-end timescales, driven by legislation or Service Level Agreements. 10. External Events Affect cases 1. external, out-of-band events and intervention can change the state of a running case, e.g., a phone call from a lawyer or the unscheduled arrival of compliance documentation. 11. Difficulty in Gaining Visibility of Case Progress 1. This is a common characteristic of case management as it is implemented today, although it is not an inherent characteristic. While case workers may have a good understanding of how they are progressing individual cases, it is often difficult to monitor progress when work has been passed to colleagues within their own unit or to an external department. At a higher level, managers usually have poor visibility of how long it takes to progress a case on average, how much a case costs to process, and what the expected completion time is for a particular case. It may also be difficult to obtain information on which cases are stalled waiting for an external communication and which steps in a case are repeatedly causing bottlenecks. The result is that processing of cases is often serialized, because to run them in parallel, while more efficient, is just too difficult for many organizations to manage. 12. Strong Reporting Requirements 1. There is usually a significant requirement to report on and analyze information derived from case handling, both at operational and management levels, for example workload analysis of cases by stage, by individual and by department and case performance versus target. Managers want gain insight into operational performance and quickly identify exceptions. 13. History (Documentation, Accountability) 1. Every action performed, every decision taken and every piece of correspondence received has to be tracked, not just for audit purposes, but also to provide guidance for future similar cases. Case workers need access to this history when making decisions, while auditors need the history to ensure policies are being adhered to. The case history is the organization’s defense mechanism against any allegations of failure to perform, particularly in cases which have high cost or personal impact. 14. Security 1. There is a requirement to provide fine-grained control over who has access to particular information and functionality. In certain environments, these security requirements assume particular significance e.g. policing, health care and child protection. 15. Isolated Pockets of Automation 1. This is a characteristic of case management as it is generally implemented today, rather than an inherent characteristic. Case management is usually only partly automated and there is disjoint between those pockets of automation. Legacy systems automate slices of the processes, but the end-to-end management of a case still relies too heavily on paper documentation, physical folders, spreadsheets and email. ## Why is Case Management Important? ## Case Management related to [[Knowledge Management]] Case workers are knowledge workers. Tom Davenport has defined knowledge workers as “people whose primary job is to do something with knowledge: to create it, distribute it, apply it.”iii Knowledge workers think for a living. They solve problems, they understand and meet the needs of customers, they make decisions, and they collaborate and communicate with other people in the course of doing their work.iv ^c7f2d2 Knowledge workers are the most important and fastest growing section of the workforce, but the processes they use in their work are not well supported by technology; and generally they haven’t been the focus of systematic process improvement initiatives. ## The Importance of Combining Process and Knowledge Case Managers need to have access to knowledge, and supported by a knowledge-centric process to carry out their work. It is self-evident that there should be good linkage between knowledge-centric processes and the underlying knowledge needed to carry out those processes.xii However, process and knowledge are generally not well integrated. In a 2005 article, L.Russell Records of CSC Consulting discussed the parallel evolution of business process reengineering and Knowledge Management, highlighting the lack of integration between the two: There was (and still is) a general lack of understanding of how valuable the fusion of processes and knowledge can be. The thought of actually taking the distilled knowledge and making it easily available to people executing the process was somehow overlooked. Employees would only stop to access the available knowledge base when the process execution came to a screeching halt due to an inability on the part of the employee to continue. Many times this would involve looking up information in an offline source like a procedures handbook or calling a friend who might know the answerxiii It is difficult to replicate human expertise in systems. Because human constantly interact with others to update, and reformulate their knowledge. Paul Harmon, editor of BPTrends, described in a 2006 article how approaches from cognitive psychology and computer science were used in the 1980s to capture and embed knowledge in software systems (known as ”expert systems”)xiv. According to Harmon: Ultimately expert systems have not proven very viable. It turns out that human expertise – if it’s worthy of the name – needs to be constantly maintained. Human experts attend conferences, read books and research papers, and constantly interact with peers while trying to solve hard problems. All this leads to their reformulating their knowledge. It turns out that it is expensive to capture human knowledge from an expert system, but it is much more expensive to maintain that knowledge. Knowledge management movement started in 1990s, is an attempt to make knowledge accessible by workers. But the inability to find the right information at the right time is the problem. The next major attempt to focus on the use of knowledge in work was the Knowledge Management movement, which gained momentum in the late 1990s. Knowledge Management aimed to capture knowledge effectively, categorize it and then make that knowledge available across an organization. For the most part, it wasn’t particularly successful, because we didn’t look closely at how knowledge workers did their work.... Most organizations simply created one big repository for all knowledge and all workers. The only way to get people to use knowledge on the job is to understand how they do their jobs and then figure out some way to inject knowledge into the course of their day-to-day work, not make it a separate thing you have to consult when you need knowledge. ... The best way is to use technology to bake the knowledge into the job.xv This inability to access the right information at the point in a process when it is needed is a problem: Process execution normally stops when someone has to retrieve knowledge that has not been provisioned for them to use. When this occurs in a customer-facing process, the cost to execute the process skyrockets.xvi ## Case Management in Clinical / Social Services [[An Introduction to the practice of case management in social services.pdf]] [[C20200327 Why do we formulate cases]] Article [[Article - A Meta Analysis of the Effectiveness of Mental Health Case Management Over 20 Years]]