Peer interviews, mentors = happy case managers
Hospital system increases staff satisfaction
New case managers at Carolinas HealthCare System are chosen by their peers and as part of orientation, work closely with a preceptor, then meet with a mentor for a year.
- Case managers who will be working with the new hire interview candidates and make the final selection.
- The preceptor follows them as they complete the case management training orientation program that includes hands-on training.
- When they start their new job, they are assigned a mentor who meets regularly with them for a year and is available for questions and concerns.
At Carolinas HealthCare System, case manager candidates are interviewed by their peers, who make the final selection. Then, as part of their training and orientation, they work with a preceptor for at least six weeks and a mentor for a full year.
The program has helped the case management department hire people who will fit into the culture of the organization and has helped the organization retain experienced case managers and have increased employee satisfaction, says Barbara DeSilva, MSN, MHA, FACHE, CPM, ACM, vice president of clinical management for the seven-hospital healthcare system with headquarters in Charlotte, NC.
"We have a large, stable workforce and an engaged workforce. Our training and mentoring program also helps us develop leaders. About 80% of the people who rise through the ranks and become managers were staff members in our own department," she says.
When there is an opening, DeSilva selects potential candidates from the pool of applicants. The hospital system requires its case managers to have a four-year degree and a strong clinical background, and preferably have case management experience.
A team of case managers that includes people who will be working with the new employee interviews the candidates one at a time. "We work in small teams at our hospital, and the chemistry between team members is important. The peer interviewing team spends a lot of time with each applicant to make sure they will fit in," she says.
The three-person peer interviewing team includes case managers and social workers, all of whom have gone through a peer interviewing class offered by the health system’s employee development department.
They use a set of questions the department has developed as a guideline, describe the job in detail, and encourage the candidates to ask questions. "I want the candidates to get an accurate picture of what the job is like. We give them the opportunity to ask questions about the role and get clarity," DeSilva says.
The team of peers can answer questions about the day-to-day work on the unit, information that management may not know in detail, she adds.
When new case managers begin work, they go through a multi-dimensional educational process that includes classroom time and on-the-job training. They go through the health system’s week-long orientation session and then are assigned to a preceptor who works with them as they complete a six-week case management orientation and training program. The preceptors are tenured staff members with good communication skills and good productivity records. The department tries to assign a preceptor who works as closely as possible to the unit where the new case manager is going to work.
The new case managers must demonstrate competency in each of the training modules. For instance, in the utilization review area, they start by reviewing one chart at a time while the preceptor watches. "It is pretty hard for people to get their arms around a role unless they have done it. We tell them that it takes a solid year before they will feel totally comfortable in the job," she says.
Their training includes time in the health system’s resource center to learn about insurance, hands-on time to learn the computer system, and InterQual training. In addition to work on the floor, they also spend time with home health to become familiar with the post-acute side.
While orientation and training typically lasts six weeks, it can be extended if the new case manager is struggling. "If people have a passion for the work and are truly trying, they can take as long as they need to. Not everybody is a quick learner," she says.
Then the new employees are assigned to a unit and work closely with the case managers on the unit, starting with one case and gradually taking on a bigger workload as they learn how the unit operates. "We try to place new people on units that are big enough to have two nurses. Case management can be very isolating, and we want the new employees to have someone to work with in the beginning," DeSilva says.
Once new employees are assigned to a unit, they also are assigned a mentor who may or may not be the preceptor. If they have questions or concerns, they have someone they feel comfortable with to whom they can turn for answers. The mentoring program lasts a year. The new case manager and mentor meet at least once a month, usually more often. "The mentor role is strictly voluntary. We do want experienced case managers, and we try to match the mentor whose personality matches that of the employee," she says.
The management team monitors the work of the new case managers and meets with each unit at least once a week to review the cases. "We want to make sure the new hires are comfortable in the role and happy with the job. We can find out a lot just by talking through the cases," she says.
The health system recently revamped its orientation and training program and developed a new six-week education program.
"We use educational modules to include topics such as short-stays, observation criteria, Medicare Conditions of Participation requirements, and the Recovery Auditors and other auditing programs," she says.
