From the Executive Editor

Despite the Challenges, Case Managers Must Prioritize Their Patients’ Care

Catherine M. Mullahy

While the title “case manager” has been a term that’s used to describe our primary role and should be synonymous with it, its meaning seems to have been diminished. This is especially true in this postpandemic era.

This issue of CareManagement will underscore that time does not stand still for case managers, not even in the summer. We have a great deal of information in this issue, and hopefully you’ll be able to find some time to read the contents. It’s also important to take some time to renew our spirits and enjoy our family and friends, but today’s staffing challenges are making it difficult for many case managers and other health care professionals to take vacation time. How will this impact you?

Staffing shortages persist and the “great resignation” continues. New graduates from nursing programs, social work programs, and medical schools will all be starting their first professional jobs, which often results in staff and resource reallocations and increasing stress for everyone. There will be pressures on existing staff, many of whom will be asked or assigned to be preceptors for inexperienced staff members. Experienced case managers will be mentoring those who will transition into their new roles. With these additional responsibilities, challenges will also increase, not just in one setting but across the care continuum. There used to be a saying, “Don’t get sick in July.” Sadly, this upheaval causes what health care workers call “The July Effect” in the United States and the “August Killing Season” in the United Kingdom (where the shift happens in August). The changeover harms patient care, increases medical and medication errors, and causes longer hospital stays. In July, U.S. death rates in teaching hospitals surge between 8% and 34%—between 1,500 and 2,750 deaths. UC San Diego research-

ers found that fatal medication errors “spike by 10% in July and in no other month.” This is alarming and should cause all case managers to consider what they can do to help address this situation. Unfortunately, inexperienced staff members continue to have a direct impact on care, safety, and the patient experience. Of course, case managers continue to experience the repercussions and challenges associated with inexperienced staff members.

While we need to deliberately and actively position ourselves as advocates for our patients, I wonder if the term “advocate” has lost its impact. While the title “case manager” has been a term that’s used to describe our primary role and should be synonymous with it, its meaning seems to have been diminished. This is especially true in this postpandemic era. Several prominent leaders in nursing, social work, case management, and medicine have expressed increased concern about the attitudes and demeanor of our colleagues and are calling for action. Their observations have been especially troubling as they relate to the diminished kindness, concern, and willingness by case management professionals and their colleagues (ie, nurses, social workers, and others on the patient’s care team) to address these concerns. These leaders proposed that these problems need to be addressed in a decidedly direct and unique manner, and it was interesting that the terms being used—disruptive innovation and disruptive advocacy—were quite similar. Our colleagues have noticed and felt compelled to address their concerns in presentations, social media, and various publications. The image and description of the actions that were being proposed appears in Figure 1.

During the past few months, I

FIGURE 1

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