What are cues that care management is not working well and what can be done about it?

Here are some examples of care management, after a reasonable introduction period, not working well looks like:

• Providers and staff do not refer to the care manager.
• Providers and staff really don’t know the care manager or what s/he does.
• Providers and staff don’t trust the care manager.
• The care manager is often pulled into routine clinical care – rooming patients, giving injections, etc.

• Providers and staff don’t believe that a care manager is needed, feel threatened, or feel that they should provide care for the patient (i.e., lack of interest in team care).
• There are no data on the effectiveness of the program, or the data show that no impact is being made.
• The care manager works as an independent operation – separate from the practice without communication with providers and staff.

Paying attention to those aspects of how groups think about and work together to address real world problems will help you implement and sustain your care management program. Considering these processes, here is a tongue-in-cheek list for making care management (or any intervention) NOT work. In other words, here are ways to derail successful implementation:

1. Have a mental model about the way things are or should be and don’t change it to accommodate new information or ways of doing things. (Mental models)
2. Don’t think the new initiative is important and don’t try to consider alternative view points on its benefits.
3. Don’t take the time or the steps to plan out who might need to be involved or the resources needed. (Planning)
4. When an unknown pops up and you’re not sure what the answer might turn out to be, just stop and be stuck. (Managing unknown)
5. Don’t work with other people to make sure your efforts are working in concert with one another. (Coordination)
6. Just keep doing what you’re doing and do not make decisions about what to do next. Whine and complain about how difficult it is and blame the EMR/health system/insurance companies/etc. (Decision making)
7. Don’t look for new information, but when you do get new information, don’t consider it or incorporate it into your plans or decisions. (Monitoring and detecting; Sense-making and learning)