Care Management as Management

Abstract

The model for this study derived from my combined MSW and MBA degrees as well as from my observations over the years, as a social work educator and practitioner, that a good deal of social work practice included the application of corporate management functions. Some important differences or modifications do, however, distinguish social work practices from the functions of true corporte management. Hospital care managers were a most promising group on whom to test my hunches because hospital social work care management practice is carried out in a service delivery setting which is analogous to a corporate milieu. A hospital milieu is, like a large for-profit corporation, characterized by complexity, ambiguity, and practice among a range of health care personnel working on teams to achieve patient care goals. Such hospital settings also are characterized by the necessity for rapid and streamlined decision-making, quick assessment, time-limited interventions, efficient and creative application of scarce resources, and constant empirical evaluation of goal achievement and outcomes. Social work care management practitioners in complex hospital settings were therefore an ideal group among which to test my management ideas. The management model for the care management study of 245 care management outcomes in 13 general hospitals posits six management functions and subsumes a variety of care management activities carried out by social workers in each of the six management categories. These management functions and care management activities formed the units of analysis for the study data. Figure 1 depicts the management functions and activities within each management function. In short, care management is a continuous process which includes direct clinical interventions. But most important in the current managed care climate, care management is dominated by an interlocking, interdisciplinary set of management functions which are designed to ensure cost-efficient and effective interventions with clients, families, groups, organizations, and communities. Good management assures optimal service outcomes for clients, many of whom experience complex, interwoven, long-term, and often quite intractable, problems. STUDY FINDINGS: WHAT SOCIAL WORK CARE MANAGERS ACTUALLY DO Previous studies of the management aspects of care management (Mizrahi & Berger, 1998, 2001) focused on the views of directors of social services in large hospitals. The care management outcomes study described in this article is on the other hand the first to focus on the use of management skills and techniques in social work care management practice interventions by line social work care managers, those in direct contact with clients. The study was undertaken in April-May, 1998 under the auspices of the Massachusetts chapter of the National Association of Social Workers. The study obtained 245 care management outcomes among 122 social work care managers in 13 hospital settings in the Boston, Greater Boston, and Western Massachusetts areas. (See Appendix 1 for a list of participating hospitals and directors of Social Services). Results of this study, from a strictly clinical social work intervention point of view, were reported in a paper delivered at the Council on Social Work Education Annual Program Committee Meeting (Brooks, Veeder, Brill, Sankar, and Daniels, 1999). SAMPLE The study sample of 122 social work care managers was purposively selected from among the larger general hospitals in Boston, Greater Boston, and Western Massachusetts. The initial choice of hospitals was made by the NASW Ad Hoc Case Management Task Force which consisted of health care social work administrators and social work research and field educators in the Boston area. The Ad Hoc Task Force designed the study and jointly selected the study settings. The National Association of Social Workers (Massachusetts chapter) wanted data about care management outcomes in order to shore up the social work care management function in hospitals which at the time were under siege. …