Posts Tagged ‘oncology’

Integrated Case Management Scripts Keep MSKCC Patient Care Team on Same Page

February 1st, 2018 by Patricia Donovan
Healthcare Scripting

MSKCC scripting improved the consistency of patient communication and staff efficiency.

To help ensure its patients receive consistent messages, Memorial Sloan-Kettering Cancer Center (MSKCC) has developed a series of scripts for use by its integrated case management team. Here, Laura Ostrowsky, RN, CCM, MUP, MSKCC director of case management, describes some scripting scenarios employed by the state-of-the-art specialty hospital.

There are a variety of ways we’ve done scripting. For example, there was a time when a case manager would meet with a doctor and the doctor would say, “I think we need to set up hospice for this patient.” The case manager then would go into the patient’s room and say, “I’m here to help you to set up your discharge plan. I know you’ll be going to hospice.”

And then the patient would say, “What are you talking about?”

One thing all case managers know is that when you go into a patient’s room, especially if someone told you they said something to the patient, you first must confirm what the patient understands about that previous conversation. If it turns out that they didn’t understand what you were told to talk about, then you don’t have that conversation. You go back to the staff member that sent you in there and discuss it. Perhaps you schedule a family meeting to discuss that issue.

We also developed scripts not only for preadmission staff, but for all staff trying to get approvals from insurers for high-cost medications and for procedures. We work with them to identify how to answer questions from the insurance company or insurance case manager so that those tasks can be handled by the doctor’s office or admitting department rather than by case management.

The approach of our length of stay reduction teams, while not exactly scripted, is concerned about consistency of message. The teams came up with the steps and planned the patient education material with the imperative that we never overestimate a length of stay, but rather err on the short side.

The imperative is that everybody speaks to the patient the same way. The case managers make a point to tell the team, “Don’t make promises we can’t keep.” That’s not exactly scripting, but it keeps everybody on the same page. For example, don’t tell a patient they are going to have plenty of help at home. Or that they will get home care and someone will be there every day, because you don’t know if that is going to happen.

Instead, you can say to the patient, “We are going to see if you are eligible for home care. I am going to send the case manager in to see you. They will check your benefits and go over eligibility. We will do our best to get you the services you need.”

Source: Integrated Case Management: Elevating Quality and Clinical Metrics with Multidisciplinary Team-Based Care

integrated case management

Integrated Case Management: Elevating Quality and Clinical Metrics with Multidisciplinary Team-Based Care details the framework and implementation of the service-based multidisciplinary program MSKCC adopted to ensure that the care it provides to more than 25,000 admitted patients each year is both cost-effective and cost-efficient.

‘Connect the Dots’ Transitional Care Boosts ROI by Including Typically Overlooked Populations

October 11th, 2016 by Patricia Donovan

Typically overlooked patient populations do benefit greatly from nurse-directed transitional care management.

Some typically overlooked patient populations do benefit greatly from nurse-directed transitional care management.

Determining early on that transitional care works better for some patients than others, the award-winning Community Care of North Carolina (CCNC) transitional care (TC) program is careful to allocate resource-intensive TC interventions to those patients that would benefit most. Here, Carlos Jackson, Ph.D., CCNC director of program evaluation, explains the benefits of including often-overlooked patients in TC initiatives.

Transitional care must be targeted towards patients with multiple, chronic or catastrophic conditions to optimize your return on investment. These patients are the ones that benefit the most. It’s the ‘multiple complex’ part that is the key; this includes conditions that are typically overlooked in transitional care, such as behavioral health or cancers.

We may pass over and not focus on these patients in typical transitional care programs, but actually, they do benefit greatly from our nurse-directed transitional care management.

For example, with a cancer population, transitional care keeps them out of the hospital longer. The transitional care is not necessarily preventing or curing the cancer, but it’s helping to connect those dots in a way that keeps them from returning to the hospital. Again, we are also talking about complex patients. This is not just anybody with cancer; this is somebody with cancer and multiple other physical ailments as well.

The same is true for people who come in with a psychiatric condition. Again, we’re talking about a very sick population. For every 100 discharges, without transitional care almost 100 of these patients will go back to the hospital within the next 12 months. That’s almost a 100 percent return to the hospital. But with transitional care, only about 80 percent return to the hospital within the coming year.

This translates to an expected savings of nearly $100,000 just in averted hospitalizations per 100 patients managed. We were able to demonstrate that the aversions happened not only with the non-psychiatric hospitalizations, but also on the psychiatric hospitalizations.

Even though nurse care managers often tend to be siloed, by doing this coordinated ‘connecting the dots’ transitional care, they were able to prevent psychiatric hospitalization. That certainly has implications for capitated behavioral health systems. We don’t want to forget about these individuals.

Source: Home Visits for Clinically Complex Patients: Targeting Transitional Care for Maximum Outcomes and ROI

Home Visits for Clinically Complex Patients: Targeting Transitional Care for Maximum Outcomes and ROI describes the award-winning Community Care of North Carolina (CCNC) transitional care program, how it discerns and manages a priority population for transitional care, and why home visits have risen to the forefront of activities by CCNC transitional care managers.

Infographic: Healthcare Innovations in Oncology

December 26th, 2013 by Jackie Lyons

Although worldwide cancer incidence is expected to increase by 2030, oncology breakthroughs and innovations are rapidly advancing as well, according to a new infographic from CBI.

This infographic includes cancer mortality rate statistics, therapy and prevention procedures, education and quality of life, patient access, cancer research progress, effects of the Affordable Care Act (ACA) and more.

Healthcare Innovations in Oncology

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

You may also be interested in this related resource: The Handbook of Health Behavior Change, 4th Edition.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Healthcare Business Week in Review: Care Coordination, Oncology Nurse Navigators, Readmissions, ACA

December 13th, 2013 by Cheryl Miller

Primary care outside the doctor’s office is getting its due. According to a final ruling from CMS, payment rates and policies for 2014 are focusing on improved care coordination, including a major proposal to support care management outside the routine office interaction.

The ruling also includes other policies to promote high quality care and efficiency in Medicare. CMS officials consider the care coordination policy a milestone, demonstrating Medicare’s recognition of the importance of care that occurs outside of a face-to-face visit for a wide range of beneficiaries beginning in 2015.

But there is a time and place for face-to-face visits: namely, between nurses and newly diagnosed cancer patients. According to a new study from the Group Health Research Institute, cancer patients who received support from a nurse navigator or advocate soon after being diagnosed had better experiences and fewer problems with their care, particularly in the areas of health information, care coordination and psychological and social care. Patients reported feeling that the healthcare team had gone out of its way to make them feel better emotionally. The extra help is especially welcome with new cancer patients, given that they and their caregivers need help translating medical jargon and navigating the healthcare maze, researchers say.

While the covering of catastrophic illnesses like cancer is one of the key issues behind healthcare reform, it is not enough to sell the nearly 30 percent of Americans opting out of coverage. According to the latest tracking poll from Gallup, one out of four uninsured Americans are planning on paying the government penalty rather than buy health insurance. The reason? Not what you think; details inside.

An automated prediction tool that identifies newly admitted patients at risk for readmission within 30 days of discharge has been successfully incorporated into the EHR of the University of Pennsylvania Health System.

The tool predicts at-risk patients as those who have been admitted to the hospital two or more times in the 12 months prior to admission. Once it identifies these high-risk patients, it creates a flag in their EHR, which appears next to the patient’s name in a column titled “readmission risk” once the patient is admitted.

We’d love to hear how your organization is working to reduce hospital readmissions by taking HIN’s fourth comprehensive Reducing Hospital Readmissions Benchmark Survey. Respond by January 3, 2014 and receive an e-summary of the results once they are compiled.

Healthcare Business Week in Review: Oncology PCMH; Medication Management; Seniors on FB

November 29th, 2013 by Cheryl Miller

As families gathered this week to celebrate Thanksgivikkuh, (which won’t happen again for 77,000 years!) we offered several stories that demonstrate the strength of partnerships.

To begin, a first-of-its-kind patient-centered medical home (PCMH) model for oncology from Aetna and Consultants in Medical Oncology and Hematology, PC (CMOH).

The collaboration combines evidence-based decision support in cancer care with enhanced personalized services and realigned payment structure and is designed to increase treatment coordination and improve quality outcomes and costs for cancer patients. Researchers found that more than half of all new cancer patients are 65 or older, and most have one or more health conditions in addition to cancer. Given their frequency of contact with patients, oncologists are well positioned to help their patients coordinate care for multiple conditions.

Physician-led, team-based models of care are the future of healthcare, according to the AMA, which has issued a set of recommendations for implementing these models, including a report for the development of payment mechanisms that promote satisfaction and sustainability of team-based models in various practice settings. Among the recommendations: establishing payment distribution models that foster physician-led team based care, and reimbursing those physicians who lead these teams accordingly.

High-risk heart failure patients receiving nursing interventions were four times as likely to take their medication, but their hospital readmission rates were not impacted, according to a new study at Duke Medicine.

Patients who were tutored about managing their symptoms, taking their pills on schedule, and developing an action plan for addressing their symptoms were more likely to take their prescribed medications. They were encouraged to use doctors’ offices and clinics rather than the emergency department.

But when the researchers looked at the hospital readmission rate, they found that readmissions were not significantly different between the two groups. Medication management is just one of many issues facing patients most at risk for their conditions to worsen, researchers found, and redesigning care to confront the issues that are keeping the vulnerable from regaining their health has to be addressed.

Developing a communication hub, virtually and in person, is critical to a successful care coordination plan for dual eligibles, says Timothy C. Schwab, MD, FACP, former chief medical officer of SCAN Health Plan. It ensures that all members of the immediate and long-term support team are in sync with each other.

Seniors want to stay connected. According to a new Accenture survey, more than half of seniors 65 years and older are seeking digital options for managing their health services remotely. In fact, researchers found that at least three-fourths of Medicare recipients access the Internet at least once a day for e-mail (91 percent) or to conduct online searches (73 percent) and a third access social media sites, such as Facebook, at least once a week.

And lastly, a way for you to communicate with us: participate in our fourth comprehensive online survey, Reducing Hospital Readmissions Benchmark Survey, and we will send you a free e-summary of the results once they are compiled.

25 to 31 Million Americans Receive Care Through ACOs

December 11th, 2012 by Cheryl Miller

In just two years, the number of ACOs has swelled across the country, according to a new report from Oliver Wyman. A total of 25 to 31 million U.S. patients currently receive their care through ACOs, and an estimated 45 percent of the population live in regions served by at least one ACO. Researchers weren’t surprised by some of the ACO-intensive areas, namely urban areas like Los Angeles and Boston. But other ACO-rich areas were surprising, findings that support researchers’ claims that ACOs are poised to offer a competitive threat to traditional FFS medicine.

Increasing patient numbers, especially among the uninsured and Medicaid-eligible, has always been a problem for public hospitals, according to a study from the Center for Studying Health System Change (HSC), and will continue to be a problem in light of ongoing health reform. How to continue to service low-income patients without sacrificing care quality? Expanding primary care access and attracting privately insured patients are two of six strategies public hospitals are taking; other strategies are detailed in this issue.

Rising healthcare costs could be contained by an estimated $200 to $600 billion in savings over the next 10 years if care provider payments are reformed, according to a report from UnitedHealth Group’s Center for Health Reform & Modernization. Around half of these savings might apply to Medicare and Medicaid, but even under optimistic assumptions about net savings and speed of adoption, health spending would continue to grow faster than incomes. Researchers maintain that payment reform is not the only answer, and needs to be pursued with other alternatives.

One potential solution for the sadly soaring numbers of cancer patients: oncology-specific EMRs that chart evidence-based treatment plans, according to a clinicians at The Mount Sinai Hospital. These EMRs enable drugs to be prescribed and health records to be exchanged electronically. Quality-related clinical data can also be captured for analysis. A panel convened specifically to study the EMRs’ effectiveness found that nearly 80 percent of people using them felt they increased their day-to-day efficiency and improved the quality of patient care.

And lastly, one aspect of healthcare that needs to be increased: the use of health coaching as a critical tool in population health management. Studies are showing that health coaches help to boost self-management of disease and reduce risk and associated cost across the health continuum. What do you think? Take HIN’s fourth annual Health Coaching survey; results will demonstrate how healthcare organizations use health coaching as well as the financial and clinical outcomes that result. Complete the survey by December 21, 2012 and receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.

Read all of these stories in their entirety in this week’s Healthcare Business Weekly Update.

Meet Healthcare Case Manager Sheryl Riley: Survivorship Critical Next Challenge for Care Managers

October 1st, 2012 by Cheryl Miller

This month we provide an inside look at a healthcare case management manager, the choices she made on the road to success, and the challenges ahead.

Sheryl Riley, RN, OCN, CMCN, Managing Partner, Clarion LLC

HIN: You’ve spent nearly a decade working in the field of oncology as a case/care manager. Can you briefly describe your work history?

Sheryl Riley: I started my career as an LPN and then in 1985 got my RN degree as well as a degree in business. At that time I was not involved in oncology but in cardiac disease, intensive care unit (ICU,) critical care unit (CCU,) step-down unit. Approximately five years into my career, I was approached by a group of physicians who asked me to help them build an intravenous (IV) infusion company. This opportunity is where it all started. I learned how businesses are run, how case management can work in case or care management in so many different areas, not just telephonically but in the home as well.

For example, we were called by a health plan to assist a patient who needed chemotherapy in the home, which was extremely progressive in late ’80s, early ’90s. We were doing IV antibiotics, partial parenteral nutrition (PPN) and enteral therapy, which were simply routine therapies, however, I soon realized there was more to it. Thus began a quest to build care management with an IV infusion component. During the 10 years that I worked in IV infusion companies I really attempted to spread the idea of care management, which enabled me to put together a new type of IV infusion nurse program. I had a great time with the last company that I ran; we opened up offices all over the country and built a model not only in the home but in some acute facilities. It really created some exciting opportunities to do some innovative care management around IV infusion therapy and things like dopamine therapy. We were able to take it out of the hospital ICU and translate it into sub-acute facilities because we had the ability to start the lines and manage the critical cases. Though their cases were complicated they were no longer critical cases and they were able to return home. We didn’t want them to have the cost of the hospitalization, so we managed them in sub-acute facilities for about a quarter of the price.

But the real breakaway came with the building of the first care management oncology program ever in the early ’90s here in New Jersey with an entrepreneur. We built our own computer system to go with it and we had nurses on the ground in other parts of the country. I would go in and visit with oncologists and speak with them regarding the concept and how the program operated as well as show them the value of our oncology nurses. At that point Humana and United were on board and we were in negotiations with Aetna. We were working in the Florida, Pennsylvania and New Jersey markets.

It was very, very exciting, because we created care paths based not just on diagnosis but nutrition, exercise and side effects management, in addition to end of life issues. If need be we also addressed respite care, babysitting, and pre-emptive issues for those that were younger with cancer such as sperm banking and egg banking. We created pathways based on disease process and trajectory of disease and it wasn’t your standard pathway. I worked with a team of highly skilled and trained oncology masters prepared nurses. When we sat down we not only created a pathway for the nurses to follow but a patient pathway as well, taking into account the National Comprehensive Cancer Care Network (NCCN) guidelines. We were focused on making them patient-centric even before it was a popular notion. It was also important that the program be on a computer system that either could be accessed easily by the patient and nurse as well as have a printable form.

So we kept building on my care management. Today they call it care coordination, which is the model inside the ACO. Currently the American Nurse Associations (ANA) and three other groups have put out white papers on care coordination models utilizing RNs. It is really care management as we know it, but they’re calling it care coordination because I think some people get confused with case versus care. About ten years ago I wrote an article on the difference between the two which was pretty progressive back then because case was really based on non-clinical aspects. It was simply considered moving somebody from a high level of care to a lower level of care around cost and service, with minimal regard for the clinical aspects of what they did. It wasn’t only clinical people doing that.

The crux of care management is making patients feel secure and empowered about the decisions that they’re making, with your help. One of the biggest changes in my career came when I realized that patient education wasn’t about me telling them what to do, it was them telling me what their goals were and then me trying to help them find a way to help them achieve those goals. That was my most exciting revelation: really understanding how to change behavior, how to reach that person who could never be reached before. That to me was probably one of the most exciting things.

HIN: What are some of the challenges in working with this population?

The biggest challenge is that people don’t know how to define care management. I have to tell some of my private patients, I’m not here to deny you care. I’m not here to disallow you anything. I’m here to expand your knowledge and work with you to find the best resources and the best opportunity for care for you or your family member.

The other challenge that we all face in oncology is that eventually, many of our patients will succumb to their disease and that is one thing that you cannot change. You’re going to cheat it occasionally and you’re going to help them hopefully experience the best quality of life humanly possible that they can achieve with your guidance. Yet it is hard every single day knowing that 50 percent of your population won’t make it. It’s not like dealing with a surgical patient that’s going to get better or even a diabetic, because they probably have a longer life expectancy. That aspect of my job I have learned to accept and embrace, because we learn so much from our patients at every stage of their care.

Given the many strides we’ve seen in the treatment of cancer, we are now seeing an upswing in survivorship, which is fantastic, but it opens the door to a new aspect of oncology care management, care of the survivors, not just immediately but 10 to 12 years down the road when the effects of the treatment can be seen on their vital organs.

We now have over 50 percent of the population surviving. The question that remains is how to best manage their needs. You’re dealing with drugs that have ravaged the body to kill cancer, but have also had deleterious effects including weakened bone, bone marrow and organs, particularly the heart and the lungs. Now these patients face cardiac anomalies, lung problems, bone problems, bone marrow problems and possibly down the road a lymphoma or something of that nature. So survivorship is the next big challenge that we face with this population. And with survivorship, there also is a level of emotional instability, because a quarter of the time, patients may lose their spouse. The spouse will divorce them or walk away from them. So what I see many times, when a person survives, the family is so excited about their survival that they’re just overwhelmed. But the patient feels like they survived for a reason and they want to give back. They want to get involved with others so that they can help them survive. And the families sometimes say: “I’m done with cancer. You’re done with cancer. Walk away!” And many of the survivors feel like they’ve been given a gift and they want to share that gift, however there are some family members who can’t deal with that so they will face those issues as well. Though there is much challenge dealing with the death, the dying, the helping with the decision making, the next big challenge for us as care managers is survivorship. And how are we going to help the patients manage this process as well as the family.

HIN: Will care managers need particular training for this sort of thing, for survivorship?

Yes. I think that we have spent our careers dealing with death and dying, and now we need to begin to educate ourselves on survivorship. I’m not going as far as saying there should be certification for it, but it’s definitely another line of education that we need to look at. And it’s out there. The Oncology Nursing Society (ONS), the NCCN and the National Cancer Institute (NCI) are starting to come out with survivorship programs.

But not a lot of care managers are taking advantage of them, given their lack of time. It’s disheartening because the real collaboration between oncology care managers really isn’t there. The majority of the 29,000 oncology nurses that belong to ONS are still working within hospitals and doctors’ offices, and haven’t truly embraced the care management mantra and what it stands for. They’re giving chemo. They’re trying to manage the patient there at the chair side or the bedside or wherever. But they’re not really out in the community. They’re not out in the patient’s home. They’re not taking a lot of phone calls after hours. They’re dealing with it all through a 9 to 5 job, Monday through Friday at a hospital or in a private office. For those of us that deal with our patients on a telephonic basis or a home basis, or go to the doctor’s office with the patient and get involved from the care management perspective, we feel that there’s a need for us to talk and learn from each other.

I learn so much from all other care managers. Listening to what they do, how they do it, when they do it, how they intervene, things they say, for me that’s the best part of the experience. If we could break down the barriers between nurses and become a truly collaborative group, we would have the largest voice and the best opportunity to change process anywhere in the country.

HIN: What do your chronically ill patients value most? And how can we align those goals for case management in the healthcare industry?

Chronically ill patients need education and resources. And the care manager is pivotal in finding those sorts of things. When I look at a patient who says: “I can’t afford this,” or “I can’t afford that,” regardless of disease, it’s my job to understand their financial situation and try to find drug assistance or services for them, community services from local organizations, and national organizations when necessary. These are things they can’t find on their own. Another role that we play is being there to help them organize their visits. If they’re seeing five different doctors, find out why. If they’re on a generic brand of one medication and a name brand of another, make sure their doctors are aware and work it out with them. It is quite possible that they don’t need to see five doctors. For example in the 65 and older population they may just need to see a gerontologist instead.

Care managers add a unique value to the chronically ill patient because healthcare is an ever changing venue and they need assistance when it comes to understanding plan benefits and when those have been exhausted where the patient must go to find appropriate resources. Especially for chronically ill Medicare patients, we need to help them find resources. We need to find churches and community services, national organizations and friend, family and relatives and whatever necessary to pull it all together. It is important to consider their caregiver as well. If you’ve got a chronically ill 85 year old who is taking care of a chronically ill 90 year old, you’ve got issues. We help them deal with all of that. I personally think if you take care management away and the chronically ill will fall prey to so many more issues. There is a disturbing trend going with the chronically ill population but if these patients needs can be recognized early on then more can be done to utilize our healthcare dollars more effectively. The people that are 55 right now, that are teetering on diabetes, hypertension, teetering on being chronically ill, in 10 more years they may be chronically ill. More than likely they are already on some medication. Their diet is terrible. So dealing with chronically ill patients is easier because they know they need your help, they know they need some resources and they’re willing to listen to what you have to say. It’s the population that’s growing into chronic care where we have the biggest problem, because they’re still working, active everyday, and somehow you need to change their behavior. And that’s got to come from somebody. And I really think that care management can make a difference there.

Years ago I had set up programs for employer groups where you would go to the site. If they had warehouses, we would send a nurse in to do a little health fair and take blood pressures and cholesterol screenings, have them answer all these questions. You would get 90 percent of your risk assessments done at these screenings. It was great because now you could begin to focus on those people that really needed it. This environment was also perfect for group programs. Many times you would find that in this plan you had a high incidence of hypertension and diabetes. This presented an opportunity for people to learn in larger groups and identify with other with the same condition. It’s better when people learn together, especially at that age. Because it’s like:
“Oh, Joe, you have the same problem I have. I like that Mexican food, or I like that Italian food. Or I like my beer.”
Okay, let’s design programs so that you can have some of those things without depriving yourself of everything. You need somebody who understands chronic illness, understands care management, understands resources. And that’s why I think the care manager has the advantage. They know all of those things. They can act a little bit like a social worker, a little bit like a physical therapist, a little bit like a nurse, a little bit like a case manager from the health plan, and they can pull it all together for a patient. I don’t think any other entity can do that except for a care manager.

HIN: Where do you see case management going in the next five years?

If you’re going to take 40 million Americans and throw them in Medicaid you’re going to totally blow up the system. I think that will have a negative effect on our Medicare population as well as what care managers can and cannot do. Instead I hope to see more of the larger clinics and larger facilities take on care managers. There is a slight problem with that plan, as I said earlier; there is a whole trend of moving from the word care management to care coordination. When situations are in a state of flux even with the support of whitepapers supporting RNs as the care coordinator, you see if you change the word to coordination you’re really eliminating medical management, any medical aspects, because what they’re thinking that you’re only going to do is coordinate their services. Most of the general public do not believe that you need an RN to coordinate services. If you look at the way the new models are set up for care coordination, they are RN models. There’s an RN and a social worker in a non-clinical model. The RN model allows for all the aspects of care management. Leaving the question as to why are they changing the title to care coordination. I personally don’t understand it and don’t like it. I have to teach it. I have to try to explain it to clients and to nurses, but I truly don’t understand except that they’re trying to diminish the role of the nurse and put non clinical people in these roles so that they don’t have to pay the rate of a highly trained nurse or care manager. And that is frightening. That is scary. I really don’t want to see that happen. We’ve come such a long way.

Click here to learn how you can be featured in one of our Case Manager Profiles.

Meet Healthcare Case Manager Sonia Morrison: Respect and Kindness Key to End of Life Care

June 15th, 2012 by Cheryl Miller

This month we provide an inside look at a healthcare case manager, the choices she made on the road to success, and the challenges ahead.

Sonia Morrison, RN, CM, BSN, RN case manager at Salinas Valley Memorial Healthcare System (SVMHCS), Nurse Assessment Consultant and Educator for veterans at Visiting Angels of Santa Cruz

HIN:Tell us a little about yourself.

I am certified as a nurse case manager in oncology, and have worked in oncology for 21 years. I also worked in hospice for 11 years, was a certified nursing assistant (CNA) for three years, and a licensed vocational nurse (LVN) for one year.

What was your first job out of college and how did you get into case management?

I was in a junior college career ladder program, so I worked nights as a CNA in med-surg acute care and then in a licensed vocational nursing (LVN) registry, mostly in ob/gyn, prior to graduation. My first job was as an RN in the oncology med-surg unit at Salinas Valley Memorial Hospital (now Health Care System) or the SVMHCS, and I am still there.

Has there been a defining moment in your career? Perhaps when you knew you were on the right road?

I thought I wanted to be a midwife when I started my nursing education, however, I did not like assisting births in the hospital with strangers. In my last year of working toward my associate degree in nursing (ADN), I met an amazing oncology instructor. At the same time, my best friend was dying of cancer, thus I became an oncology case manager.

More recently, I taught a CNA program for several years. In mid 2011 I attended a life directions seminar and was able to harness all of my passions and focus them around caregiving.

In brief, describe your organization.

SVMHCS is an acute care hospital with an average census of 166.

What are two or three important concepts or rules that you follow in case management?

  • The keys to successful utilization review and discharge planning and collaboration are communication, including written documentation and collaboration with the full team, including the patient, family, doctor, nursing staff and other providers.
  • Patients are assessed and educated within the first 24 to 48 hours of admissions.
  • Balanced self-care allows me to serve my team the best.
  • What is the single most successful thing that your organization is doing now?

    Expanding the role of case management to include p.m. shifts.

    Do you see a trend or path that you have to lock onto for 2012?

    Money talks and reimbursement has been the biggest challenge.

    What is the most satisfying thing about being a case manager?

    Treating patients and families with respect and kindness, especially at the end of life.

    What is the greatest challenge of case management, and how are you working to overcome this challenge?

    Finding services for obese or no pay source patients. SVMHCS case managers are working with management for creative sponsoring of needed services.

    What is the single most effective workflow, process, tool or form case managers are using today?

    Extended Care Information Network and executive health referrals.

    Where did you grow up?

    I was born in Los Angeles, CA, one of five girls and two surviving boys.

    What college did you attend? Is there a moment from that time that stands out?

    I attended Cabrillo Community College, Santa Cruz, CA for an advanced degree in nursing and a bachelor degree in public health nursing (PHN) at California State University at Dominguez Hills, CA. I enjoyed being of creative service in the community during my PHN clinicals; I used bilingual teaching tools to explain lab results, diet choices and I created new curriculum to introduce teens to human health by relating what they knew to horse health, disease, symptoms and interventions.

    Are you married? Do you have children?

    I have a husband of twelve years, a forty year old son and a six year old granddaughter.

    What is your favorite hobby and how did it develop in your life?

    The very first profession I fell in love with was a veterinarian, but my parents told me I was not smart enough to be a vet. So then I wanted to be a dancer, but my parents told me I couldn’t do that because if I broke my leg, I couldn’t support myself. So, now, I am a dancing nurse with six dogs!

    Is there a book you recently read or movie you saw that you would recommend?

    A book I wrote: The Heart of Caregiving, A Guide to Joyful Caring.

    Click here to learn how you can be featured in one of our Case Manager Profiles.