Case Management and Healthcare Blog

Understand How Burnout Develops and the Measures That Can Be Taken to Prevent It

“Burnout” is a term that was first coined in 1974 by American psychologist Herbert Freudenberger in his seminal book, “Burnout: The High Cost of High Achievement.” In the decades since, the definition of burnout has been refined to “a state of emotional, mental and physical exhaustion brought on by repeated and chronic stress when the job is in control of the person performing it.”

The experience of burnout and its impact on people and organization has driven many professional associations to look at the factors that contribute to this dysphoria. While some experts feel burnout is an extension of depressive symptoms, the World Health Organization announced in May 2019 the ICD-11 classifies burnout as an occupational and not medical condition.

Given the complexities and demands of care management jobs in healthcare settings, it is crucial that care managers and case management leaders understand how burnout develops and the measures that can be taken to prevent it.

Risk Factors and Implications

The ICD-11 describes burnout as a syndrome resulting from chronic workplace stress and characterized by work-induced feelings of exhaustion, increased mental distance from work, and reduced professional effectiveness.

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Depression Affects Millions of People in the United States

Depression is a medical condition that affects millions of people in the United States, including up to 5 percent of Americans age 65 or older. The prevalence of depression is significantly higher – between 11.5% and 13.5% – in older hospitalized patients and in who require home health care.

Unfortunately, older Americans also face a greater risk that their depression will not be properly diagnosed or treated, in part because they may be less likely to share feelings of sadness or vulnerability and in part because symptoms may be dismissed as a normal part of aging.

The experience of depression is more than just feeling sad or blue but rather a serious mood disorder that requires treatment. It is important to recognize that, although depression may be more common in older adults, it is not a normal part of aging.

Care managers can help older patients and clients understand the risks associated with depression, identify troubling symptoms that could be signs of depression, and access services for assessment, diagnosis, and treatment.

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Case Managers Can Help Clients Reduce Risk Factors, Avoid Complications

In the back wall of a human’s abdominal cavity are two small organs. Each is the size of a computer mouse. These organs – kidneys – filter all the blood inside the body every 30 minutes to remove toxins, excess fluid, and waste material. They also secrete hormones to help regulate blood pressure and stimulate red blood cell production and other chemicals crucial to life.

In the U.S., 30 million people live with chronic kidney disease (CKD), also known as chronic kidney failure. Risk factors include including diabetes, high blood pressure, heart disease, or having a family member with kidney disease. People over age 60 are also at greater risk.

Early detection and management of health conditions than can lead to kidney disease is vital. Both help prevent progression leading to kidney failure, and ultimately the need for a transplant or dialysis. Care managers can be invaluable to people who are at risk for kidney disease or are already experiencing it.

How Kidney Disease Affects the Body

When kidneys begin to fail, waste products and toxins are not being adequately filtered and removed from the body. The additional toxic load can cause trouble sleeping, skin conditions, muscle cramps, nausea, and vomiting. Some people experience swelling in the feet and ankles, as well as fluid in the lungs, making breathing difficult.

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Integration of Motivational Interviewing Techniques May Improve Outcomes

There is abundant evidence the current medical system is not meeting the needs of people with Type 2 diabetes, nor adequately educating patients on the strategies they may use to delay or eliminate the onset of the disease.

One reason may be that people are being cared for in an acute care system not well suited to address the complex and on-going needs of someone suffering with a chronic disease. Primary care systems have the expertise and experience to optimize care in many situations, but chronic illnesses with several accompanying comorbid conditions strains the system to overload.

These challenges underscore the importance of high quality case management, which has shown to be effective in improving outcomes and reducing the risk of complications of Type 2 diabetes.

Financial Burden Rising for System, Families  

The Centers for Disease Control and Prevention estimates that 23.1 million people in the United States have been diagnosed with Type 2 diabetes, and an additional 7.2 million people have the disease but are unaware of it.

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Studies Demonstrate Powerful Impact of Effective Case Management

In healthcare, fiscal responsibility and patient outcomes are essential to the bottom line, and both are significantly impacted by the efforts, expertise, and effectiveness of case managers.

Case management grew from a program in the 1970s designed to integrate social welfare services, and has since evolved into an integral part of providing quality healthcare. It has continued to evolve in the shift toward value-based care initiatives that tie payment to patient outcomes.

A recent study by Harvard Medical School researchers compared eight years of data from patients enrolled in Blue Cross Blue Shield’s Alternative Quality Contract (AQC) to a control group in other states. The AQC is a population-based payment model that includes rewards and penalties for healthcare provider performance.

The study found there was slower growth in spending and savings that, over time, exceeded the incentives. In the early years of the study, the savings were driven by lower prices, but as the program gained momentum, the savings resulted from a lower utilization of services, including labs, emergency room visits, and some imaging.

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Education, Early Intervention is Key to Improving Outcomes

Improving healthcare outcomes for patients with heart failure is challenging. Research shows the opportunity for patient success is greater when the case management process begins in the hospital, where care managements can facilitate a successful transition to discharge and a strong cardiac rehabilitation plan.

In one study, researchers undertook a systematic review of 22 studies evaluating the impact of care management for patients with cardiovascular disease. Seventeen studies looked at patients for whom case management interventions were initiated in the hospital, and five studies looked at patients where interventions began after discharge.

The researchers found hospital-initiated case management had a greater impact on reducing unplanned readmissions and in reducing the length of stay. Although the evidence for case management initiated within the community was limited, there is strong evidence collaboration between community and hospital-based medical professionals builds a culture of health in the community and has a strong impact on patient care.

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Five Criteria That Are the Cornerstones of an Effective Leadership Model in Healthcare

Great leadership skills are instrumental in the success of any organization, and case management leadership in a hospital setting is no exception. If you are serving in this integral role, you know it requires a unique skill set.

Though leadership is a universally valued trait, not all people or organizations define it the same way. In a paper published in the Journal of Healthcare Leadership, a research team at Duke University identified five criteria as cornerstones of an effective leadership model in healthcare: emotional intelligence, critical thinking, teamwork, integrity, and selfless service.

Emotional Intelligence Is the Keystone Skill in Healthcare Leadership

The Duke team recognized emotional intelligence as a core competency that held the other factors together. In fact, the authors argued, without emotional intelligence the entire model would crumble.

This term refers to the ability to identify and manage emotions. Emotional intelligence requires three skills: awareness, management, and the ability to utilize emotions and apply them to problem solving.

Emotional intelligence is sometimes called emotional quotient or EQ. In healthcare case management, it enables a care manager to be smart about personal feelings and the feelings of others, and therefore enhances his or her ability to lead others, manage behavior, and engage team members and patients in a plan of care.

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Multimorbidity Is Now Regarded as the Norm for an Aging Population

Case management is a vital strategy for hospitals and health plans seeking to obtain the best possible outcomes for people with multiple comorbidities, research shows.

This state, called “multimorbidity,” means a patient is suffering from at least two chronic diseases such as cardiovascular disease, lung disease, and Type 2 diabetes.

The World Health Organization (WHO) defines multimorbidity as “the coexistence of two or more chronic conditions, where each must be a non-communicable disease, a mental health disorder, or an infectious disease of long duration.”

In a systematic review of 27 studies that examined five models of care, the Centers for Disease Control and Prevention (CDC) wrote care management, case management and disease management are the most promising models for those suffering multimorbidity.

The study also found that multimorbidity is now regarded as the norm for an aging population, and that focusing on a subgroup with multiple conditions may be the basis for improving healthcare outcomes.

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Care Managers Play an Important Role in Helping Patients, Families Tackle Addiction

Substance use disorders affect people from all lifestyles. Some people become addicts after they begin using drugs recreationally; others begin misusing prescription medication and develop a dependence on it that can consume their lives.

Hospital case managers are in a unique position to evaluate patients and families when they are at their most vulnerable. If a patient is experiencing full-blown addiction, it can be extremely difficult to stop without effective professional treatment.

In mid-2017, drug overdoses became the leading cause of death in Americans under the age of 50. In 2016, over 4,000 people died from unintentional drug overdoses in Ohio, a 36% increase from the year before when the state had led the nation in overdose deaths.

Heroin or prescription painkillers, sometimes laced with a synthetic opioid, Fentanyl, are commonly abused drugs, as is alcohol. Case managers may also encounter patients who abuse steroids, stimulants, ecstasy, crystal meth, bath salts or cocaine.

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Care Managers Must Know the Signs of Mental Illness to Best Serve Clients

Most people believe mental illness is rare, but the numbers tell a different story. For case managers, it is especially important to know whether a client with chronic disease or complex needs may be struggling with mental illness.

Mental illness is a disease causing disturbances in thought and/or behavior, resulting in patients who are unable to cope with some of the ordinary demands and routines in life. There are more than 200 classified forms of mental health conditions; some may be caused by a biochemical imbalance, while others can be triggered by stress associated with chronic disease.

Mental Health by the Numbers

The incidence of adults and children in America who suffer from mental health challenges is staggering. Case managers who work exclusively with this population can typically offer a wide range of support, including coordinating community services and effective treatment, and assisting clients and families in achieving independence.

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