The Link Between Collaborative Problem Solving and Care PlanningWorking in a healthcare means you face complex challenges; chief among them is supporting a patient population suffering an increasing rate of chronic health conditions. With growing financial and regulatory constraints and rapidly evolving medical technology, healthcare organizations and providers are struggling to engage patients and find ways to address social determinants of health like poverty, food insecurity, and housing.
Today more than ever, case management and care coordination strives to incorporate medical treatment and interventions, social support, and an individual’s self-identified goals in a comprehensive care plan. Engaging in collaborative strategies between clients and the healthcare system improves healthcare planning, and ultimately outcomes. As healthcare shifts toward strategies focusing on needs and outcomes of specific populations, it is important to identify interventions most effectively yielding the best results.
One vital factor is developing collaborative problem-solving strategies engaging the healthcare system, community and clients’ toward a common goal of improved care, reduced cost and preferred outcomes.
Collaboration Leads to Better Outcomes
Have you ever owned a pair of scissors where the pin in the center comes loose? No matter how sharp the blades, the scissors don’t cut well. Collaborative efforts between the healthcare system and clients are similar. The case manager is the essential linchpin between two strategic populations, both experts in their own knowledge, who must willingly participate cooperatively in care management to achieve the optimum outcome.
Collaborative problem solving skills were best identified by anthropologist Edwin Hutchins description in his book “Cognition in the Wild.” He asked readers to scan their immediate environment and identify anything that was not produced collaboratively. In doing so, Hutchins remarked he was only able to identify a pebble on his desk, as all other objects were the result of team production.
The term collaborative problem solving involves two different constructs: collaboration and problem-solving. When more than one individual is involved, or the task is too complex for one person to work through independently, problem solving benefits most from the joint competencies of a team. In sharing resources and strategies to reach a common goal through a shared communication process, the team is able to identify the problem and its elements from all perspectives and exchange ideas, incorporating information each may hold independently.
The process must be non-punitive and non-adversarial, designed to create the best environment possible in a challenging situation. Collaborative problem solving was originally developed by Dr. Ross Greene as a method of conflict resolution for working with children. However, just as children responded well to the strategies used, so do clients who are more likely to adhere to plans of care in which they have invested their time and energy.
A Collaborative Environment Improves Care Management
The original work by Greene assumed “kids do well if they can. If they can’t, we adults need to figure out why, so we can help.” Translated into a care management environment, this might read, “Client’s do well if they can. If they can’t or don’t have the tools to accomplish the needed tasks, the community and healthcare system need to figure out why, and do what is possible to improve the client’s situation.”
Understanding behaviors and attitudes help to guide interventions and strategies with the goal to achieve the best outcome possible. This focus has had positive outcomes in a variety of settings and research settings. Motivational interviewing is a specific strategy that has proven effective in helping clients identify and set their own goals of care. It is first necessary to win the partnership of clients and families in order to negotiate and agree on a definition of the problem and potential strategies. By communicating and defining targets and goals, based on evidence relating to the management of the clients problem and the individual needs of the client, collaborative problem solving is more apt to be successful. It’s important to address several principles to improve success, including:
- An agreed communication platform on which to share information
- An understanding of the client and family’s beliefs, needs and circumstances
- Identifying the lead person to be the main communicator with the client
- An agreed upon definition of the issues, plans and goals
- A negotiated plan between all concerned parties – client, family, community, healthcare provider
- Planned and scheduled follow up with the client and team review
Putting the Patient in the Driver’s Seat
Case managers are an important leader in an effective interdisciplinary team approach with clients who have complex social and medical needs. Defining and implementing a collaborative care management plan requires access to necessary information from all parties, including the client who plays an active role as the expert in their own individual life circumstances.
Understanding the value of collaboration is the first step in developing plans of care designed to achieve the greatest possible success. Developing these plans requires patience, persistence and consistent communication with clients and families who may not at first understand the benefits of collaboration. In some cases, clients and families may expect the healthcare team to completely guide the plan of care without any input.
While this may at first appear easier to the team, without working together, the client and family may be presented with a plan they are unable to execute. Employing collaborative problem solving and using strategies like motivational interviewing are vital to maximizing patient engagement and improving outcomes.
Implementation Science, 2014;9:178 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4255430/
Journal of Clinical Psychology Practice, 2010; 1: 27 https://pdfs.semanticscholar.org/fb95/cbaa50d1bdc6b910835640ddc062e75bb5d7.pdf
Social Work in Healthcare, 1992;17(1):1 https://www.ncbi.nlm.nih.gov/pubmed/1440105