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Mentorship program helps new staff learn their CM or SW duties
Team leaders assist staff in working as efficiently as possible
When new staff join the case management team at the Hospital of the University of Pennsylvania, they are trained by a team leader who works with them side by side and mentors them as they begin their new duties.
"Our team leaders have done a tremendous job of training and supporting new staff as they come on board and supporting the seasoned staff members so they can work as efficiently as possible," says Kathy Rickard, RN, BSN, MBA, associate director, clinical resource management and social work at the quaternary care academic medical center in Philadelphia.
The hospital has two full-time RN team leaders and another RN who has a dual role of team lead and appeals and denials coordinator. There also are two social worker team leads. The full-time team leaders oversee between 15 and 17 clinical resource coordinators or social workers.
The team leaders are assigned geographically with the exception of Diane Limbert, RN, whose job includes denials management and who supervises seven part-time employees who work regular shifts but fill in wherever they are needed.
At the Hospital of the University of Pennsylvania, care is coordinated by RNs, called clinical resource coordinators, who perform the clinical reviews, facilitate discharge plans to home, and team with the social workers for placements to other levels of care. The social workers offer psycho-social counseling and help families with financial issues.
The department has a separate clinical documentation integrity program staffed by RNs who have primary responsibility for the clinical documentation review.
The clinical resource coordinators work closely with the clinical documentation nurses and encourage the medical staff and nurse practitioners to document appropriately to ensure that patients meet the criteria for severity of illness and intensity of services and to assure that the hospital receives appropriate reimbursement, she says.
The caseloads of the clinical resource coordinators vary with the area they cover, but they each average about 22 patients.
The mentorship program helps nurses and social workers meet the challenges of a demanding job, Rickard says.
"Today's patients require more and more preparation for discharge than ever before. It's a balancing act to make sure the patients leave the facility with appropriate follow-up care and that they are informed about how to take care of themselves after discharge. It's a big change from bedside nursing or social work in another setting, because in addition to patient care, the staff must have a business focus," she adds.
When new employees complete their central orientation, the team leaders start the training process by sitting down with them and giving them a global picture of how the department operates and what their duties will be, says Barbara Leone, BA, RN, CRRN, clinical resource coordinator team leader.
The team leaders use an orientation program recently developed by the clinical resource management and social work members of the hospital's shared governance committee. Orientation for the clinical resource coordinator role takes about four weeks to complete.
The team leaders and staff preceptors work one on one with the new clinical resource coordinators as they learn their new role.
'Like an apprenticeship'
"It's like an apprenticeship. We introduce them to their assigned unit and give them hands-on experience. Our goal is to familiarize them with their patient population, but first and foremost to introduce them to the people they will be working with within the unit," Leone says.
The team leaders also educate the new staff about the discharge planning resources in the community and what the various payer sources will cover.
"With the advent of Medicare D, it's more complex and complicated to determine what coverage patients do or don't have," Rickard adds.
Learning the hospital's computer systems and how they interface is a major portion of the training program, Leone adds.
"It takes a while to learn how to integrate the multiple computer programs we use to get our hospital paid and to safely move patients on to the next step in the continuum of care. It's a huge effort. We break it into chunks so they can assimilate each part," Leone says.
The orientation program includes competencies for the staff to complete as they learn.
"As we go through the training process, we can back them up or move them forward according to how they perform on the competencies," Limbert says.
The orientation program for the part-time clinical resource coordinators may take longer than four weeks because most can't be available to train five days a week, Limbert says.
"The part-time CRCs have an additional challenge because they may be on a surgical floor one day and a med-surg floor the next. The clinical resource coordinators have developed unit-specific tools that can be used to guide them through the day-to-day operations of each unit," Limbert says.
The hospital's clinical resource coordinators are a mixture of floor nurses who have transferred from within the hospital and case managers from other organizations, such as long-term care facilities, managed care companies, or other settings.
Nurses who come from within the hospital system know the culture of the hospital and how things work, and although they still have to learn the complicated case management computer system, they may have an easier transition, Leone points out.
"I try to encourage the nurses not to expect too much of themselves for the first six months. This is a complex role that incorporates utilization review and discharge planning, and it seems like both take eight hours a day," she says.
The team leaders work with the seasoned staff to help them learn to "work smarter. Our staff are also involved in improving employee satisfaction and departmental performance through shared governance initiatives," Rickard says.
"The team leaders observe the staff and objectively look at how they are doing things. The seasoned staff members may have to change things they've been doing for 10 or 25 years to keep up with the new requirements from payers and to participate in hospital initiatives. We are always looking at ways to improve performance, and the team leaders are instrumental in helping us with this," she says.
The department uses a computer-based tool to generate a quality review report for each employee each month. The information is compiled and used for employees' annual performance review, says Kathryn Tigani, BSN, RN, clinical resource coordinator team leader.
The team leaders use the information on the monthly reports as training tools to ensure that all employees are meeting guidelines and performing their duties correctly. When there are deficits, the team leaders work one on one with the clinical resource coordinators to improve their performance.
Having objective data helps the management team determine each staff member's performance level and identify staff members who need help in meeting their performance goals, Rickard says.
"We pick up on trends and deficiencies and may create a learning plan for an employee or shadow them again to make sure they overcome the deficits. We pay particular attention to those who have recently finished orientation, but the mentoring is ongoing for all staff," Leone adds.
The department uses its data to determine the optimal caseloads for each unit and in monthly quality reviews of staff.
"The performance data help us to assign caseloads by acuity and make it possible to level the playing field for case managers who work on various units. Numbers don't always tell the entire story. Patients on some units have much more complex needs than others. We use our data to help make sure the caseloads are balanced," she says.
The team leaders support the staff on a day-to-day basis, filling in when needed and helping them become an integral part of the interdisciplinary team, Tigani says.
"As team leaders, we are front-line managers on the floors, and we work with the clinical resource coordinators on our team to help them whenever necessary. They can come to us for help problem solving, and we work with them if they are going to a new area or opening up a new floor. We're there on a daily basis to be their mentor," she adds.
The team leaders keep the clinical resource coordinators up to date with changes in regulations and requirements from the Centers for Medicare & Medicaid Services and other payers as well as new information within the department or the hospital. The teams are notified by e-mail, through team meetings, and monthly staff meetings. The entire clinical resource department has a weekly clinical high-risk meeting to discuss difficult cases.