CASE STUDY: Introduction of digital CASE MANAGEMENT

In this article, we present various German clinics that are already practicing case management successfully. In this case study, we look at the specific challenges faced during implementation, as well as the benefits that have resulted from the introduction of case management.

However, before we go into more detail about the individual clinics, let us clarify what we mean by “case management”.

Definition of case management

Digital case management is a pragmatic and effective method for improving the quality and efficiency of your organization. Process excellence and digitalization make it possible to better coordinate and even individualize patient care. This means that many of the current challenges can be addressed and solved.

Overall, it should be noted that there are different forms of case management in terms of design and each has its justification.

The three clinics

Below we show you three German clinics that have successfully integrated case management, in different variations, into their day-to-day work.

The Lüdenscheid Clinic began gradually introducing case management back in 2005. The hospital paid particular attention to implementing the “discharge management” expert standard. Further measures, such as the targeted use of resources, a reorganization of processes and the introduction of case managers, not only reduced costs, but also improved patient care and ultimately reduced the workload of ward staff.

At Dresden University Hospital (UKD), a number of variants of digital case management have proven their worth in a wide range of specialist areas. Case management with a focus on “internal control” has been integrated into the Polyclinic for Radiotherapy and Radiooncology at Dresden University Hospital.

The Paracelsus Clinic in Bremen, which focuses on patients with special care needs, uses case management in a similar way to the Lüdenscheid clinic to control discharge management.

Reasons for the introduction

The reason for introducing case management at Lüdenscheid Hospital was the discrepancy between ensuring medical and nursing quality and maintaining economic efficiency. Due to drastic budget cuts, the Lüdenscheid Clinic was forced to reduce the average length of stay. This not only led to an increased risk of patients being discharged due to reaching the maximum length of stay. It was also recognized that there was a risk of neglecting patients’ individual care needs and social aspects. To counteract this, it was decided to gradually introduce case management, which the hospital also refers to as discharge management.

The Paracelsus Clinic in Bremen has introduced case management due to its focus on the treatment of disabled, very elderly and dementia patients As the aim of the clinic is to support its patients in leading as self-determined a life as possible in line with their needs, they have introduced case management with a focus on discharge management (case management and outpatient consultation hours). It serves as a central point of contact for patients. All steps from admission to discharge are coordinated and organized there. This is done together with the patient, relatives and, if necessary, the caregiver during the hospital stay.

The Polyclinic for Radiotherapy and Radiation Oncology at Dresden University Hospital has set itself the following goals for the introduction of case management:

• an increase in patient satisfaction through a fixed contact person,
• Transparency of the treatment process for patients, professional groups involved & aftercare providers
• Optimization of inpatient processes
• Relief/improvement of processes for doctors, nursing staff and social services

The concrete introduction of case management

Lüdenscheid Clinic

Case management was gradually implemented at patient and system level at Lüdenscheid Hospital. The management supported this by providing the necessary resources, among other things. The introduction took place in departments that were willing to cooperate in order to involve and motivate employees. Medical management played an important role here in the form of formal authority and professional competence.

During the introduction, organizational changes were made to optimize the discharge processes and define clear responsibilities. The case managers support the attending physicians in making decisions regarding further care. At the same time, patients and relatives are actively involved. In addition, special social work groups were introduced to ensure comprehensive support.

At the system level, cooperation with general practitioners and other providers of aftercare services has been institutionalized. Prior to inpatient treatment, patients with special treatment and/or aftercare needs are already registered by the doctors in private practice. Case management provides the doctors providing further treatment with relevant information in good time before discharge. In addition, the surrounding retirement homes actively report vacancies to the clinic in order to minimize the effort required for searches.

Paracelsus Clinic Bremen

To ensure that nursing care is provided, the Paracelsus Clinic Bremen pursues a comprehensive and structured approach to admission and discharge management. This aims to start discharge planning as early as the admission stage. Discharge management acts as a central point of contact for patients and relatives and coordinates all steps from admission to discharge. The hospital stay is discussed together with the patient and, if necessary, relatives or carers, and individual needs are identified.
Case management takes over the coordination of care after hospitalization and organizes the transfer to other care systems. Cooperation with institutions and volunteers involved in the care of people with dementia is also encouraged.
In addition, caring for patients with special care needs requires special manners. Training courses are offered for the employees concerned to provide a basic understanding of these patients. These training courses are available in the Paracelsus Training Academy’s annual further education and training program for nursing staff, doctors, therapists, administrative and service staff.

Polyclinic for Radiotherapy and Radiation Oncology at Dresden University Hospital

The introduction of case management began in July 2013 with a project group consisting of employees from the nursing service, the medical service and the social service, supported by the clinic director. During the planning phase, the tasks of case management were defined, treatment paths developed and the required resources clarified. Work shadowing was carried out in other clinics at the UKD and throughout Germany. The test phase ran from October to December 2013.

Two nursing staff alternated as case managers and took on tasks such as organizing admissions, talking to relatives and coordinating examinations as well as aftercare planning in collaboration with social services.

A cooperative management style and interprofessional personnel development create trust and a healthy working environment. Overcoming differences between the professional groups and creating good framework conditions turned out to be crucial for successful teams and the optimization of care processes in the hospital.

The case managers manage the stay, coordinate services and ensure that resources are provided in line with requirements, focusing on the care of all patients in an area.

Advantages and benefits of case management in the three clinics

Lüdenscheid Clinic

In retrospect, the introduction of case management at Lüdenscheid Hospital has proven to be extremely successful, as employee satisfaction and patient surveys show. Senior physicians give case management a grade of 1.6. In addition, 94% of patients stated in a survey that they would be happy to contact case management again if necessary.
Case management is not only worthwhile in terms of high-quality discharge management, but also in worthwhile . In addition to a high level of satisfaction among patients, relatives and referring physicians as well as the clinical departments, successes such as the relief of nursing staff and doctors, punctual discharges and the avoidance of readmissions through needs-based post-inpatient care have been recorded.

Paracelsus Clinic Bremen

The holistic treatment structure of the Paracelsus Clinic Bremen (integrated care) can simplify the treatment processes, especially for patients with mental and multiple disabilities. The multidisciplinary team of doctors, nurses and psychologists can coordinate and facilitate admission, hospitalization and aftercare with caregivers, everyday companions, facilities and general practitioners.

Polyclinic for Radiotherapy and Radiation Oncology at the UKD

In the Outpatient Clinic for Radiotherapy and Radiation Oncology at the UKD, the satisfaction of the medical and social services as well as patients and aftercare providers is very high following the introduction of case management. Before the introduction of case management, there were concerns in the nursing service, particularly with regard to role conflicts with the case managers. However, these concerns were dispelled soon after the case manager was hired, as her practical benefits for patients, nursing staff and doctors quickly became clear. Transparency regarding the funding of this position, which does not come exclusively from the nursing service’s personnel cost budget, is also important.

Case management is now an integral part of the clinic organization and is visible in joint team meetings . It enjoys a high level of acceptance among patients and all partners involved. Honest cooperation between the professional groups and the handling of common specialist topics and challenges are essential.
A cooperative and transparent management style on the part of superiors also creates and interprofessional personnel development is important for a healthy and safe working environment. Overcoming differences within and between professional groups and creating good framework conditions are therefore crucial to the success of the teams.

Possible challenges in establishing case management

The introduction of new methods and processes is always accompanied by a number of challenges. In most cases, the difficulties arise due to internal resistance. As mentioned above, there were also concerns at the Dresden Polyclinic prior to the introduction of case management. Here we have shown you how to deal with such defensive reactions in the best possible way and for the benefit of all.

In summary, the introduction of digital case management can not only be successful, but can also lead to a number of benefits for the clinic as well as patients and relatives. We have explained in detail in the following blog articles that a structured approach is essential when initiating and implementing any measure in this area.

If you are looking for a reliable partner at your side along the way, then the BAMAC GROUP is the right place for you, because we know how to manage projects and implement change. Above all, it is important to us to support our customers individually and with an end-to-end approach. If you would like to know more about this, please contact us.

Sources used:
Mattern, Kerstin; Vogelbusch, Heike; Lutz, Jana: Case management in hospitals – a practical report. In: CM -Case Management 3, 2016, p. 152 -155. https://www.uniklinikum-dresden.de/de/das-klinikum/geschaeftsbereiche/pflege-service-dokumentation-2/download/160922072737_0001.pdf

Paracelsus Clinic Bremen: Treatment concept for patients with special care needs .

Deutsche Krankenhausgesellschaft e.V.: Lüdenscheid Hospital: Introduction of case management