C O L L A B O R A T I V E C A S E M A N A G E M E N T
Getting the Most from Consultant Resources
By Martha J. Koen, ACM, MN, RN
Many case management departments engage the expertise of consultants from time to time. Getting the most from consultant resources requires
time to select the company with professional expertise. The process begins even before the consultant walks into the hospital. This article will
discuss what a consultant can provide, making the decision to engage a consultant, suggestions for choosing a consultant, and ways in which
a case management department can ensure the consultant’s efficiency.
WHAT A CONSULTANT CAN PROVIDE
A consultant resource is available on every topic, process, or idea any
professional can conjure up. They each come with varying degrees of expertise
and experience. A case management consultant can help to confirm that a
hospital case management service is on the right track, or, if not, can assist with
education, enhancements or redesign. A redesign often includes identifying and
eliminating fragmentation and duplication of processes, reducing work steps,
structuring data collection, or redefining the roles and responsibilities of the
staff. A case management consultant can also analyze patient throughput,
capacity management, and patient, staff and physician satisfaction and create an
optimal process that effectively uses personnel, facilities and resources.
A consultant can also help identify situations when:
• The task or process does not match an individual’s knowledge, skills and
abilities. One example of this would be utilizing highly compensated
professionals to do clerical/support tasks. This does not allow effective
leveraging of each employee. In such a case, the most expensive source of a
hospital’s intellectual capital − its employees − are wasted.
• The job descriptions do not contain adequate and clear information to direct
“A day in the life” of the individuals in the roles.
• Employees do not have sufficient education and training for their roles.
• Physician support is sub optimal.
Typically, there are two sources for requests for hospital case management
consulting services. The first comes from within the case management
department itself, and may occur when the leader needs ‘outside” assistance to
gain organizational support or necessary operational changes for Case
Management Services. The second type of request comes directly from an
administrative leader. This type of request often stems from a perception that the
Case Management Services are not meeting the expectations of the
administrative leadership team. Both sources indicate the need for
improvements, but the specific improvements may vary.
WHEN TO HIRE A CONSULTANT
Initially, how does a hospital case management department identify which
consultant services would be beneficial and cost-effective? The decision to hire a
consultant should be considered if the following situations exist:
• Achieving prompt results is essential. Engaging outside assistance will drive
the process according to a strictly defined timeline.
• The case management department has already attempted to make needed
changes on its own, without success. Hiring a consultant will enlist the
experience and expertise of someone who has requisite experience.
• An unbiased opinion is required. A consultant, coming into the hospital from
outside, has the advantage of not being personally invested in the people or
programs. This enables her/him to focus only on the processes and outcomes.
• The existing case management model is not achieving desired outcomes.
• The case management department is unable to determine where to start or
how to prioritize resources to gain improved efficiencies, outcomes or both.
• The case management department requires outside support to influence the
hospital administrative leadership that certain operational or clinical changes
must be made.
Before engaging a consultant, the case management department should
identify its specific consulting needs, in order to give the consultant clear
direction. For example, is the department having difficulty reducing the length of
stay? If so, what is the targeted length of stay? Is the length of stay rising? Is there
an administrative mandate to cut back on resources or FTE’s (full-time
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equivalents)? There should be at least a general idea of either needs or desired
outcomes. Otherwise, the consultant will need to conduct an assessment to
determine the improvement opportunities. Simply saying, “We need some help
here,” leaves the door wide open for a consultant and may result in confusion
and ambiguity.
It should be noted that consultants are not always retained for the express
purpose of changing things. Frequently, hospital administrators engage
consultants to confirm that they are on the right track. In the spirit of process
improvement, however, there are always opportunities to do things better and
they need a consultant to find opportunities to improve, and ways to work
smarter or faster. A consultant can tell the client, one, here are the deficiencies,
and two, here is what can be done to correct them. One more important point:
CEO approval of the case management department decision to hire a consultant
is highly advisable.
CHOOSING THE RIGHT CONSULTANT
A key point to consider when choosing a consultant is whether the
consultant has a background as a hands-on practitioner. Some consultants
tend to be conceptual, not practical, because they have never actually worked
in healthcare. They can offer a theory, or suggestions that should work, but
may not be specific to healthcare. Even though business principles
theoretically apply to hospital operations, they often must be tailored to the
specific nuances of healthcare.
How can a consultant with healthcare experience be located? References from
colleagues at other health care institutions who have utilized consulting services,
is one of the best methods. In the event a Request for Proposal, (RFP) has been
prepared and sent to several consulting companies, the selection will require
some comparisons.
Focus on obtaining consulting services from a company with specific
expertise in healthcare and experience in case management. Any potential
consulting firm should be put through the rigors of an interview to determine
their philosophy of work and general principles towards case management.
Reference checks should be conducted to verify that previous clients were
pleased with the results of their experience. Obtain information on the specific
consultants who will be assigned to the project. Frequently, consulting
companies have separate staffs of individuals, marketing and operations.
Lastly, review the cost. Prices can often be negotiated. The important factor to
consider is each consultant company’s proposed process and deliverables.
Compare “apples to apples,” instead of focusing on the cost. Selecting the
cheapest consultant does not guarantee quality services.
In the preliminary discussions before signing a contract, the case
management director or administrator who is responsible for consultant
selection should obtain assurance that the consultant will work with everyone in
case management, not just the management staff. Another important point to
insist on is a thorough assessment of the organization’s culture and the “players”
− physicians, leadership personnel and staff members. Finally, the consultant
must be willing to give honest feedback on what really needs to improve, not just
what the people want to hear.
The contract should explicitly address actual deliverables or tangible
outcomes − what the case management department will have in its possession
when the project is completed. Some examples are policies and procedures,
forms, systems, objectives, teaching materials, or job descriptions.
Other points that the contract should include are:
• Time frame: how much time the project will require;
• Consultant resources dedicated to the project: how many consultants and
how often they will be on site; (continued on page 7)
 C O L L A B O R A T I V E
As the rapid growth of the case management profession demonstrates, the
value to the fiscal health of hospitals and health systems is recognized more
often. It should be the role of every case manager to help their organizations
understand the powerful influence that case management has on the fiscal
health of the organization. Because the nature of the job includes a focus on
clinical quality and the job often is one of facilitator, the fiscal contribution can
Specific case management experiences that can prove valuable include:
OPPORTUNITY
Take on high-visibility projects that involve the
process improvement.
Step outside of case management department to serve on
multi-disciplinary teams.
Identify opportunities for improvement in own area of influence and
volunteer to start and lead a work group.
Take specific course work in field(s) of business lacking on your academic
resume – finance, organizational development or some other field.
Offer to serve on community boards as a hospital representative.
ABOUT THE AUTHOR
Ms. Legere is currently the Vice President of Operations and Clinical Services at
Catholic Medical Center in Manchester, New Hampshire. Her Bachelors of Social
Work is from Bridgewater State College in Massachusetts, MSW from University of
Getting the Most from Consultant Resources (continued from page 3)
• Expense reimbursements: which expenses will be billed to the hospital.
ENHANCING THE CONSULTANT’S EFFICIENCY
What can a case management director or a registered nurse or social worker
member of the department do to enhance the efficiency of the consultants? First,
and perhaps most obviously, the consultant should be given an orientation to the
case management department and the hospital. Introductions to key people in
both case management and the clinical management team are not just a courtesy;
they are an important method of integrating the consultant into the work milieu.
The second most important step to enhance the efficiency of a consultant is
for the manager or director to encourage the staff to participate and share
information openly and honestly with the consultant. There are times when a
consultant’s presence is threatening to staff. There are also times when the
presence of a consultant is threatening to the manager or director. It is important
to remember that a consultant must have accurate and complete information to
appropriately recommend changes or enhance processes. Someone who chooses
to interact with the consultant demonstrates an attitude of cooperation,
commitment and openness. Consultants are supposedly experts in their field;
however they are constantly learning new and improved methods of approaching
work. If a consultant does not welcome input, feedback or challenge from the
staff, they may not be the “right” consultant.
Also, the hospital must provide appropriate workspace for the consultants and
to furnish helpful resources such as hospital and physician phone directories,
organizational charts, and campus map. Information on how to contact the
consultant on-site, office phone number, location, and hospital e-mail address
should be distributed throughout the hospital.
Communication to the entire hospital staff as to why consultants are in the
hospital, what their names are, and what the expected outcome is must occur
prior to the beginning of the project. If staff members are not told what is going
on, human nature inevitably leads them to “make up” their own version. Rumors
and speculation are harmful, and difficult to retract.
An administrative leader must be identified as the consulting project leader.
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C A S E M A N A G E M E N T
be overlooked. It is critical to seek and cultivate case management champions
within the organization’s leadership and to stay vigilant for opportunities to
demonstrate the value that the case management service delivers. When the
department claims this success, all case managers gain the acknowledgement
and recognition for their broad-based skills and their ability to speak and
understand that second language of the “business of healthcare.”
SKILLS GAINED AND SHOWCASED
Demonstrate knowledge of QI, gain operations perspective outside
of own department.
Demonstrates ability to contribute to success in a multi-disciplinary
setting and forges strong relationships outside of case management.
Demonstrates leadership skills.
Demonstrates enthusiasm and initiative as well as the new core
knowledge gained.
Refines leadership skills, provides community visibility for the hospital
and provides opportunity to work with and learn from leaders in
different industries.
Connecticut, and her MBA and Healthcare Administration Certificate are both
from Rivier College in Nashua, New Hampshire. She is an ACHE Certified
Healthcare Executive.
This individual needs to facilitate the processes between the case management
department and the leadership and management teams to establish good
rapport and communication between the groups. A consultant should utilize
input from everyone including the case management staff, and this needs to be
clearly understood. Non-cooperation by any individual will compromise the
consultant’s time and potentially lead to decreased efficiency and effectiveness.
For optimal results, the staff and the consultants need to be collaborative
partners. The consultant can work most efficiently when everyone speaks openly
and honestly, and views herself/himself as an active participant and potential
beneficiary in the process. Human nature being as it is, individuals tend to
assume that changes will make their work situation worse. The “fear of the
unknown” versus status quo is often frightening. On the contrary, with a good
consultant, the case management process will improve.
CONCLUSION
In summary, hiring a consultant must be a thoroughly planned endeavor. It
can be an important step towards achieving optimal case management
outcomes. It should begin with the identification of the problem and/or
identification of the desired results. Selecting the best consultant requires
rigorous review of philosophy, work principles, consultant experience, references
and resources. The contract should reflect the timeline, resources and terms.
There also needs to be the understanding that a consultant cannot work in a
vacuum, and that hospital-wide cooperation is paramount to success. The most
effective consulting projects include everyone, from case management
department staff members through senior leadership.
ABOUT THE AUTHOR
Martha J. Koen is Co-owner of the National Institute for Case Management, Inc.,
Little Rock, Ark. She has been a nurse for more than 25 years. Ms. Koen holds a
B.S.N. degree from William Carey College and a Master of Nursing Administration
from Louisiana State University School of Medical Sciences. She holds the
Accredited Case Manager credential for hospital/health system case management.