2023 CASE MANAGEMENT PRACTICE IMPROVEMENT AWARD

PROJECT TITLE: Virtual Inpatient Case Management Program

RECIPIENT: Kaiser Permanente of Washington

CATEGORY: Case Management Staffing

ABSTRACT: Kaiser Permanente Washington (KPWA) employs 45 FTE inpatient case managers who are responsible for the assessment of and discharge planning for our members. These staff were hired pre-pandemic to specific partner hospital sites with whom KPWA contracts to provide services to our members. In the state of WA, there are a total of 9 contracted, rounded partner hospital sites where our members can receive services. In addition to these sites, members can also be hospitalized, as necessary, to non-partner sites and assigned to a group of Case Managers in our Centralized Inpatient Administration group who oversee the case management services being provided to our members and assist in transitions from one level of care to the next. Like many organizations during the COVID-19 pandemic, KPWA Case Management experienced a great deal of staff turnover and, at one point, has as much as a 40% vacancy rate. Because staff were assigned to cover identified facilities in person, the vacancy rates at various sites led to significant disparities between site caseload levels. The coverage for call-outs that we could secure per site was incomplete, which led to disjointed services for our members. Several more staff members expressed that they were actively seeking other employment as well. The department was also experiencing significant barriers in recruiting qualified candidates to apply for open positions. To stabilize workforce retention and recruitment, the decision was made to move all case management staff to a voluntary, remote status. This was based on feedback from candidates and current staff. It was presented to all staff that we would be creating a Virtual Inpatient Team (VIP) where we would be pooling our staff resources in order to balance caseloads across all partner hospital sites. This allowed each case manager autonomy over their work environment and more importantly, improve services being provided to our KPWA members through more balanced caseloads lending to more timely engagement and action being taken in patient care. All clinical CM staff were cross trained to all hospital EMR's which allowed for quality cross coverage and clinical documentation. A virtual preceptor and training program were developed, and communication channels were established to help streamline the work necessary to progress patients to the most appropriate level of care.

The identified problem of our project was the increasing dissatisfaction and worker burnout of our case management staff in the setting of the ongoing COVID-19 pandemic. As a leadership team, we identified that it was critical to the sustainability of services in our partner sites to rethink how we delivered case management for the near term. We needed to develop a staffing model/method that would allow us to continue to provide services to members admitted at our partner hospitals, stabilize the workforce, and fill open positions to return to pre-pandemic staffing levels. It was important for us to preserve our presence in our partner hospitals not only because of the unique structure of KPWA and the need to be familiar with referral processes to progress patients timely but also because our partner sites were experiencing the same if not more significant, staffing issues. Undoubtedly, if we were to have ceased covering any of our partner sites, it would have been reasonable to expect that the length of stay for our patients, as well as others, would have delayed patient progression in a time when hospital beds were scarce.

RESULTS / OUTCOMES: Though this was a very difficult decision to come to, it paved the way for no further staff attrition for the first 90 days after the announcement of the VIP model. With the ability to offer positions voluntarily remote, we experienced a dramatic increase in the number of qualified candidates applying for open positions. All told, in the span of 3 weeks a total of 15 new staff members were hired for the department and plans for onboarding were underway. Since launching the VIP nearly a year ago, our staffing levels have stabilized and remain consistent.

Benchmark: Staff Stabilization: Zero turnover in the first six months of the program

Benchmark: Staff Hired: All fifteen vacancies were filled within 30 days