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Another Look at Roles and Functions: Has Hospital Case Management Lost Its Way?

Reynolds, John J. BA, LCSW

doi: 10.1097/NCM.0b013e31829c8aa8

Purpose of the Study: The purpose of this study was to identify the roles, functions, and types of activities that hospital case managers engage in on a day-to-day basis and that leverage the most amounts of time. Previous studies superimpose a priori categories on research tools.

Practice Setting: Hospital case management.

Methodology and Sample: This study analyzes 4,064 spontaneous, unstructured list serve postings from the American Case Management Association Learning Link list serve from August 15, 2011, to August 18, 2012. The study group was a cross section of 415 case management professionals.

Implications for Practice: The data suggest that hospital case managers' time is inordinately leveraged by issues related to observation status/leveling of patients and the Centers for Medicare and Medicaid Services compliance. The data also suggest that hospital case management has taken a conceptual trajectory that has deviated significantly from what was initially conceived (quality, advocacy, and care coordination) and what is publicly purported. Case management education and practical orientation will need to be commensurate with this emerging emphasis. Case management leadership will need to be adept at mitigating the stresses of role confusion, role conflict, and role ambiguity.

John Jude Reynolds, CCM, CPHM, LCSW, has been a CCM since 1996 and a health care manager for 24 years. He has published numerous articles for the American Hospital Association and most recently in the American Journal of Nursing. John is currently the Director of Care Management & Patient Access at St. Vincent's Medical Center, Westport Campus, Westport, CT.

Address correspondence to John J. Reynolds, BA, LCSW, Care Management & Patient Access, Saint Vincent's Medical Center, 47 Long Lots Rd., Westport, CT 06880 (

The author reports no conflicts of interest.

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.