With the recent coronavirus disease-2019 (COVID-19) pandemic, there is increased pressure on health care providers to serve patients in a variety of settings. As a result, health care systems have rapidly expanded their modes of care delivery and payment for services such as digital health, telehealth, and virtual care (Dyrda, 2020). This will likely lead to an increase in telephonic case management, as well.
Telephonic case management and other telehealth services are often used in managing workers' compensation cases, particularly after the first few weeks of in-person visits when follow-up by phone can be time-efficient and cost-effective (Mann, 2017). Now, in the wake of COVID-19, case managers in a variety of settings are working remotely using Skype, Zoom, and Google Hangouts, and communicating telephonically and digitally.
Communication in all forms is composed of both verbal (what is said) and nonverbal (how it is said) content. An underlying emotional component is empathy—to perceive, understand, experience, acknowledge, and respond—to the concerns and emotions of another person.
To connect with individuals receiving case management services (“clients,” who are also known as patients in some care settings), case managers need to put an emphasis on empathy. With empathic communication, professional case managers are better equipped to deliver and facilitate patient-centered care, which is one of the Six Domains of Health Care Quality identified by the Institutes of Medicine (Agency for Healthcare Research and Quality, 2018).
Patient-centered care relies on effective communication, with empathy and compassion to forge a trusted relationship between the professional case manager and the client. This promotes shared decision-making to help clients and their support systems identify and articulate their goals. Such outcomes are also guided by ethical principles for Certified Case Managers such as autonomy, respecting the person's right to self-determination, and beneficence, to act with compassion and take positive actions to help others (Commission for Case Manager Certification, 2015). Research also suggests that greater empathy supports active listening to support patient outcomes (Haley et al., 2017). Empathy can also increase the case manager's cultural competence and sensitivity when advocating for individuals who come from a variety of multicultural backgrounds. The National Association of Social Workers (NASW), in its Standards and Indicators for Cultural Competence in Social Work Practice, states: “Most specifically, active listening, empathy, and strengths-based interventions are essential in culturally competent practice” (NASW, 2015, p. 28). Thus, the importance of empathy in health and human services is well established.
When using telephonic and digital means to communicate, however, empathy can be diminished or lost altogether. The reason may not be a lack of empathy on the part of the professional case manager; rather, the cause may be the transition to a less-familiar mode of communicating with clients. Using webcams and platforms such as Zoom and Skype to interact with clients can feel unnatural. As a result, a case manager who may come across as warm, approachable, and empathic in person may seem distant or rushed when communicating online or even telephonically. To increase their comfort in communicating with clients telephonically and digitally, case managers need to assess their technology skills and also become more self-aware of how they are perceived by others.
Connecting With Clients Over the Distance
I have practiced telephonic case management for most of my career. One of my most interesting assignments was as a case manager for a nationally known traveling circus. My responsibilities entailed coordinating care for circus crews and performers. Care plans often included surgeries and postoperative treatments that could span multiple cities. I never saw my clients face-to-face, yet I established rapport and trust with each of them so I could be an effective advocate for whatever they needed. As I learned then, and continue to experience now, communications skills are considered “soft skills,” but they give hard results. When rapport and empathy are established with clients over a distance, communication and understanding are enhanced and outcomes can improve.
Conveying empathy takes verbal and nonverbal awareness. Word choice, tone of voice, and pace of speech are all crucial to communicating in person, and they become further amplified when speaking with a client telephonically or online. Over a digital platform, facial expressions and gestures can help convey empathy, but there is a lack of other context such as body posture and setting. As a result, even small things can send the wrong message without other context to challenge a negative impression. For example, speaking too rapidly may inadvertently convey as “I'm too busy to spend time on the phone with you,” while an unfamiliar word could intimidate someone.
Case managers using Skype or another video conferencing application may not be aware of their facial expressions. Perhaps the case manager scowls when listening intently, which the client then interprets as impatience or annoyance. Self-awareness begins by gathering feedback, such as by doing a practice video conference with a colleague or even family or close friends. The question, “How do I come across?” is an invitation to gather important feedback.
For example, a case manager recently expressed her concerns that an initial telephonic consultation with a client did not go as well as it could. The client did not interact and answered mostly with “yes” and “no” replies, and sometimes did not say anything at all. When I asked her to walk me through the call, it became clear that the case manager used high-level explanations to inform the individual about the case management process. Once the case manager reflected on the conversation, she realized the word choice could have intimidated this individual; plus, she tended to talk quickly. With that awareness, the next telephonic meeting was far more successful. She simplified her message and consciously spoke more slowly. The result was two-way communication that established a connection and led to a free flow of information.
In addition, case managers need to speak, listen, and act as if the other person is sitting in front of them—that means no multitasking or distraction. The sounds of someone shuffling papers, typing notes, or checking e-mail can be detected over the phone. Moreover, the momentary distraction can be heard in the case manager's voice. All of these seemingly small things can break the connection.
Listening to Unlock Motivation
Empathy also helps professional case managers engage in motivational interviewing with clients. As a person-centered communication skill, motivational interviewing is very effective for gathering information about clients' health status, their mental health, and psychosocial factors, including social determinants of health. Motivational interviewing, which relies on asking open-ended questions, also helps case managers uncover what is helping or hindering clients in achieving their goals and reaching desired outcomes.
By taking the time to understand, case managers can also ascertain whether the individual had previous bad experiences in the health care system. If not addressed, these prior experiences and negative perceptions can prevent the person from being fully engaged in their own care and treatment. People may appear resistant to engage in their care plan, but the underlying reason is their fear or upset over what happened in the past.
When clients feel that they are being listened to with empathy, rapport and trust are further strengthened. It comes down to a person-centered approach not only to care delivery, but also to communication. Case managers must demonstrate that they know where the client is coming from, what challenges or obstacles they face, and what support and resources they need. The differentiator is empathy, whether communication occurs in person, telephonically, or digitally. The case manager's message is the same: “I understand you and your needs, and I am here to advocate for you.”
Agency for Healthcare Research and Quality. (2018). Six domains of health care quality. Retrieved from https://www.ahrq.gov/talkingquality/measures/six-domains.html
Commission for Case Manager Certification. (2015). Code of Professional Conduct for Case Managers. Retrieved from https://ccmcertification.org/about-ccmc/code-professional-conduct
Haley B., Heo S., Wright P., Barone C., Rettiganti M., Anders M. (2017). Relationships among active listening, self-awareness, empathy, and patient-centered care in associate and baccalaureate degree nursing students. Nursing Plus Open. 3, 11–16. doi.org/10.1016/j.npls.2017.05.001
Mann C. (2017, November/December). Multistate licensure paves the way for greater access to telephonic case management. Professional Case Management, 22(6), 304–305. doi:10.1097/NCM.0000000000000256
National Association of Social Workers. (2015). Standards and indicators for cultural competence in social work practice. Washington, DC: Author.