What is Case Management?

So much discussion recently about Case Management, but do we really know what we mean?  Let me collect here some definitions, and then offer my own.  (You will find many of these ideas expanded in full in “When Thinking Matters in the Workplace“)

The Case Management Society of America, a health care oriented professional group, defines case management as:

“a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote quality cost-effective outcomes.”

While the health care industry is a large user of Case Management, they are not the only user.  One legal site defined case management as:

techniques used to process cases from one stage of the proceeding to another, such as setting deadlines for discovery or scheduling a series of pretrial conferences. Case management calls for different approaches from one case to the next and is the primary responsibility of judges, assisted by lawyers and clerks’ office personnel.

In the legal profession we have the terms “case file” (a complete collection of documents for a case) and “case law” (the law as laid down in the decisions of the courts).  There is no question that a “case” is a unit of work; it is a package of some sort.  The case is used as a focal point to collect all the information about a the work.  There may be a goal, but somehow the case exists independent of a motivating goal.  It exists as something to be worked on, and thus case management is a way of organizing or accomplishing work around the case.  A mental health care site offered this:

Case management is the coordination of community services for mental health patients by allocating a professional to be responsible for the assessment of need and implementation of care plans.

Notice that decisions are made as part of case work.  There is a clear feeling that the work to be done is not precisely defined, but rather you have to figure out the work to be done as you go.  You have the information, but there is an assumption of judgment on the part of the people working on the case.

Law enforcement as well is familiar with cases which are used to represent current investigations, and case management is the handling of those investigations.

Other definitions devolve into specific expectations of what one might expect to achieve using case management, and I list a few of those definitions here for context:

The linking of a consumer to the service system and coordinating the various system components in order to achieve a successful outcome. The five case management activities are: (1) assessment, (2) planning, (3) linking, (4) monitoring, and (5) advocacy. Case management’s primary goal is service provision for the consumer, not management of the system or its resources.

Coordination of services to help meet a patient’s healthcare needs, usually when the patient has a condition which requires multiple services from multiple providers.

An individualized plan for securing, coordinating, and monitoring the appropriate treatment interventions and ancillary services necessary to treat each offender successfully for optimal justice system outcomes.

Offers a single point of entry to the aging services network. Managers assess clients’ needs, create care plans, and coordinate and monitor services. They may operate privately or may be employed by social service agencies or public programs. Typically, case managers are nurses or social workers.

A method by which a health plan attempts to control costs by directing all of the procedures for care of an individual through a nurse or other health care professional.

While many of the above definitions attempt to explain what Case Management might accomplish, and what it might mean in a particular situation, we can certainly draw some commonalities out of them:  there is work to be done, but it hard to say ahead of time exactly what that work is; there is a collection of information (documents) which are needed by people in order to make intelligent decisions about the course of actions which unfold as the work progresses.

Can we come up with a generic description which is free of biases of a particular industry? How about:

Case management is a coordinative and goal-oriented process, to handle cases from opening to closure, interactively between an internal or external client and a case manager or case team.

BP Trends offers in July 2009 this definition:

Case Management is the management of long-lived collaborative processes that coordinate knowledge, content, correspondence and resources to progress a case to achieve a particular goal; where the path of execution cannot be predetermined in advance of execution; where human judgment is required to determine how the end goal can be achieved; and where the state of a case can be altered by external out-of-band events.

This is a strong attempt at providing a definition that includes many characteristics and is independent of any particular industry.  It is, however, a mouthful and too detailed to be used in everyday conversation.

A Modest Proposal

The term “process” describes a collection of activities, even those not strictly ordered.   Some purists insist that a process must be pre-defined and strictly ordered, but what about the concept of “Ad-Hoc Process“.  Central to a case is the idea that there is more than one thing to do, usually requiring coordination of more than one person, so the term process fits.  The question is: what kind of process?

The answer lies in the word “Routine“.   A routine process is one that is “well known”, “repeatable”, “normal”, and “common”.   The most important thing about routine tasks or routine jobs is that they are “predictable” — there are no surprises.  Case management is for dealing with processes which are not predictable in advance.

My proposed definition is then simply:

Case Management is the handling of non-routine work processes.

This will not replace the earlier lengthy precise definition for those who want to be technical or scholarly.  But for day-to-day use, this is a fairly accurate and useful definition of what Case Management is used for, without getting bogged down in specifics about how one might accomplish it.

Seven Domains of Predictability

This reflects on how predictable a process is.  Routine processes are predictable, while non-routine processes are less predictable, or possibly unpredictable.  We can break out seven different ranges of predictability. which can be categorized by the technology that one might use to support it:

  1. Traditional Application Development
  2. Process Driven Server Integration
  3. Human Process Management
  4. Production Case Management
  5. Adaptive Case Management
  6. Social Business Software
  7. Telecom, Email, Texting, SMS, Twitter, etc.

Patient care, in general, is not routine and tends to fall in either production case management or adaptive case management as treatment is led by a doctor.  Legal cases are in general not routine because all the routine stuff is settled law does not need testing.  Law enforcement investigations are not routine because the situation is always changing.  The type of work that executives and knowledge workers perform are not routine either. It is a useful definition for that conversation in the elevator.

So What is Dynamic BPM?

This is a related concept.  Fujitsu in Interstage BPM  is using the term “Dynamic BPM” to cover the idea of a technology that can be used for predictable processes, as well as unpredictable processes.  It spans the range from System Centric BPM, to Human Centric BPM, to Case Management.  Dynamic BPM falls into categories 2 thru 5.  There is some server to server integration capabilities, a lot of human workflow capabilities, but also the dynamic process and dynamic task brings the approach into production and adaptive case management.  A single offering can cover multiple ranges of predictability.



16 thoughts on “What is Case Management?

  1. This isn’t a bad definition of case management in my view. Although, I must say, lots of routine processes are still handled like cases – so a lot of the process work I’ve done over the last few years has been helping people convert from a case-oriented way to realizing the work is fungible if you assist the user by providing all the data they need to do their job – thus making the process routine more often than not.

    That doesn’t mean there aren’t still non-routine processes – there are. The process for defining processes is non-routine… I wouldn’t describe it as “case management” but it isn’t routine. I think the definition works in-so-far as it helps distinguish between the subset of processes that are “cases to be managed” and the subset that aren’t.

    I think it also makes it more clear why “case management” is orthogonal to whether or not it is “lean”. No one would describe detective work as a lean process, but it is certainly case management… 🙂

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  3. Scott, you make a good point. I am assuming that people are using technology appropriate to the task. Many routine processes which SHOULD be implemented by defined process are improperly handled in case management, and vice-versa: there are probably many non-routine processes which are inappropriately shoe horned into a process. It is well known that when the defined process does not fit, people find ways to work around it. So I might be more accurate to say: “Case Management is the most appropriate way to handle non-routine work processes.” Nah, I will stick the shorter version.

    In retrospect, I have realized that my world of “work processes” is probably more limited than reality. I have a built in assumption to think about processes which might in fact be supported by technology. There are many thing outside of that. For example, a skydiving instructor may have some non-routine work processes and it would be ridiculous to talk about automating those with any kind of middleware. I used the term “work process” because the term “business process” is far too hyped in recent years to expect all readers to understand the same meaning for that. I might use “office work processes”…

  4. The Nov 2009 WfMC meeting will be a Thought Leader Summit in Maidenhead, England, just outside of London. Nov 3: discussion of Case Management/Dynamic BPM. What is the emerging area? What is it not? How can we define the space so that products that actually fit the category are readily identified, and products which are not in the category are not mistaken for being in. See http://wfmc.org/november-member-meeting.html

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  6. In the last 6 months I have been in a lot of intense discussions on this. We still describe BPM and Workflow as handling “routine” processes. But instead of non-routine (defining something as a negative), we describe case management as handling “unpredictable” processes. In reflection, the thing that will prevent knowledge work from becoming routine, is that the processes are inherently unpredictable.

  7. I think you proposed clear and narrow definition which is great when you start thinking about case management. Other definitions tend to be a bit complicated and confusing at first, especially for those who are not very familliar with CM, BPM etc.

  8. Case management in the social services sector is an overused mechanism whereby a client is seen as having some kind of deficit that needs to be managed in such a way that a resolution to a problem can be resolved. It does this through a collaborative process with a case manager (the expert) and a client (the person with deficit) this plan includes some kind of direct intervention in order to resolve the issue. It is often expensive and ineffective and more natural process such as the proper use of “Group work” can be both more organic and respectful to the persons involved.

  9. Yes I agree with the last comment. The term case managing implies that the client is a case to manage and that automatically sets a negative tone or at least a sense of independency from the client’s side on the case worker to do everything for him or her and that doesn’t lead to any success at he end of the process anyways, it may even cause more harm.

  10. @John, @Sara, wow, that is really interesting! You seem to be saying that a “case” automatically implies something difficult, maybe unusually difficult. Hence the pejorative use of case when someone says “You’re a real case”.

    In the four years I have actively been involved in promotion of case management, I have not run across that situation before — so I am thankful you have alerted me to it. To me, a case is simply something holds things. You can have good cases and bad cases, in the meaning of the word is “whatever the case may be”. Does the phrase “I’ll take the case” always mean that the person is signing up for an odious job? WE talk about “open & shut cases” which are clearly easy to resolve, but they are still called cases.

    What other term is used? For example, a kid is orphaned. I had though that a case would be opened to help a case manager track all the details of taking care of the situation. This does not mean that the child is a problem, just that there needs to be a focal point. The kid might be charming, delightful, and there might be dozens of relatives vying to adopt the kid, however it is still a case to be managed. Is there a non-pejorative term that describes getting things done in social work?

    • In the example you are citing we would suggest that this means you would have a person or agency that would be assigned as the gate keeper. This ensures that appropriate doors/gates are opened and inappropriate gates are kept shut and someone takes responsibility (as they should) for the child’s welfare. This ensures that the best interests of the child are always at the forefront, the proposal of “Case Management” still comes back to what is in the best interests of the client and the subjective nature of what constitutes “the best interests” and how this can be best achieved and whose best interests are being served?

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  12. This is great thinking you have mentioned. but Case management stands on some philosophy like-

    Case management is an area of specialty practice within the health and human services professions. Its underlying premise is that everyone benefits when clients(1) reach their optimum level of wellness, self-management, and functional capability.The stakeholders include the clients being served; their support systems; the health care delivery systems, including the providers of care; the employers; and the various payer sources.

    Case management facilitates the achievement of client wellness and autonomy through advocacy, assessment, planning, communication, education, resource management, and service facilitation. Based on the needs and values of the client, and in collaboration with all service providers, the case manager links clients with appropriate providers and resources throughout the continuum of health and human services and care settings, while ensuring that the care provided is safe, effective, client-centered, timely, efficient, and equitable. This approach achieves optimum value and desirable outcomes for all stakeholders.

    Case management services are optimized best if offered in a climate that allows direct communication among the case manager, the client, the payer, the primary care provider, and other service delivery professionals. The case manager is able to enhance these services by maintaining the client’s privacy, confidentiality, health, and safety through advocacy and adherence to ethical, legal, accreditation, certification, and regulatory standards or guidelines.

    Certification demonstrates that the case manager possesses the education, skills, knowledge, and experience required to render appropriate services delivered according to sound principles of practice.

    • Shirley, thanks for the comment and there is a lot of wisdom in what you are saying. For the field of human health and services you have listed a lot of goals for the case manager to aspire to.

      I only would like to add that case management is used in many fields, and in each field such goals can be different. For example when police use case management to solve a murder crime, their capabilities that they look for to support case management are different. Court system use case management in yet another way.

      I know this sounds a bit like splitting hairs, but it is important to distinguish between the underlying case management approach, and the application of case management. A particular certification would no enable anyone to use case management in any field, but only in the particular field of the certification, and that would enable them to use case management in an optimal way that corresponds with customs of their particular field.

  13. Wow this is interesting that this discussion has been revived. Shirley your description of the interrelationships the case manager works through describes very much a role of a gate keeper. Case management from my observations still very much works on a deficit model in terms of the client and has come at the expense of group work. The gang situation in Melbourne at the moment is a classic case in point as it almost is a re-run of the same issues that occurred in the mid 80s – this time however the response has been to “case manage” the individuals totally ignoring the significance of the value they place on the group they belong to. In the 80s we worked with the gang – using group work processes, this worked well. Supports such as Community Youth Support Schemes where highly effective in changing gang culture and as a result individual outcomes. I subscribe more to a Michael White type of approach whereby the client is the centre and the expert in their own life and that work with the person is more of exploration and facilitating changes with the client within the context of their lived experiences. Case management as you said ensures the delivery of services (a passive experience for the client) group work encourages and facilitates the environment in which the client has the skills and knowledge to seek the service they need.

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