Defining case management success: a qualitative study of case manager perspectives from a large-scale health and social needs support program.

Abstract

Health systems are expanding efforts to address health and social risks, although the heterogeneity of early evidence indicates need for more nuanced exploration of how such programs work and how to holistically assess program success. This qualitative study aims to identify characteristics of success in a large-scale, health and social needs case management program from the perspective of interdisciplinary case managers. Case management program for high-risk, complex patients run by an integrated, county-based public health system. 30 out of 70 case managers, purposively sampled to represent their interdisciplinary health and social work backgrounds. Interviews took place in March-November 2019. The analysis intended to identify characteristics of success working with patients. Case managers described three characteristics of success working with patients: (1) establishing trust; (2) observing change in patients' mindset or initiative and (3) promoting stability and independence. Cross-cutting these characteristics, case managers emphasised the importance of patients defining their own success, often demonstrated through individualised, incremental progress. Thus, moments of success commonly contrasted with external perceptions and operational or productivity metrics. Themes emphasise the importance of compassion for complexity in patients' lives, and success as a step-by-step process that is built over longitudinal relationships.