Development Tools for Case Management: A Pilot Study

Nursalam, Candra Panji Asmoro, Tintin Sukartini, Hanik Endang Nihayati, Erna Dwi Wahyuni, Eka

Mishbahatul MHas and Kristiawati

Faculty of Nursing Universitas Airlangga, Kampus C Mulyorejo, Surabaya, Indonesia

Keywords: Development Tool, Case Management, Case Manager.

Abstract: Case management is a procedure for planning, searching, evaluating, and monitoring services that patients

receive from several health professions. Case managers needs a tool that can help their performance optimally.

This study aims to develop the tools for case management based on Indonesian standardized tasks and the

role of a case manager. This study used research and development method. The total sample in this study was

30 nurses. Phase 1 comprised of the identification and creation of the research instrument. Phase 2 tested the

instruments and expert discussion was conducted. Phase 3 comprised a pilot study. The Cronbach's alpha

coefficients for the reliability of the first screening was 0.832 the utility assessment was 0.777 the service

management plan was 0.643 the service management implementation was 0.832 the service management

evaluation was 0.643, and the continual service was 0.643. The information regarding function based on the

respondents’ and experts’ opinions indicated that the instrument was ready to use for the experiment. The test

measures with Pearson's product moment showed that several items for each instrument neededs to be revised

but many of them were valid. The tools that have been formulated together can support the documentation of

case management implementation and avoid overlapping tasks between case managers and tasks as nurse unit

managers.

1 BACKGROUND

Case management is an intervention strategy used by

health providers and systems to support clients,

coordinate health services, and facilitate results, both

in price and quality (Huber, 2010). Case management

is a procedure for planning, seeking, evaluating, and

monitoring services that patients receive from several

health professions (Sunaringtyas & Sulisno, 2015).

The type of nursing service as an integral part of a

hospital also determines its quality (Tafreshi &

Saeedi, 2007). Low quality nursing care will lead to

dissatisfaction not only to hospital customers but also

to other communities. The impact of this potential

discontent makes customers choose other hospitals

(Lupiyoadi & Hamdani, 2006; Study et al., 2010)

The member of staff that conducts case

management is the case manager. Case managers are

generally responsible for the coordination and

continuity of patient care. Specific service phases are

very close to patients so that case management

models can provide patient-centered care-based

health services (Aeni, 2014). Several hospitals aiming

for the Joint Commission International (JCI) have

adopted a case management model. Experimental

panel studies agreed on a case management nursing

model as an attempt to realize the preference or the

rights of patients to determine treatment options

according to their needs and expectations (Morales-

Asencio et al. 2010). The case manager works

together with the patient to ensure that the planning

matches their wishes and needs.

Case management is defined as a process of

planning, coordinating, managing, and reviewing a

patient's care. The general goal is to develop cost-

effective ways of coordinating services to improve

quality of life (Ross, Curry, & Goodwin, 2011). The

reason this research is important to conduct is because

case management provides a clinical model for the

management of quality and cost control strategies,

designed to facilitate the expected outcome of

patients in long-term care and with appropriate

resource management. A case managers work

professionally in hospitals to conducts outpatient

service management. Patient service management is a

collaborative process of assessment, planning,

facilitation, coordination of care, evaluation. and

advocacy for options and services for the fulfillment

Nursalam, ., Asmoro, C., Sukartini, T., Nihayati, H., Wahyuni, E., MHas, E. and Kristiawati, .

Development Tools for Case Management: A Pilot Study.

DOI: 10.5220/0008320400560060

In Proceedings of the 9th International Nursing Conference (INC 2018), pages 56-60

ISBN: 978-989-758-336-0

of the comprehensive needs of patients and their

families, through communication and available

resources to provide cost-effective quality patient

care (CMSA, 2010). Case managers also helps the

patient as a liaison between the patient, their family,

and doctors. Case managers must understand the

patient's condition and treatment to help the patient

understand it. So, the aim of this study is to support

case managers in knowing their role. While, at the

same time, conducting their role as a nurse unit

manager.

2 METHODS

2.1 Study Design

This study was conducted through a research and

development model and aimed to develop the tools

for case management based on Indonesian

standardized tasks and roles of case managers. This

study was certified for ethical clearance by the

Faculty of Nursing, Universitas Airlangga with the

number 547/KEPK.

The population included all Nurse Unit Managers

(NUM) who had authorized letters from the hospital

director. Samples were obtained by purposive

sampling. The inclusion criteria were as follows: 1)

case manager in a ward; 2) have authorized letter

from the hospital director as a case manager; 3)

graduated from diploma minimally but have

experience as a NUM for at least 3 years and 4)

graduated from a Bachelor of Nursing or professional

program. The sample size was 30 participants

selected from two hospitals.

2.2 Data Collection

Test statistics in the research for the study used the

Pearson Product Moment and Cronbach alpha. The

Pearson Product Moment correlation test was used to

analyze the instruments’ validity. Statements were

declared valid if the value of the r count on each item

was greater than the r table. Cronbach alpha was used

to analyze instrument reliability. The basic decision

making of this test was if the value of the r count

(Cronbach alpha value) was greater than the r table,

declaring the instrument reliable.

3 RESULTS

Table 1 shows that most of the items in the

instruments (76.67 %) were not valid. It shows that

most of the respondents were confused about how

they must fill out the instruments. The overall

instrument reliability test score was less than an r

count of 0.754 with α 0.643. This was the basis for

the researcher to redesign the instrument through

Focus Group Discussion (FGD). The first Focus

Group Discussion

will present representatives of

respondents, nursing leaders, and the nursing

committee in each hospital.

Table 1: Result of instrument validity.

Table 2 shows that more than half of the

respondents in the study (70 %) were26-45 years old.

Instruments r count r table Result

Instrument of function 1

Item 1 r: 0.643 0.754 Not vali

Item 2 r: 0.643 0.754 Not vali

Item 3 r: 0.643 0.754 Not vali

Item 4 r: 0.643 0.754 Vali

Item 5 r: 0.643 0.754 Not vali

Instrument of function 2

Item 1 r: 0.754 0.754 Vali

Item 2 r: 0.754 0.754 Vali

Item 3 r: 0.643 0.754 Not vali

Item 4 r: 0.643 0.754 Not vali

Instrument of function 3

Item 1 r: 0.643 0.754 Not vali

Item 2 r: 0.643 0.754 Not vali

Item 3 r: 0.643 0.754 Not vali

Item 4 r: 0.754 0.754 Vali

Item 5 r: 0.754 0.754 Vali

Item 6 r: 0.643 0.754 Not vali

Item 7 r: 0.643 0.754 Not vali

Item 8 r: 0.643 0.754 Not vali

Item 9 r: 0.643 0.754 Not vali

Item 10 r: 0.643 0.754 Not vali

Item 11 r: 0.643 0.754 Not vali

Item 12 r: 0.643 0.754 Not vali

Item 13 r: 0.643 0.754 Not vali

Instrument of function 4

Item 1 r: 0.643 0.754 Not vali

Item 2 r: 0.936 0.754 Vali

Item 3 r: 0.643 0.754 Not vali

Instrument of function 5

Item 1 r: 0.643 0.754 Not vali

Item 2 r: 0.643 0.754 Not vali

Item 3 r: 0.849 0.754 Vali

Instrument of function 6

Item 1 r: 0.643 0.754 Not vali

Item 2 r: 0.643 0.754 Not vali

Total “valid” item (%) 23.33%

Total “not valid” item (%) 76.67%

Development Tools for Case Management: A Pilot Study

More than half of respondents (73.3 %) had a

bachelor education background. More than half of

respondents (66.6 %) were female. More than half of

respondents (53.3 %) had 5-10 years’ experience as a

NUM.

Table 2: Demographic characteristics of respondents.

Characteristic Indicators f

(

)

Age 2645 years

21 70

46-70

ears

9 30

Total

100

Education Di

loma

26.7

Bachelo

73.3

Maste

Docto

Total

100

Gende

Male

10 33.3

Female

20 66.6

Total

100

Experience as a NUM < 5 years

5 16,7

–

10 years

16 53.3

> 10

ears

930

Total

100

Table 3: The conclusion of 1

FGD and 2

and decision of the researcher.

Strate

ic Issue Proble

FGD 2

FGD

(

ert

)

Decision

First screening There is no early

observation

format in patients

with high risk

Formatting is

clear enough, but

not complicated

The initial assessment

completeness column

can be removed

The rights and obligations

information columns and the

assessment completion

column will be removed and

do not change the instrument

arameters

Utility

assessment

There is no

observation

format of utility

assessment in case

management

implementation

The appropriate

utility assessment

format helps the

case manager.

Formatting is also

not complicated

Item parameters of the

utility assessment

format are sufficient

to include clinical,

psychosocial,

socioeconomic, and

payment systems

information

The utility assessment

format will be tailored to the

input of the expert and add

the date of the assessment of

each parameter

Service

management

plan

There is no

observation

format of service

management

planning in case

management

implementation

The completion

format is

sufficient

The format of the

service management

plan is not as it has

been made, but the

management plan

should clearly include

other health care

personnel treating the

patient

The format will be modified

by accommodating other

health professionals other

than nurses i.e. doctors,

pharmacists, nutritionists,

analysts, and

physiotherapists, as well as

allowing non-health

personnel to be added,

namely the medical record

or health insurance office

Service

management

implementation

There is no

observation

format of service

management

lementation in

The completion

format is

sufficient to

accommodate

other health

The implementation

format should be

adopted from the

integrated records

The implementation format

will be converted to a case

manager event format and

adopt integrated records

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

case management

implementation

workers to deliver

their

implementation to

the

atient

Table 4: The conclusion of 1

FGD and 2

and decision of the researcher (continued).

Strate

ic Issue Proble

FGD 2

FGD

(

ert

)

Decision

Service

management

evaluation

There is no

evaluation format

for service

management

evaluation in case

of management

implementation

Case management

evaluation format

for case manager

if biased, does not

separate from

another format so

that bias is

inte

rate

The evaluation format

is sufficiently made

that the format can be

completed by every

health worker

involved and given

the date of completion

The format will be made to

incorporate others that

format the results of

assessment, planning,

implementation, and

evaluation so they are all on

one page

Continuity

service

There is no

observed format

of service

continuity in case

management

implementation

The format of

continuity is in

accordance with

the parameters set

together

Continuity of service

should be included in

the initial screening

format because it

assesses the patient

until after discharge

The format of continuity of

service will be integrated

into the patient's initial

screening format for case

management

4 DISCUSSION

The result of this instrument case management

development is an instrument of case manager

activity in performing patient service management.

The instrument consists of one sheet consisting of an

initial screening of patients, planning, and

implementation based on a case manager’s function

(KARS, 2012), date, evaluation follow-up plan, and

the case manager’s signature. The instrument is

compiled to be as short as possible without reducing

the content of the documentation. It aims to maximize

the use of the documentation without having to write

too much, since the case manager carries out

multiple-jobs. The instruments resulted from multiple

revisions of field test results, expert discussions, and

theoretical studies.

Chen et al. (2018), on assessing the reliability and

validity of the assessment scales for nursing case

management competencies, states that the scale of

competence is a valuable tool for assessing task-

related competencies. This study indicates that

participants who have attended case management

courses have superior case management abilities

compared to those who have not. It can be assessed

through the development of which competencies a

first case manager must master and determine the

scale of his judgement. According to the researcher,

it is initially important to develop tools that can

support the performance of case managers in the

implementation of case management in hospitals.

This effort is appropriate for research regarding case

managers who are also nurse unit managers, capable

carrying out the role of case manager, despite holding

two roles in the ward.

A proposed recommendation is the flow of

implementation because this is lacking in hospitals.

The management channel used is the flow of

complaints and quality control. The

recommendations of the channels that we propose

refer to the flow of case management based on the

Hospital Accreditation Committee or KARS (2012)

combined with the handling of problems and

complaints through interviews in the field of nursing

with: the head of quality and development, and the

head and deputy head of the ward

The results of this study show that case managers

in the surgical ward experienced several obstacles:

first technical obstacles, including the unavailability

of documentation of case management

implementation. The case manager completed the

main task but there was still overlap between the case

manager and tasks of the head of the Nurse Unit

Manager because in the appointment decree it is not

in the job description of the case manager. The case

manager in the Surgical Ward at the government

hospital is the NUM who also runs several other

functions alongside the role of case manager and the

NUMs function. Such functions are complaint

management, quality team control, and others. The

case manager is appointed based on the decision letter

from the director of the hospital, stating that all

NUMs are designated as case managers.

The results of this study are in accordance with the

explanation by KARS (2012). The definition of a case

manager is: general doctor or nurse with education S1

Development Tools for Case Management: A Pilot Study

minimum 3–5 years’ experience in clinical services

and has additional training. Case management is a

collaborative process through the assessment,

planning, coordination, monitoring, and evaluation of

services to meet the patient's health needs through

communication and available cost-effective resources

(CMSA, 2010). The Indonesian Ministry of Health

stated that case managers will arrange patient services

for the duration of hospitalization, improve continuity

of service, coordination of services, patient

satisfaction, service quality, and expected results,

which are necessary for certain complex patients and

other patients in specified hospitals (Kemenkes,

2011).

Knowledge of case management in a surgery ward

is sufficient, along with the interest and willingness

to carry out case management, but the component of

case managers' documentation does not exist, thus is

a major obstacle to unstructured and standardized

management cases. So, from the findings in the field

it was necessary to conduct a FGD to develop an

innovative flow sheet of case management

implementation and its documentation that can be

implemented in the surgery ward.

5 CONCLUSIONS

The tools that have been formulated can support the

documentation of case management implementation

and avoid overlapping tasks between case managers

and nurse unit managers. It can support case

managers when facilitating assessments, planning,

coordination, monitoring, and evaluation in the

implementation of case management, to improve the

quality of services in the ward and to support KARS

and JCI accreditation to be implemented by hospitals,

especially on the assessment of elements of APK 2.

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INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research