Last week, I shared a story titled When the System Works It Works Well. A comment from a reader made me rethink this story and see a different perspective that I had not considered. I wanted to share it with you as it was an important realization that we must remember as nurse case managers and other healthcare team members.
The Comment:
Great story. In this case, as was the patient, healthcare professionals were thoughtful and willing to be flexible. The insurer was willing to work with both parties and approve payment. The result was a successful treatment and healthy outcome. The success can be attributed to thinking “out of the box” and questioning “by the book” responses. Well done!
Reflection on the Case
As I thought about the comment, I realized the injured worker was the force behind the success of this case. He was the one who, although in pain, scared, and worried about his future, asked the doctor to allow him to try conservative treatment. Even though two doctors thought surgery was the best option based on his presentation, the MRI, and their expertise, they listened to the patient and allowed him to try conservative treatment.
Yes, everything worked – but it was because the patient followed the plan of care: he participated in therapy despite the pain, was willing to go back to work, and used his knowledge of the industry he worked in to create a new position for himself that allowed him to return to gainful employment.
I know the doctor did not think the injured worker would do as well as he did. He thought he would come back after the first visit and agree to surgery. But the patient persisted and allowed his body to heal on its own. The team designed a plan that included medication, water therapy, and family support, which helped him get through the hard part of the process.
Outcomes
Several studies show that engaging patients in decision-making and behavior change should be how we (nurse case managers, physicians, therapists, and others involved in patient care) practice. Effectively engaging patients in their care improves health outcomes and satisfaction with the care experience, reduces costs, and even benefits the clinician experience.
Takeaways
Some take-a-ways I leave with you:
- Listen to the patient.
- Put the team together who will listen to the patient after options and ramifications are explained.
- Give them time to heal naturally.
- Utilize the non-surgical resources first.
- Allow healthcare team members to use their expertise and resources to address challenges. It may take a little longer, but ultimately, we achieve a positive outcome for the patient.
- Empower the patient to participate in THEIR plan of care.
- Engage the family to support the patient.
- Talk to the employer to find simple ways to bring someone back to work, utilizing the patient’s transferable skills to try something outside their comfort zone.
- Celebrate your successes!
Thanks for reading this post. Please let me know if you have a comment you want to share as we get smarter together!
If you missed the original article When the System Works: It Works Well You can read it here: https://nursesadvocates.com/when-the-system-works-it-works-well-2
Not in this case, but too often employers are unwilling to bring an injured worker back (for a number of reasons (fear of increasing the injury, showing other employees what an injury might earn them, a lesser job, etc., the reasons or too numerous to name). But not being willing to bring them back in some capacity (when they capable per the MD to return with restrictions – it is a temporary position – but it lets them know they cannot just sit at home and do nothing in between PT visits, they need to be engaged, although rest is important) sets the employee up for deconditioning (PT does not stop or prevent this), emotionally devalues the person, and in some cases rewards the person if the injury is not as bad as claimed. While counting paperclips is not really the answer (but it is a task for them to do) or sitting at a desk in the media center as children check out books, typing up-grades to manuals, answering service calls, dispatching service trucks, etc.; it is getting them to show up and be present; realize that they need to return to the environment the injury occurred, everything works together to help improve their well-being and the injury. The employer and or the employee may not like it, but if the goal is to return the injured person to work, decrease cost, prompt healing (regardless of how small), even the smallest piece must be tried/utilized.
Thank you so much, Anne!!!!! I will pass it forward!
For sure I will bookmark this article along with the prior one When The System Works It Works Well. I plan to share this with others who may benefit from your “words of wisdom”.
Although retired, friends and acquaintances who are aware of my having practiced nursing and managed care for 49 years, often ask me their advice about medical issues. I remind them I am not a MD, listen to and discuss with their MD(s) their particular issues, having them look/think outside the box for all possibilities, which I did with my clients when working!. Often I will share with them how to go about speaking with their clinicians, reminding them I no longer have an active RN license. It is amazing how grateful they are for my even listening to them and encouraging them to speak up and advocate for themselves!