Part 5: Performance of Case Managers

• Role of Case Managers
• Recruitment
• Induction Programme
• Ongoing Training and Support
• Monitoring and Assessment
• Incentives
• Catalyst Case Managers

Role of Case Managers

5.1
Case managers are facilitators. Their role is to:

• assess a claimant’s needs;
• liaise with health service providers and the claimant’s employer (if any);
• organise and co-ordinate the range of services provided to the claimant; and
• monitor and evaluate progress.

5.2
Case managers are not required to have a background in health. They do not provide treatment or rehabilitation services. Rather, they focus on managing a programme of assessment, treatment, and rehabilitation options aimed at rehabilitating claimants as quickly and effectively as possible. Case managers are expected to involve claimants in planning ahead and setting goals.

5.3
The cost of treatment is not a case manager’s primary focus when considering decisions about cover or treatment options. Prices for many procedures are already fixed and monitored by the Healthwise business unit at Head Office. Case managers work with individual claimants, not at the level of overall accident compensation scheme costs and trends. The case manager’s aim is to ensure that any particular treatment or rehabilitation activity is justified in terms of the injury and resulting needs of the claimant – that is, the treatment or activity will be useful in rehabilitating the claimant.

5.4
Case managers are required to carry out a lot of administrative work, relating both to file management and to their own reporting and assessment.

5.5
Overall, we were impressed with the professionalism and diligence displayed by the case managers and other ACC staff that we met. We note, though, that some claimants perceive that their case manager is insensitive to the impact that their injury has had on their circumstances. However, case managers are following the philosophy promoted by Head Office (see paragraph 3.22 on page 48).

Recruitment

5.6
Case managers come from a diverse range of occupational backgrounds. They almost always have some form of tertiary qualification, and experience in a professional field – though not necessarily health.

5.7
ACC told us that it looks for process-oriented applicants – people who are good at organising and progressing a course of action – to fill case manager positions. It seeks staff who have strong communication skills, are able to demonstrate professional judgement, and who enjoy dealing with a wide range of people. ACC is now starting to use psychological testing and targeted interviewing techniques to ensure that it identifies applicants with the appropriate qualities.

5.8
Annual turnover of case managers is around 8% – with a branch range from 2% to 12% for reasons such as the scarcity, or otherwise, of alternative job options in the places where branches are located. Despite this, the branch staff turnover rate is generally low against that of ACC overall (12.5%36), and those of other organisations. Some staff have been with ACC for many years. Furthermore, internal transfer or promotion is a common reason for case managers to leave a particular branch.

5.9
However (and ACC recognises this), Māori and other ethnic groups are underrepresented in the organisation. For example, while Māori make up about 15% of the general population, about 8.2% of staff within ACC in general and 10.2% in the branches³⁷ identify themselves as Māori. ACC has been making efforts to rectify this imbalance. For example, ACC has been using the Pae Arahi in an attempt to recruit more Māori case managers. Additionally, ACC tries to identify Māori staff in other parts of the organisation who could be trained to be case managers.

Induction Programme

5.10
ACC has a national induction programme (StartUp), which in our view recognises all the knowledge and skills required by new staff to undertake case management responsibilities. StartUp consists of a number of core modules (such as using Informe) as well as specialised modules (such as caseload management). The sixweek programme involves structured activities mainly supervised by a team manager, and supported by a ‘buddy’ system.

5.11
A one-day workshop (Orientation) is held at Head Office for all new recruits within the first 12 weeks of their employment. The workshop gives them a strategic overview of ACC’s role and functions, and notes key moments in ACC’s history that have influenced how it operates now.

5.12
Self-directed learning modules are supported by written material, crossreferenced to working documents such as the Training Workbook.

5.13
Staff at branches that we visited generally described their induction as successful. They were mainly satisfied with the written material supplied, the guidance available from the buddy system, and the input from the team manager. Most felt no pressure to accept a full caseload before they had completed the sixth week of the induction programme.

5.14
However, in branches where staff turnover was high, new staff were required to assume a full caseload before completing the induction programme. It may disadvantage both the case manager and their claimants to have the case manager working on a full caseload before the end of their induction.

5.15
Feedback from all staff after induction is systematically recorded and evaluated. After the information is collated, it is used to improve the choice of topics, the content of the documented material, and the teaching provided during induction courses. This evaluation process is comprehensive, and provides Head Office with useful information for improving future programmes.

Ongoing Training and Support

5.16 A staff training strategy and learning framework aims to deliver training programmes to support case management and to assist with the professional development of staff members.

5.17
Known as TeamUp, ACC’s formal staff training programme is delivered through:

• workshops;
• self-directed learning modules; and
• team-based sessions.

5.18
Training workshops cover communication modules, skills in negotiation, and interview room safety. The self-directed learning modules include customer care, entitlements, rehabilitation, and the review process.

5.19
The team-based weekly training sessions take one hour and are scheduled three times a month in each branch. These sessions amount to about 2550 hours a month for all the branches.³⁸ Staff agreed that training was valuable as the topics are focused and introduce any new policies or initiatives. Topics also reinforce specific training needs as they arise. Staff training has helped to improve the knowledge and core skills required during the introduction of new requirements and procedures in branches – such as the Code of ACC Claimants’ Rights.

5.20
Essential knowledge and skills learned during the training sessions are supported through coaching by team managers. Coaching is well received by case managers, who told us that it helps to raise their performance. ACC considers that training and coaching contributed to the reduction of case manager turnover last year.

5.21
ACC also recognises that strong branch leadership has an important influence on the quality of case manager performance. Accordingly, it uses external management training to improve branch leadership and communication.

5.22
Case managers are encouraged to fulfil their own professional development plans by attending courses and conferences, and obtaining higher qualifications. Some case managers attended a University of Auckland diploma course on managed health care that had an emphasis on ACC activities. We met a number of ACC case managers who had completed the course, and they all spoke favourably of it. We understand that ACC is reconsidering its involvement as case managers must go to Auckland to attend the course, which places a strain on branch resources.

Monitoring and Assessment

5.23
Branch and team managers have a wealth of computerised information to enable them to monitor and assess case managers. For instance, case listings provide data on current files, and staff reports detail individual and team achievement of KPIs. Such information is provided weekly and monthly.

5.24
Team managers assess the performance of case managers regularly in a number of ways – including:

• informal coaching (as required);
• scheduled coaching (eight times a year);
• stocktake meetings (April and October);
• interim formal performance review (January); and
• final formal performance review (June).

5.25
Each year, the performance of case managers is formally judged by a set of clearly defined KPIs. They cover eight different areas, each of which has a set level of emphasis. Four KPIs are “results” focused; that is, they relate to quantity and process. At present, the KPIs include:

• the number of claimants leaving the accident compensation scheme within the expected maximum duration for each type of injury as identified by the MDA computer program;
• new claimants who are entitled to weekly compensation who leave within five months;
• agreement of Individual Rehabilitation Plans within 13 weeks; and
• long-term claimants who are entitled to weekly compensation who leave the scheme.

5.26
The other four KPIs are “quality” focused. They relate to matters such as customer service and teamwork.

5.27
Together, the results and quality KPIs produce an overall rating, on a five-point scale, of the case manager’s performance.

5.28
We observed team managers assessing the performance of case managers and noted the considerable time and effort put into the exercise. The assessment process is well documented. The results KPIs are measured statistically, and all case managers are assessed to the same standards.

5.29
However, the measurement of quality KPIs was variable, often simply arrived at through an overall impression gained by the team manager. It was not clear how those measures could be assessed consistently throughout ACC.

Incentives

5.30
Remuneration of case managers is determined annually by a strict formula, which is detailed and transparent. It is based on a combination of the case manager’s:

• level of performance (as determined by their overall rating against the KPIs); and
• current place in the salary band for their position (determined by a widely used remuneration measurement system).

5.31
Professional development is encouraged, and ACC supports staff undertaking specialist and post-graduate study.

5.32
A common perception among claimants is that case managers are directly compensated for getting claimants “off the scheme”. However, we found no evidence that case managers are directly rewarded for achieving such results. One of the KPIs for case managers relates to the number of short-term claimants who leave the scheme within a defined time, and another relates to long-term claimants who leave the scheme. These measures do affect the assessment of a case manager’s performance. However, they are only two of a number of measures against which case managers are judged. Moreover, the existence of such measures is consistent with ACC’s legislative role to rehabilitate claimants to the point that they no longer require assistance from ACC.

Catalyst Case Managers

5.33
All of the Catalyst case managers we met showed commitment and displayed professional respect when dealing with claimants. Overall, we found few differences between how Catalyst and branch case managers perform their functions.

5.34
Case managers in Catalyst had responsibility for:

• receiving selected claimants from branches;
• progressing the rehabilitation process as agreed in the Individual Rehabilitation Plan;
• monitoring and reviewing the progress of implementing the Individual Rehabilitation Plan; and
• achieving a set number of claimants leaving the scheme within 12-15 months.

5.35
Catalyst case managers usually had a tertiary qualification, some in health. They had good skills for dealing with customers and for negotiating, and case management experience was preferred. Many were previously case managers in branches, while others were recruited from Work and Income. They also needed experience in management, and knowledge of all rehabilitation services – especially for claimants who required more specialised medical treatment and assessment.

5.36
From the general comments made in the Catalyst Claimants Survey, Catalyst case managers were considered professional and efficient. As shown in Figure 8, 61% of claimants were satisfied or very satisfied with the service from Catalyst case managers.

Figure 8
Claimant Satisfaction With Service Provided by Catalyst Case Managers

5.37
However, only 41% of respondents to the survey felt that their case manager clearly explained to them how their claim was to be progressed. Furthermore, only 25% of respondents said that their case manager clearly explained what their entitlements were and what assistance they were entitled to receive.

5.38
Claimants noted that they wished to have more face-to-face contact and communication with their Catalyst case managers and wanted them to have a more understanding and friendly attitude during meetings and telephone calls. Other criticisms were that case managers did not return calls promptly, and did not provide enough information on entitlements. Catalyst claimants noted that they wanted to be kept informed regularly and to be made aware of their progress.

5.39
Some claimants interviewed for the survey felt that insufficient attention was given to their rehabilitation needs and mentioned that, apart from a more direct service, they also wished to have access to more retraining, physiotherapy, pain management, and better equipment.

36: Accident Compensation Corporation Annual Report 2003, page 5.

37: The figure for Māori in the branches includes all positions, such as case manager and branch manager. ACC was unable to produce an exact figure for the number of Māori case managers that it employs.

38: All forms of training provided to ACC branches – including workshops, modules, team-based weekly training sessions, and orientation – amount to about 4800 hours a month.