By: Dr. John S. Lyons
Have you ever had this situation?
You have talented staff and ask them to take on the most challenging cases, but then they burn out and leave for a different job, and as a manager you are now left with the staff you’ve been working around when it comes to managing challenging cases? Most program managers have had this type of experience. One of the key drivers of this phenomenon is that we manage caseloads consistent with service system thinking. For example, each case manager might be expected to maintain a caseload of 20 cases. New referrals will generally go to the case manager with the fewest cases to keep the caseloads equitable.
Here is the problem with that logic.
Not all cases are equally easy or challenging. Some cases take more time and emotional energy. Thus, pretending all cases are equivalent actually penalizes staff who are willing to take on the most challenging cases. This management strategy also provides a clear incentive for case managers to hold on to cases that could possibly be transitioned from the program. Typically it is less work to hang on to a case with which you are familiar and is stable than to take on a new case.
Within a TCOM framework this is an easy fix. Managing workload simultaneous to caseload provides a more equitable management strategy and rewards staff for both taking on challenging cases and transitioning those who are ready to finish their transformational experience within that program.
Think about it this way:
Workload=Total number of actionable needs summed over total number of cases
With the action levels of the typical communimetric measure — 0=no evidence, no need for action, 1=watchful waiting prevention, 2=action and 3=immediate/intensive action, — all that is required is a count of the number of ‘2’ and ‘3’ ratings on need items for each case. This number is summed over a worker’s caseload resulting in a workload metric.
For example, you might have two staff:
Staff A has a caseload of 22 and
Staff B has a caseload of 17.
When a new case comes in, to whom do you refer this person or family? Traditional caseload management would say of course it is Staff B who gets the new case. But what if you look at the actionable needs and come up with a workload and see the following:
Staff A has a workload of 44
Staff B has a workload of 85
In this situation, Staff A’s caseload has an average of two actionable needs per case while Staff B’s caseload has an average of five actionable needs. It may make far more sense to refer the new case to Staff A.
Here’s another way to think of this:
Lets say two people are carrying a stack of boxes. Person 1 carried 6 boxes and Person 2 carried 4. If all boxes were the same size and weight, then this might not sound “fair.” But in reality, these boxes (like cases) are of different shapes and sizes.
Of course, a precise threshold of when workload over-rides caseload in referral decisions requires program policies. Taking the average number of actionable needs for the program and using a cut-off of two or three times this number might make sense. With experience, program managers can begin to get a sense of this type of decision support. Thus the workload metric is one more tool for programs to use for effective management within the TCOM framework.