Workplace Violence and Bullying: You Can Survive.

One of biggest challenges facing the health care industry today is workplace violence and bullying. Sadly, this trend has increased so dramatically that The Joint Commission is tracking these trends and has instituted new requirements in 2022. This Editorial describes the trend and suggests methods to mitigate the situation.

Collective Occupational Trauma, Health Care Quality, and Trauma-Informed Leadership: Intersections and Implications.

Managing stress, burnout, and vicarious trauma is a long-standing issue for the health and behavioral health workforce, including those in case management. Yet, the recent novel coronavirus pandemic has amplified routine burnout to record levels. Practitioners and patients are amid a new dynamic of collective occupational trauma (COT). In this realm, health and behavioral health workers (HBWs) experience the same reality as their patients, families, and support systems; professional boundaries become blurred, leading to heightened levels of emotional vulnerability that can prompt the development of more pervasive psychopathology. This reality has put the Quadruple Aim in peril, with increased workforce turnover, staff shortages, costs, and quality challenges. This article: Applicable to all health and behavioral health settings where case management is practiced. Organizational cultures must shift from a "process and roll" mindset to one that is trauma-informed. Implementation of TIC has yielded successful outcomes for the workforce via enhanced patient engagement, treatment adherence, and successful outcomes. In tandem, TIC leadership and supervision models have had promising results and should be more readily utilized; they acknowledge and address workforce trauma while prioritizing staff health, mental health, and wellness. Failure to shift the culture will result in an ongoing exodus of practitioners, leaving insufficient numbers to render safe, cost-effective, efficient, and patient-centered care. The case management workforce comprises professional disciplines across health and behavioral health, employed in every setting. The expanding workforce presence has put them at risk of COT. Leadership strategies must shift to acknowledge workforce exposure to occupational trauma, address mental health and wellness, and address professional self-care. This shift is key to mitigating retention, sustainability, and quality challenges.

The Ethical Context of Hope: Case Management's Ongoing Challenge.

Case management's ethical tenets are timeless and remain a foundational pillar of case management practice. These tenets are independent of patient or situation context, even with the tremendous post/parapandemic times. Yet, the question beckons: Despite the times or their circumstances, how do health care professionals engage in ethical practice while still maintaining hope?

Informing the Professional Case Manager's Career Path: Five Lessons.

Professional case management's career path offers countless opportunities to pursue, from attainment of the highest levels of licensure and credentialing to education, and that terminal degree. Defining each point of the journey and individual milestones warrants keen attention to a number of areas. All of these decisions and options evolve in response to the industry landscape, as well as professional and personal development. Five key lessons provide case managers clear starting points to consider the most appropriate career path to travel amid a landscape marked by constant change.

End of Life Care's Ongoing Evolution.

PURPOSE/OBJECTIVES: PRIMARY PRACTICE SETTINGS:: Applicable to all settings across the transitions of care where case management practice occurs. FINDINGS/CONCLUSIONS: Continuing shifts in society's cultural landscape, ongoing emphasis on value versus volume, and other industry fiscal imperatives continue to evoke an evolution in end-of-life care. The attainment of successful outcomes by professional case managers with those populations will be dependent on awareness and comprehension of regulations, legislation, and reimbursement; the influences of ongoing industry trends; availability of emerging resources; and ongoing technological advances. Ethical excellence remains at the core of case management across the interprofessional workforce and the transitions of care. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: The professional case management workforce is tasked to effectively intervene across diverse client populations, with their caregivers and support systems. This action spans every life stage and illness course. With end-of-life care treatment and processes continuing to receive prime industry attention, case managers must be knowledgeable of the moving parts of this arena. Awareness of the ethical edges of each professional's sandbox is essential to quality-driven case management practice.

Leveraging Interprofessional Team-Based Care Toward Case Management Excellence: Part 2, Team Development, Interprofessional Team Activation, and Sustainability.

: Health care teams are constructive and efficient ways to approach, assess, coordinate, plan, and facilitate the client-centric and population-based care. Some iteration of team is in place across most practice settings, comprising different professionals and specialists, from multidisciplinary, interdisciplinary, and transdisciplinary to the most recent interprofessional model. This 2-part article series sets the tone for how interprofessional team-based care (IPTBC) empowers the care process. Part 1 focused on the history and fundamental concepts of interprofessional models, with outcomes to promote the value proposition for IPTBC implementation.This Part 2 article focuses on the identification of seminal group development and team processes. An original model, the Interprofessional Team Activation Cycle (ITAC), is presented, as well as defined tactics for professional case managers to promote successful implementation of IPTBC in their organizations. PURPOSE/OBJECTIVES: This article: PRIMARY PRACTICE SETTING(S):: Applicable to all health and behavioral health settings where case management is practiced. FINDINGS/CONCLUSIONS: Shifts in reimbursement models, organizational cultures, and client populations have yielded emphasis on the swift IPTBC implementation. In addition, the recognition of team development as a fluid process endemic to achieve client-centric outcomes and organizational return on investment mandates a keen eye to the phases of a team implementation, especially those that are interprofessional in scope. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: With case management so closely linked to the fiscal imperatives of organizations, engagement in IPTBC is a necessity for every practice setting yet not always implemented properly or successfully. Poor team collaboration contributes to unsuccessful outcomes for clients, increased costs, and concerning quality and risk management issues for the organization. Models focused on group development serve to support how health and behavioral health organizations consider and implement interprofessional teams.

Responding to the Changing Face of the Social Determinants of Health.

The social determinants of health (SDoH) are at the top of every health care organization's priority list. The ability to respond to these nonclinical client needs is driving the financial sustainability, if not survivability, of facilities and programs across the globe. Although a number of traditional populations have been long identified with the SDoH, the face of those clients and communities is changing. With these demographic shifts come new ethical challenges for case managers, particularly in response to prevailing personal biases. With the case management positioned on the front lines of care, the workforce must be able to identify and respond ethically and effectively to the emerging new face of the SDoH.

Leveraging Interprofessional Team-Based Care Toward Case Management Excellence: Part 1, History, Fundamentals, Evidence.

: Health care teams continue to be a constructive way to approach, assess, coordinate, plan, and facilitate the care of clients and populations. Independent of practice setting, some type of team is in place, engaging different professionals and specialists. There has been considerable evolution of these teams over the years, with a heritage of terms to frame each one, including "multidisciplinary," "interdisciplinary," and "transdisciplinary." However, these long-standing framings have been replaced by a timelier model that shifts both focus and aim of the team effort. Interprofessional team-based care (IPTBC) sets the tone for how students entering the industry are educated and empowers the workforce to a more intentional means to the care end. This is the first in a 2-part series focusing on the evolution and implementation of IPTBC across the industry. Part 1 focuses on the history and fundamental concepts of interprofessional models. Evidence and outcomes to promote the value proposition for IPTBC implementation are also provided. PURPOSE/OBJECTIVES: This article: PRIMARY PRACTICE SETTING(S):: Applicable to all health and behavioral health settings where case management is practiced. FINDINGS/CONCLUSIONS: Interprofessional team-based care models demonstrate a successful means to achieve client-driven, quality, and cost-effective care across disease states and practice settings. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: With case management so closely linked to the fiscal imperatives of organizations, engagement in IPTBC is a necessity for every practice setting. Poor team collaboration contributes to unsuccessful outcomes for clients, increased costs, and concerning quality and risk management issues for the organization. The latest generation of value-based care initiatives and complex population health needs (e.g., social determinants of health, co-occurring physical and behavioral health) translates to greater pressures on case managers to maximize financial risk and attain their share of financial incentives (e.g., bonuses, shared savings) by avoiding readmissions, preventable complications, and duplicate services.

Six Lessons to Guide Intentional Career Action: Homage to the Queen of Soul and a Maverick Senator.

Independent of political perspective or musical preferences, the deaths of two individuals who played a major role in history was worthy of a moment of pause. The life lessons inspired by the efforts of these icons, plus the work of motivational author Jon Acuff together serve to empower the intentional action of professional case managers in defining a successful career path.

The New Age of Bullying and Violence in Health Care: Part 4: Managing Organizational Cultures and Beyond.

Disrespect among the health and behavioral health workforce may have reached the point of no return. The industry is on heightened alert, as the disruptive behaviors of bullying and lateral violence, plus escalating incidents of workforce harassment and workplace violence incidents, impact every practice setting. These behaviors contribute to concerns around client and professional safety, quality-of-care processes, as well as workforce retention and mental health. PURPOSE/OBJECTIVES: This article: PRIMARY PRACTICE SETTING(S):: Applicable to all health and behavioral health settings where case management is practiced. FINDINGS/CONCLUSIONS: Despite glaring improvements in how care is rendered and an enhanced focus on quality delivery of care, organizations must address cultures that support as opposed to negate disruptive workplace behaviors. The emerging regulatory and organizational initiatives to reframe the delivery of care will become meaningless without consistent attention to enforcement of regulatory, policy, and prevention actions. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Professionals who hesitate to confront and address incidents of disruptive and oppressive behavior in the health care workplace potentially practice unethically. Bullying has fostered a dangerous culture of silence in the industry, one which impacts client safety, quality care delivery, plus has longer term behavioral health implications for the professionals striving to render care. Add the escalating numbers specific to workplace violence and the trends speak to an atmosphere of safety and quality in the health care workplace that puts clients and professionals at risk.

Managing the Social Determinants of Health: Part II: Leveraging Assessment Toward Comprehensive Case Management.

BEHAVIORAL LEARNING OBJECTIVES: This article will: PRIMARY PRACTICE SETTINGS(S):: Applicable to health and behavioral health settings where case management is practiced. FINDINGS/CONCLUSIONS: When professional case managers use comprehensive assessments to inform their work with populations impacted by the SDH, barriers to care access can be more readily addressed (e.g., poverty, employment, housing insufficiency, health literacy, migration, and medication adherence). Initiatives, programming, and treatment plans can be advanced to provide target populations with individualized and appropriate intervention. Case management involvement can also be leveraged to coordinate and facilitate successful interprofessional team efforts (; ). IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Case managers must engage clients from a wholistic lens that reflects their standards of practice and accounts for all domains of assessment: medical, cognitive and behavioral, functional, and social. Comprehensive tools to guide a robust and exhaustive screening of issues and opportunities ensure more successful outcomes.

Managing the Social Determinants of Health: Part I: Fundamental Knowledge for Professional Case Management.

OBJECTIVES: PRIMARY PRACTICE SETTING(S):: Applicable to health and behavioral health settings, wherever case management is practiced. FINDING/CONCLUSION: The SDH pose major challenges to the health care workforce in terms of effective resource provision, health and behavioral health treatment planning plus adherence, and overall coordination of care. Obstacles and variances to needed interventions easily lead to less than optimal outcomes for case managers and their health care organizations. Possessing sound knowledge and clear understanding of each SDH, the historical perspectives, main theories, and integral dynamics, as well as creative resource solutions, all support a higher level of intentional and effective professional case management practice. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Those persons and communities impacted most by the SDH comprise every case management practice setting. These clients can be among the most vulnerable and disenfranchised members of society, which can easily engender biases on the part of the interprofessional workforce. They are also among the costliest to care for with 50% of costs for only 5% of the population. Critical attention to knowledge about managing the SDH leverages and informs case management practice, evolves more effective programming, and enhances operational outcomes across practice settings.

The New Age of Bullying and Violence in Health Care: Part 3: Managing the Bullying Boss and Leadership.

PURPOSE/OBJECTIVES: PRIMARY PRACTICE SETTING(S):: Applicable to all health care sections where case management is practiced. FINDINGS/CONCLUSIONS: This article is the third of a 4-part series on the topic of bullying in the health care workplace. Part 3 addresses the dimensions of the bullying boss and leadership, posing major implications for patient safety plus the mental health of staff members. The complex constructs and dynamics broached by the bullying boss and department leadership are explored. These include the underlying forces at play such as power, gender, leadership styles, plus weaves in assessment models. Strategic and proactive management of bullying by leadership is vital to workforce retention and well-being. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: The increasing incidence and impact of bullying across all sectors have made it a major workforce performance management challenge. Health care settings are especially tense environments, often making it difficult for individuals to distinguish between bullying behavior and high expectations for staff. Bullying impacts both direct targets and bystanders who witness the assaultive behaviors, with ethical implications as well.Case management is poised to promote a safe health care workplace for patients and practitioners alike amid these intricate circumstances. Understanding types of bullying bosses and leadership styles is integral to a case manager's success in the workplace.