We speak to Jennifer Whittall about her journey into case management and the challenges and opportunities facing case managers today.
Can you share your background and route into case management?
I qualified as a chartered physiotherapist from the Oswestry school of physiotherapy based at the Robert Jones and Agnes Hunt Orthopaedic Hospital in Gobowen.
The Midlands Centre of Spinal Injuries was based there, and during our training we would assist on the spinal unit – from there my interest and passion in spinal injuries grew.
Once qualified, I progressed to being the senior therapist on the unit. By chance, I had the opportunity to work with Barbara Scandrett who at the time was the social worker on the unit.
Over time, Barbara set up a complex care company called Complete Personal Assistants (CPA) who specialised in live in care. I was asked to be the manager of this company and so my journey into care assessments began.
Working on the unit, I was able to develop skills in all aspects of support and rehabilitation for spinal cord injured clients.
When working with CPA, case management was not widely recognised in the field of spinal injuries, but I was fortunate to work with Barbara and a group of solicitors who gradually began to introduce this concept.
I gradually developed recognition in this field and moved on from being a manager into being a case manager. I worked with CPA as a case manager until 2006, when I set up my own company, Jennifer M Whittall Limited.
How vital a role does case management play in neuro-rehab?
Case management is integral to supporting clients’ neuro rehabilitation.
Clients more often than not present with a complex series of challenges and problems to deal with.
A good case manager can identify what the challenges are for the client and then research the appropriate professionals that will become part of a neuro rehabilitation team.
They then coordinate and facilitate the team in establishing a comprehensive set of goals which are meaningful for clients and which they can aspire to.
The key is then to coordinate the team’s input to the benefit of the client.
Communication is key on so many levels with so many people involved, so it is a time-consuming role to perform effectively.
From a case managers’ perspective, it is an exciting and tremendously inspirational role supporting a neuro rehab team.
We are in exciting times in terms of the progression of neuro rehabilitation, particularly from a physical perspective with the introduction of all the rehabilitation technology, assistive technology and AI.
It will be interesting to see how neuro rehabilitation will progress with these new modalities which can be brought into the team.
What should someone look for in appointing a case manager?
Obviously experience and knowledge of the case manager are the key to the success for a client, whether that be a physiotherapist, occupational therapist or nurse background.
The key is to be able to instil confidence in a client that you will be there for them in every step of their journey.
In meeting a case manager, the client should look at how that experience and knowledge has been applied for the benefit of previous clients, with experiential and practical examples of how they have supported clients in the past.
When meeting the client for the first time, I share practical examples of how I have helped other clients.
However, at at the same time, I understand that this is their journey and as such, while there are common features in everyone’s rehabilitation, their journey is unique to them.
It is important to recognise that the client and family lived a full and independent life prior to their accident.
This understanding will help set the scene as to how goals can be integrated into their lifestyle and give more insight into how that process of rehabilitation needs to be managed.
The client should understand that, as a case manager, you do not take over: you work together to help facilitate their goals and wishes.
But at the same time, a case manager will provide an educational role to help them understand the wider ranging effects of the disability for either themselves or within the family.
I also convey that rehabilitation and case management can be intrusive and challenging.
While we strive to work together in a positive manner, there may be occasions where we disagree on certain aspects.
I want them to understand that that is okay to disagree, and that they must feel that they can speak openly to a case manager, so that disagreements can be explored and solutions sought.
Please describe your way of working and how you co-ordinate the MDT
The key to setting up a good multidisciplinary team is a comprehensive assessment, which will identify the client’s problems, their experiences to date and their specific goals.
We can only coordinate an MDT if we have an appropriate budget, so I select appropriate MDT members and identify an outline budget that we can request from the litigation team to apply for.
There is nothing worse than building up the expectations and then not having the funding with which to proceed.
In some cases, clients have been waiting for rehabilitation for a long time so the shopping list for rehabilitation can seem very long and daunting.
I therefore consider their and from there, try to plan and coordinate instruction of the MDT according to the client’s key goals and wishes.
I ask key members of the MDT to then carry out their own assessment and try to establish a relationship with the client and together identify their particular goals.
I like to share each member of the team’s reports with one another so that we can identify and explore the dynamics and requirements.
I also go through the reports with the clients, so that they too can understand the process and also establish whether they actually understand each team member’s goal.
We then hold an MDT where we discuss the overarching team goals and then set up a goal setting document.
This meeting establishes all the goals for the priorities which need to be addressed and explored joint working where therapists have identified similar goals.
And if there is a shared goal, I will designate one member of the team as the lead for that specific goal as it clearly falls within their professional remit – and from there, joint meetings can be planned,
I am very mindful the client’s life can be taken up by therapy meetings which detracts from their own personal lives.
So the team has to be managed to make sure that they understand the needs of the family or the client as an individual, rather than just pushing it forwards in the name of rehabilitation.
We do use software called Team Up, where we can coordinate dates, save time and avoid clashes.
Once the goals are identified and the team is up and running, I ask them to provide a brief update at the end of each therapy session to share with the team.
Managing an MDT can be a challenging process. Communication has to be a priority.
I’m also mindful that we do not have mavericks setting off in their own direction and leaving the team behind them.
There are occasions when conversations have to be hard with those kinds of individuals so they understand that, while they may believe their rehabilitation is a priority, they’re only as good as the people who joined them in that process, and we cannot afford to leave any individual behind.
Can you share an example of a particularly successful outcome for a client?
One of JMW’s significant achievements is supporting clients who have gone on to represent their country at the Commonwealth Games in many sports including basketball, triathlon and wheelchair racing.
As a team, we supported one client in the backup challenge of the Snowdon Push.
Prior to his accident over 15 years ago he was a fell runner and had been up Snowdon mere days before his accident.
It was his wish to go up Snowdon again but this time in his wheelchair – and he succeeded.
With a team of 16, we achieved the second-fastest time up and down Snowdon. The greatest pleasure and sense of achievement came from taking that client back up Snowdon to support him to achieve his goal.
Can you share an example of how you have overcome a challenge within the MDT.
We currently have a client who is presenting with difficulties and challenges due to his physical disability and brain injury.
He’s prone to throw random items at staff, but because he requires personal care, staff have to move within his personal space which in itself is a trigger.
This is certainly work in progress, but again, it is the close teamwork, communication and reflective practice that allows us to continue to support and work through the difficulties.
Keeping the litigation solicitors and the deputy informed is vital in this particular case, with budget management critical with this particular client.
The client is proving to be a particularly challenging person and although we are yet to resolve the challenges, we continue to introduce strategies and goals to improve his life.
One significant measure of success is that no member of the team has walked away from supporting him and we have managed to maintain stability.
Would you recommend a move into case management? Is it suitable for anyone with a healthcare background? What specialist skills do you need?
Case management is a particularly interesting and fulfilling role.
But it is important to recognise that there are many different types of case managers, and different ways of practicing, from being fully hands-on in the more complex cases, to being a desk-based case manager.
So before becoming a case manager, it is important to do the research and reach out to case management companies to understand the different ways in which they practice.
From there, an individual can decide whether it’s going to be a role for them and in what direction they would like to develop.
Case management will not suit everybody. But as you network with case managers, you will see that they come from all sort of diverse background.
I believe having worked in a multidisciplinary team gives you a good grounding to understand the work of a case manager, where you will have to communicate with many different agencies.
I also find that those who’ve worked in a busy large team can find it difficult to adjust to working as a case manager where you can spend many hours away from your base and office team.
It’s also worth thinking about your availability.
I’m not convinced that case managers can work part time because their clients do not have a part time disability. This may well determine the direction of case management that an individual takes.
I look for the following skills in a case manager:
- Good clinical background knowledge, relative to their profession,
- An appropriate area of clinical expertise, whether physical disability or brain injury
- Exceptional communication skills
- Good interpersonal skills
- A proven track record re. assessments and report writing and planning
- An understanding of the role of other healthcare professionals and how they would fit into an MDT
- A flexible approach to working
- A good problem solver able to respond to challenges in the moment
- An individual who can demonstrate effective time management
- Someone who is a good listener and instils confidence in those they work with
- And last but by no means least, a good sense of humour and patience
Why would you recommend your firm in particular?
We describe Jennifer M Whittall Ltd as a small but perfectly-formed company.
Rather than trying to grow the company to an unmanageable size with too many clients, we go for quality, not quantity.
We pride ourselves in being able to support our clients and their families in a personable manner and respond to them in a timely fashion.
The team is exceptionally well-balanced, so when solicitors and clients come to us, they understand that can provide a wealth of knowledge combined and accumulated over a number of years.
This applies not only to our case managers but with our office staff, too.
There is lot of change and development in the case management world today.
We pride ourselves in being able to keep abreast of all these changes while participating within organisational bodies to help steer the direction to these changes.
With its growing profile and the creation of the IRCM bringing new levels of professional accreditation to the profession, what do you think is the outlook for case management?
IRCM intends to improve and maintain standards within case management and is also an opportunity to give support to case managers who may not necessarily follow the healthcare profession route.
Those of us who are used to working within a registered and regulated framework do not necessarily see this as a problem as we have always been accountable to our professional bodies.
It may be alien to others, and some may see it as a barrier.
As a registered body, it will be someone clients can go to when they feel that the case manager is not meeting the necessary standards.
However, IRCM should not be seen as a body that is there to address challenges and underperforming case managers, but rather as a body that’s going to help set the standards for the future.
I think we have more to learn about how the organisation is and how it will work in practice.
Please tell us a little about your life outside of work – and try and give us a fact about yourself few people will know!
Very few people will know that I used to be a shot putter in the Lancashire schools’ team, and that I have been both a gondolier and a toreador in my former lives.
I like to go to the gym three or four times a week which helps me unwind. It also helps to counteract the many hours I spend sitting in the car.
One of our biggest passions is traveling in Europe in our motorhome, who is affectionately named Olive after a dear friend.
In September, we can be seen crossing the Channel to travel down to Europe.
The biggest decision is whether to go left or right from Calais. Going right invariably ends up in Portugal or Spain, going left has taken us through Belgium, Germany, Australia and down into Italy.
We even have a scooter that follows us on our trailer, which can help us reach places where the motorhome won’t go. You can find our blog, which we write when travelling.
The other passions in our lives are our beautiful granddaughters, our family, and of course our French bulldogs, Nelly and Daisy.
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