WORKING IN A MILITARY ENVIRONMENT

1. WORKING IN A MILITARY ENVIRONMENT Randy Carey-Walden, RN, BSN, MS Illinois Army National Guard Case Manager Contractor

2. What is Case Management? Case management is defined by the Case Management Society of America (CMSA) as "....a collaborative process which assesses, plans, implements, coordinates, monitors and evaluates options and services to meet an individual’s health needs using communication and available resources to promote quality, cost effective outcomes." This is further defined by our contract and your individual SOW (Statement of Work).

4. A Little History Case management as a process began post-World War II in 1945. Military wounded were sent home with devastating injuries that required complicated medical care and rehabilitation for reentry into civilian life. Magnifying this need were the advances in medical technology. The term "case management" first appeared in social work and nursing literature in the 1960’s.

5. Military Case Management • Soon the military branches began to see a need for case management. The creation of TRICARE, which manages the healthcare for dependents of Active Duty Service Members and retirees, produced a cultural change in healthcare delivery. The military and civilian healthcare sectors were now working hand in hand with civilian HMOs. The military health system had never been exposed to terms such as "preauthorization", "covered benefits", "network and non-network providers", "Memorandums of Understanding", and the list goes on. • In 1994, the first Department of Defense Utilization Management Plan appeared, which created a formal utilization management program for the military healthcare systems. This change brought new challenges. Cost containment had never been an issue. The more beds that the Military Treatment Facility (MTF) had occupied, the more money and resources were allocated to the MTF.

6. Effective Team Players • Demonstrate reliability • Communicate constructively • Listen actively • Function as an active participant • Share openly and willingly • Cooperate—pitch in to help • Exhibit flexibility • Show commitment to the team • Work as a problem solver • Treat others respectfully and supportively

7. Tips for Playing Well with Others • Make the best of it. We spend more hours with co-workers than with any other group of people • Teamwork is not only necessary—we cannot do this job without it • People come from varying backgrounds, levels of education, ethnic groups, etc. • Making the most of your time at work can mean the difference between loving your job and rewriting your resume

8. Check your Attitude

9. You’re in the Army now! • Working with the military is rewarding and exciting, but it is not the same as a civilian medical environment • You’re not in a democracy. Orders are issued at different levels and we follow orders just as Soldiers do • We all contribute to the Individual Medical Readiness (IMR) of the Army National Guard (ARNG) but we are here to meet their goals—not our own • Your input is often sought, but our duties are driven by our contract and by army regulations

10. Civilians & the Military • 40% of army personnel resources are now civilian positions but this is still a military operation • Positive military-civilian working relationships are critical to success • Productivity is adversely affected if working relationships are poor—this is true in any work place

11. Regulations • Army regulations are the policies and procedures of the military • Army regulations cover nearly every aspect of military operations • Change is effected, but only within regulations

12. Learn to think outside the circle too!

13. Basic Tips for Success • Heads up! Don’t continue tapping away at your keyboard when someone is talking to you. Look up and make eye contact. • Listen! Don’t assume you know what someone wants to say or what response they need. Ask questions to clarify what you don’t understand. • Show interest! You don’t have to be best friends at work, but showing interest in others makes for a better work environment.

14. Basic Tips for Success • Be a mentor! If asked to train someone, take it seriously and give everyone every chance to learn. Everyone learns at their own pace and no one wants to be “thrown to the wolves.” • Assume the best! You may be the best employee in the world, but don’t set standards for others that you can’t meet. Don’t assume your colleagues are stupid or incompetent. • Share credit when due! Even if you feel like you did most of the work, sharing your success will make you look like more of a winner. None of us really do it alone, do we?

15. Basic Tips for Success • You might be wrong! Be open to that possibility. It happens to the best of us. Correct what needs to be corrected, apologize if necessary and move on. • Honor commitments! If you promise that something will be done by close of business (COB), make sure it is done! Integrity is a value of the ARNG and it should be one of your values also! • Be appreciative! Even thanking someone for simply doing their job goes a long way. It may be the waiter’s job to refill your iced tea, but “thanks” is still necessary.

16. Basic Tips for Success • To BFF or not. Don’t expect to like everyone and don’t expect everyone to like you. It isn’t in your contract and it isn’t a requirement. There’s something good in every person. Find that and concentrate on this. Be tolerant and pick your battles. Killing your co-workers is never a good idea. There’s always too much paperwork involved and it may just ruin someone’s day. • Don’t play the blame game! You will do nothing but alienate coworkers, supervisors and military staff. If you goof, admit it, fix it, move on and don’t do it again! Simple!

17. Everyone is Good at Something

18. Basic Tips for Success • Go to a meeting prepared! Bring data. Your presence at a meeting is either to learn or to provide input. Know what the agenda is and be prepared. Always bring a pad and pen. • Body language speaks volumes! The hair flip/head toss and rolling your eyes does not say, “Yes, sir!” Be aware of how you are responding to others.

19. Basic Tips for Success • Be helpful! If someone seeks your advice or assistance, give it your all. If you’re swamped at the moment, respond with a simple, “I’ll be glad to help with that, but I have a deadline to meet right now.” • Don’t blind side! The first time a problem is discussed is not at a staff meeting or directly with the supervisor. Also called lynching, ambushing or throwing a coworker under the bus. It’s inappropriate and will only earn you a reputation as having no integrity.

20. Pay Attention—There Will be a Test Later • That test may be that you’re required to pull a report from MEDPROS or other systems. Learn, learn, learn. This is a complex position for most of us. • I tell new staff in Illinois to give themselves a year before they’re comfortable and don’t get frustrated. Ask questions and learn.

22. Questions?

23. More Tips • Be positive (negative attitudes are toxic) • Be friendly, supportive and cooperative • Be a responsible member of the team • Be considerate of others • Focus on coworker’s good points • Don’t discuss personal issues if you don’t want it repeated • Make the best of any situation • Seek assistance when needed

24. More Tips • Be complimentary to others when they’re deserving • Be proud but don’t brag • Recognize that each person has a unique personality • Communicate in a relaxed and patient manner • Plan what you want to say beforehand • Be straight forward but not rude • Don’t put people on the defensive • Make sure you understand what was said • Allow everyone to speak or make suggestions • Private criticism, public praise

25. The Case Management Team • 54 different armies: Every state will do things a little differently • MCCs are supervised by case managers • Case managers will report to the military person in the respective state, usually the HSS and DSS

26. The ILARNG as an Example • MCCs report to the case manager that works with a specific brigade (5 in Illinois) • All Case Managers (and ultimately the MCCs) report to me • All travel requests, timesheets, etc. go through me so that Sterling is not flooded with individual emails • I act as the POC for the contract and try to answer questions and deal with situations so that Sterling can concentrate on other areas. Most questions can be answered locally • I report to the HSS and DSS

27. If there is a question about what duties a contracted civilian on the MCM Contract can perform, the military defers to me: Example: The full time LOD (Line of Duty) NCO needed assistance. Our contract specifically forbids work on LODs and we could not provide administrative support in this area Example: Illinois’ military archives contained medical documentation inappropriately mixed with personnel documents. They requested temporary help removing medical documentation from these records and filing them correctly in the medical record. This is an appropriate use of our personnel and administrative support was granted.