Case management survey: caseloads, commitment and self-training
RTWMatters teamWe share results from the 2021 Return to Work Matters Case Management Survey, completed by more than 60 insurance case managers, RTW Coordinators and rehabilitation professionals.
Over several months in 2021, 62 people completed the Return to Work Matters Case Management Survey, most of whom were either insurance case managers (32%) or RTW Coordinators (32%). Rehabilitation professionals made up a further 20%, with the remainder (16%) comprising a mix of professions, ranging from industrial organisers to regulators.
In this article, we share the numerical data from this survey, along with some background information to contextualise the results. Elsewhere, we report on what case managers told us they find rewarding about their work and highlight an opportunity to utilise an untapped resource in case management training, the committed and experienced career case manager.
The case management survey was advertised via the Return to Work Matters website and newsletter, and on LinkedIn. People took part from all over Australia except Tasmania, and there were a couple of respondents from New Zealand too. The top five jurisdictions in terms of participation were Queensland (35%), NSW (20%), Victoria (17%), South Australia (14%) and Western Australia (7%).
More than half (52%) of the people who completed the survey had been in the industry for ten plus years, with a further 21% having notched up 5-10 years’ experience. People with 3-5 years’ experience in the industry made up 16% of respondents, with just 3% and 8% in the industry for 1-2 years and 0-12 months respectively.
This means that our survey may not be representative of case managers more generally, given the recognised high turn-over in the field. The results below should be interpreted as representing the perspective of an experienced, committed cohort of case managers: a potentially valuable resource for employers, insurers and regulators wanting to support people new to this challenging role.
Caseloads were a mixed bag, with 29% of respondents managing 41-60 cases; 23% managing 20-40 cases; 21% managing 61-80 cases; 11% managing 100+ cases; 11% managing less than 20 cases; and 5% managing 81-100 cases.
A quarter of participants (26%) said they did not have enough time to do their job effectively and an equal proportion said they “somewhat” had enough time, indicating that more than half of respondents struggle with juggling their responsibilities. A third (34%) indicated that it was a stretch but they generally had enough time, while an additional 16% said that they had enough time. No respondents indicated that they had more than enough time to do their job, though the option was there.
Of note, no respondents who’d been in their role for less than two years said that they had “enough time” to do the work involved.
The graph below compares length of time working in the industry to perceptions of the manageability of the role.
Most respondents were fairly positive about the training they’d received, with a quarter (24%) saying they’d been trained reasonably well, slightly more than a third (36%) saying that they had been trained very well, and a sixth (16%) describing their training as excellent. However, a quarter of respondents were less positive, either saying that they were trained in the basics only (15%) or received no training at all (10%). No one under 3 years in the industry said their training had been excellent.
A more nuanced picture of case manager training emerged in the optional comments section of this question, captured in an open-ended text box.
Case managers tended to be more positive about the technical aspects of their training than the soft skills, with 44% saying that they were trained very well in things like complying with legislation, scheme rules, decision making processes and so on, compared to 31% for things like communication, influence and engaging people. More people also said that they’d received either a little or no training in soft skills (32%) than technical skills (25%).
Again, open-ended comments provided by some case managers pointed to the importance of self-training and learning on the job.
Regarding training in the technical aspects of the role, ten case managers entered a comment, with seven of these describing self-funded or self-initiated training, spurred on by curiosity and desire to perform the job well.
On-the-job training in the form of case discussions was offered in exactly 50% of organisations, meaning that half are going without.
Of those with access to case discussions, one case manager described an “excellent set up with formal panels accessible near daily, including access to other disciplines, expert clinicians and also o [occupational] physician.”
However, more common were comments acknowledging that case discussions sometimes occurred but were often missed because of time pressures and competing priorities.
Only 41% of respondents worked in an organisation that had a system for mentoring, suggesting that there is also room for improvement in continuous learning for case managers. Proportionally, mentoring was more common amongst rehabilitation professionals than insurance case managers or RTW Coordinators.
The widespread lack of mentoring is particularly striking given the profile that emerged from the survey of a cohort of highly experienced, engaged and committed case managers, who would likely have a great deal of wisdom and insight to offer less experienced colleagues. We further highlight this issue in an article on missed opportunities in case management.
By far and away, the topic case managers most wanted to learn more about was how to impact a worker’s motivation, with 43% indicating that as a training priority. Influencing the workplace was next (18%), followed by engaging health practitioners (16%), assessing the biopsychosocial aspects of a case (16%), and how to have an initial conversation about return to work (5%).
As Dr Wyatt noted when we discussed these results, influencing the workplace is probably the best way of influencing worker motivation, suggesting that there is an opportunity for further training on workplace issues.
There was a close to even split on the issue of salary, with 55% of case managers saying that their salary was adequate given their skills and expertise, and 45% saying it was not.
Many (45%) said that salary was an important influence but not the major driver on their decision to stay in or leave the industry, while 18% said it was a major factor. Close to one fifth (19%) said that their salary level made no impact on their decision to stay in case management, while 15% said it had a small impact.
Employer factors such as case load and culture were seen as the major barriers to success, with 56% of respondents flagging them as a problem, closely followed by system factors such as rules, agencies and legal structures, problematic for 45% of respondents. Problems with skills, training and experience were barriers for 16% of survey participants.
Other barriers identified by respondents via the optional comment box included:
- Relationships with supervisors and managers in the workplace;
- Limits to their own ability to be proactive;
- Geographical limitations;
- Growing claim complexity, with a commensurate growth in workload; and
- Other organisational responsibilities.
Interestingly, more than one case manager described a sense that their high level of experience was not welcomed by case management organisations.
One wrote they were unable to find an employer who “is not afraid of my experience base, who understands my strengths and is willing to provide me the autonomy to give to the organisation what they need, and admit they don’t really know what they need but will embrace what I deliver that I understand meets their unknown needs.”
Asked to describe what they found most rewarding about their work, case managers tended to reply in the following six themes, listed here in descending order of frequency:
- Personal connections and relationships;
- Belief in the personal and social value of recovery and RTW; and
- Meeting technical challenges.
For more information on what motivates committed, experienced case managers, see our article exploring the rewards of the role.
Or read our case management opportunity alert, which shares many more comments from the case managers who completed the survey.
Finally, get the perspective of a NSW claims adviser turned whistle blower here.
A huge thank you to everyone who participated in the survey. We hope it serves the RTW community well, clarifying opportunities to improve case management practices and highlighting the skills, motivations and caring approach of those who shape their career around helping injured workers.