TY - JOUR
T1 - Understanding the work of case managers in Australian community aged care
T2 - a longitudinal time and motion study
AU - Prgomet, Mirela
AU - Walter, Scott
AU - Jorgensen, Mikaela
AU - Georgiou, Andrew
AU - Westbrook, Johanna
PY - 2020/12/1
Y1 - 2020/12/1
N2 - Objective: The aim of this study was to quantify the work activities of community aged care case managers and assess changes following consumer-directed policy reforms. Methods: A longitudinal, time and motion study was performed, with direct observation (n = 339 h) of case managers undertaking work in the office or in the community. We compared the distribution of proportions of time spent across seven broad work task categories during May-August 2014 (P1) and May-October 2016 (P2). Results: Office time was primarily consumed by communication (43.7%) and documentation (33.3%) tasks. Documentation increased substantially from P1 to P2 (29.4% vs 37.0% respectively; P < 0.001), with more time spent on the subtask of recording information (18.0% vs 24.5% respectively; P = 0.039). Travel (45.9%) and communication (41.0%) accounted for most community time. Time in communication increased from P1 to P2 (37.3% vs 48.4% respectively; P = 0.047), with more time allocated to client communication (14.6% vs 31.7%; P < 0.001). Case managers spent 33.6% of community time in clients' homes (median 25.2 min per client; 22.8 vs 30.1 min in P1 and P2 respectively) and visited a median of two clients per day (3 vs 1 visits per day in P1 and P2 respectively). Conclusions: This study provides the first quantification of task-time distribution among this workforce and how work patterns have changed during a time of significant policy reform and operational changes within the community aged care sector. What is known about the topic?: Early qualitative studies gauging case managers' perceptions of the effect of consumer-directed care reforms on their work activities indicate an increase in time spent working directly with aged care clients. However, there is no existing quantitative evidence examining changes to case managers' work activities. What does this paper add?: By capturing timed, multidimensional data, this study provides new quantitative evidence of how case managers distribute their time on work activities in office and community settings. Further, the results provide an indication of changes in work task-time distribution over a 2-year period when significant policy reforms and operational changes occurred. Amid a changing aged care landscape, how and with whom case managers spend their time was found to shift, with an increase in time spent recording information and communicating with clients identified. What are the implications for practitioners?: This study demonstrates that direct observational studies provide important evidence of the ways in which policy and organisational changes affect community aged care case managers' work activities in practice. Triangulating this quantitative evidence with existing qualitative accounts of policy impact can further allow assessment of how complex reforms may affect everyday work. For policy makers and aged care organisations, such evidence can help discern whether policies and changes are having their desired effects, as well as providing insights as to why or why not.
AB - Objective: The aim of this study was to quantify the work activities of community aged care case managers and assess changes following consumer-directed policy reforms. Methods: A longitudinal, time and motion study was performed, with direct observation (n = 339 h) of case managers undertaking work in the office or in the community. We compared the distribution of proportions of time spent across seven broad work task categories during May-August 2014 (P1) and May-October 2016 (P2). Results: Office time was primarily consumed by communication (43.7%) and documentation (33.3%) tasks. Documentation increased substantially from P1 to P2 (29.4% vs 37.0% respectively; P < 0.001), with more time spent on the subtask of recording information (18.0% vs 24.5% respectively; P = 0.039). Travel (45.9%) and communication (41.0%) accounted for most community time. Time in communication increased from P1 to P2 (37.3% vs 48.4% respectively; P = 0.047), with more time allocated to client communication (14.6% vs 31.7%; P < 0.001). Case managers spent 33.6% of community time in clients' homes (median 25.2 min per client; 22.8 vs 30.1 min in P1 and P2 respectively) and visited a median of two clients per day (3 vs 1 visits per day in P1 and P2 respectively). Conclusions: This study provides the first quantification of task-time distribution among this workforce and how work patterns have changed during a time of significant policy reform and operational changes within the community aged care sector. What is known about the topic?: Early qualitative studies gauging case managers' perceptions of the effect of consumer-directed care reforms on their work activities indicate an increase in time spent working directly with aged care clients. However, there is no existing quantitative evidence examining changes to case managers' work activities. What does this paper add?: By capturing timed, multidimensional data, this study provides new quantitative evidence of how case managers distribute their time on work activities in office and community settings. Further, the results provide an indication of changes in work task-time distribution over a 2-year period when significant policy reforms and operational changes occurred. Amid a changing aged care landscape, how and with whom case managers spend their time was found to shift, with an increase in time spent recording information and communicating with clients identified. What are the implications for practitioners?: This study demonstrates that direct observational studies provide important evidence of the ways in which policy and organisational changes affect community aged care case managers' work activities in practice. Triangulating this quantitative evidence with existing qualitative accounts of policy impact can further allow assessment of how complex reforms may affect everyday work. For policy makers and aged care organisations, such evidence can help discern whether policies and changes are having their desired effects, as well as providing insights as to why or why not.
KW - aged
KW - Australia
KW - case managers
KW - community health services
KW - health care reform
KW - health policy
KW - time and motion
KW - work measurement
UR - http://www.scopus.com/inward/record.url?scp=85097199822&partnerID=8YFLogxK
U2 - 10.1071/AH20078
DO - 10.1071/AH20078
M3 - Article
C2 - 33256896
AN - SCOPUS:85097199822
SN - 0156-5788
VL - 44
SP - 853
EP - 861
JO - Australian Health Review
JF - Australian Health Review
IS - 6
ER -