Caseload Management

Caseload management refers to the ability to manage a number of clients, within a given amount of time and provide optimum services (this is the client specific aspect of workload management). Rural and remote practice is one of the most challenging in terms of implementing caseload management strategies. However it also has excellent potential for change and innovation by health professionals who already demonstrate many new ways of looking at things, flexibility and non-traditional thinking.

Both positive (supporting) and negative (impeding) factors must be considered when implementing caseload management strategies in a rural or remote context:
 

Factors Influencing Caseload Management

Sound caseload management can allow more effective use of the limited resources you have available allowing a greater scope of service provision across the continuum from preventative services to treatment services. Understanding the factors that influence the way you manage your caseload, the number of clients you see and the way you provide your services is a great starting step.

Contact Frequency: Specific types of clients or intervention may require a high contact frequency at specific points in their patient journey.

Complexity: Complexity is a significant variable in decision making about workload
management at individual, team and service level. Case complexity is multi-dimensional and includes consideration of co-morbidities, social circumstances and emotional factors, complexity of intervention/s, identification and management of clinical risk and factors relating to complex decision-making.

Prioritisation & Demand Management systems

Allied Health Assistants and Other Support Workers: The delegation of tasks to Allied Health Assistants can increase workload capacity. However, consideration must be given to factors such as training and supervision of assistants, and the development of intervention programs that are appropriate for the assistant to implement.

Use of Technology: Telehealth (phone, videoconferencing etc) can be used to reduce travel time required to provide and access services. Telephone triage strategies have also proven effective in supporting appropriate prioritization of patients. See the Telehealth page for more information.

Service Model: Service delivery models are another means of managing workload. Adoption of each of these different models can have significant implications for the delivery of allied health services. Common service models utilised by Allied Health Professionals include:

• Direct service to one client (one on one)
• Consultation (Allied Health Professional determines intervention targets, procedures and contexts, but relied on another agent to carry out the program);
• Direct service in groups;
• Collaborative model (Allied Health Professionals works with carer, teacher, parent, volunteer or other personnel).

Inter-professional (Team) Practice: Working with team members across the professions is highly regarded by allied health professionals. Multi-professional work is a very effective means of delivering best care to the client and has been found to be an important means to share ideas, improve skills, network and communicate with other health professionals. See the Team Practice page for more information.

Patient/Client Clusters: The extent to which you can cluster or group clients can have a significant effect on caseload management. Clusters allow for the development of pathways (see below) and one to many type service arrangements (e.g. groups).

Care Pathways and Packages of Care: Pathways describe the steps and components of services. They include information on eligibly/entry criteria, assessment and interventions process and discharge strategies. Utilisation of pathways can streamline services and assist in understanding the capacity requirements of a particular pathway.

Caseload Maturity: More time may be required when seeing new clients, as opposed to those that have been on the caseload for some time. Caseload turnover may impact of workload capacity.

Location of Clients: Additional time must be factored in for planning, travelling, and post visit activities when undertaking outreach services. See Outreach for more information.

Competencies: Allied Health Professionals must possess the necessary competencies the management patients with their caseload. Lack of competency (or confidence) may impact on service capacity.

Additional Roles: In the rural and remote setting, Allied Health Professionals often wear multiple hats. Additional roles and responsibilities may impact of workload capacity and must be considered.

Some simple strategies to assist in caseload management include:

• Understand your caseload and how you delivery services (see above).
• Know all the resources you have to allocate to your caseload.
• Establish a caseload database (this can be as simple as a excel spreadsheet), including new referrals, waiting list information and service requirements (current and future)..
• Keep an appointment diary or planner. Schedule clinical and non-clinical activities into your diary.
• Take the time to plan your caseload (individual, as a department and as a team).
• Constantly review and evaluate the way you manage your caseload.

Caseload Management and You

• How are caseloads allocated and organised within your department/organisation?
• Consider your caseload in terms of the above factors. What factors enhance capacity? What factors limit capacity?
• What strategies can you utilised to better manage your caseload?

Useful Resources

• Prioritisation & Demand Management
• Workload Management.