The Relational Nature of Case Manager Resource Allocation Decision Making: An Illustrated Case

Article excerpt

We used ethnographic methods in the tradition of Spradley (1979) and constant comparative analysis to explore case manager resource allocation decision making. We interviewed, observed, and shadowed 11 case managers within a children's home care program in a regional health authority in western Canada as they went about their daily work over a 5-month period. Our findings provide knowledge about the little-understood set of processes at the micro level of resource allocation. Although the case manager considers many factors, reported elsewhere (Fraser, Estabrooks, Allen, & Strang, 2009), they balance and weigh these factors within a relational context. The purpose of this article is to use Jenna's story as a case example to illustrate how the case manager balances and weighs the factors that influence their resource allocation decisions within this context. Jenna's story demonstrates the complex and multidimensional processes that are embedded in the relational nature of resource allocation decisions. We discuss home care case manager resource allocation decisions as viewed through the lens of relational ethics.

Keywords: home care; service authorization; relational ethics; care planning

Everything affects everything else. The case manager keeps the wheels turning. They are all wheels that work together and all the little cogs need to be in order for everything to function. (case manager)

It takes a lot of work to maintain a healthy family life. That work is exponentially increased in families living with chronically ill and medically fragile children who have complex care needs. Families provide much of the sophisticated and heavy care to these children (Peter et al., 2007). Home care programs provide care that supports these families in keeping their children at home within the family unit. Case managers working within home care programs are charged with making resource allocation decisions regarding the type and amount of services to be provided for these chronically ill children.

To many people, decisions are choices between competing alternatives, but to home care case managers, their decisions are much more complex and are embedded within relationships in a multidimensional decision-making context. Case managers work closely with clients and their families as they intricately balance and weigh various influencing factors within system constraints so that children with complex medical needs can be cared for at home. The factors that case managers use are reported in detail elsewhere (Fraser, Estabrooks, Allen, & Strang, 2008).

In this article, we share a case that resonated with us as we conducted the previously mentioned ethnographic study. Our purpose in telling Jenna's story, as told to us primarily through Rosie, her case manager, is to illustrate how case managers balance and weigh the factors that influence them in making resource allocation decisions through the lens of relational ethics. We use Jenna's case to highlight the relational nature of the process that surround case manager resource allocation decisions in the midst of complexity.

METHODS

Our research study was approved by the Health Ethics Review Board at the University of Alberta. We received administrative approval from the health region in which it was conducted. We used ethnographic methods, specifically ethnoscience (Spradley, 1979), to uncover the factors that influence case managers in making resource allocation decisions for home care clients in the main study. Ethnoscience is used to study language and, in particular, how people use language to categorize their world. Specific data collection and analysis procedures for the main ethnographic study are fully described elsewhere (Fraser et al., 2008). In addition to ethnoscience, we used constant comparative analysis to analyze the process date that arose in the study. This case arose out of the constant comparative analysis. An overview of the research context, participants, and methods is provided here to help situate this case in the overall study. …