Case Manager Work and Workload: Uncovering a Wicked Problem—A Secondary Analysis Using Interpretive Description
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Bibliographic record
Abstract
Canada’s population is aging, and by 2027, it is expected that 22 million people will be older than 65 years. Home care services were used by 2.2 million individuals, or 8% of Canadians 15 years of age and older in 2012. Home care programs are continually expanding to meet the needs of the growing number of clients, and goals include keeping people in their homes for as long as possible, delaying the need for institutional care, and maintaining quality of life. Case managers are the gatekeepers to home care in Canada. They collaborate with families to plan care, coordinate home care services and community supports, as well as monitor client progress and evaluate outcomes. The aim of our study was to conduct a qualitative secondary analysis to understand the factors that influence case manager work and workload in home care. We completed a secondary analysis of four data sets from four primary studies of related concepts that occurred between 2006 and 2013. Our study design was inductively driven using the tenets of interpretive description. Case managers’ work and workloads are messy and affected by interrelated complex structures of home care programs within health care systems. The concept of a wicked problem, which describes a problem that is complex and intractable, is a useful construct we use to gain some clarity around the work and workload problems that case managers face. Case managers aim to make a positive difference in their client’s lives, but are constantly dealing with change, and can experience feelings of being their client’s last resort with the resulting pressure ultimately impacting their workload. In addition, case managers reported health system failures, including a lack of capacity and structural integration within home care programs that increase their work and workload. Case manager work and workload requires further research including the development and refinement of accurate workload measurement tools that consider the multiple aspects of professional responsibilities and case management activities. Workload and workload measurement tools are needed to account for the unplanned and unpredictable nature of case management work and assist with the distribution of more equitable caseloads among case managers and home care teams.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.002 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it