Whole of Client Health Care in a Gridlocked System: An Insider Dialogue Between the Theory and Practice of Community Case Management

Abstract

This article blends theory with empirical qualitative research to investigate the present practices of Community Case Management and develop a new and informed model driven by a whole of client approach rather than agency ownership. The Case Management Society of Australia presents an idealistic model that has never been fully implemented. Our exploration of the gap between this theory and the actual real-world practice demonstrates that a whole of client focus has been marginalized and frustrates full implementation. Recent Australian government policy changes to the Home and Community Care program have encouraged competitive, market-oriented delivery in an attempt to reempower the client, but it has come at the expense of collaboration. Introducing competition has added another dimension to impediments to client-centered care that include funding pressures, turf wars, territorialism, and organizationally induced gridlocked systems, all of which shift the focus from the client to the organization. In the face of this, it is paramount that case managers remain client focused and be willing to collaborate/communicate with all parties involved in the cares of the client. Failure to do so may lead to the eventual failure of the Home and Community Care program.