title: Speaking up in case management, part II: implementing speaking up behaviors.
abstract: OBJECTIVE
  Case managers will occasionally witness colleagues from their own or other healthcare disciplines providing care in ways that frankly deviate from or violate standards of care, rules, regulations, policies, and procedures. This article discusses the case manager's ethical obligation to speak up in such instances, as well as lists strategies and techniques that facilitate and enhance professional communications around "speaking up."
  
  
  METHODS
  All case management work environments.
  
  
  CONCLUSIONS
  When healthcare professionals practice in ways that deviate from established policies, procedures, rules, regulations, and standards of care, they jeopardize the safety and welfare of their clients and, often, their employing institutions. Unfortunately, professionals often remain silent about such errors and deviations for fear that they might suffer retaliation if they speak up or because they do not anticipate a constructive or positive organizational response. Nevertheless, organizations and employees who recognize the value of speaking up can use a variety of strategies described in this article that enable speaking up to become a professional and organizational reality.
  
  
  CONCLUSIONS
  Because they practice in the midst of multidisciplinary care, case managers have a marked opportunity to witness any number of practice standards being ignored or violated. Case managers need to develop communication skills and organizational savvy regarding how to approach and remedy such situations, especially when deviations from standards of care have become routine or "normalized." Critical elements in speaking up include cultivating a method to discern the moral perils of remaining silent, learning communication techniques to conduct emotionally challenging conversations, and building organizational leadership that recognizes the value of speaking up and supports safe harbors for employees who speak up appropriately.
authors.affiliation: Department of Rehabilitation Medicine, Emory University, Atlanta, GA 30322, USA. jbanja@emory.edu
authors.forename: John D
authors.initials: JD
authors.lastname: Banja
authors.forename: Kathy
authors.initials: K
authors.lastname: Craig
mesh_terms: D019090:Case Management; D003142:Communication; D006801:Humans; D007857:Leadership; D024802:Nurse's Role; D009732:Nursing Care / Q000379:methods* / Q000639:trends; D024382:Professional Role; D011369:Professional-Patient Relations; D012931:Social Environment; D014937:Work