Developments in primary and intermediate care services have enhanced interest in the notion of care management, the processes that it encompasses and the challenges that it poses to practitioners who are more used to working in a uni- or multidisciplinary manner. This article explores the way that a set of practitioners, new to care management, coped with the challenges of working within a newly created care-managed assessment and rehabilitation service for older people in one UK county. Data were gathered via non-participant observation, and group and individual interviews, as part of a wider action-research evaluation study. Three themes emerged from the data: the processes of ‘learning’ to become a care manager; ‘doing’ care management; and ‘experiences’ of the role. In order to ‘learn’ care management, staff needed to develop a range of new skills, establish supportive care-management processes, develop a new identity and work in an interdisciplinary way. ‘Doing’ care management involved working with a small group of patients with complex needs and precarious levels of homeostasis. Problem solving and crisis management were key activities and often required a creative approach to practice. Although care managers derived great satisfaction from their role, their ‘experiences’ were characterized by stress and anxiety. The practitioners from healthcare backgrounds needed more preparation to adapt to their new levels of responsibility and client risk. Successful management of the transition to care manager requires support from the key stakeholders and strong leadership within care manager teams. In-house competency-based training and induction programmes, and mentorship, can also play an important role, together with innovative forms of postqualifying education and training, for example, via job exchanges or an apprenticeship model
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