November 2017 VOL 8, NO 11

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Category VII: Operations Management, Organizational Development, Health Economics, Healthcare Economics, Operations Management, Organizational Development

Can Transparency of Individual Navigation Performance Improve Overall Navigation Program’s Operational and Quality Metrics?

Kendra Nelms, MHA, RN, OCN
Sarah Cannon, San Antonio, TX 

Background: Sarah Cannon’s San Antonio market was seeking a way to effectively improve key quality and operational navigation metrics on their monthly Navigation Market Scorecard. The market scorecard was reflective of overall metric results for 3 tumor-specific cancer-navigated programs (breast, lung, and complex GI) and 8 oncology nurse navigators (ONNs). With the market scorecard, it was difficult for individual ONNs to understand how their individual performance impacted the overall score; therefore, they were unable to identify if their performance was causing any of the metrics to result below benchmark. Focus areas for improvement were patient adherence to clinical treatment pathways for breast and pancreatic cancers, and also patient satisfaction survey results.

Objective: To improve Navigation Market Scorecard metrics to benchmark or above for clinical treatment pathway adherence and patient satisfaction results by developing individual navigator-specific programmatic scorecards for each hospital within the market.

Methods: Utilizing the same format, design, and color scheme, individual scorecards were developed for each navigator-specific program. Only market metrics that pertained to that navigator’s scorecard were added. For each metric, the data pulled were related only to the patients who were navigated by each individual navigator. Metrics were also added to the programmatic scorecard that were not on the market scorecard. These were navigator program–specific metrics that were not being followed at the corporate level but were integral components of the program. Data were pulled from 2 sources, including Press Ganey Survey Reports and the iNavigate Navigator Documentation Software.

The programmatic scorecards were released to the navigators at the same time the market scorecard was released. They were able to see performance at the market level, their individual performance, and the transparency of how their peers were performing. This allowed for immediate drill-down into the market scores to see how their individual performance may have impacted those scores. The navigators met with their director within 1 week of the scorecards being released. The navigators came to the meeting prepared to follow up on their programmatic scorecard results with justifications and/or action plans for improvement.

Results: Over a 7-month period, there were significant improvements seen in the focus areas. Patient satisfaction increased from an average score of 80% to 95%. Breast Cancer Treatment Pathway adherence increased from an average compliance score of 63% to 83%. Pancreatic Cancer Treatment Pathway increased from an average compliance of 15% to 74%. The programmatic scorecards also allowed for an effective way to communicate navigation value that the director would review with clinical and executive leaders at each hospital within the market.

Conclusions: Navigation scorecards are essential to display value and quality of navigation programs. Success of the program is dependent on clear and timely communication to navigators on how their performance impacts the overall quality of the program. With navigator-specific programmatic scorecards, the navigator and his/her director are able to make timely interventions and action plans to improve work performance and/or initiate the appropriate process improvement plan to enhance the overall quality of the program.

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