September 2017 VOL 8, NO 9

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Evidence into Practice

The Importance of Operations Management, Organizational Development, and Health Economics

Cheryl Bellomo, MSN, RN, OCN, ONN-CG; Nicole DeLano, MSN, RN, ONN-CG; Tricia Strusowski, MS, RN 

Operations management has been described as an area of business management concerned with designing, controlling the processes of production by managing resources efficiently, and redesigning business operations in the production of goods and services to ensure quality. Although not commonly thought of, operations management is vital in the healthcare industry to ensure that processes are in place to provide safe, equitable, effective, efficient, timely, and patient-centered care.

The cost of cancer care is rising faster than many sectors of medicine. The cost of cancer care has increased to $125 billion in 2010 from $72 billion in 2004 and is projected to reach $173 billion by 2020. Rising costs are making cancer care less affordable for patients and their families and are creating disparities in patients’ access to high-quality cancer care.1

Navigators play a key role in operations management through their daily contact with patients and their families along the continuum of care. Early navigator support for patients with cancer improves the patient experience and reduces problems in care. The identification of barriers, recognizing how barriers impact patient care, and providing interventions/resources to address barriers related to flow and processes of care are at the heart of operations management. Navigators can assist patients with the logistics of their care, from managing appointments, completing medical forms and obtaining medical records, and exploring funding/insurance coverage options to making arrangements for transportation to appointments and securing childcare services during times of treatment. The role of the navigator can reduce the number of no-shows and cancellations, which may reduce disparities to screening and nonadherence to treatment and follow-up.

As members of the multidisciplinary team, navigators are instrumental in assessing and recognizing the patient flow process and identifying efficient and effective ways to implement the flow process as well as determine changes. Navigation assistance can shorten the time from referral to multidisciplinary revenue-generating services, which can expedite staging work up and coordination of care to ensure timely initiation of treatment and improved patient outcomes. Interventions of navigation can improve communication between care settings, which facilitates timely transfer of medical information from the acute care setting to outpatient healthcare providers.

It is imperative for navigators to have a working knowledge of healthcare economics and an understanding of the barriers to care that can drive inefficiencies. By taking the time to observe the care process of patients, performing community needs assessments, and utilizing critical thinking and problem-solving skills, navigators are able to identify barriers to care, ineffective processes, and communication gaps. Navigation is integral to facilitate effective interprofessional collaboration and promote patient satisfaction and care quality, as well as the efficient use of healthcare resources to decrease costs across oncology patient populations and healthcare settings.

An understanding of navigation metrics and their implementation is an important competency for the navigator to possess to measure structure, process, and outcomes, as well as to demonstrate their value through the roles and responsibilities they perform. Return on investment (ROI), or business performance, metrics look to measure the success of a navigation program in supporting the infrastructure of the cancer program to ensure financial strength. Business performance metrics, unlike patient experience or clinical outcomes, are much less familiar for navigation programs. Yet, this category is becoming increasingly important as cancer program administrators question the ROI for navigation services.

Five major goals that support ROI for a navigation program are to:

  • Remove barriers
  • Promote treatment adherence—navigators can impact treatment adherence through patient education and informed decision-making, resulting in improved outcomes and cost-effective healthcare
  • Enhance revenue—navigators can impact revenue with referral to downstream revenue-generating services such as rehabilitative services. Navigators can have an impact on revenue by monitoring no-shows and decreasing outmigration
  • Decrease preventable emergency room visits—navigator interventions can keep patients from being frequently seen in the ER or admitted to the hospital for avoidable reasons such as constipation, nausea, or vomiting, resulting in more cost-effective healthcare
  • Decrease hospital readmissions

Academy of Oncology Nurse & Patient Navigators Competencies for the Domain of Operations Management/Organizational Development/Health Economics

  • Healthcare reform
  • Utilization of resources
  • Workforce shortages
  • Organizational structure, mission, and vision
  • Organizational development
  • Healthcare economics

Reference

  1. Institute of Medicine. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. Levit L, Balogh E, Nass S, et al, eds. Washington, DC: National Academies Press; 2013.
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