Administering a Navigation Program

Bonnie Miller, RN, BSN, OCN, FAAMA
Administrative Director, Women’s Cancer Center, Clinical Nurse Navigation, Fox Chase Cancer Center, Philadelphia, Pennsylvania

Elizabeth Whitley, PhD, RN
Principal Investigator, Colorado Patient Navigator Training Program, Denver, Colorado

Elizabeth Whitley, PhD, RN, who presented “Leading and Administering a Patient Navigation Program” with Bonnie Miller, RN, BSN, OCN, FAAMA, reminded participants that patient navigators are not necessarily nurses but can include other health personnel. Ms Miller pointed out that successful implementation of a program required buy-in, clearly defined roles, and evaluations of performance.

Dr Whitley described the navigators in her system, which includes laypersons, paraprofessionals, allied health professionals, and unlicensed health professionals from other countries. Their role is to eliminate health disparities by identifying and reducing barriers to healthcare for vulnerable and underserved populations. She focused on her system, in which navigators are involved with community-based screening and navigation to care, eg, barbershop programs, and which includes screening for cardiovascular issues, glucose, and cholesterol, not just cancer.

She described 6 essential elements for patient navigator success:

1. Evidence-based clinical guidelines, eg, US Preventive Services Task Force guides
2. Registries for specific populations/electronic medical records (EMRs) to identify candidates for screening
3. Standard work, ie, job descriptions and clear roles
4. Patient navigator training and orientation centered on knowledge and skills, competency-based performance measures
5. Avoid scope creep; provide supervision and support
6. Robust evaluation, which is included in the program budget

Dr Whitley thinks there is a need for more clinical and financial efficacy data concerning cancer navigation.
Ms Miller discussed the development and implementation of navigation services at her institution. Requirements for successful implementation noted by Ms Miller include buy-in, clearly defined structure and roles, ability to evaluate and willingness to share outcomes, and ensuring sustainability of the program. Navigation has to be integrated into the cancer care continuum. It is important to document the value of navigators and their impact on patient care by tracking volumes, outcome, and quality, and by quantifying return on investment, eg, by demonstrating patient retention within the system.

Ms Miller also discussed having navigators walk through or map the patient flow and experience as a way of identifying gaps in care or care coordination. In her institution it took 2 days to map the experience with everyone who would interact with patients including doctors, nurse practitioners, surgeons, etc. She showed navigation statistics, which included retention rates, and listed the many navigation measures being collected at her center. They know from patient surveys that some patients have chosen Fox Chase because they have navigators.