Developing a New Specialty Multidisciplinary Clinic While Orienting as a Novice Nurse Navigator

Background: As our cancer program evolves with multidisciplinary care, leadership approved adding 2 specialty multidisciplinary clinics (MDCs), hepatobiliary (GI) and skin and soft tissue (SST) to existing breast, thoracic, and prostate MDCs. Physicians were invested in developing these MDCs. Our model of MDC coordination by nurse navigators required hiring 2 navigators facing the chal_lenges of learning the role as well as developing the clinics.

Objectives: Identify

Background: As our cancer program evolves with multidisciplinary care, leadership approved adding 2 specialty multidisciplinary clinics (MDCs), hepatobiliary (GI) and skin and soft tissue (SST) to existing breast, thoracic, and prostate MDCs. Physicians were invested in developing these MDCs. Our model of MDC coordination by nurse navigators required hiring 2 navigators facing the chal­lenges of learning the role as well as developing the clinics.

Objectives: Identify “must haves” to develop an MDC; demonstrate high patient satisfaction; establish and nurture relationship with physician team; improve novice navigators’ competency through structured orientation.

Methods: Guided by NCCCP MDC Assessment Tool and Oncology Roundtable “Maximizing the Value of Patient Navigation,” navigator interviews involved physicians, key to assuring the right fit. MDC “must haves” were identified by physicians completing an LVHN MDC application form. “Must haves” in place included physician team, support staff, and clinic space. Metrics chosen were patient satisfaction (homegrown tool) and volumes. Patient satisfaction should match existing MDCs. Navigators completed an 8-week orientation with a competency checklist and preceptor that included shadowing navigators, attending specialty MDCs, and meeting with cancer support staff to understand their roles. Shadowing physicians and observing surgeries were crucial in establishing collegial relations. Navigators self-educated and researched their specialty through NCCN guidelines, the LVHN standard. Navigators attended MDC team meetings to plan the start-up of their MDC.

Results: An 8-week orientation competency checklist was completed. Navigator/physician relationship began with interviews and continued through orientation. Overall patient satisfaction score for SST = 4.7/5, for GI = 4.9/5. Existing goal is 4.7/5. Anticipated MDC volumes for SST = 50/year; GI = 144/year; actual to date for SST at 6 months = 29, GI at 7 months = 37.

Conclusions: The navigator as coordinator of the MDC has proven successful and yielded high patient satisfaction. Administrative and physician support for both the MDC and the investment in a structured, comprehensive navigator orientation were critical to the success of a new MDC. As the navigator assumes the role of coordinator, development of collegial relationships among all team members is also critical. MDCs are marks of quality and can differentiate your program from the competition.