Collecting metrics as part of an oncology navigation program may seem like an intimidating endeavor, but according to Tricia Strusowski, RN, MS, collecting metrics can not only be fun, it can be addictive.
Ms Strusowski, an independent oncology consultant and Chair of the Academy of Oncology Nurse & Patient Navigators (AONN+) Navigation Metrics Committee, served on a metrics panel session at the AONN+ 12th Annual Navigation & Survivorship Conference in November 2021. She, along with Danelle Johnston, MSN, RN, HON-ONN-CG, OCN; Kristina Rua, MSN, RN, OCN, ONN-CG; and Jamie Callahan, BSN-RN, CBCN, OCN, discussed everything metrics, along with an interactive audience.
The panel reviewed the background of the AONN+ navigation metrics; candidly discussed the good, the bad, and the ugly about metrics “addiction”; and provided some real-world outcomes of adopting the metrics in their own cancer programs.
“We all know the difference we make as navigators,” said Ms Callahan, an oncology nurse navigator at UCHealth in northern Colorado. “We can explain it to people, but some people want more than anecdotal stories. That means we have to explain our job in numbers and data, which sometimes can be difficult.”
The Evolution of the Navigation Metrics
According to Ms Johnston, member of the AONN+ Metrics Committee and senior vice president at Mission Delivery Cancer Support Community, the development of the metrics was born of a simple conversation among navigators at an AONN+ conference, the sentiment of that discussion being: “We currently have no way to measure our impact on care delivery as navigators.”
“That charted our course into metrics,” she said.
In 2016, the newly established multidisciplinary AONN+ Navigation Metrics Task Force took a deep dive into the literature and worked to develop standardized navigation metrics to demonstrate the impact of navigation on patient outcomes, putting each metric through rigorous criteria to ensure its accuracy and soundness.
In 2017, AONN+ first presented their 35 evidence-based navigation metrics relevant to cancer care. These metrics are centered around the 3 categories of patient experience, clinical outcomes, and return on investment and are designed to be utilized by all models of navigation in all settings.
Then, in 2018, AONN+ teamed up with the American Cancer Society and Chartis Oncology Solutions to conduct a first-of-its-kind national navigation metrics study.
“We identified 10 metrics that supported our role as navigators as well as value-based cancer care,” said Ms Strusowski. “That then led to the 2020 Metrics Toolkit that utilized all of these best practices and everything that we learned through our research.”
The AONN+ Navigation Metrics Toolkit was developed to help not only navigators but also oncology program administrators, healthcare executives, and other clinicians who are linked to navigation to understand and support the integration of these standardized metrics into their normal business processes. The interactive toolkit is available free of charge on the AONN+ website and includes helpful resources like case studies and information dashboards that can help cancer programs with the process of collecting their own navigation metrics.
National Quality Standards and Quality Indicators: Accountability Is Key
According to Ms Johnston, the rationale behind metrics is simple: providers, including healthcare systems, health plans, physicians, program administrators, and navigators, must be held accountable for demonstrating that they provide and improve quality of care through quality measures.
“As we talk about metrics, it’s important that we remember what we need to anchor on, and that’s national quality standards and indicators that help drive quality for our programs,” she said. “It’s important that we understand that we need to be held accountable, so that we really are improving patient care and outcomes.”
But, it’s not enough to just collect metrics; the metrics have to mean something. “So we need to be thoughtful in our approach to metrics implementation and measurement,” she added.
As a result, the evidence-based metrics identified in the AONN+ toolkit have become critical to helping the navigation field demonstrate its value and contributions to achieving and improving quality patient care.
“But we didn’t only want to anchor to national quality standards and indicators,” said Ms Johnston. “We also wanted to align with the navigator role.”
To do this, the Metrics Taskforce designed the metrics around the 8 certification domains that measure navigator core competency: Community Outreach/Prevention; Coordination of Care/Care Transitions; Patient Advocacy/Patient Empowerment; Psychosocial Support Services/Assessment; Survivorship/End of Life; Professional Roles and Responsibilities; Operations Management/Organizational Development/Health Economics; and Research/Quality/Performance Improvement.
Ms Johnston stressed the importance of oncology nurse and patient navigators understanding that active participation in data collection, analytics, and reporting outcomes is not an added responsibility, but is already a part of their professional role.
“Be thoughtful about what you want to measure in your program, what story you need to tell, and what processes you want to improve. Stay focused, and don’t try to boil the ocean,” she advised. “Every day is a fresh start with metrics.”
Real-World Experience from Navigators
Asked about some of the biggest fears they held and barriers they encountered in implementing the metrics at their institutions, Ms Rua and Ms Callahan led the discussion.
Ms Rua, director of navigation at Sarah Cannon Cancer Institute in the East Florida Division, cited integration of the metrics into IT platforms as one of their biggest challenges. “It can be daunting and overwhelming,” she said, noting the benefits of becoming “best friends” with your IT team.
Her biggest fear, she confessed, was finding out that her navigation program wasn’t providing the value she thought it was.
Ms Callahan agreed: “I think the biggest fear with metrics is, ‘what are we going to find?’” she said. “What if we find that, according to these metrics, we should actually be working twice as hard? What if they say we’re not doing a good job?”
She noted another fear being lack of buy-in from her navigation team. “One of my fears was, what if the rest of my team doesn’t care about tracking these metrics?” she recalled. “How am I going to motivate my team to keep documenting, especially when we haven’t been able to incorporate these metrics into our EMR [electronic medical record] yet, and I’m essentially asking them to double-document?”
Ms Rua enthusiastically agreed. “We talk about getting buy-in from our key stakeholders and our facilities, but we need buy-in from our team first,” she added. “If your team has not bought in, and they don’t understand what your goal is, you’re going to flop.”
Ms Callahan advised first looking at the AONN+ metrics with your navigation team and finding out which ones people are most motivated by. “Start there, and get the ball rolling,” she said.
Asked about their biggest successes in implementing the metrics, Ms Rua mentioned actually being able to show their footprint: the expansion of their program and the depths of services that they offer.
“We started our program 3 years ago in Florida, and to be able to show our growth over the years, as well as the resources that we’ve been able to acquire, has been a tremendous success,” she said. “And that’s all thanks to metrics.”
According to Ms Callahan, her program’s biggest success has been their ability to incorporate a huge amount of data into their EMR.
“At this point we’re able to gather so much data that I’m almost overwhelmed with the amount I have, and it’s going to take me a very long time to get through it,” she said. “But I have to remember that I can’t possibly focus on all 35 metrics; it’s far too many. Remember to only focus on a few.”