Supporting the Value Proposition of Patient Navigation

Since President Nixon declared a national war on cancer in 1971 through the National Cancer Act, our nation’s healthcare systems and research centers have devoted billions of dollars to improving cancer care and cancer outcomes. For many cancers, we have made progress in terms of survivorship, but these improvements have not benefited all patients across all demographics. Indeed, research points out that cultural, social, and economic barriers prevent certain populations of patients from achieving the same outcomes as others. Patient navigation emerged as a possible solution to address this disparity in outcomes. The nation’s first patient navigation program was conceived and introduced in 1990 in Harlem, New York City, by Harold P. Freeman, MD. This original program focused on the critical window of opportunity to save lives from cancer by eliminating barriers to timely care between the point of a suspicious finding and the resolution of the finding by further diagnosis and treatment.¹ Over the past decade, the majority of the hospitals and hospital systems that have comprehensive oncology programs have developed patient navigation programs in an attempt to fulfill the Commission on Cancer standard, and patient navigation has emerged as its own discipline within oncology nursing.² Patient navigation isn’t a function that is solely fit for addressing social disparities in medicine. It can help healthcare organizations create mindshare in the eyes of consumers and create physician brand loyalty if done well. But there is a significant difference in simply sponsoring a minimalistic patient navigation program and creating a robust patient navigation program.

One of the key challenges in developing or growing an oncology navigation program is creating and leveraging connections with executive leaders and gaining their support for ongoing program development. This effort typically occurs as a 2-phased drama. First, a foundation must be laid, then a structure can be built on it and expanded as needed. The program is matured and nurtured through a series of identified best prac­tices that keep the patient at the center of the model, which is driven forward by meeting identified program outcomes and metrics.

Success Factors

Announcing the formation of an oncology navigation program is just the initial step, but giving it legitimacy and resources to fully function is an entirely different matter. Best practices that can fuel long-term program success include:

• Building a personal presence that is marked by leadership, professionalism, knowledge, and competence as it relates to cancer care
• Establishing a consistent job description and defining the role and scope of navigation. This should help prevent scope creep and prevent the scope of navigation from being forcibly expanded to cover unrelated organizational gaps
• Developing meaningful program metrics by examining metrics that have been established by the Academy of Oncology Nurse & Patient Navigators: https://aonnonline.org/education/standard ized-metrics/navigation-metrics-quality-study
• Sharing early results to gain support, such as results from pilot programmatic initiatives
• Identifying success measures that connect to hard and soft return on investment such as growth, patient satisfaction, timeliness of care, and productivity, measured by benchmarks
• Creating an innovative strategy to identify unfilled needs
• Seeking a mentor or training to learn new personal and professional skills

If the above actions can help launch navigation programs and move them from crawling to walking, how can navigation programs become self-sustaining and vital and vigorous parts of the oncology patient care agenda? Successful patient navigation programs cannot be built and sustained by leaders and navigators who operate in isolation. Navigators must serve as a link between individuals and groups at all levels of the organization. Developing the organizational savvy and emotional intelligence to network across an organization is key; this skill is often not innate, but it can be learned.

Consider the following strategies to secure ongoing leadership support and network effectively:

• Establish a web of influence across the organization, touching both clinical and administrative areas (CEO, CMO, CNO, CQO, and COO)
• Maintain regular communications with leaders—Grabbing and holding the attention of C-suite leaders will be difficult for the navigation leader without identified metrics. The best tactic is to generate short graphic reports that can be easily transmitted to and consumed by the C-suite leaders on a monthly or quarterly basis. Equally important is the work to adopt language that resonates with executive leaders
• Increase visibility for program among key clinical leaders (CEO, CMO, CNO, CQO, and COO), typically through rounds or special programmatic initiatives
• Anticipate questions that executives may pose about the program and be prepared to provide objective responses

The Secret Ingredient: Networking

Nurses possess extreme passion for their patients, and they set the needs of the patient as paramount. They fight daily battles within complex health systems on behalf of their patients, day in and day out. Nurses constantly need to be on watch for challenges and obstacles that fall in the path of their patients’ road to treatment and recovery. Without a doubt, oncology nurse navigators understand this crusade. To be successful, nurse navigators must not only be able to care for the patients and their families but must also possess the ability and skills to actively influence the clinical teams that are involved in the patient care process. Networking and collaborating with physicians, nursing colleagues, and other members of the care team will help navigation leaders and navigators achieve business goals and provide the platform to communicate and show value with key stakeholders. In other words, networking opens new channels that will provide the opportunity to influence the audiences that care about improving outcomes and patient experience. These audiences need to see navigators in that channel.

In short, relationships and networks matter. Today, building and sustaining relationships is critical given the pace at which organizations and healthcare are changing. Matrixed reporting structures, specialized jobs and skills, complex challenges, cross-functional teams, and partnerships with external parties make caring for patients more complicated than ever. Nurse navigators who have mastered the skills needed to exchange knowledge, ideas, information, and resources can garner the support they need to help patients and measure performance.

When navigation leaders and navigators have leadership support, it is possible to access information and additional resources, as well as technical expertise. The best way to build this support is to make strong interpersonal connections with personnel who are stakeholders. This can only be done by presenting the case for a 2-way relationship, one that delivers value to both parties.

Sarah Cannon, the Cancer Institute of HCA Healthcare, has implemented the largest cancer navigator program in the United States with more than 200 oncology-trained nurse navigators providing clinical expertise to patients and their caregivers. From our experience, utilizing and applying some of the above best practices builds innovative navigation programs. The concrete impact of patient navigation for oncology patients is still being defined, though not debated or denied. The fluid nature of this value proposition should not detract from its obvious value. It is not surprising that patient navigation as a discipline continues to expand across all sectors of healthcare, validating its overall worth.³

Because navigation is not generally a reimbursed service, cancer programs must be diligent about measuring the impact of this service.⁴ But navigators must also develop the ability to share these results and garner attention. By leveraging new and existing relationships, navigators are helping to redefine and raise the bar in cancer care for patients today and for years to come.

References

1. Freeman HP, Rodriguez RL. The history and principles of patient navigation. Cancer. 2011;117(15 Suppl):3539-3542.
2. Academy of Oncology Nurse & Patient Navigators. https://aonnonline.org.
3. PatientEngagementHIT. Healthcare Pros Expand Patient Navigators for Continuity of Care. https://patientengagementhit.com/news/healthcare- pros-expand-patient-navigators-for-continuity-of-care.
4. Advisory Board. Maximizing the Value of Patient Navigation. Lessons for Optimizing Program Performance. www.advisory.com/research/oncology- roundtable/studies/2011/maximizing-the-value-of-patient-navigation. March 10, 2011.