Melissa K. Plavsa, FNP-BC, ACHPN, CN-BP, is a Nurse Practitioner and Manager of Community Healthcare System in Northwest Indiana.
Community Healthcare System (CHS) in Northwest Indiana has 4 not-for-profit hospitals: Community Hospital in Munster, IN; St. Catherine Hospital in East Chicago, IN; St. Mary Medical Center in Hobart, IN; and Community Stroke & Rehabilitation Center in Crown Point, IN.
CHS offers a vast network of care locations that include outpatient, surgical and rehabilitation centers, physician practices, behavioral health, occupational health, home care, a medically based fitness center, as well as the Community Cancer Research Foundation and the Cancer Resource Centre. They offer numerous free programs, special events, preventive screenings, and support groups that aim to improve the quality of patients’ lives.
Several years ago, CHS established a navigation program to meet the Commission on Cancer (CoC) standards and to implement survivorship care plans. But soon after, they realized the impact their navigation program could have on every aspect of patient care and set out to strengthen their program. That objective included implementing metrics. After conducting a thorough literature search, Academy of Oncology Nurse & Patient Navigators (AONN+) member Melissa K. Plavsa, FNP-BC, ACHPN, CN-BP, decided to use the AONN+ Navigation Metrics Toolkit in her mission to strengthen the CHS navigation program. We had the pleasure of speaking with Ms Plavsa about the CHS navigation program and her experience using the AONN+ Metrics Toolkit (found at https://AONNonline.org/toolkit).
What follows is our thoughtful exchange.
JONS Thank you for speaking with us today about your experience with the AONN+ Toolkit. To begin, can you share a little about the history of your navigation program?
Ms Plavsa We launched a cancer navigation program 6 years ago to fulfill the requirements for CoC accreditation. Also, several key members of our oncology team recognized the value of providing a navigation program. They believed a navigation program could really enhance care for patients with cancer.
When our navigation program started, the majority of the nurses’ workflow focused on completing survivorship care plans. But in January 2020, our leaders recognized the need to change the delivery of care to assure that patients felt engaged and supported through their entire cancer care journey. We decided to integrate personalized patient services that addressed the needs of patients from screening through survivorship.
JONS How many navigators are a part of your program, and are they assigned to specific disease states?
Ms Plavsa We currently have 5 nurse navigators; 2 are dedicated to breast cancer and 3 to lung cancer. When needed, they will also assist patients who are diagnosed with other types of cancer.
JONS What were some of the challenges you faced when implementing your navigation program?
Ms Plavsa One of the greatest challenges with the implementation and expansion of our navigation program is our ability to successfully identify, capture, and organize the data required for validation and reporting of the efficacy of our program. We do not currently have any tools capable of capturing the full scope of the navigation services we provide. To date, most metrics used in our program are being captured manually. I have discovered that these results can often vary because they are dependent on each navigator’s understanding of what they should be documenting and reporting, as well as how to interpret those data.
Another challenge for our program is intermittent and fragmented communication with members of the multidisciplinary cancer team, because many of the providers are not hospital employees. We also note a general misunderstanding by many of the healthcare providers regarding what navigation is and how our navigation staff can enhance patient care throughout the entire cancer journey.
Our program leaders and team members agree that it is critical to address these challenges by sharing our past experiences and ideas. By clearly delineating the capabilities and responsibilities of our navigation staff, we are confident that we can strengthen our cancer care services. The collection and reporting of clinical outcomes metrics, which is something more familiar to healthcare providers, will also reinforce the value of our cancer navigation program.
JONS After that experience, do you have any advice for a healthcare group that is in the process of establishing a navigation program?
Ms Plavsa First, it’s critical to complete a needs assessment of the community—this will help to identify the gaps in care that need to be addressed when creating the foundation of a program. The second most important thing is to make a list of available resources. Third, outline the objectives and goals of the navigation program. Your goals should be realistic and attainable. Prioritizing staff time and responsibilities is also vital because it’s very easy to lose focus and become derailed from the original intent of the program you started.
I also believe it is an absolute necessity for any navigation program to have the support of the administration. We were blessed to have this right from the very beginning, and it has propelled our program forward in the best way.
One last thought is that it is important to cultivate collaborative relationships with all multidisciplinary team members—this will ensure seamless, timely cancer care for patients.
JONS How did you come to learn about the AONN+ Metrics Toolkit, and can you discuss the process of selecting metrics for your program?
Ms Plavsa For us, the first step in choosing which metrics would be most meaningful for our navigation program involved the completion of a comprehensive literature search, which I conducted over 2 months’ time. The most valuable and applicable data that I found were contained within the AONN+ Navigation Metrics Toolkit.
After composing a list of evidence-based navigation metrics outlined in the AONN+ Navigation Metrics Toolkit, I met with our service line administrator to discuss which metrics would best validate the objectives of our navigation program and fulfill the goals of our key stakeholders. We also talked about the importance of choosing metrics that would enhance our capability to monitor, assess, and modify our objectives, as well as help us identify future goals.
JONS Can you give an example of an AONN+ metric you plan to implement in your program?
Ms Plavsa We decided that one of our primary goals was to improve timeliness of care because unnecessary delays in care can adversely affect a patient’s outcome. The “Diagnosis to Initial Treatment” navigation metric specifically addresses this goal.
The metric requires us to measure the number of business days from diagnosis, which is the date the pathology results are delivered, to the initial modality, or the date of first treatment. We have started using this metric in our navigation program, and as a result we have been able to successfully reduce the number of days from date of diagnosis to time of surgery.
JONS Do you have any advice for an established navigation program that is considering incorporating metrics into their practice?
Ms Plavsa Implementing navigation metrics may seem intimidating, but while it may be labor-intensive in the beginning, they truly are a driving force for all navigation programs. Metrics help prioritize and improve the delivery of cancer care, and they challenge us to create new and improved models of best practice within our multidisciplinary teams and healthcare systems.
Metrics are also invaluable for providing objective, factual evidence to show the value and successes of a navigation program.
JONS Thank you very much for your time, and our best wishes for continued success.
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