Demonstrating the sustainability of patient navigation is crucial to the survival of the field, but it’s hard to do without the proper tools.
At the AONN+ 2023 Annual Conference in San Antonio, Sharon Gentry, MSN, RN, HON-ONN-CG, AOCN, CBCN, along with Andi Dwyer, MS, discussed the importance of clinical sustainability in navigation and explained the components of the Patient Navigation Sustainability Assessment Tool (PNSAT), which navigation programs can adopt to demonstrate their own sustainability.
Clinical sustainability is the ability of an organization to maintain structured clinical care practices over time while evolving and adapting these practices in response to new information.
“You have to think about where your organization is going to be in 5 years,” said Ms Gentry. “Seasoned navigators who have been in the field for 10 years or more, do you do the same thing you did the first year you came into this job? You’ve evolved, but you’ve also adapted to changes and taken in new information that we’ve been giving you over the past decade.”
Sustainability in navigation goes beyond the financial aspect, she added. Sustainability tools in patient navigation should support the integration of programs and interventions with other clinical practices. Unlike oncology nurses, oncology navigators do not work in a silo and must establish and maintain relationships with all members of the care team to prepare patients for the path ahead.
Sustainability is also integral to building capacity and making the business case for maintaining patient navigation practices.
“You need to know what to show someone when you say, ‘I need more navigators,’” she noted.
According Ms Dwyer, program director and instructor at the Colorado School of Public Health and the University of Colorado Cancer Center, trying to measure the sustainability of navigation programs without the necessary tools can be close to impossible, but demonstrating the sustainability of navigation is necessary to securing funding and resources for these programs. Even when funds are secured, there’s no guarantee that those funds will remain, again underscoring the importance of nurturing program development and demonstrating sustainability in a holistic way.
In response to this need, many national organizations (including AONN+) have now adopted the PNSAT, born of combining 2 sustainability frameworks developed by Washington University in St. Louis: the Program Sustainability Assessment Tool and the Clinical Sustainability Assessment Tool. These sustainability frameworks were developed to describe internal and external factors (domains) that affect the likelihood that a public health program or clinical practice will be sustained.
Ms Dwyer noted that although the PNSAT is a great example of a sustainability tool, it is not the only one available. What’s important is implementing a thoughtful model for demonstrating sustainability, no matter which model you choose, she said.
“Don’t reinvent the wheel,” added Ms Gentry. “We already have tools that work.”
The PNSAT focuses on 8 domains of navigation sustainability, each of which informs the next:
According to Ms Dwyer, adopting this type of common language is crucial when it comes to discussing navigation sustainability with federal agencies, local leaders, and other stakeholders in the clinical setting. This allows for literal and deliberate thinking around big—and often daunting—concepts like sustainability.
“If we can use common language about what sustainability means,” she added, “that will keep us moving forward with a unified approach to navigation.”
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