In 2023, the Northwell Health Cancer Institute set out to differentiate and expand its oncology nurse navigation program. The program’s key differentiator is its longitudinal approach to navigation, pairing each patient with a dedicated navigator throughout their entire oncology journey.
Northwell partnered with IA Collaborative, a global design and innovation consultancy, to investigate the needs of participating patients and caregivers to determine how best to scale the program. Research revealed critical gaps: existing digital solutions were leveraged to manage logistics of care, with few options other than the navigators themselves to address the deeper emotional needs of patients; a sense of advocacy from their care team, trust that the right plans were being assembled according to their unique needs; understanding and education on next steps in their care plan, and also how this will change their life; and deep compassion that they are a human being with a life to live, and not just a patient.
This paper proposes a theory for defining a new navigation model at Northwell, called Effective Navigation, to address said gaps. The model is defined as the critical intersection of “being” (logistically) and “feeling” (emotionally) navigated from diagnoses through active treatment and into survivorship. The work identifies proposed approaches combining technology and navigator skill that can achieve this model at scale.
Patient navigation is a health delivery support strategy in healthcare. Harold P. Freeman, MD, created the first patient navigation program in 1990 at Harlem Hospital in New York City in response to social determinants of health (SDOH) (eg, education access, economic stability, social and community context) blocking underserved patients in accessing timely and effective cancer treatment.
Dr Freeman’s initiative had the ultimate goal of equitable access to care, providing individualized assistance to navigate systemic barriers throughout the treatment journey.1 These first patient navigators worked through the often overwhelming financial, communication, and emotional barriers that keep historically marginalized groups from accessing care.
Imagine you’re 73, live alone, and have just been diagnosed with stage IV metastatic breast cancer. After diagnosis, you may not know that additional testing can be required before scheduling treatment.
You might not know that insurance pays for some tests and not others. You might not know how to find an oncologist, how to schedule an appointment, or be aware of any clinical trials for which you may qualify. Above all else, you might need some reassurance, hope, and help to make a plan.
These needs and critical pieces of information, among many other things, are what a navigator addresses. And as we have seen from its inception, navigation works. It has yielded many upsides, including:
In the 30+ years since Dr Freeman’s first program, navigation has become an increasingly popular service across health systems. But this widespread growth comes with a range of emerging definitions as each system shapes navigation to fit its specific needs.
The Academy of Oncology Nurse & Patient Navigators defines navigation as: The process of helping patients overcome healthcare system barriers and providing them with timely access to quality medical and psychosocial care from before cancer diagnosis through all phases of their cancer experience.4
In speaking with patients across hospitals and health institutions, we heard a wide range of definitions for navigator, including:
Depending on where one might go to receive care, there are different iterations of navigation programs, each available at different moments across the patient journey. Communicating the specific services or value a navigation program offers can be difficult with so many definitions.
Northwell is focused on providing a longitudinal5 patient navigation approach, pairing patients with a single, tumor-specific nurse for consistent touchpoints throughout their journey from diagnosis through survivorship.
With this comprehensive approach, Northwell aims to position its nurse navigation program as a differentiator among the sea of oncology competitors in the New York City metropolitan area.
Northwell Health is one of the largest healthcare systems in the United States.6 Its cancer program, the Northwell Health Cancer Institute, consists of 10 cancer centers that treat more than 19,000 new oncology patients annually.
It offers a wide range of services, including radiation therapy, chemotherapy, surgery, and access to clinical trials. The Breast Navigation Program, which Northwell launched in 2022, was the beginning of the Cancer Institute’s nurse navigation initiative that has grown exponentially over the past few years.
Northwell was faced with the task of differentiating and scaling oncology nurse navigation while keeping in mind 2 unique opportunities for their organization—size and reach.
Northwell is a large organization that has scaled rapidly. What began as a merger of 2 specialized care hospitals on Long Island in 1997 has grown over the past 28 years to encompass 21 hospitals and over 900 outpatient facilities across 11 counties in the New York metropolitan area.
While this rapid growth has significantly expanded patient reach, it has also resulted in a complex network of disjointed systems and processes that do not always communicate seamlessly. For patients, this can translate into a fragmented experience—difficulty accessing information, inconsistent communication across care teams, and a lack of clarity about their next steps—all at a time when they need the most support.
For Northwell, having a large footprint means opportunity for a large impact. But the Northwell navigation team needed help expanding the program across cancer centers and service lines to support more patients in need.
Northwell’s services go far beyond oncology, including but not limited to cardiovascular care, neurology and neurosurgery, women’s health, and behavioral health. This means patients can have connected care across all their health needs, not just oncology.
No matter where you get chemo or surgery, you’ll go back home afterwards. You’ll be cared for by your general practitioner, and it just so happens at Northwell, you’re already within the same system. We should be treating patients from the time they’re born to when they die. Northwell is the perfect melting pot for that.—Northwell Physician
While this means the scale potential of navigation could be much larger at Northwell, it also means more moving pieces to navigate in a complex and multifaceted system. In addition, Northwell does not yet have the nurse navigator headcount to support the demand.
Following a successful Breast Cancer Navigation Pilot in 2022 with 600 patients, the program expanded to serve all 19,000 annual Cancer Institute patients in June 2023. Even with a growing team of navigators, this potential 3000% increase in cases forced the team to confront the urgent challenge of maintaining the consistent, human connection throughout a patient’s journey that made the program so successful.
The human element of interaction is key, not just in healthcare but in everything we do. It’s what binds us together as a community and as an organization focused on providing not just care, but empathy and understanding.—Michael Dowling, CEO, Northwell
SDOH, or nonmedical barriers to care, account for up to 80% of health outcomes. Clinical care contributes only approximately 20%.7 As mentioned, navigation began as a resource for helping patients overcome these barriers, including financial. Today, the bespoke support required to navigate such barriers often comes at a significant cost in the form of concierge medicine (in one example, $4000 per individual)8 and are not accessible to those who need them most. Navigation programs offer a tangible, accessible solution for addressing these disparities.
With navigation at Northwell, our goal is to provide the same experience to all our patients, no matter where you live or what insurance you have.—Kristen Beyer, Assistant Vice President, Northwell Health Cancer Institute
Northwell Health is recognized for serving a highly diverse patient base across New York and the tristate area, reflecting the linguistic and cultural diversity of the region. At Long Island Jewish Forest Hills, one of Northwell’s most diverse hospitals, 164 languages and dialects are spoken by patients. Certain demographic groups, particularly racial and ethnic minorities and those in lower income communities, continue to experience higher cancer rates and worse outcomes.9 Efforts to close these gaps have increased, but disparities persist. Northwell’s navigation program builds on Dr Freeman’s original work,1 continuing to address these health disparities with individualized care.
With its size and expansive reach, Northwell is working to embody the original spirit of navigation in this modern age from its own bespoke perspective, and expanding the program within the Northwell network.
For Northwell, having a large footprint means opportunity for a large impact. But the navigation team needed help expanding the program across cancer centers and service lines to support more patients in need.
To address Northwell’s challenge, the team wanted to get as close to patients, caregivers, physicians, and nurse navigators as possible to truly understand the state of navigation today.
To do this, Northwell conducted 2 phases of in-depth qualitative research. The first phase focused on clearly articulating a patient-centered definition of navigation. The second aimed to test early concepts for digital and organizational innovations that would allow the program to scale while centering patient needs.
For both phases, Northwell partnered with IA Collaborative, a global design and innovation consultancy. IA Collaborative partners with organizations across industries—including healthcare—to unlock creative solutions to multilayered problems.10 The team relies on a process called human-centered design (HCD), a methodology that puts people at the center through in-context observations and open-ended interviews to surface their lived experience.
Their stories become not only valuable examples of complex systems at work but also inspire calls to action that foster a more emotional understanding of the problem space. Designers then use these insights to create solutions that meet real user needs.
The ability of HCD to tackle complex challenges makes it a valuable method for healthcare innovation. The healthcare industry is no stranger to the design process, with internal design teams first integrating with US health systems more than 20 years ago.11 It would make sense that these 2 industries have coalesced (Table 1).
The goal of the first phase of research was to create a Northwell-specific definition for nurse navigation. While a process already existed, the term itself was not well understood throughout the organization. Conducted over 9 weeks, the work was focused on defining what patients and caregivers need from an Effective Navigation program.
“Where is navigation done really well in the US? What does it look like at other institutions? What does successful navigation feel like in practice?” To answer these questions, the team observed 11 participants comprising Northwell and non-Northwell patients from across the US—remotely and in their homes—as they shared their experiences at various oncology centers. This was an open-ended, exploratory phase focused on understanding what participants need from navigation services.
Because HCD is inherently systemic, it was equally important to understand the experience of those providing care. Physicians, nurse navigators, and other providers play a critical role in shaping the navigation experience, influencing how patients and caregivers access and engage with support. To capture a complete picture, the research also included in-depth conversations and observations with these care providers, uncovering the challenges they face, the gaps they navigate within the system, and the moments when they feel best equipped (or ill equipped) to support their patients. This holistic approach ensured that the final definition of Effective Navigation accounted not only for patient and caregiver needs but also for the realities of those delivering care. An outline of key recruitment criteria is included in Table 2.
The goal of the second phase was to learn how to further activate navigation at Northwell. Testing to learn is paramount to the HCD process and often involves creating nonprecious prototypes to see how concepts play out in the real world.
A prototype is a physical or digital representation of a future solution that can be tested and refined with actual users early in the development process. Over the next 7 weeks, the research team centered patient experience through 11 observations focused on participant engagement with a set of 3 research- informed prototypes (Table 3).
The team took what they learned from phase 1 of research and created early implementations of potential solutions to observe in action, gaining immediate, focused user feedback. Again, in addition to patient and caregiver observations, the team conducted 2 weeks of on-site observations with navigators, physicians, and administrators to observe the prototypes in context. Across both phases, the team traveled throughout Long Island, meeting with patients and caregivers at hospitals, in their homes, or anywhere in the world we could observe what influenced patients positively or negatively on their cancer journey.
An outline of participants for phase 2 of research is included in Table 4.
Patients and caregivers described a 2-part definition of what they needed from navigation. “Navigation” can mean many different things, but according to IA Collaborative’s research, a successful program must ensure patients are both being and feeling navigated. These 2 states of navigation are interconnected and have a unique relationship with each other to achieve what we are calling “Effective Navigation.”
Being navigated is about the logistics of care. It’s about getting patients to the right doctors, connecting them with the right services, and communicating well—essentially ensuring patients efficiently move from point A to B to C. Team-specific operational processes and patient portals are some key tools that enable this kind of navigation. Below are key insights.
In today’s world, beautifully branded patient apps and electronic medical records provide a more streamlined way for patients to communicate with their care teams, access documentation, and schedule appointments. It can seem like technology is the silver bullet for effective patient navigation, but these tools all struggle with the same siloes as the rest of healthcare.
Being navigated throughout a single healthcare system is one thing, but some patients are treated by multiple physicians across multiple hospitals, and those systems do not always connect. This often puts the logistical burden on the patient to navigate next steps and move care forward.
One patient without a navigator found himself in the middle of 2 physicians giving conflicting advice: “My (medical) oncologist said not to get surgery, but my surgeon said I should move forward with it. I put both doctors on 1 email and asked them to coordinate their recommendations.”
We heard from patients and caregivers that they can often end up in this situation—bridging the communication gap between care teams. Participants described this feeling like a full-time job; something that many don’t have the time, capacity, or understanding to take on.
Even within a single health system, good digital solutions do not necessarily mean good navigation. We observed that strong digital patient tools and back-end systems combined with specialized care can help build trust in an institution.
A patient who was getting treatment at a specialized hospital said, “I have faith in the system—I trust anyone [here] will do a good job because of the reputation.” Effective electronic health records (EHRs) and patient portals can make it much easier to ensure clinical information is captured, shared, and acted on. While it’s important none of that falls through the cracks, there is an emotional element to navigation that digital solutions today often do not serve.
As one patient said, “a lot of communication takes place in the portal. It’s nice, but it’s not personal. You can’t be so cancer-focused that you forget there’s still a patient there.”
The stakes in navigation from a patient perspective are extremely high—for many patients, ensuring the exact right care and taking the exact correct steps feels like life or death. To be navigated is an indication of a hospital’s capability to leverage its own systems and pass information effectively to those providing care to ensure all goes smoothly.
Gaps or missteps are disappointing and can shift trust in the hospital and in the care it provides. As a result, patients often take navigation into their own hands. This was illustrated in research when a non-Northwell patient’s husband noticed there was the slightest delay in their navigator securing a prescription for his wife, who was receiving care for a unique type of breast cancer.
He said, “There’s so many different people talking back and forth. There’s miscommunication that gets in the way of my wife receiving her medication on time.” Upon this realization, he inserted himself as a project manager for his wife’s medication management, including the setup of calendar reminders to call different members of the care team 3 days in advance of appointments to ensure the lab had the proper medication.
Not only does this add work for patients and their caregivers, but they also do not have the same insider access as a navigator does.12 Navigators may have more direct phone lines, access to send Microsoft Teams messages, or personal connections that help address challenges much faster than a patient could on their own. That means when patients lose trust in their navigator, they lose a crucial resource.
Feeling navigated focuses on the emotional side of care. Patients want to know there’s someone involved in their treatment who sees past the diagnosis, knows them as a person, is ready to advocate for their needs.
Navigators at Northwell are tasked with guiding patients through a complex and often disconnected health system. During the first step in the care journey, Northwell’s navigators are in regular, direct contact with patients. They have all the clinical information they need to direct them to the right physician to develop a care plan. But when a patient’s treatment plan changes or a new ancillary service such as chemo port placement is required, there’s a new need to be navigated to the next step in care.
Navigators know these moments are important, but with a scaling program, they’re looking for improved visibility into when these moments occur. Without the right technological support, navigators become reliant on patients raising their hand. As one navigator described, “The very sweet ones are the ones who don’t normally speak up about their care. It’s interesting we called him too, but he never said anything about needing help with scans. It’s the quiet ones who kind of slip through the cracks.”
Feeling navigated focuses on the emotional side of care. Patients want to know there’s someone involved in their treatment who sees past the diagnosis, knows them as a person, and is ready to advocate for their needs. These interactions are what patients remember when recalling their navigation experience.
We learned that consistent touchpoints enable patients to feel navigated. The timing of these touchpoints matters, and when done correctly, navigators can learn important, nonclinical information that helps them better understand their patients’ needs.
One patient in research was receiving treatment at a renowned oncology center. He did not have an official navigator through the hospital but had registered for the study as “navigated.” When asked about this, he spoke about a registered nurse who called him once a month for 5 to 10 minutes as part of an insurance program, completely separate from the oncology center: “The nurse called and checked in during gaps in appointments. I don’t remember what we talked about, but I remember that it happened.” Without access to his records or an ability to schedule appointments through his hospital, this nurse could not do much to ensure he was being navigated. But those small touchpoints made him feel navigated.
Another patient, this time at Northwell, described her experience with her navigator after surgery. “She was very clear on the phone that she was here for questions and support. She visited me multiple times [in the hospital]. She even brought me a bathrobe!” These small, consistent check-ins with a single contact were important for both of these patients in feeling supported throughout the process. However, consistency is not the only reason why small touchpoints like this matter.
While consistent touchpoints are key to patients feeling navigated, the timing of these interactions matters as well. Key moments for patients do not always align with what hospitals consider to be key moments.
We observed these moments occurring most often once patients have left the clinic and are experiencing the following needs:
One non-Northwell patient referenced the need for navigation during the early days of her breast cancer diagnosis. “That week of waiting was ‘the anxious week’—waiting for the biopsy report. I know it’s cancer, but no one’s said it yet.” Without official navigators there to provide emotional support, she described turning to her girlfriends, all of whom had dealt with cancer in some way.
During this heightened emotional moment, this patient had to seek out support on her own. A proactive touchpoint with an experienced navigator may not have changed how she felt, but it would have been a meaningful interaction and a chance to establish the navigator as a trusted resource for the rest of the journey.
At Northwell, another patient described a different experience connecting with his navigator after a colon cancer diagnosis. His navigator was in contact as soon as he got the news and didn’t just connect him with doctors: “She said if there’s ever an appointment you’re not comfortable with, let me know, and I can come. I found an angel on earth [with my navigator].”
During these key moments, both in-person and over the phone, navigators and care team members learned more contextual information about patients—information not directly pertaining to their diagnosis, treatment, or medical history.
While not necessarily categorized as clinical, these were important notes to understand how to deliver the best care. Navigators would use these data to determine when and how to best engage with patients. This nonclinical information is a key indicator of when and how to make patients feel navigated.
Nonclinical information is often obtained through observation or off-hand conversations and is not officially tracked in medical records. For example, we heard from a clinical administrator that a particular patient was not responding to their phone calls. As soon as they tried emailing, the patient responded immediately, and it turned out he was unable to speak. This likely came up earlier in his care and could have found its way into an FYI section in the EHR.
But more often, information like this does not go beyond a staff member’s memory or private notes. Other examples of key nonclinical information the team observed across both phases of research include:
Capturing, understanding, and acting on this information means patients receive support that feels more genuine and personalized. As one patient said, “There is a good doctor, but then there is a good fit for me.”
When patients are not feeling navigated, the team observed them relying on a range of counterproductive coping mechanisms, including over-researching, hypervigilance, or overinvolvement in logistics. One caregiver described her father losing trust in his care team and wanting to do his own research, potentially delaying care.
Another caregiver observed her family member leaning into the logistics of scheduling appointments: “My dad is very analytical, so setting up his schedule was good for him. But sometimes, he would get really upset and not want to know the answer to questions like ‘what does this mean’ and ‘what do I do next.’”
As a Northwell physician told the team, “efficiency is good cancer care.” While it’s important that patients deal with their diagnosis in their own way, feeling supported through the process can have more than just an emotional impact—it can also, quite literally, expedite care.
Today at Northwell, nurse navigators deliver emotional and personalized support as much as they can for all of their patients. But, as patient numbers increase, it becomes harder to maintain the same level of support.
The relationships forged between navigator and patient are strong—sometimes so strong that patients would continue to call their navigator into survivorship. However, as Northwell’s navigation program began to scale, in-person interactions and the time available to proactively check in on patients decreased, putting the responsibility of reaching out for support later in the care journey on clinics and patients.
Feeling connected with someone is critical in healthcare, but the degree of human connection desired by patients is not scalable on its own. In order to scale navigation, the regular consistency of the relationship will eventually have to end. And, if patients are navigated well, they won’t need navigators anymore.
During the initial phase of research, we identified 2 core elements of Effective Navigation: being navigated and feeling navigated. While these aspects have distinct characteristics, we found that both are essential for truly effective and differentiated navigation programs.
Structured, scalable processes reassure patients that they won’t get lost in their oncology journey, but as we heard, process alone can feel transactional. Northwell’s nurse navigation program excels at making patients feel navigated from the start, but without proper support, the personal touch that sets it apart is at risk as the program scales.
We observed many digital solutions focused on streamlining the process of navigating patients, from more formal tools like EHRs with robust work queues to more grassroots approaches like spreadsheets and custom applications. All of these tools focused on the being side of navigation.
In the second phase of research, the team wanted to explore the opportunity for technology to support the feeling side as well. As mentioned above, the team developed 3 low-fidelity prototypes to represent what a potential future solution might be for the purposes of testing.
To better understand when and how patients want to connect with a navigator, the team designed a simple form that simulated a direct messaging experience at hypothesized key moments. Patients in active treatment from institutions across the country signed up to receive “automated” text messages sent by the research team with a link to the form that would capture their nonclinical questions.
Over the course of 2 weeks, they shared their questions as well as their expectations around a response. The team conducted follow-up interviews with a subset of participants to reflect on their experience.
The second prototype aimed to uncover what nonclinical information is most crucial for navigators to effectively navigate their patients. Rather than designing a specific tool, the team paired 1 navigator and 1 clinical administrator (a staff member who takes on many of the more granular navigation tasks as a patient goes through a specific treatment) and facilitated daily meetings for them to discuss nonclinical updates on their shared patients. These meetings focused on crucial factors, including time since last contact, emotional needs, missed appointments, and signs of nonproductive coping mechanisms.
The third prototype was a simulated onboarding form for a would-be peer navigation program to understand how leveraging patients who have similar experiences would help with the emotional component of treatment, and how leveraging shared experiences might reduce workload for navigators. The prototype captured preferences and expectations around how to match patients together and cadence of interaction.
After 2 weeks of running these prototypes and debriefing with participants, we found there were opportunities to use technology to unlock new touchpoints for delivering effective navigation.
It’s easy to see where technology can support the logistical navigation needs of a scaling program, but as demand grows, there’s also an opportunity for technology to enable navigators to continue providing a bespoke experience that meets the emotional needs of their patients.
We identified 2 ways technology could augment the navigation experience, allowing them to provide personalized care at scale:
Documenting nonclinical information is essential for providing patients with a truly personalized and supportive navigation experience, yet it is often overlooked. Through facilitated conversations in the prototype, we uncovered several examples of the types of details that navigators and clinic staff found helpful to share. These details varied widely. Sometimes, it was basic information, such as indicating that the number listed in the EHR is for a caregiver, not the patient. Other times it was much more sensitive. As we heard from one staff member, “I’m not always comfortable capturing information that would be helpful. Like for this patient, we know him and his wife don’t get along, but she’s listed as the caregiver.”
Care team members and navigators exchange information that is actionable in real time—that would not only impact the patient experience but could enhance care further down the line. One sensitive case from the prototype illustrated the importance of documenting and sharing context beyond clinical details. The clinical administrator noticed that a typically cheerful patient was not her normal self when calling to confirm her appointment. She later learned the patient had just had a difficult conversation with the doctor about fertility. Noticing the difference in behavior, the administrator alerted the navigator, who then reached out by phone. The conversation ended up being with the patient’s husband. By approaching this interaction with the right context and tone, the navigator learned the family was feeling overwhelmed by the conversation and had fallen behind on scheduling appointments. Despite the couple’s preference to handle scheduling on their own (another note from the clinical administrator), the navigator was able to help coordinate upcoming appointments to ensure they stayed on track.
“I appreciated the heads-up when a patient I’m navigating is having a hard time. I’m really glad I called them today.”—Northwell Navigator
This example highlights how nonclinical information—often gathered through observation or casual conversations—can be crucial to providing effective support. However, this valuable contextual information is often overlooked in documentation.
A relationship management tool should include a space to capture this nuanced information, but Northwell must also teach and guide providers how best to inquire about this information, and how to document, share, and apply it.
As one patient insightfully put it, “How I’m dealing with my journey is more important than the actual timeline. Just because I’m still receiving treatment doesn’t mean I’m still in the same headspace about it.”
This story highlights another opportunity for technology in navigation: knowing when patients need support. A small change in a patient’s tone is just one of many indicators that can signal the need for a navigator to reach out. But without consistent visibility into patient interactions, these subtle, nonclinical cues—which an experienced nurse navigator would immediately know how to act on—often go unnoticed.
As one clinical administrator said, “I hope that [knowing when to contact a patient] will become more systemic instead of having to rely on memory.” The facilitated conversations in the first prototype helped identify the most important nonclinical cues that signal when patients need support, setting the foundation for future technology that can document, detect, and flag them at scale.
While patients worried about being perceived as a squeaky wheel by the staff if they called too much, we heard that messaging felt like a much safer space to document their thoughts, especially after hours.
But this was not the only way technology provided visibility into when patients needed support. We also heard from patients that check-ins—even when they’re automated—can have a large impact, making them feel like they have not been forgotten and helping navigators feel like they’re still connected. As we heard, consistent, proactive touchpoints are essential for patients to feel guided, but large caseloads and limited visibility into patient needs make this difficult.
Automated messaging offers a solution by highlighting moments when patients need extra support, without a large lift from navigators. While patients appreciate the sentiment of a navigator who is always there for them, they often don’t feel comfortable reaching out. As one patient described, “‘Call us if you need anything’ doesn’t always work because what if I don’t know what I need?”
Several patients worried that their questions might feel too small or “silly” to warrant a phone call. Instead of calling, they might keep a running list of questions and wait to ask during an appointment, or not ask their questions at all, regardless of urgency or clinical importance. While patients worried about being perceived as a squeaky wheel by the staff if they called too much, we heard that messaging felt like a much safer space to document their thoughts, especially after hours. By giving patients an easier way to raise a hand, messaging could elevate the quieter voices and help navigators understand when extra support is needed.
For example, a younger patient sent a series of anxious questions one night, including: “Can I wear a hat to the hospital for my evaluation.” When we spoke with him after the prototype, he said he didn’t really need an answer to those questions—he was just feeling nervous about the appointment and didn’t feel comfortable asking for support: “I don’t want to ask for emotional support or to talk to someone on the phone. I want it to be a more safe, less judgmental space.” Capturing these types of questions, even if they’re not answered immediately, has the potential to provide navigators with visibility into the margins of care they don’t have today. In his case, a navigator eventually connected him with a peer who talked him through his anxieties around treatment. But with a consistent check-in, as modeled by the prototype, his needs could have been identified even earlier.
When patients do not trust an institution implicitly, they need to feel navigated to believe they are being cared for behind the scenes. The stronger the reputation, the less proof a patient needs.
Anticipatory messaging allows for these proactive touchpoints without overwhelming navigators who already deal with large caseloads. As one navigator said, “I would feel so much better knowing they have heard from me in some way, just a reminder I am still there. Even just an automated text. I can’t always just check in.” Patients were comfortable with this as well. We heard from one patient, “I liked getting reminders. Even when it’s automated. It makes me feel like they are staying on top of things. It gives me more confidence.” These messages don’t replace touchpoints with a navigator; they simply make it easier for those interstitial moments of connection to occur.
Even without technological interventions, Northwell’s navigators are uniquely positioned to deliver Effective Navigation and create significant value for patients, clinics, and the organization as a whole. Because the navigation team is centralized, they operate beyond the boundaries of any single clinic and can serve as the connective tissue across the health system.
This is their greatest opportunity. As one physician explained, “There’s a handoff [when patients cross disciplines]. That’s where we struggle. The navigator can prevent those handoffs.” In doing so, navigators not only build trust with patients—a benefit well documented in both our observations and the broader literature13—but also foster stronger trust and collaboration among clinics within Northwell.
Interclinic collaboration is both a requirement and an outcome of practicing Effective Navigation, as strong partnerships are essential to its success.14,15 While navigation today often occurs in silos within individual clinics, a formalized program can unify these efforts under a shared goal. As programs expand and care becomes more complex, a system- wide navigation model offers a way to complement and strengthen the work already happening at the clinic level. By providing a common language and framework, this model of Effective Navigation enables clinics to align their efforts and work together more seamlessly.
When patients don’t trust an institution implicitly, they need to feel navigated to believe they are being cared for behind the scenes. The stronger the reputation, the less proof a patient needs. As we saw earlier, specialized institutions have processes and reputations patients know they can rely on, no matter who (or what) is navigating them. Large healthcare networks like Northwell do not have that same level of institutional trust; patients rely more on individuals within the system who make them feel navigated. Navigators at Northwell today are often the representative of the institution and can continue to build a positive reputation for the duration of the patient’s time within the healthcare system.
It’s exciting to see the changes that are already taking place after the completion of this robust initiative. Effective Navigation at Northwell lives at the intersection of “being” (logistically) and “feeling” (emotionally) navigated from diagnoses through active treatment and into survivorship, combining technology and navigator skill to achieve patient care at scale.
As of October 2024, the navigation team has hired 15 navigators and 10 coordinators (nonclinical support staff who also assist with navigation tasks), meaning they can expand their bandwidth as demand continues to grow. The Effective Navigation framework is constantly leveraged and helps navigators prioritize patient connection, communication, and coordination accordingly.
With the implementation of Epic on the horizon, there are high hopes for more connected systems and processes unique to navigation use cases, specifically the documentation and tracking of nonclinical information. As the program continues to grow and continuously prove its value, more clinics are partnering with navigators, and more patients are receiving coordinated care.
The challenge of balancing operational needs to scale with human needs for connection is not unique to nurse navigation. These principles for navigation in oncology can be applied to other complex pathways involving multistep treatments. The foundational work and insights from this project enable Northwell to do just that.
Navigation started to address the logistical barriers that are tied to SDOH. But a purely logistical approach and understanding of the disparities that exist do not build the trust required to bring previously underserved patients into the system. Patients cannot overcome these barriers alone, and our insights show that effective navigation is ultimately a method for institutions to build connections for people to get the care they deserve. Northwell aims to leverage technology to amplify this mindset, making a large institution feel smaller, and scale the impact of navigation in a meaningful way, ensuring the best quality care for all patients for years to come.
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