by Tricia Strusowski, MS, RN
It is amazing how the world of patient navigation has changed over the last 20 years! Fate has aligned me with many wonderful opportunities, and over the years I’ve been honored to be an active participant both in the navigation role itself and in navigation program development. The journey has been a labor of love, a true passion, and extremely gratifying.
I was first introduced to the concept of navigation through my role in case management in the mid-1990s. Identifying the needs of the patients even before their cancer care commenced became a necessity to help transition the patients to the correct level of care. The goal was to provide the best services, decrease duplication of care, contain costs, and increase communication among the healthcare team. The patient and the family were active participants in their plan of care.
Toward the end of the decade, in 1998, my then-employer, Christiana Care Health System, Helen F. Graham Cancer Center, identified the need for “care coordination” for oncology patients and families (navigation was not yet a familiar term). We were one of the earlier adopters of “care coordination” or what we now call navigation. Our team consisted of disease-site-specific oncology nurses and social workers. We were under the “administrative microscope” to coordinate care across the continuum from cancer diagnosis through end of treatment or end-of-life care. After a bumpy start, we developed and then standardized our program. We created pathways, guidelines, standing order sets, a patient journal, and patient tools, which are now called decision aids. Learn more here.
Here are some navigation lessons learned over the years.
Lesson learned #1: Create tools and reports to reflect American College of Surgeons Commission on Cancer (CoC) national standards; identify metrics to demonstrate the success of your program. Define your reports and metrics for the staff so that information/data is collected in a consistent manner.
As a new navigation program we initially made our patients and families too dependent on our services and as our volume increased, the caseloads became unmanageable. The staff became overwhelmed and we needed to address this immediately to provide the best service for our patients.
Lesson learned #2: Empower your patients with decision-aid tools/educational materials and provide health literacy training for staff. Monitor the caseloads and close cases when active treatment is completed. Hold morning meetings or huddles to share patient information with the healthcare team across the continuum. Keeping your healthcare team updated increases productivity.
In 2007 Christiana was an original member of the NCI Community Cancer Centers Program (NCCCP) initiative. I co-chaired the Quality of Care Subcommittee. As a result of navigation discussions we created the Navigation Networking Committee and listserv; we held monthly conference calls to discuss our programs, best practices, document tools, and models of navigation. Our committee grew to more than 90 attendees. It was a fantastic learning and bonding experience; many of us are still close colleagues today. One resource developed through the NCCCP was a Navigation Assessment Tool for growing a program. Learn more.
Lesson learned # 3: Collaborate with your internal and external resources to identify best practices. Use the internal resources/experts in your healthcare system, i.e., pastoral care, finance, volunteer department, etc. Partner with your external resources, such as the American Cancer Society (ACS), state Breast Cancer Coalition, Leukemia & Lymphoma Society, and Cancer Support Community.
From 2008 to 2009 ACCC provided me with an exceptional opportunity to teach a two-day patient navigation workshop at six community cancer programs. I met with the teams and we discussed the goals, roles and responsibilities, documentation tools, job descriptions, guidelines, reports, and performance improvement initiatives. The programs were all very appreciative of the information because there really were not many resources available at the time. At the end of these training sessions ACCC held its first webinar on navigation.
Lesson learned # 4: Don’t reinvent the wheel. Today there are many resources available for navigation through ACCC, AONN+, ONS, AOSW, NCI, IOM, and ASCO, just to name a few. Network with your colleagues via listservs.
Navigation at times can be a “catch all” service; navigators may get bogged down with scheduling appointments, calling insurers, and data entry as well as other clerical duties. Although some of these responsibilities are inevitable, it is important to identify support staff to assist with these tasks.
Lesson learned # 5: As a professional navigator it is essential that you function to the top of your license. You don’t want to turn into an expensive clerk.
Today, as I continue my role as independent consultant, I always tell my clients that patients and families always come first. If you take excellent care of the patients using national standards and best practices, the rest will fall into place.
Guest blogger Tricia Strusowski, RN, MS, is a consultant with Oncology Solutions, LLC.