Integrating Metrics and Role Delineation into a Navigation Program for Quality Improvement

November 2017 Vol 8, No 11
Carolyn Allsen, BSN, RN, OCN, ONN-CG
Memorial Hermann – The Woodlands
Sylvia Brown, MS, RN, OCN, CNL, ONN-CG
Sandra Miller, MHSM, RN, NE-BC

Background: Since the inception of the oncology nurse navigator (ONN) program at Memorial Hermann Hospital System (MHHS) in 2009, the role of the ONN was vastly misunderstood, and the overall potential benefits for the hospital and patient were undefined. The ONNs were overwhelmed by the caseloads, which included new and previously diagnosed patients. Lacking a systemized method of metric reporting, the navigators were unable to collectively provide measurable outcomes and had no supporting evidence to justify the need for additional FTEs in order to navigate the 6200 newly diagnosed cancer patients per year at MHHS.

Objectives: To demonstrate value and benefit of the navigation team by establishing systemwide metric reporting with the goal of expanding navigation services, improving patient quality, and enhancing the continuum of care for all patients across the healthcare system.

Methods: The ONNs began with a thorough literature search using key terms such as navigation, quality outcomes, and best practice to validate the effect navigation has on the quality of a cancer patients’ care and outcomes, as well as to educate the hospital administration regarding navigators’ current caseload. The information gathered in the literature search was used to develop a business proposal determining appropriate caseload per navigator and incorporating formalized navigation documentation, which included preset metrics allowing for reporting outcomes. Based on the evidence found, the navigators decided on the following reporting measures: number of cases by tumor site, and number of new and total patients per navigator. Each was measured over a 4-month period.

Results: It was discovered that each navigator was averaging a total caseload of 280 patients in 4 months. Based on the implementation and reporting of systemwide metrics that included caseloads per navigator, administrators acknowledged the need for support and expansion of the ONN program, which resulted in 2 additional FTEs.

Conclusion: Standardized navigation metrics support the efficacy and sustainability of navigation programs across the healthcare system. Through standardized metrics reporting, navigators are able to continually assess, revise, and improve the navigation process as well as quality outcomes across the continuum of care.


George Washington Cancer Institute. Best Practices in Patient Navigation and Cancer Survivorship Survey Results. 2013.

Lubejko BG, Bellfield S, Kahn E, et al. Oncology nurse navigation: results of the 2016 role delineation study. Clin J Oncol Nurs. 2017;21:43-50.

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Last modified: June 11, 2018

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