Do administrators really understand the needs of the navigator, and are they fully aware of the infrastructure needed for their navigation programs?
In a discussion on administrative engagement in navigation programs at the AONN+ Midyear Conference, Tricia Strusowski, RN, MS, posed these and other provocative questions to attendees.
Cancer center administrators may typically take a back seat in the development and implementation of navigation programs at their institutions, but according to Ms Strusowski, key stakeholder engagement, from administrators as well as physicians, is essential to the process of developing, implementing, and reassessing a sound navigation program. It is crucial that administrators understand what their navigators need to keep their programs running smoothly.
"Many of us started by being told, 'You are our navigator; now go navigate,'" said Ms Strusowski, Manager of Oncology Solutions in Decatur, GA, and Chair of the AONN+ Evidence into Practice Metrics Subcommittee.
This lack of guidance is still evident today. Cancer centers are in the process of reorganizing their programs because silos exist, and patients are not being followed across the continuum of care.
According to the American Society of Clinical Oncology, the yearly cost of oncology care in the United States is set to reach a staggering $173 billion by 2020. For the US healthcare system to meet the Triple Aim of improving health, improving quality care delivery, and reducing cost to care, healthcare reforms are needed. Simultaneously, the landscape of healthcare is evolving, and value-based payment models are now becoming integrated into programs across the country.
"As navigators, providers, and administrators, we have to get ourselves business savvy about what we need to do in regard to value-based cancer care," she said. "Because, guess what? It's not going away."
Key Barriers to Administrator Engagement
A focus group made up of administrators and navigators convened at the 8th Annual AONN+ Navigation & Survivorship Conference to address the barriers and challenges navigators currently face with administrator engagement.
When asked what was needed from administrators to foster the support of navigation programs, the group cited 2 major requirements: (1) clear job descriptions that reflect navigator core competencies, national guidelines, and knowledge domains, and (2) strong and specific navigation orientation, and annual competencies.
The focus group also expressed concern that navigation programs were deficient in collecting outcome metrics for navigation processes to measure return on investment (ROI), clinical outcomes, and patient satisfaction.
"If you want to have your program around a few years from now, you need reports and metrics," said Ms Strusowski.
What Should Administrators Know About Navigation Programs?
Administrators need to know the value of a navigation program to justify the utilization of its services and the program's ROI. Because of the economic challenges of cancer and the move toward value-based care, this knowledge is critical.
The Advisory Board Oncology Roundtable came up with 5 key questions that administrators should be asking of the navigation programs at their institutions:
- How do I make sure navigators are adding value to the cancer program?
- How do I help navigators succeed in their role?
- How do I integrate navigators into the broader team?
- How do I make sure the patients who would benefit the most from navigation receive it?
- How do I measure the value of navigators?
To increase the ROI for navigation, the Advisory Board recommends that programs perform data-driven analyses to demonstrate the impacts on patient care delivery and outcomes due to navigation
"When you can look at these hard numbers, and they show you exactly where to go with your programs, it's very, very powerful," she said. "And administrators are always looking at the numbers. The first thing they're saying is, 'Show me the data.'"
The NAVmetrics Study
To demonstrate the value of navigation through hard data, AONN+ published 35 standardized, evidence-based, oncology navigation metrics in 2017. The next phase of the initiative will be launching a multisite quality pilot study of 10 of the metrics to test the feasibility of data collection across settings, and to further validate the reliability and validity of the measures, Ms Strusowski explained.
The pilot study, NAVmetrics, is a collaboration among AONN+, the American Cancer Society, and Chartis Oncology Solutions. It will launch at 8 sites: 2 academic care centers, 2 community care centers, 2 centers that participate in the Oncology Care Model, and 2 maturing programs with no reports or metrics in place. Each site will report on their data collection processes, as well as the extent to which they are able to successfully implement the chosen metrics.
According to Ms Strusowski, some sites have already expressed concern over their ability to collect valid and reliable data.
"But we're going to walk through this process together; there will be a lot of support," she said. "We don't want to only identify the barriers and challenges to implementing these metrics, we want to overcome them. We want to have sustainable results in regard to this study, because it's not going to stop at the end of this project. It's just the beginning."