Whether an oncology navigation program is just starting out or has already become a well-oiled machine, there are usually a few—or perhaps, quite a few—ways that a navigation program can potentially be improved, according to Lillie D. Shockney, RN, BS, MAS, ONN-CG, Co-Founder and Program Director of the Academy of Oncology Nurse & Patient Navigators (AONN+).
At the AONN+ 9th Annual Navigation & Survivorship Conference, Ms Shockney moderated a session focused on “supercharging” oncology navigation programs. The panelists, Crystal Dugger, RN, BSN, MBA, Assistant Vice President of Clinical Operations at Sarah Cannon; Katherine Sharpe, MTS, Senior Vice President of Patient and Caregiver Support for the American Cancer Society; and Sloan Maes, MSN, RN, Oncology Service Line Director at Memorial Hospital - University of Colorado Health, shared insight into breaking down the common barriers to developing, implementing, and sustaining a successful navigation program, and focused largely on the importance of demonstrating its value to cancer center administrators.
Don’t Reinvent the Wheel
Often, institutions don’t know where or how to begin a navigation program. According to Ms Shockney, gathering baseline information and conducting a needs assessment should come before any attempt to make changes. “I always say, ‘You cannot manage what you do not measure,’” she said.
“You’re one of the most important parts of the cancer program, and you are likely a navigator because you were cream of the crop,” said Ms Dugger. “You were the best nurse that they saw when they looked for a navigator: someone that was strong, that always followed through, had no issues with trust, and was a great communicator. And that’s why many navigators have been successful with literally no training whatsoever, because they did figure it out. That’s what we do, right?”
“But if you feel frustrated or you feel like you’re out there on an island, you are,” she added, noting the importance of utilizing resources that have already been developed and tested, such as the AONN+ Standardized Evidence-Based Oncology Navigation Metrics, or the robust metrics program designed by Sarah Cannon. Ms Maes added that navigation programs should capture metrics that are relevant to their own institution and important to their stakeholders; for instance, a community-based program would prioritize different metrics than a larger program like Sarah Cannon.
The Issue of Funding
One of the primary considerations in launching a navigation program is funding. “A lot of navigators are still funded through grants or philanthropy, and that’s really not sustainable,” said Ms Shockney.
Demonstrating return on investment is crucial to securing the funding necessary to build and sustain a navigation program. According to Ms Sharpe, the use of standardized metrics across navigation programs will continue to contribute to the evidence base around navigation and demonstrate the value of that investment.
Procuring navigators also requires a project plan. “You need a proposal. You need to understand exactly what you’re trying to accomplish, what your goals are, and what your success metrics are,” said Ms Dugger. “Administrators are usually from a health business background or an accounting background. They do not have the knowledge you have. Your impact and your knowledge are so valuable to them.”
“Shoot for the stars,” she added. At a meeting with administrators, ask for more navigators than you’ll realistically receive, and reach a compromise. Find a physician champion or champions who believe in navigation and can help in obtaining buy-in from executive leadership, and bring them to join in on the conversation. Then, pick a few metrics—3, not 30—and go demonstrate their impact, she advised.
Take every opportunity to tout the efforts of the navigation team, because that can have a major impact on funding decisions, Ms Sharpe added. Save thank you cards, patient satisfaction comments, and notes of gratitude from patients in a portfolio. “They’re incredibly important,” she said.
Defining the Navigator’s Role
According to Ms Dugger, the absence of metrics makes it incredibly difficult for administrators to really understand the role of the navigator.
“You have to be very strict in defining your focus and your priorities. You have to stick to them, and you need an administrator and a physician that have your back, understand what you’re doing, and advocate for you every single day,” she said. “And never walk into a room without data.”
Take time for yourself and use your PTO, she urged. “If you’re the only one that can do your job, then you didn’t build a very sustainable program. You have to build something that allows you the time to walk away; it’s extremely important in our programs.”
Because navigation is such a young industry, Ms Dugger encouraged navigators to share what they’ve already learned with their colleagues. “JONS would love to publish your work,” she said. “Have the confidence to turn it in. Help us learn.”
According to Ms Sharpe, there can be a lot of role blur between office nurses, social workers, and navigators. “All of these folks can do different components of what a navigator does,” she said. “So it’s really important that you define in your institution who is doing what.”
Unfortunately, attaining the necessary administrative support to build and foster a navigation program can sometimes be thwarted by “oncopolitics,” a phenomenon that essentially consists of competitive interests or power struggles in oncology care.
Some physicians will simply never be supportive of navigation programs. In acknowledgment of that, Ms Dugger said that navigators shouldn’t spin their wheels trying to win over those individuals. “Go get his partners or friends, or some of his competitors that still work with your space, and start to work with them and let them sell the story for you,” she said. “Honestly, a couple of our physicians that were our biggest naysayers are now physicians that won’t work without a navigator.”
“I encourage you and challenge you to understand who you are, to understand your impact, and to understand that your job shouldn’t be to take out the trash every day,” Ms Dugger added. “Your top priority should be what that patient needs, removing those barriers, and ensuring they can be adherent to their pathway, because you are going to impact survival.”