The Navigation Metrics Toolkit: Measuring the Effectiveness of Your Navigation Program

June 2021 Vol 12, No 6 —June 16, 2021

An Interview with Tricia Strusowski, RN, MS; Chair of the AONN+ Metrics Committee

What makes an effective navigation program? Intrinsically, you know the answer to this question. But practically, it can be difficult to prove effectiveness. Unless, of course, you have the right tools.

The Academy of Oncology Nurse & Patient Navigators (AONN+) developed 35 separate and unique measurements—or metrics—to help you prove the effectiveness of your navigation program and measure its progress. Each metric is backed by evidence from the medical literature and is designed to assist navigators in assessing their programs in terms of clinical outcomes, patient experience, and return on investment of the navigation program itself. It is not only for the navigation program; the metrics can help support the cancer program as well.

But how do navigators implement metrics? How do you select a metric, or metrics, that apply to the goals and needs of your institution? How do you collect the data? What do you do with the data once collected? To help navigators with these questions, AONN+ and the American Cancer Society teamed up to create the Navigation Metrics Toolkit.

This Toolkit is a digital resource that provides guidance on how to select, implement, report, and utilize the AONN+ navigation metrics. So, how can you access the Toolkit? Simple. Just visit https://AONNonline.org/toolkit.

We recently spoke with Tricia Strusowski, RN, MS; Chair of the AONN+ Metrics Committee, about the AONN+ metrics and the benefit of using the Navigation Metrics Toolkit.


JONS  Can you talk about the importance of tracking the impact of a navigation program?

Sample pages from the Navigation Toolkit.

Ms Strusowski  Navigation metrics are essential for demonstrating the success and sustainability of a program. As with any successful organization, there needs to be metrics in place and a plan of action or performance improvement initiatives on how to enhance the outcomes of the metrics. Also, navigators need to develop some metric benchmarks and share this rich information on a national level.

JONS  Can the AONN+ metrics be used in small community oncology practices?

Ms Strusowski  A tremendous amount of thought went into the creation of the 35 evidence-based navigation metrics to make sure any navigation program—no matter how big or how small—can use them. They can be utilized by all models of navigation in any setting.

JONS  The AONN+ metrics are designed to measure clinical outcomes, patient experience, and return on investment of the navigation program itself. We’d like to learn a little about each of these areas. To start, why was clinical outcome selected as an area of measurement?

Ms Strusowski  Clinical outcome is an obvious and vital component for a cancer program. Many national oncology initiatives, such as the Quality Oncology Practice Initiative and the Oncology Care Model (OCM), to name just a couple, have developed metrics. The metrics developed by these initiatives support the 35 AONN+ evidence-based navigation metrics. The 2020 Commission on Cancer (CoC) and the 2018 National Accreditation Program for Breast Centers also expect navigation programs to develop and monitor metrics to improve the outcomes for their patients. So basically, the AONN+ navigation metrics support national oncology guidelines and value-based cancer care initiatives.

JONS  Can you speak to patient experience as an area of measurement?

Ms Strusowski  As navigators, we want our patients to have the best possible experience during their cancer journey. We want the patient to be engaged with their healthcare team and empowered to participate fully in decisions regarding their treatment plan.

Patient experience encompasses the range of interactions that patients have with the healthcare system, including their care from health plans to doctors, nurses, and staff in hospitals, physician practices, and other healthcare facilities.

Understanding patient experience is a key step in moving toward patient-centered care. By looking at various aspects of the patient experience, one can assess the extent to which patients are receiving care that is respectful of and responsive to individual patient preferences, needs, and values. Evaluating patient experience along with other components, such as effectiveness and safety of care, is essential to providing a complete picture of healthcare quality (source: www.ahrq.gov/cahps/about-cahps/patient-experience/index.html). In oncology, the navigator provides education, support, guidance, and follow-up to ensure that patient needs are proactively being met and barriers removed.

JONS  We’d like your thoughts on the return on investment of a navigation program.

Ms Strusowski  Navigators, regardless of the practice model, have the unique role of navigating the patient across the continuum. They have contact with patients at key episodes of care, which can be periods of high distress. They evaluate barriers and provide the appropriate interventions. The result is downstream revenue and decreased hospital admissions and emergency room visits.

A navigator team or program can be an expensive investment for a cancer program. So, leadership will want to identify metrics that apply to return on investment or business performance. AONN+ identifies 8 metrics in the operations management domain. The navigator is capable of influencing metrics such as 30-, 60-, and 90-day readmissions; emergency room visits; no-show rates; and patient retention.

JONS  The big question on everyone’s mind is how navigators should use metrics. Do you have suggestions on how to incorporate this task into a navigator’s workload?

Ms Strusowski  Navigation metrics and performance improvement are included in the Oncology Nursing Society core competencies and the AONN+ knowledge domains. The navigation team should meet with their key stakeholders and review the metrics and choose just a few to start with. Metrics can be tracked in a variety of ways, but the most effective way is through the electronic health record. The metrics should initially be assessed every month. You can create performance improvement initiatives to boost outcomes. The outcomes should be shared with the cancer committee, administration, and navigation team. This information can be utilized for CoC quality standards and included in the navigator’s yearly evaluation.

JONS  AONN+ has developed a Metrics Toolbox. Can you tell us a little bit about this resource and how navigators are using it?

Ms Strusowski  When the AONN+ metrics were initially presented at the 2017 AONN+ Annual Conference, the feedback was overwhelmingly positive, but 1 question kept coming up. We heard time and time again, “These metrics are great, but how do we implement them?”

In 2018, AONN+, the American Cancer Society, and Chartis Oncology Solutions conducted a national, multisite research study to assess the extent to which navigation programs could implement a set of 10 of the 35 metrics. The selected metrics aligned with national standards and indicators for navigation performance. With the pilot study completed, the next step was to develop a toolkit to help navigators, oncology program administrators, healthcare executives, and other clinicians who are linked to navigation understand and support the integration of standardized metrics measurement into their normal business processes.

The Navigation Metrics Toolkit is a result of the Institutional Review Board metrics study as well as best practices. It is full of rich information, documentation tools, dashboards, and case studies. Every navigation program should utilize this toolkit. It’s simply invaluable.

JONS  How can someone access the Toolkit?

Ms Strusowski  The Navigation Metrics Toolkit is a complimentary digital resource found on the AONN+ site. Anyone can access it by visiting https://AONNonline.org/toolkit.

JONS  Thank you for your time, and congratulations on this work!

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Last modified: September 3, 2021

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