The Navigator Matrix

November 2011 Vol 2, No 6

At the second annual AONN Navigation and Survivorship Conference, Karyl Blaseg, RN, MSN, OCN, of the Billings Clinic Cancer Center; Tricia Strusowski, MS, RN, of the Helen F. Graham Cancer Center; and Jay R. Swanson, RN, BSN, OCN, of the Saint Elizabeth Cancer Institute presented The Navigator Matrix.

Designed to assist in standardizing navigation programs, the matrix is a tool that can also help determine what can be done to meet the needs of patient populations. Blaseg, Strusowski, and Swanson presented the following 16 navigation program building blocks, each containing 5 levels of qualification.

KEY STAKEHOLDERS are those individuals essential to making your program work (administration, navigators, staff, physicians, and specialty medical personnel). The operating levels of this aspect range from strictly administrative program support (Level 1) up to a navigation program that receives referrals from MDs, PCPs, or community partners (Level 5). The answer to growing a program’s key stakeholders, according to Swanson, is oftentimes the acquisition of a champion physician, or a “gatekeeper,” willing to connect a navi gator to the patients.

COMMUNITY PARTNERSHIPS are those entities that exist within and outside the navigation program that contribute to the support of the patient or are a referral source for the patient. According to Swanson, “You can’t exist within your own program if you’re not able to meet all of the needs of your patient. And that’s going to require a whole cadre of internal and external supporters that are going to be able to help you with that.” This building block includes partnerships with national groups (ie, NCI, ACS, Susan G. Komen, LIVESTRONG), state organizations, and local community partners.

An ACUITY SYSTEM is a way to determine the appropriate level of care that each patient needs. This area of the program includes formal assessment tools, a well-defined referral process, and other proactive approaches so there are no gaps in patient services.

QUALITY IMPROVEMENT, or METRICS AND REPORTING MEASURES, involves measuring program performance. In other words, using reports to establish the importance of the program so that others may see the benefits of navigators. At a Level 5 for this building block, a program would have multiple quality improvement initiatives in place and monitored to demonstrate program improvement, financial contribution, and cost-saving services.

The MARKETING aspect of the navigation program matrix ranges from basic word-ofmouth program marketing (Level 1) to pamphlets (Level 2) to health fairs and other multiple media sources (Level 5).

The process of getting the information out to the physicians’ and the surgeons’ offices so the patients come into the facility knowing there’s a navigator available for them is the sixth building block, PERCENTAGE OF PATIENTS OFFERED NAVIGATION.

The seventh building block, CONTINUUM OF NAVIGATIONAL CARE includes outreach/ screening, abnormal finding to diagnosis, treatment, outpatient and/or inpatient, survivorship, and end-of-life care. A Level 5 program provides patient navigation continuously across the cancer care continuum.

The next navigation program building block is SUPPORT SERVICES available and used by the navigation team. These resources are numerous and include dietitians, social workers, psychologists, clinical trials, physical/occupational/ speech therapists, pastoral care, oncology rehab, financial counselors, palliative care, genetic counselors, etc.

REPORTING STATISTICS involves documentation designed to evaluate and measure the navigation program. Levels within this matrix block range from paper patient charts (Level 1) to homegrown spreadsheets (Level 2) to formal hospital electronic medical records in which all support services provided to the patient are documented (Level 5).

FINANCIAL ASSESSMENT of patients in the navigation program is almost as important as the physical assessment. The expenses for not only medical care and treatment but also the additional costs associated with the effects on life change are dramatic for patients. A Level 5 navigation program will have proactive financial assessment completed for all oncology patients plus data collection completed on types of services provided and number of patients assisted on a regular basis.

A benchmark navigation program will FOCUS ON DISPARITIES. This entails providing outreach and effort to any underrepresented population in the community. Further more, this focus includes cancer cultural awareness among staff, with cultural objectives created on at least an annual basis.

While maintaining a central core responsibility of patient assistance, NAVIGATOR RESPONSIBILITIES must grow as a program evolves. From Level 1, when the navigator is responsible only for the support of the patient to Level 5, when responsibilities expand to support groups, tumor conferences, audits, and strategic planning, the primary focus is always the patient.

Another navigation program building block is the PATIENT IDENTIFICATION PROCESS. Navigators have to find a way to interact with their patients. This is the process of developing from a program that has to search for patients (Level 1) to a program receiving referrals from a PCP at the time of an abnormal finding (Level 5).

To ensure a high quality of care and commitment, NAVIGATION TRAINING is essential to any program. This involves defining core competencies of navigation, local training for all navigators, and finally, formal training and certification by nationally recognized programs.

With clinical trials being a major part of the advancement of cancer care, it is important that navigation ENGAGE WITH CLINICAL TRIALS to offer patients the best possible care. A Level 5 program will have a trained navigator sharing trial information with patients, engaging with research teams, and assisting with specific trial referrals for underserved populations.

The final navigator program building block is MULTIDISCIPLINARY CARE. This means the plan of care for the patient involves a multidisciplinary team approach including physicians and other healthcare providers. A benchmark navigator program includes the navigator and patient on the multidisciplinary team. The patient is informed of the case presentation, the patient receives a full report on the treatment plan discussion, and formal audits are completed.

Programs throughout the country are already using the 16 building blocks of this tool as a means to establish the importance of the program and improve quality. In closing, Swanson encouraged those in attendance to use the matrix as a foundation to advance current programs and move forward with improvements in patient navigation.

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Last modified: November 15, 2022

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