Performance Improvement: The Role of the Navigator

September 2020 Vol 11, No 9

Oncology navigators rely on metrics to demonstrate the value of their role. According to JoAnn Lovins, MS, RN, NEA-BC, performance—characterized by measures such as employee engagement, finance, volume growth, quality, and patient engagement—has recently emerged as a key metric in demonstrating the value of navigation.

“It’s now loud and clear that performance is emerging as a key measurement across the country, particularly because we’ve recently had both a healthcare crisis and an economic crisis,” said Ms Lovins, Senior Director of the Oncology Service Line at UCHealth, Fort Collins, CO.

At the AONN+ 2020 Virtual Midyear Conference, she discussed the key factors involved in facilitating performance improvements and improving patient care. The first step, she said, is recognizing that a problem is “your invitation to the table.”

“Historically, the role of the navigator has been an innovative one,” said Ms Lovins. “Their value is becoming increasingly evident, but it’s also an agile role.” She described 2 distinct processes for implementing performance improvement initiatives: Plan, Do, Check, Act, and the LEAN methodology, which she explained in further detail.

The LEAN Method

According to Ms Lovins, her institution relies heavily on the LEAN process, which involves first identifying the reason for action (the problem), then aiming to remove this barrier for patients and improve their access to care.

“Think about the different things you can do for the multiple stakeholders involved, as well as the multiple metrics that can be used,” she said. “Look at the current state, the target state, and the ideal state; look at the gaps, and then get a plan going.”

To further elucidate the LEAN method, she conducted a literature search and identified a consistent problem across institutions, including her own: that of patient referrals. The reason for action is inconsistent referrals, and patient problems were arising along the continuum that could have been prevented with early referrals. Compounding the problem was the lack of a defined process for those referrals, the fact that making a referral adds another step to the workload of other clinicians, and a lack of clarity of the value of navigators as a part of this process.

The broad aim for addressing this problem was meeting the objectives of navigation (identifying and removing barriers for patients and ensuring timely access to high-quality care). More specifically, the aim was to identify the root cause for delays and to create a standard trigger for referrals (thereby eliminating any extra work on the part of clinicians). “We found that the referral process involved too many steps, including training providers, intake coordinators, and schedulers, so we set up a standard trigger for the referrals,” she explained. “Everyone agreed that for all new patient visits, patients would be referred to our oncology navigators, a financial case coordinator, and our clinical research team.”

This plan helped them to reach the ultimate goal of consistent referrals, and in turn making the value of navigation visible to patients and all stakeholders.

“Prior to this, our referrals were inconsistent. But once we instituted electronic referrals, they were very consistent,” she said. “All new patients were told they’d be contacted by a navigator, and since COVID-19, patients have found a pre-call before their physician appointment to be more and more valuable.”

The subsequent gap and action plan involved listening to patient feedback about their own experiences, particularly regarding the time from diagnosis to treatment.

“I’m responsible for a very large budget, and at my hospital we diagnose and treat about 2000 patients a year. Now, as we’re getting patients back in who were delayed or postponed for several months due to COVID-19, the time from diagnosis to treatment becomes a key metric,” she said. “That, right there, was an invitation to the table to prove the value of navigators being able to get patients back in for treatment. If they didn’t know the financial value before, there it was.”

The Power of Stories and Data

She said one of the most valuable processes they have implemented post-COVID is the ability to gather data about current changes and trends, particularly in regard to postponing or resequencing treatment modalities. “We have virtual group huddles 3 times a week, and by gathering information and posting those numbers and trends online, we can actually see and share what’s working and what isn’t.”

Measure progress and keep what is working, she added, then modify processes to address the things that are not. The performance improvement mantra used at her institution is, “No data without stories, and no stories without data.”

Have metrics on hand when arriving to the table with payers and administrators. “Having these metrics is really helpful, along with your stories,” she said. “When you give your CFO and your contract administrators the data, also give them an illustration—through great stories—to really illustrate that value. The story along with the data make the data real, and it then remains in people’s minds and hearts.”

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Last modified: August 10, 2023

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