Building Collaborative Stakeholder Partnerships in Navigation Programs

Building collaborative relationships is crucial to the success of navigation programs, and ultimately, to patient satisfaction, according to Jess Quiring, CN-BA, OPN-CG, oncology navigation and outreach manager at New Mexico Cancer Center.

At the Academy of Oncology Nurse & Patient Navigators (AONN+) 13th Annual Navigation & Survivorship Conference held in New Orleans in November, Ms Quiring discussed the importance of navigators building collaborative relationships within their communities, how these partnerships will benefit their navigation programs, and how they can expand their capabilities to connect patients to much-needed resources and auxiliary services.

“If we could wave a wand, we would have everything we needed in our clinics, but our clinics don’t always work that way, and the health system certainly doesn’t,” she said. “We face a lot of barriers.”

But according to Ms Quiring, there are ways to build out a navigation program “without spending a bunch of money,” which is especially important to navigators who are trying to demonstrate the return on investment of their programs.

Identifying Stakeholders: Who Are They, and Why Do You Need Them?

Stakeholders are individuals or groups who have an interest in a project and can influence its outcome.

“The patient and the clinical team are primary stakeholders, but a stakeholder is really anyone who has an interest in something you’re doing,” she noted.

Identifying stakeholders who can have a positive impact on a navigation program is a crucial part of developing good collaborative relationships and establishing good rapport within programs. When successful relationships are developed, the patients reap the benefits.

According to Ms Quiring, finding these relationships requires looking beyond the walls of your clinic. Potential community partners and stakeholders might include:

• Allied Health Professionals: Abbott Nutrition, Home Care Assistance, Society for Oncology Massage, etc
• Partners like Abbott Nutrition or Nestle Health Science provide services like nutritional supplements, nutrition intervention resources (designed by local certified oncology dietitians), and free oncology dietitian consultations
• Behavioral Health/Emotional Support Partnerships: The Grief Center, Psychology Today (an excellent resource for finding local clinical professionals, psychiatrists, and treatment centers who accept insurance, as well as further information on the focus of each practice)
• Focus on identifying local behavioral health services as well (eg, Pink Warrior House is a breast support organization based in New Mexico)
• Local and National Patient Support/Advocacy Organizations: Pink Warrior House, American Cancer Society, Cancer Support Community, Thrive Causemetics, etc
• Volunteer Organizations: American Cancer Society, Leukemia & Lymphoma Society, etc
• Food Pharmacies and Community Outreach Partnerships
• Food banks typically provide their services to patients about once a month, but clinicians can refer patients in need of dietary support for weekly access to food
• COPE (Community Outreach & Patient Empowerment) serves Navajo Nation and provides Native Americans with access to healthy food in their communities
• Auxiliary Services: lymphedema specialists, oncology massage therapists, etc
• Public Health Initiatives That Impact and Support Care

“Find out what your local Department of Health is doing and identify their health educators,” she advised. “They might be doing something that you can bring into your practice to support your patients.”

According to Ms Quiring, following a few simple steps can put navigation programs on the right path toward building these collaborative stakeholder partnerships.

STEP #1: Find the Gaps in Care

“First, identify what you’re missing, that you wish you had,” she said. “What are your patients missing that they wish they had, and what are they missing that you wish they had?”

Navigators do their best, but they cannot do everything. Identifying what needs to be brought into a navigation program from the outside is crucial. Perform a gap analysis in care connections and identify what you do and do not have in your program (eg, transportation services, partnership with a food pantry, yoga/meditation groups, lymphedema therapy, a dietitian on staff).

STEP #2: Partner with Other Stakeholders to Close Gaps in Care

For example, if your navigation program is lacking transportation services, identify possible transportation partnerships and pinpoint which stakeholders make the most sense (and why), said Ms Quiring.

“Prioritize how you need to help the patients in your program,” she advised. “What is the biggest need, and which stakeholders can provide the most bang for your buck?”

Volunteer driving programs were common before the COVID pandemic, and although they have slowly begun to rebuild, many are still not operating at the capacity they once were. But navigation programs can explore other possible partnerships through companies like Ride Health (similar to Uber, but the ride is billed to the clinic), GOGO Medical Transport, Envoy America (either the patient or clinic can pay for a ride), and the American Cancer Society.

At her clinic, patients can receive up to 2 free rides through Ride Health before having to qualify for additional financial assistance for nonmedical needs like transportation.

“This has reduced our no-show rate,” said Ms Quiring. “These rides are especially helpful when patients are just getting started with treatment, they don’t want to come in, and any little thing might stand in their way. We can at least get them there.”

STEP #3: Making the Case, Leadership Buy-In

Building and sustaining these partnerships requires leadership buy-in, so navigation programs have to be prepared to make their case.

“It has to be a win for both parties,” she said. “You have to show why you need it in your cancer center, and you also have to be transparent about the win for your partner. They need a reason to want to do it, since there’s no money changing hands.”

To make your case:

• Do your homework
• Provide well-documented gap analysis data
• Provide background and justification for the partnership
• Be transparent and disclose stakeholder interest
• Will a business agreement be needed for HIPAA?
• Identify other staff involved in connecting patients to the community partnership (will it impact their workflow?)

“If other staff are not happy, that will be an impediment to the success of the program, as well as to your partner feeling welcome in the center,” she noted. “Ultimately, your patients will feel that along the way.”

• Organize a meeting for all parties if necessary
• Capture approval in writing, even if it was a verbal “yes,” and follow up with an e-mail to recap the conversation

STEP #4: Being a Good Partner

Once a partnership is established, identify the partnership program process by considering the following questions:

• Will patients access the services in the clinic, their home, at the other business, or somewhere else?
• Does an agreement or other contractual/legal document need to be signed?
• Is the service free, will insurance be used, or is it an out-of-pocket expense?
• How will the referral be made?
• How is the referral tracked in the electronic medical record? How do you plan to capture how patients are using these services?
• Is there a process for follow-up and closing the gap? (Did the patient receive services?)
• Are there any issues (process improvement)?
• Schedule frequent check-in meetings for new programs. In time, schedule meetings at regular intervals according to need

If issues are identified, do not abandon ship; first use process improvement steps to make adjustments and remedy any problems, she advised.

“There’s bound to be changes, especially when you’re working with outside partners,” she added. “Be a good partner by following up, being faithful, and having standing check-in meetings to make sure the programs are working for both sides. Then, finally, reassess your changes and improvements.”