Nicole Centers and Lindsey Reed discuss navigation program analysis at the AONN+ Annual Conference.
When it comes to justifying the need for navigation resources, building a business case is a nonnegotiable, according to Lindsey Reed, MBA, BSN, RN, OCN, ONN-CG, director of navigation for Sarah Cannon in the HCA Midwest Division, and Nicole Centers, MBA, BSN, RN, OCN, CBCN, CN-BN, executive director of Oncology Service Line at Wellstar Healthcare System in Marietta, GA.
“A business case is the justification of undertaking work or a project; it’s just a fancy word for it,” said Ms Centers. “It provides the rationale for the preferred solution, including benefits, costs, and risks. But if you go to an executive leader, they’re going to ask you how you plan to pay for it, because you don’t have unlimited funds.”
At the AONN+ 13th Annual Navigation & Survivorship Conference held in November, Ms Reed and Ms Centers detailed a step-by-step process for creating a business case for navigation, emphasizing the importance of being organized and self-assured, staying on task, fostering opportunities for engagement (while being direct but realistic about your needs), and, crucially, always having the data to back up your argument.
Program Analysis: Strengths and Weaknesses
“Program analysis is where you’ll need to start, even if you currently have a navigation program,” Ms Centers said. “Evaluating where you’re at and where you want to go is really important.”
Gaining buy-in from internal stakeholders (ie, cancer center directors, COOs, executive sponsors) is the next important step.
Gain insight from external stakeholders (ie, community partners) about gaps in care, and importantly, do not forget about patients. “Look at patient feedback from surveys and find out how they thought their care went,” she said. “You can gain so much insight from going directly to the patient and finding out their needs.”
Next, conduct a community needs assessment. “Often, this is something that your facility already has,” she said. “A lot of times it will identify the top tumor sites within your area, where patients are coming from, as well as their demographics, so you can really assess patient need and what type of navigation you want to start with.”
Subsequently, take a look at the competitive landscape and figure out what your competitors are offering patients. Do they have navigators? Where are they focusing their services? “Highlight program differentiators; if they’re doing something better than you are, consider modeling after them,” Ms Centers said.
According to Ms Reed, the bottom line is taking the best possible care of the patient. “Connect with other navigators in your city and find out what they’re doing,” she advised. “It doesn’t really matter if patients are going elsewhere; you just want to make sure that the best care is being offered to them, and as you build relationships with other navigators, you can help with that.”
Finally, take all of the information gained from these steps, and conduct a gap analysis of your program.
The Gap Analysis
Step 1: Define the current state of your navigation or oncology program.
“You want to highlight what you’re doing and celebrate those wins that you have,” she said. “But take a step back; dream big and determine where you want to go. What do you want for your patients? Are you missing out on some areas of their care? Is timeliness an issue? Honestly determine whether or not you’re meeting their needs.”
She noted that even if the metrics to support this information are lacking, rely on what navigators have actually seen. “The navigators see everything, the whole program, from start to finish,” Ms Reed said. “You can use that information to help guide where you want to go.”
Step 2: Highlight the best practices needed to move the program to the next level.
Step 3: Determine how close the organization is to reaching the desired goal.
Step 4: Evaluate the strengths and weaknesses of the program and define your stakeholders. Who will you get to support your program and help you take it to the next level?
Step 5: Create and execute an action plan to map out and reach your desired goals.
Determining Strengths and Weaknesses
When determining the strengths and weaknesses of your program, consider the following:
- Software tools (Is this a strength or a weakness?)
- Current offerings in program and locations (For example, you wouldn’t want to build a lung nodule program if you don’t have a surgeon for it)
- Workflows (Are there bottlenecks in the process? Talk with your teams—the clinic nurses or schedulers might have some great suggestions)
- Timeliness to care. “Navigators can really identify those bottlenecks and help remove some of those barriers,” Ms Reed said
- Patient satisfaction: read comments and pull out the necessary information to drive your program
- Physician satisfaction: it is crucial that physicians are happy; look for opportunities to meet with them and talk about what you can do for their patients
- Workspace in use and available: where will you meet with patients? Will it be done over the phone? How much time do you have to spend with patients?
- Current staff. “Maybe you have a navigator with some bandwidth who can take on navigating a new tumor site in addition to their current workload,” she noted.
In this process, Ms Reed noted the importance of not becoming discouraged when identifying weaknesses. “Look at those as opportunities to be successful in the future, and as a glimpse of what your program can look like,” she added.
Utilizing Registry and Data Analytics
According to Ms Reed, analytic volumes are a great place to start when determining the demographics and volumes of a patient population, including tumor sites and stages, as well as outmigration. If analytic data are not available (ie, outside of a hospital environment), intake data related to referrals, tumor type, and stage can be used.
“And if you don’t have it already, start tracking it now,” she said.
Once data analysis is complete, it’s time to map out your business case: detail the current state of your program, have the data to support your case, review your programmatic gaps, and detail the strategies necessary to achieve the future state of your program.
Preparing and Presenting the Business Case
Typically, navigation is not a billable service (unless the navigator is going to be the primary educator as well; you can bill for this service in some instances).
According to Ms Centers, when it comes to funding navigators and navigation programs, downstream revenue is usually the best bet. Downstream revenue equates to funding; this comes from things like radiology procedures, patient retention, infusion therapy, imaging, surgery, and office visits.
“All of this comes down like a rain cloud and fills your river of revenue,” she said.
However, it’s important to keep in mind that money for competing priorities like overhead, salaries, indigent care, and community services comes out of the same revenue stream (and navigation typically comes last). “So you can’t just say, ‘that whole pot is mine,’” she said.
Additional points to consider when preparing your business case include the number of new patients brought in due to navigation, grant opportunities that can offload part of the financial burden from a facility, research funds, and the overall care continuum. Look at key performance indicators (KPIs) influenced by navigation (always making sure to have a benchmark), including new patients navigated, mean time from diagnosis to treatment, average acuity, and number of emergency department visits due to chemotherapy sequelae or postsurgical events.
“We know navigators keep patients out of the emergency department and increase screening volumes,” she said. Put simply: when people are screened earlier, they are diagnosed earlier, and early-stage cancer is cheaper to treat than late-stage cancer.
“Measure KPIs so that when you go to have these conversations with your executive leadership, you can say: ‘this is where everybody else is, and this is where we are,’” she said. “You have to start somewhere.”
Bottom line: when it comes to making a business case for navigation, have sufficient data to make your case (and consider the “love language” of your audience: ie, reference KPIs relative to nursing for a nurse leader and finances/revenue streams for CFOs).
“You have to go in with the understanding that navigators are not free (so have a salary analysis), and that the leader you’re speaking to has limited time,” said Ms Centers. “We’re also in the era of cutbacks, so we have to decide where we’re going to spend our money as healthcare leaders. You have to have a valid conversation when you come to that table.”
