Part 6: Hospitals Need Product Managers – Navigators

Part 6 in the Series on why Hospitals Need Product Managers is going to focus specifically on patient or care navigators. Physicians may be the ones prescribing and recommending the care, but those that are coordinating and ensuring that the care plans are delivered to patients at the right time, right place, and in the right language are highly valuable.

pt nav 1

In my various experiences, the traditional role of a patient navigator was always held by a registered nurse. I have had the pleasure of working in several Magnet Hospitals. I was also privileged to work at one of the original 16 pilot sites for the National Cancer Institutes Community Cancer Centers Program (NCI-NCCCP). Our facility happened to have been awarded grant dollars to focus on all of the pillars, one being specific to patient navigation.

According to the research, collaboration, and sharing between the networks we discovered several shared needs and focus on the role of navigators specific to the care of patients with a cancer diagnosis.

pt nav 2

Here are 6 insights from the NCCCP research that all navigator programs should take into consideration:

1. Patient education on diagnosis and treatment

2. Connecting with local resources for financial assistance

3. Coordinating screening and follow up appointments

4. Quick referral for resolution

5. Collaboration with multidisciplinary & clinical trial teams

6. Single point of contact for patient to connect with, at times in culturally sensitive environments, & obtain support

The recommendation from the research and body of work is summed up in the navigator template.

One of the things that I discovered in my own experiences was that there were a couple of disconnects in most navigator programs. So in conducting our research we decided to again ask patients what it is that they needed and expected when it came to dealing with their care associated with a diagnosis of cancer.

Again, it came down to the 3 main categories: TIME–TEAM–TRANSITIONS

TIME: Patients did not want to have to wait. However, this “wait period” did not always mean that a patient wanted to have all of their appointments and information delivered at the same appointment.

Patients wanted options. Patients wanted to have the power of choice. Patients wanted to know if they wanted something done that day that it could be performed. Other patients wanted to have the ability to go home, talk to their family, and have them come along for support. Other patients wanted the ability to do a combination of both. Ultimately, patients wanted to be kept in the loop of the conversation, the next steps, and the progress.

Timeliness in communication was critical.

TEAM: Patients wanted to know that they had all of the “experts” weighing in on their case. Based on the 2012 Cancer Program Standards from the American College of Surgeons Commission on Cancer, Standard 1.2 requires the following physicians: Diagnostic Radiologist, Pathologist, Surgeon, Medical Oncologist, Radiation Oncologist, Cancer Registrar, Oncology Nurse, Social Worker, and Palliative Care Team.

Tumor Board

Historically this team meets on a routine basis to discuss patients that have been diagnosed with cancer. In the last 5-7 years, there has been a movement to discuss newly diagnosed patients versus reviewing cases that have already treated patients.

The disconnect is that patients are never informed of the team meeting, discussing their specific diagnosis, recommendations for care, and next steps. Generally, the medical oncologist delivers the overall message to the patient, but the power of the team meeting is never seen by the patients.

TRANSITIONS: Patients get frustrated, lost, fear and anxiety builds when too much time lapses. There needed to be clear indications on what each step entailed, what the next step in the process was going to be, when it was going to be, with whom it would be with, and where it would be performed.

Patients also didn’t need the confusion of multiple numbers, multiple people, and having to wait on hold. They needed a single point of contact to be able to connect with the same person that knew their specific plan of care and could answer and assist the patient as they needed.

 In developing a navigator program I began with a “job mapping” exercise. The exercise allowed me to understand all of the actions that need to be performed by a person in this role. (HBR article on job mapping)

The conclusion I made was that a nurse may not necessarily be the “right” person for the navigator role. Not because a nurse isn’t qualified to do the work, but because a nurse could be utilized to provide care. In fact, in most organizations I have worked for and with, most nurse navigators become the “band-aid” for broken processes in care for patients.

Instead of having the team responsible for that aspect of the patients care, a nurse navigator would step in and “do it themselves.” This may alleviate anxiety, but it doesn’t solve the problem. It also doesn’t always produce the right care for the patient.

I looked to other healthcare resources and focused on social workers. There is a 2011 publication from the National Association of Social Workers entitled Social Workers in Hospitals & Medical Centers that gives a great overview on the scope of work for most social workers.

As I began to think through the needs of a patient and their family members after a diagnosis of cancer, it became very clear: a social worker may be the key to navigating the world of a cancer diagnosis.

patient-navigator 3

Social workers are connected to the community. The are well versed in the resources available. They are used to fighting on behalf of the patient. They understand, can screen, and evaluate the psycho and social well being of a patient and their family members. Social workers are accustomed to traversing people between clinics and hospitals and managing from outpatient to inpatient stays.

Social workers are great collaborators and facilitators. They tend to be empathetic and understand all of the stakeholders needs, but facilitate and advocate on the behalf of their patients.

Social workers are highly skilled at needs assessments.

Social workers are familiar with the need to pull together disparate information. They are used to working in a multidisciplinary team to get all of the information, and then share that information with the patient and family on a timely basis.

Social workers also take the time to deliver the same message, in different ways, over several touches to ensure the message and questions are covered.

We ended up creating a new program with a “coach” that focused on the specific diagnosis of cancer for each patient.

That “coach” was introduced to the patient early in the process. Within minutes after a patient was being transitioned from NOT having a cancer diagnosis to being told that they now have cancer, they met their coach. Patients began to see that they had a person that was focused on their care, on their needs, and meeting their specific expectations.

At the same time the “coach” was well versed at how to best manage the TEAM, the TIME, and the TRANSITIONS that patients diagnosed with cancer face.

Our “coaches” helped the TEAM to produce an environment full of the care that allowed patients to not focus on the “Who, What, Where, When, and Why” of their cancer diagnosis.

Now patients could focus on the most important things:

Getting Better, Survival and Family.

 As always, you can feel free to contact me at: CANCERGEEK@GMAIL.COM or follow me on twitter @cancergeek

~CancerGeek

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