Using the navigation process to improve both your program and your patient outcomes

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DENVER, CO—Navigation programs are developed to provide education for patients, family, and caregivers; timely assessment of patients' needs; guidance on managing care, community resources, and provide emotional support. But once your program is in place, where do you go from there?

The key to the sustainability of a navigation program is effective use of quality benchmark measures, explained Karyl Blaseg, MSN, RN, OCN, and Tricia Strusowski, MS, RN, of Billings Clinic Cancer Center in Billings, Montana, in their presentation at the 2015 Oncology Nurse Advisor Navigation Summit. Navigators have an in-depth knowledge of evidence-based care guidelines and a unique awareness of care barriers, and can readily identify process improvement opportunities.

Successful quality improvement (QI) programs focus on the customer. An important measure of a navigation program is the extent to which the patient understands their care. A problem statement would identify the gap in care and measures the impact on patients.

The QI program needs to define the process. Two commonly used tools are the process flow map and the fishbone diagram. The process flow map illustrates a specific process by showing the sequence of events. When you follow the sequence, you can identify barriers and inefficiencies. A fishbone/cause and effect diagram identifies the contributing factors that lead up to the problem.

Analyze the data to develop the goals needed to improve outcomes. In her example, Strusowski defined the problem as patients undergoing breast surgery were not consistently referred to a lymphedema specialist (LES). Based on their institution's data, only 48% of these patients were referred to a LES. The impact was that 52% of patients at risk for lymphedema were not receive appropriate preventive education and lost revenues of $7,000. The goal was to have 100% of patients undergoing breast surgery be referred to a LES preoperatively or within 30 days postoperatively.

Finally, Strusowski emphasized the importance of teamwork to make effective changes. The more people you have involved in the process, the greater your chances of making the changes needed to improve patient outcomes.

Navigators are in a key position to identify and lead improvement initiatives. All QI models have common elements; therefore, navigators need to assess how their programs meet the needs and expectations of their patients to use the model that best monitors how their program functions. Navigators can start with small changes; identify two priorities they want to address and the strategies they might use. Consider the motto, “Progress, not perfection.”


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