The Health Care Manager Volume 33, Number 1, pp. 47–52 Copyright # 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Patient Service Navigator Improving Quality and Services and Reducing Cost Under the Affordable Care Act Llewellyn E. Piper, PhD, FACHE This article proposes the implementation of a Patient Service Navigator to improve quality, service, and the patient and family experience and to reduce costs in caring for patients in a hospital setting. Under the Affordable Care Act, the Patient Service Navigator is a means to address value-based purchasing whereby hospitals will be reimbursed based on quality and Hospital Consumer Assessment of Healthcare Providers and System scores for Medicare patients. In this article, the reader will learn the history, background, purpose, and role of the Patient Service Navigator as a critical component of a multidisciplinary health care team in supporting inpatient care with a human touch. Navigating for the patient and family in a confusing and complex health care delivery environment is critical today in order to survive the mandates of the Affordable Care Act. Key words: Affordable Care Act, hospital culture, Patient Service Navigator, patient- and family-centered care, value-based purchasing
P
UBLIC LAW 111-148, known as the Patient Protection and Affordable Care Act, commonly referred to as the Affordable Care Act (ACA), was signed into law on March 23, 2010.1 Although contested since its signing by President Obama in March 2010, it was upheld by the Supreme Court and by the public in the reelection of President Obama in 2012. The ACA is now the health care law of the land.2 This new health care law will significantly challenge the financial stability and survivability of hospitals and health care systems. Under the ACA, hospitals will face the wild unrest of the inbound urge of the incoming tide of illimitable change. The poignant essence of this change is the value-based purchasing mandate within this law that became effective in 2013. The haunting and disquieting effect is that hospitals will be confronted with a competitive value-based marketplace. In this cruel
Author Affiliation: Onslow Memorial Hospital, Jacksonville, North Carolina. The author reports no conflicts of interest. Correspondence: Llewellyn E. Piper, PhD, FACHE, PO Box 1358, Jacksonville, NC 28541-1358 ([email protected]). DOI: 10.1097/01.HCM.0000440619.54761.f9
sea of survival-of-the-fittest marketplace, there will be survivors and losers. Hospitals that survive will be those that are successful in competing on quality, services, cost, and the patient and family’s perception of care based on the Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) scores. As the rivers of change flow to the sea of unknowns, today’s health care leaders and managers must implement change to embrace the strong currents under the ACA. Survivors on this river of change will be those leaders who chart a new course of transforming the culture with a human touch and implement programs that reduce cost while improving quality, services, and the patient and family experience. ACA MANDATE The ACA is a mandate for change in the delivery of health care in America. Not since the passage of Medicare in 1965 has there been such a revolutionary federal mandate to change the socioeconomic dimensions of health care delivery and support of American citizens.1 Title III of the ACA will mandate a financial incentive to improve quality, services, and the patient experience under the Medicare program. This financial mandate is implemented through the Value-Based Purchasing Program, which 47
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
48
THE HEALTH CARE MANAGER/JANUARY–MARCH 2014
began in fiscal year 2013 with reimbursements for patient discharges starting October 1, 2012.1 With value-based purchasing, the paradigm shifts from volume to value based on quality care outcomes. Hospitals will be financially rewarded or financially punished based on national benchmarks for quality care outcomes related to specific conditions or procedures1: acute myocardial infarction heart failure pneumonia surgeries related to the surgical care improvement project health care–associated infections 30-day readmissions The HCAHPS scores comprise the second component of value-based purchasing. Hospitals will compete not only for quality outcomes but also on the patient experience or level of satisfaction as reported under HCAHPS scores. Again, hospitals will either be financially rewarded or financially punished based on HCAHPS scores.1 By law, transparency is now mandated with the requirement of public reporting of quality outcomes and the patient experience—HCAHPS scores. These scores will be publicly reported on a quarterly basis on a national Web site, www.hospitalcompare.hhs.gov. The financial survivability and sustainability of hospitals are now directly linked to quality outcomes and satisfaction scores that are available to the public on the Hospital Compare Web site, where ratings and comparison of hospitals will be the new era of health care.1,3 As leadership and managers consider programs to address the financial impact of the ACA, a program that is showing support of a methodology to reduce cost and improve quality, service, and the patient and family experience in the hospital setting is the Patient Service Navigator Program. Key to the success of the Patient Service Navigator Program is an organizational culture that embodies certain humanistic principles. BACKGROUND: PATIENT SERVICE NAVIGATOR Harold P. Freeman, MD, a surgical oncologist at Harlem Hospital in New York, came up with
the concept of patient navigators as means to eliminate barriers to timely cancer treatment and supportive care. The concept driving the patient navigator is to pair each patient with a navigator. The navigator is a nonmedical professional who can help guide patients through the complexity and dynamics of the health care delivery system. Freeman compared the navigator as a lifeboat; the navigator knows where the rocks are and can best guide the patient through the currents and safely to shore. Freeman launched the first patient navigator program in 1990 at Harlem Hospital in New York.4 On June 29, 2005, President George Bush signed into law P.L. 109-18, ‘‘Patient Navigator Outreach and Chronic Disease Prevention Act of 2005.’’ With the passage of this law, the US Congress provided $25 million in funding to implement the Patient Navigator Program nationally. The program has expanded over the years since the law was signed to support cancer patients in a more formalized and coordinated way to eliminate many barriers in cancer care.5 The Patient Navigator Program is starting to be used in the hospital setting to guide patients with other diseases and comorbidity issues. The program is now known in the noncancer care environment as Patient Service Navigator Program. PATIENT SERVICE NAVIGATOR The Patient Service Navigator is a problem solver and a highly resourceful individual. The Patient Service Navigator is a critical member of a multidisciplinary health care team to include the providers, the nurses, the technicians (laboratory, x-ray), therapist (rehab, dietitian, respiratory), and pharmacist as well as the discharge planner and patient educator. The navigator is a layperson who can coordinate the needed health care services. A social worker background is the best suited qualification for a navigator because of the skills and knowledge required. The Patient Service Navigator is trained to anticipate, address, and overcome barriers to care and guide patients through the health care delivery activities in the hospital setting. The social work experience is optimal along with a vast experience in health care delivery within the hospital setting and an understanding of
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Patient Service Navigator external support services such as rehabilitation, nursing homes, home health, and so on. Important characteristics of an individual who would be a navigator include the following: passion in sensing others compassion energy—self-starting capability intelligence great communication skills interpersonal relations skills sensitivity to culture diversity capability of working with all age groups, especially the elderly good team player problem-solving capability Definition, Role, and Responsibilities The Patient Service Navigator is a key member of a multidisciplinary health care team in the hospital setting with the following defined characteristics4,5: is patient and family centric focuses on the movement of patients along the continuum of medical care guides patients and their families through the complexity of the health care delivery system ensures that all barriers of the care are resolved and be a problem solver is available to answer questions and keep the patient and family informed serves as the point of contact and go-to person for issues regarding medical care in the hospital setting as a member of a multidisciplinary health care team, coordinates with the health care providers, nursing, dietary, pharmacy, respiratory therapy, physical therapy, and discharge planner to list a few anticipates, addresses, and overcomes barriers to care such as financial, communication, and transportation problems and identifies local resources and provides emotional support and comfort from fear and anxiety Proposed job description The foundation and framework for the Patient Service Navigator are a well-thought-out
49
and established job description. The 2 core components of the job description are qualifications and job summary as listed. Qualifications 1. Bachelor’s degree in social work, psychology, sociology, or related field 2. Excellent analytical and problem-solving skills 3. Demonstrated experience reflecting excellent interpersonal and communication skills 4. Ability to interact effectively and efficiently with patients and families undergoing physical, spiritual, and emotional stress 5. Ability to interact effectively and efficiently with all members of a diversified multidisciplinary medical care team 6. Ability to empathize with patients and families undergoing care in a complex health care delivery system 7. Ability to synthesize and process large quantities of information rapidly 8. Ability to coordinate and conduct conflict resolution 9. Knowledge of current quality, safety, and service improvement concepts and patient satisfaction criteria to include HCAHPS 10. Demonstrated experience of self-initiated and self-directed motivation to seek opportunities to assist patients and families Job summary 1. Responsible for providing personalized guidance and support to patients, families, and other members of the health care team to remove barriers toward a seamless patient and family experience in the hospital setting 2. Facilitates and encourages the patient and family to become a part of the health care team 3. Collaborates with the health care team to coordinate service initiatives to positively impact patient satisfaction
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
50
THE HEALTH CARE MANAGER/JANUARY–MARCH 2014
4. Provides point of service conflict resolution and involves health care team members when necessary 5. Provides timely follow-up to patients and families with concerns and grievances 6. Adheres and promotes the 4 principles of the patient- and family-centered philosophy: respect and dignity, collaboration, information sharing, and participation 7. Provides internal and external resources to patients and families to create a seamless navigation through the health care continuum 8. Serves as a key member of the unitspecific health care team and provides insight and perspective of patient care and service improvement opportunities by sensing the needs of others 9. Provides and maintains an effective and organized database to include patient visits, requests, concerns, grievances, and issue resolutions 10. Ensures confidentiality while providing oversight and guidance through the complexity of health care delivery in the hospital setting The principles of the Patient Service Navigator As the Patient Service Navigator Program has grown and become more defined with the primary role and duties, key principles of the navigator have developed over the years since 1990. As the program has evolved from addressing socioeconomic disparities and challenges in supporting cancer patients and their families, the program is now a communitybased intervention in the hospital setting for other disease challenges in navigating patient care. With this transformation and growing need, a list of 9 principles of the Patient Service Navigator has been established. These principles are as follows6: 1. functions within a patient-centric health care service delivery model 2. serves to virtually integrate a fragmented health care system for the individual patient 3. eliminates barriers to timely care (a core function)
4. works within a clearly defined scope of practice that distinguishes the role and responsibilities from that of other members of the health care team 5. provides cost-effective services commensurate with the training and skills necessary to navigate patients 6. possesses the required skills as determined based on needs 7. determines when navigation is needed, when it begins, and when it ends 8. functions across disconnected systems of care 9. coordinates with all providers of care The Patient Service Navigator under ACA From its humble beginning from the passion and insight of Dr Harold Freeman,6 the concept of patient navigator to the present Patient Service Navigator has been widely established and implemented in diverse frameworks at hundred of hospitals in the United States and in several countries. The Patient Service Navigator Program is an emerging health care intervention. Under the ACA, the Patient Service Navigator has the potential of greatly improving cost, quality, services, and the patient and their family experience in the hospital setting. Improving timely care, addressing issues, and anticipating barriers are critical for the success of hospitals as they accommodate the many federal mandates under the ACA. With a well-defined Patient Service Navigator Program, cost can be reduced by timely anticipation and resolution of barriers, delays, and coordination of timely care. The patient and family experience can be enhanced by reducing fear, anxiety, and the emotional toll of being in the hospital setting. By better coordination and communication, the quality of care can also be improved along with a reduction of medical and human errors. A transformed hospital culture is needed in order to implement the Patient Service Navigator Program in the hospital setting. A proposed model is provided to ensure an effective and efficient Patient Service Navigator Program.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Patient Service Navigator THE HOSPITAL CULTURE MODEL As the leadership of hospitals and health care organizations and systems faces the demands of the ACA, the culture must be transformed with a humanistic touch. The Patient Service Navigator is the core essence of this human touch connection. The Patient Service Navigator is the one person in the hospital setting who is able to formalize a gestalt and holistic perspective of the patient and family health care experience. As the Patient Service Navigator senses the needs of the patient and family, the Patient Service Navigator becomes an active ombudsman and advocate to ensure quality and a human touch experience. A model is suggested to be used that covers the human dynamics to ensure an attitude and behavior change to face the daunting variables of reducing cost and improving quality, services, and the patient and family experience in the hospital setting. A proposed model based on a Patient Service Navigator culture is provided in the Figure. The Patient Service Navigator model reflects the critical ACA variables of cost, quality, services, and the patient experience. These variables are the key elements of value-based purchasing. The ACA variables are represented by a triangle with the transformed humanistic culture in the center, inner circle with the supporting elements of the humanistic factors of sensing others’ needs (SON), and the patientand family-centered care (PFCC) philosophy.
51
The Patient Service Navigator is the supporting foundation of the culture that is guided by a pursuit of SON and a PFCC environment. Sensing others’ needs is the humanistic principle that the staff will sense each other’s needs as members of the health care team as well as the patient and family. Sensing means that everyone in the organization is conscious, aware, and responsive in SON. And from the patient and family perspective, SON includes the patient’s clinical needs, psychological needs, spiritual needs, and social needs that contribute to the overall well-being of the patient and family. With PFCC, the staff ensures that everyone is aware of the philosophy and principles of PFCC. These principles include treating everyone with dignity and respect, information sharing, collaboration, and partnership. The staff is educated on the importance of the PFCC philosophy in improving quality, services, and safety. In the culture with PFCC, the principles guide the attitude and behavior. The behavior is one of partnership with the patient and family by keeping them informed and with collaboration of having the patient and family being kept informed and part of the care activities. The Patient Service Navigator ensures that the PFCC principles are adhered to in the hospital experience. CONCLUSION In the confusing and complex dynamics of health care delivery in the hospital setting, the Patient Service Navigator provides an opportunity to improve cost, quality, and services. With the ACA mandates, health care leaders and managers must transform the culture to embrace the challenges ahead. Launching a Patient Service Navigator Program is the course to pursue in the uncharted waters that all hospitals will face in the vast unknown ocean of ACA. REFERENCES
Figure. Patient Service Navigator model. Abbreviations: SON, sensing others’ needs; PFCC, patient- and family-centered care.
1. Public Law 111-148, The Patient Protection and Affordable Care Act. Washington, DC: Government Printing Office; 2010:1-16. 2. Goozner M. Healthcare’s Tumultuous Year. Modern Healthcare. Chicago, IL: Grain Communications, Inc.; 2012:6.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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THE HEALTH CARE MANAGER/JANUARY–MARCH 2014
3. Studer Q, Robinson B, Cook K. The HCAHPS Handbook: Hardwire Your Hospital for Pay for Performance. Gulf Breeze, FL: Fire Starter Publishing; 2010:3-6. 4. Navigating Difficult Waters: The History of the Patient Navigators. April 2009. http://www.cancer.org. Accessed September 9, 2013.
5. Freeman H. The Origin and Evolution of Patient Navigator. Symposium on Social Inequities in Health, Paris, France, October 7, 2010. 6. Freeman HP, Rodriquez RL. History and principles of Patient Navigator. In: Cancer. Chicago, IL: American Cancer Society; 2011:3541.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Patient Service Navigator Improving Quality and Services and Reducing Cost Under the Affordable Care Act Llewellyn E. Piper, PhD, FACHE This article proposes the implementation of a Patient Service Navigator to improve quality, service, and the patient and family experience and to reduce costs in caring for patients in a hospital setting. Under the Affordable Care Act, the Patient Service Navigator is a means to address value-based purchasing whereby hospitals will be reimbursed based on quality and Hospital Consumer Assessment of Healthcare Providers and System scores for Medicare patients. In this article, the reader will learn the history, background, purpose, and role of the Patient Service Navigator as a critical component of a multidisciplinary health care team in supporting inpatient care with a human touch. Navigating for the patient and family in a confusing and complex health care delivery environment is critical today in order to survive the mandates of the Affordable Care Act. Key words: Affordable Care Act, hospital culture, Patient Service Navigator, patient- and family-centered care, value-based purchasing
P
UBLIC LAW 111-148, known as the Patient Protection and Affordable Care Act, commonly referred to as the Affordable Care Act (ACA), was signed into law on March 23, 2010.1 Although contested since its signing by President Obama in March 2010, it was upheld by the Supreme Court and by the public in the reelection of President Obama in 2012. The ACA is now the health care law of the land.2 This new health care law will significantly challenge the financial stability and survivability of hospitals and health care systems. Under the ACA, hospitals will face the wild unrest of the inbound urge of the incoming tide of illimitable change. The poignant essence of this change is the value-based purchasing mandate within this law that became effective in 2013. The haunting and disquieting effect is that hospitals will be confronted with a competitive value-based marketplace. In this cruel
Author Affiliation: Onslow Memorial Hospital, Jacksonville, North Carolina. The author reports no conflicts of interest. Correspondence: Llewellyn E. Piper, PhD, FACHE, PO Box 1358, Jacksonville, NC 28541-1358 ([email protected]). DOI: 10.1097/01.HCM.0000440619.54761.f9
sea of survival-of-the-fittest marketplace, there will be survivors and losers. Hospitals that survive will be those that are successful in competing on quality, services, cost, and the patient and family’s perception of care based on the Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) scores. As the rivers of change flow to the sea of unknowns, today’s health care leaders and managers must implement change to embrace the strong currents under the ACA. Survivors on this river of change will be those leaders who chart a new course of transforming the culture with a human touch and implement programs that reduce cost while improving quality, services, and the patient and family experience. ACA MANDATE The ACA is a mandate for change in the delivery of health care in America. Not since the passage of Medicare in 1965 has there been such a revolutionary federal mandate to change the socioeconomic dimensions of health care delivery and support of American citizens.1 Title III of the ACA will mandate a financial incentive to improve quality, services, and the patient experience under the Medicare program. This financial mandate is implemented through the Value-Based Purchasing Program, which 47
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
48
THE HEALTH CARE MANAGER/JANUARY–MARCH 2014
began in fiscal year 2013 with reimbursements for patient discharges starting October 1, 2012.1 With value-based purchasing, the paradigm shifts from volume to value based on quality care outcomes. Hospitals will be financially rewarded or financially punished based on national benchmarks for quality care outcomes related to specific conditions or procedures1: acute myocardial infarction heart failure pneumonia surgeries related to the surgical care improvement project health care–associated infections 30-day readmissions The HCAHPS scores comprise the second component of value-based purchasing. Hospitals will compete not only for quality outcomes but also on the patient experience or level of satisfaction as reported under HCAHPS scores. Again, hospitals will either be financially rewarded or financially punished based on HCAHPS scores.1 By law, transparency is now mandated with the requirement of public reporting of quality outcomes and the patient experience—HCAHPS scores. These scores will be publicly reported on a quarterly basis on a national Web site, www.hospitalcompare.hhs.gov. The financial survivability and sustainability of hospitals are now directly linked to quality outcomes and satisfaction scores that are available to the public on the Hospital Compare Web site, where ratings and comparison of hospitals will be the new era of health care.1,3 As leadership and managers consider programs to address the financial impact of the ACA, a program that is showing support of a methodology to reduce cost and improve quality, service, and the patient and family experience in the hospital setting is the Patient Service Navigator Program. Key to the success of the Patient Service Navigator Program is an organizational culture that embodies certain humanistic principles. BACKGROUND: PATIENT SERVICE NAVIGATOR Harold P. Freeman, MD, a surgical oncologist at Harlem Hospital in New York, came up with
the concept of patient navigators as means to eliminate barriers to timely cancer treatment and supportive care. The concept driving the patient navigator is to pair each patient with a navigator. The navigator is a nonmedical professional who can help guide patients through the complexity and dynamics of the health care delivery system. Freeman compared the navigator as a lifeboat; the navigator knows where the rocks are and can best guide the patient through the currents and safely to shore. Freeman launched the first patient navigator program in 1990 at Harlem Hospital in New York.4 On June 29, 2005, President George Bush signed into law P.L. 109-18, ‘‘Patient Navigator Outreach and Chronic Disease Prevention Act of 2005.’’ With the passage of this law, the US Congress provided $25 million in funding to implement the Patient Navigator Program nationally. The program has expanded over the years since the law was signed to support cancer patients in a more formalized and coordinated way to eliminate many barriers in cancer care.5 The Patient Navigator Program is starting to be used in the hospital setting to guide patients with other diseases and comorbidity issues. The program is now known in the noncancer care environment as Patient Service Navigator Program. PATIENT SERVICE NAVIGATOR The Patient Service Navigator is a problem solver and a highly resourceful individual. The Patient Service Navigator is a critical member of a multidisciplinary health care team to include the providers, the nurses, the technicians (laboratory, x-ray), therapist (rehab, dietitian, respiratory), and pharmacist as well as the discharge planner and patient educator. The navigator is a layperson who can coordinate the needed health care services. A social worker background is the best suited qualification for a navigator because of the skills and knowledge required. The Patient Service Navigator is trained to anticipate, address, and overcome barriers to care and guide patients through the health care delivery activities in the hospital setting. The social work experience is optimal along with a vast experience in health care delivery within the hospital setting and an understanding of
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Patient Service Navigator external support services such as rehabilitation, nursing homes, home health, and so on. Important characteristics of an individual who would be a navigator include the following: passion in sensing others compassion energy—self-starting capability intelligence great communication skills interpersonal relations skills sensitivity to culture diversity capability of working with all age groups, especially the elderly good team player problem-solving capability Definition, Role, and Responsibilities The Patient Service Navigator is a key member of a multidisciplinary health care team in the hospital setting with the following defined characteristics4,5: is patient and family centric focuses on the movement of patients along the continuum of medical care guides patients and their families through the complexity of the health care delivery system ensures that all barriers of the care are resolved and be a problem solver is available to answer questions and keep the patient and family informed serves as the point of contact and go-to person for issues regarding medical care in the hospital setting as a member of a multidisciplinary health care team, coordinates with the health care providers, nursing, dietary, pharmacy, respiratory therapy, physical therapy, and discharge planner to list a few anticipates, addresses, and overcomes barriers to care such as financial, communication, and transportation problems and identifies local resources and provides emotional support and comfort from fear and anxiety Proposed job description The foundation and framework for the Patient Service Navigator are a well-thought-out
49
and established job description. The 2 core components of the job description are qualifications and job summary as listed. Qualifications 1. Bachelor’s degree in social work, psychology, sociology, or related field 2. Excellent analytical and problem-solving skills 3. Demonstrated experience reflecting excellent interpersonal and communication skills 4. Ability to interact effectively and efficiently with patients and families undergoing physical, spiritual, and emotional stress 5. Ability to interact effectively and efficiently with all members of a diversified multidisciplinary medical care team 6. Ability to empathize with patients and families undergoing care in a complex health care delivery system 7. Ability to synthesize and process large quantities of information rapidly 8. Ability to coordinate and conduct conflict resolution 9. Knowledge of current quality, safety, and service improvement concepts and patient satisfaction criteria to include HCAHPS 10. Demonstrated experience of self-initiated and self-directed motivation to seek opportunities to assist patients and families Job summary 1. Responsible for providing personalized guidance and support to patients, families, and other members of the health care team to remove barriers toward a seamless patient and family experience in the hospital setting 2. Facilitates and encourages the patient and family to become a part of the health care team 3. Collaborates with the health care team to coordinate service initiatives to positively impact patient satisfaction
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
50
THE HEALTH CARE MANAGER/JANUARY–MARCH 2014
4. Provides point of service conflict resolution and involves health care team members when necessary 5. Provides timely follow-up to patients and families with concerns and grievances 6. Adheres and promotes the 4 principles of the patient- and family-centered philosophy: respect and dignity, collaboration, information sharing, and participation 7. Provides internal and external resources to patients and families to create a seamless navigation through the health care continuum 8. Serves as a key member of the unitspecific health care team and provides insight and perspective of patient care and service improvement opportunities by sensing the needs of others 9. Provides and maintains an effective and organized database to include patient visits, requests, concerns, grievances, and issue resolutions 10. Ensures confidentiality while providing oversight and guidance through the complexity of health care delivery in the hospital setting The principles of the Patient Service Navigator As the Patient Service Navigator Program has grown and become more defined with the primary role and duties, key principles of the navigator have developed over the years since 1990. As the program has evolved from addressing socioeconomic disparities and challenges in supporting cancer patients and their families, the program is now a communitybased intervention in the hospital setting for other disease challenges in navigating patient care. With this transformation and growing need, a list of 9 principles of the Patient Service Navigator has been established. These principles are as follows6: 1. functions within a patient-centric health care service delivery model 2. serves to virtually integrate a fragmented health care system for the individual patient 3. eliminates barriers to timely care (a core function)
4. works within a clearly defined scope of practice that distinguishes the role and responsibilities from that of other members of the health care team 5. provides cost-effective services commensurate with the training and skills necessary to navigate patients 6. possesses the required skills as determined based on needs 7. determines when navigation is needed, when it begins, and when it ends 8. functions across disconnected systems of care 9. coordinates with all providers of care The Patient Service Navigator under ACA From its humble beginning from the passion and insight of Dr Harold Freeman,6 the concept of patient navigator to the present Patient Service Navigator has been widely established and implemented in diverse frameworks at hundred of hospitals in the United States and in several countries. The Patient Service Navigator Program is an emerging health care intervention. Under the ACA, the Patient Service Navigator has the potential of greatly improving cost, quality, services, and the patient and their family experience in the hospital setting. Improving timely care, addressing issues, and anticipating barriers are critical for the success of hospitals as they accommodate the many federal mandates under the ACA. With a well-defined Patient Service Navigator Program, cost can be reduced by timely anticipation and resolution of barriers, delays, and coordination of timely care. The patient and family experience can be enhanced by reducing fear, anxiety, and the emotional toll of being in the hospital setting. By better coordination and communication, the quality of care can also be improved along with a reduction of medical and human errors. A transformed hospital culture is needed in order to implement the Patient Service Navigator Program in the hospital setting. A proposed model is provided to ensure an effective and efficient Patient Service Navigator Program.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Patient Service Navigator THE HOSPITAL CULTURE MODEL As the leadership of hospitals and health care organizations and systems faces the demands of the ACA, the culture must be transformed with a humanistic touch. The Patient Service Navigator is the core essence of this human touch connection. The Patient Service Navigator is the one person in the hospital setting who is able to formalize a gestalt and holistic perspective of the patient and family health care experience. As the Patient Service Navigator senses the needs of the patient and family, the Patient Service Navigator becomes an active ombudsman and advocate to ensure quality and a human touch experience. A model is suggested to be used that covers the human dynamics to ensure an attitude and behavior change to face the daunting variables of reducing cost and improving quality, services, and the patient and family experience in the hospital setting. A proposed model based on a Patient Service Navigator culture is provided in the Figure. The Patient Service Navigator model reflects the critical ACA variables of cost, quality, services, and the patient experience. These variables are the key elements of value-based purchasing. The ACA variables are represented by a triangle with the transformed humanistic culture in the center, inner circle with the supporting elements of the humanistic factors of sensing others’ needs (SON), and the patientand family-centered care (PFCC) philosophy.
51
The Patient Service Navigator is the supporting foundation of the culture that is guided by a pursuit of SON and a PFCC environment. Sensing others’ needs is the humanistic principle that the staff will sense each other’s needs as members of the health care team as well as the patient and family. Sensing means that everyone in the organization is conscious, aware, and responsive in SON. And from the patient and family perspective, SON includes the patient’s clinical needs, psychological needs, spiritual needs, and social needs that contribute to the overall well-being of the patient and family. With PFCC, the staff ensures that everyone is aware of the philosophy and principles of PFCC. These principles include treating everyone with dignity and respect, information sharing, collaboration, and partnership. The staff is educated on the importance of the PFCC philosophy in improving quality, services, and safety. In the culture with PFCC, the principles guide the attitude and behavior. The behavior is one of partnership with the patient and family by keeping them informed and with collaboration of having the patient and family being kept informed and part of the care activities. The Patient Service Navigator ensures that the PFCC principles are adhered to in the hospital experience. CONCLUSION In the confusing and complex dynamics of health care delivery in the hospital setting, the Patient Service Navigator provides an opportunity to improve cost, quality, and services. With the ACA mandates, health care leaders and managers must transform the culture to embrace the challenges ahead. Launching a Patient Service Navigator Program is the course to pursue in the uncharted waters that all hospitals will face in the vast unknown ocean of ACA. REFERENCES
Figure. Patient Service Navigator model. Abbreviations: SON, sensing others’ needs; PFCC, patient- and family-centered care.
1. Public Law 111-148, The Patient Protection and Affordable Care Act. Washington, DC: Government Printing Office; 2010:1-16. 2. Goozner M. Healthcare’s Tumultuous Year. Modern Healthcare. Chicago, IL: Grain Communications, Inc.; 2012:6.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
52
THE HEALTH CARE MANAGER/JANUARY–MARCH 2014
3. Studer Q, Robinson B, Cook K. The HCAHPS Handbook: Hardwire Your Hospital for Pay for Performance. Gulf Breeze, FL: Fire Starter Publishing; 2010:3-6. 4. Navigating Difficult Waters: The History of the Patient Navigators. April 2009. http://www.cancer.org. Accessed September 9, 2013.
5. Freeman H. The Origin and Evolution of Patient Navigator. Symposium on Social Inequities in Health, Paris, France, October 7, 2010. 6. Freeman HP, Rodriquez RL. History and principles of Patient Navigator. In: Cancer. Chicago, IL: American Cancer Society; 2011:3541.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
