Navigating the Maze

"Sometimes you have several different caregivers working with a patient or family member, and communication can break down," she says. "A patient may not hear what is said, or two different providers are saying the same thing in two different ways."

What about quality?
Whether after diagnosis or during treatment, hospital-employed or private, advocates clearly help soothe patients and improve communication—but do they ultimately have a meaningful impact on quality?

"I think there's no question that it increases the chances that they'll get the best-quality care," says Kevin Cullen, MD, director of the University of Maryland Marlene and Stewart Greenebaum Cancer Center. "More and more of what we do is multidisciplinary, so the complexity for the patient increases." Without proper guidance, Cullen says, "The chance for them to fall through the cracks increases as well."

Patient navigators are used as part of the University of Maryland's Baltimore City Cancer Program, which offers free cancer screenings to uninsured city residents. Cullen says the patient navigators are often crucial to making sure that those whose screenings show a need for more tests get the treatment they need.

"Once we had navigators in place, we found that the length of time between when a woman had an abnormal mammogram and when she received further treatment decreased," he says. "The navigators helped them expedite their workup so that they got through the system as efficiently as possible." And with cancer—or any other disease—quicker care can lead to better outcomes, Cullen says, giving those who are diagnosed with it a better chance at beating the disease.

Most advocate or navigator programs currently in place focus on cancer and related illnesses, but many working in the field believe that fostering a better patient-provider relationship can improve the quality of care for patients with a variety of conditions.

"Heart disease, chronic lung disease, chronic obstructive pulmonary disease, diabetes—these kind of issues that have a chronicity to them—I don't know why you couldn't navigate people through good health and prevention," Browning says.

Good for business
In addition to improving patient care, a navigator program can have a positive impact on another facet of the hospital: the bottom line.

"Having a navigator is sort of like going to AAA and getting a Trip Tik [AAA's personalized travel guide product]," says James Conway, MS, senior vice president for the Institute for Healthcare Improvement. When travelers have specific directions, they reach their destination faster and more efficiently. Their trip takes less time and, therefore, costs less. The same happens in healthcare, Conway says—patients who are guided through their healthcare experience spend less time in the hospital and cost less to treat. "The likelihood of having better outcomes is demonstrably better."

Conway points to a study by Harold P. Freeman, MD, at Harlem Hospital in the 1990s. Freeman, now the president of the Ralph Lauren Center for Cancer Care and Prevention in New York and a pioneer of the patient navigation concept, found that when patients were navigated through their care, they received treatment at less advanced stages of their illness and spent their time with clinicians more efficiently. Use of patient navigators also helped identify service gaps, increase patient satisfaction, and strengthen the hospital's community connections—all things that can contribute to a healthier bottom line.

"At the end of the day, that's why we exist," Conway says. "Any hospital that's focused on quality of patient care—they'll see a strong connection with their survival rates, patient satisfaction, and financial outcomes. We want to have good outcomes, and do it with as little waste as possible."