Losing patience with the slow adoption of patient navigation.
Our health care system has been unwell for so long that it has attracted legions of cures.
Some of these involve spending vast new dollars, like what Premier Ford has pledged to make Ontario’s long-term care facilities less deadly. But many other cures look to make the existing system work more efficiently within existing budgets.
One of these is the concept of patient navigation. Those two words didn’t exist together until 1990 when cancer surgeon Dr. Harold Freeman established the first program at the Harlem Hospital in New York where he worked with mostly poor, Black patients. As he said: “No person with cancer should have to spend more time fighting their way through the cancer care system than fighting their disease.”
Dr. Freeman also created a nine-point framework for patient navigation. It has become the gold standard for patient navigation throughout the industrialized world.
The first principle is to use patient navigation to integrate a fragmented healthcare system. This makes instant sense, of course, whether you’re a patient in Harlem in 1990 or in Toronto 30 years later. Canada’s different systems are seen as highly-fragmented if you’re a doctor or administrator. So imagine you’re a patient seeking that system to make you well again and you know approximately nothing about the maze and which way to go, no general practitioner and feeling completely alone.
I believe it’s a sign of how serious the fragmentation is in Canada that only one disease group, cancer, has integrated patient navigation as a central value and service of patient care. Only patient navigation around oncology has nation-wide standards, procedures and measurements for quality assurance for all patients.
But why is patient navigation not used with other chronic diseases such as mental illness, diabetes and chronic pain? All of these are very expensive conditions to diagnose and treat. They are costing the system billions of dollars a year. Yet offering patients a personal guide who can proactively support and navigate patients through the mental health system would save many lives and many millions of dollars.
Giving the patient an app and expecting them to use it as a GPS for finding the fastest, best treatment, makes no sense at all. Technology can help of course. But healthcare is essentially a human business.
Today in Canada, most patient navigators for cancer patients are nurses. For mental health patients, they’re nurses and social workers. For other patient groups, they’re often administrators who have some terminology training.
This is a start, but nowhere near good enough. The concept of patient navigation is proven to reduce costs and wait times, and improve the quality of care. None of this is in doubt.
So if we’re serious about integrating our fragmented system, one way to start doing that is to seriously ramp-up the funding commitment to patient navigation – in hospitals as well as in health-care plans.
I believe that the nine principles of patient navigation are so vital to making our system work better than I’m going to write about each one in a different blog every week.
Next week: how it significantly improves a patient-centred healthcare delivery model.