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Issue 1, Number 3 - Fall/Winter 2011


PATIENT-CENTERED HEALTH CARE

Patient navigation forms the connective tissue of health care

Patient navigators are health care professionals who assist individuals with their health needs by clarifying their goals, identifying resources, and making a plan of small, achievable steps to meet those goals. The patient navigator also offers emotional support to help this happen, as well as guidance for navigating complex medical systems, improved access to care and resources, and advocacy on behalf of patients while teaching them self-advocacy. The new, one-year Patient Navigator Certificate Program offered through the Sonoma State University Department of Extended Education in partnership with the Integrative Medical Clinic Foundation, graduated 14 navigators this past spring and is now in its second year with 17 new students.

As the program’s creator and administrator, Pam Koppel brings 20 years of experience as a health care provider to the table. She began her career as a licensed clinical social worker in the hospice setting, which proved to be an advanced form of patient navigation, sowing the seeds of her future.

Koppel has worked in Integrative Medicine since 1996. Along with Dr. Robert Dozor, she co-founded the Integrative Medical Clinic of Santa Rosa where she provided team development and facilitation for the Integrative Provider team for 11 years. She also initiated and led the clinic’s Integrative Patient Care Conference. She is also presently the program coordinator for the Sutter North Bay’s Integrative Health and Healing Services Program providing complementary therapies to women going through cancer treatment.

A relatively new field, patient navigation has been mostly limited to the field of oncology. The new SSU program is expanding beyond these boundaries by teaching support and advocacy not only for cancer patients but also for those with other chronic diseases and health concerns. The program integrates complementary, alternative medicine resources and trains “lay” navigators as well as licensed clinicians.

Pacific Health Magazine invited Koppel to share her thoughts about the emerging role of patient navigation, particularly in light of health care reform driving the shift toward more patient-centered care.

PH: How did the SSU patient navigation certification program come about?

PK: In 1996, I started a business called “Healing Alternatives” which provided navigation services by phone for people who called in with health issues. We helped them understand the various complementary and alternative medicine (CAM) options and gave them referrals. We also educated people about the importance of finding a provider with whom they felt rapport, and about taking charge of their own health care path. In 1998, I started working with a Santa Rosa physician named Bob Dozor who was collaborating with a team of CAM providers. They also had a navigator who supported patients on these same issues: understanding their choices and becoming active participants in their own health care.

Since the beginning of my health care career, I have always been passionate about supporting patients in this way, providing navigation services in various ways and leading trainings to help other providers understand and utilize this role. Around 2004, after experiencing my own challenging health situation during which I really could have used a patient navigator, I had the idea to train navigators and place them in physician practices and clinics, with the long-term vision of some day seeing a patient navigator in every doctor’s office.

For the next several years, I worked with Dr. Ellen Barnett under the auspices of the Integrative Medical Clinic Foundation (the non-profit arm of the Integrative Medical Clinic of Santa Rosa) to develop a patient navigation training curriculum. We convened focus groups with physicians and nurse practitioners to solicit their feedback and then made adjustments accordingly. I was not able to find an educational institution willing or ready to establish a patient navigation training program for a few years. Then in 2009, I attended a grant reception during which numerous grant recipients kept referring to “our patient navigator…” when speaking about their organizations. I realized the time had come. I made a proposal to the Sonoma State University Department of Extended Education to partner with us and make the Patient Navigation Certification Program a reality.

PH: What are the goals for the SSU certification program?

PK: We have a long list of goals but our main one is to teach people to really listen to patients and to drop their own agendas so they can help people identify the best path for themselves. Other goals include learning to provide education, advocacy, and resources. In our overstressed, crazy health care system, many patients find themselves confused and unsure about where to go for answers —or even about the right questions to ask. People with acute illnesses are very scared and people with chronic illnesses are very tired. Our current medical system is highly focused on protocol. Only recently has including the patient’s wishes as part of protocol begun to be considered.

Another major goal of the program is to expand navigation beyond the realm of cancer care and to add “lay” navigators to the mix. Nurse navigators are quite commonplace in cancer care (especially breast cancer). But people with health challenges of all kinds need these services. In addition, nurse navigators focus on very clinical issues, such as helping people understand the details of their illness and their treatment options. This is a crucial role, of course, but there is also a place for patient navigators who do not hold a nursing or medical license, who can help people find other resources, provide emotional support, and lay out an individualized plan for coping with the stress of illness, according to their personal needs and wishes. Both nurse navigators and lay navigators can help facilitate communication between patients and their health care providers to ensure that they are on the same page.

PH: What is your personal vision for patient navigation?

PK: I would like to see patient navigators become commonplace in the health care system. There is also an important distinction between patient navigation and patient advocacy, which are often used interchangeably. I see advocacy as a part of navigation (just as advocates see navigation as a part of advocacy), but I think the two roles have a different focus and different implications. Both are very valuable and best utilized at different points in a person’s health journey.

There are times when a person is overwhelmed or too sick to be able to speak or act on their own behalf and usually do not have the inside knowledge and connections that an advocate has. At these times, advocacy is irreplaceable. At other times, advocating for someone implies that they need to be taken care of or “fixed” and are not able to speak for themselves. In patient navigation training, we teach that being actively involved and taking charge of one’s own care and decision making is part of the healing process. Our goal is for patients to become their own best advocates and to find their own “inner compass,” allowing them to proceed on a path best suited for them. My personal hope is that patient navigation grows to become an integral part of the health care system.

PH: What are some of the present challenges with expanding the role of patient navigation beyond the original area of oncology?

PK: Our health care system is extremely overstressed and overtaxed, both financially and professionally. In introducing patient navigation, we are adding a new element to a very rigid system. Most health care professionals see the value in this but also do not have the time to understand how best to utilize this new role. Then there is the challenge with how to pay for the role. Insurance carriers do not cover patient navigation at this point, leaving either the patient or the provider to pay. Either way, an education process is involved to help everyone understand the value of this service and how it can save time for doctors, which translates into saving money and helping patients get their health care needs met more effectively.

PH: How can patient navigators benefit patients, providers, and health care overall?

PK: Navigators help patients put together a map of the big picture, assisting them in clarifying their needs and priorities, identifying existing support, and helping direct them to other resources to fill in the gaps. The navigator makes things cohesive; the various clinicians and practitioners work with patients on the details, whether in medicine, physical therapy, psychotherapy, or acupuncture. The ideal navigator is able to set aside any personal agenda and focus respectfully on the patient’s agenda. Both our interns and working navigators report that patients often cry when given space and time by a navigator to talk about how they are doing and what it is they really want. We have heard patients say time and time again, “No one has really asked me that before!”

Patient navigators support health care providers by following up with patients to make sure they understand their treatment plan and have the information and resources they need to be successful in their healing process. Often times, for patients who have multiple conditions and issues and thus high emotional needs, physicians can refer their patient to a navigator to provide the type of support the physician simply does not have time to offer. The navigator can also facilitate the provider team process and make sure the lines of communication are smooth and clear, which can often be challenging when several providers are involved. The navigator works to keep all parties—the providers and the patient— on the same page.

One of our navigator graduates, who now works in a community clinic, reported that after months of working there one of the doctors told her, “You really do pull things together, don’t you?”

In terms of overall health care, ultimately people are healthier and more successful recovering from illness when they participate actively in their health care and decision-making. When patients and their providers are able to truly function as partners, and when patients are educated and have the resources and support they need to overcome their health challenges, both the health care system and its participants will become healthier all around.

Learn more about the SSU Patient Navigator Certificate Program at: www.sonoma.edu/exed/patient-navigator


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