What are the 5 most important influences on navigator-to-patient ratios?
Last week, Paul Pugsley reviewed the number of patients an oncology nurse navigator can be expected to navigate over the course of a year. This week, I wanted to address the topic for spine nurse navigators. Determining how many patients one spine nurse navigator can manage can often be the difference between success and failure in a program.
In preparation for this post I conducted a survey of 23 spine programs employing at least one nurse navigator and managing at least 500 patients in 2012. Most programs managing 1500 spine patients or fewer, per year, employed a single navigator. A second navigator was generally hired as volumes drifted above that number.
The scatter plot diagram below shows the relationship between program volume and the number of nurse navigators employed at each of the participating facilities.
The bar chart below shows the distribution of hospitals at each navigator to patient ratio.
The significant variation of navigator to patient ratios among our programs confirms that staffing levels are based on factors beyond simple patient volumes. The scope of a spine nurse navigator position description is often more critical to establishing appropriate navigator/patient ratios. For example, while all Priority Consult Spine programs provide intake services, patient education, and initial navigation services, only slightly more than half of these same navigators track their patients throughout the full continuum of care.
In our experience, the top five factors that influence nurse navigator / spine patient ratios are:
1) Is your nurse navigator a “dedicated” navigator?
Hub & Spoke Spine Centers often allow nurse navigators to perform their roles independent of a clinical office space. When navigators are asked to “cover” responsibilities in the clinic office, they are often unable to also provide sufficient navigation and support to patients obtaining pre-appointment or nonsurgical treatment. Similarly, navigators who are asked to perform managerial and/or administrative tasks often see a significant decrease in the number of patients they are able to effectively navigate.
2) Is the scope of nurse navigator responsibilities limited to outpatient services?
Most outpatient nurse navigators are responsible for communicating treatment plans to patients, coordinating outpatient care, and documenting patient activities for referring and treating care providers. Programs that also ask navigators to manage the aspects of inpatient care are likely to see the nurse navigator to patient ratio cut in half, to 1000 / 1 or lower. Inpatient navigation responsibilities include teaching pre-operative classes , initiating the collection of surgical outcomes, discharge planning and post-operative follow-up.
3) Will your navigator be responsible for insurance authorization?
Assisting patients and physician offices with the time-consuming responsibilities of scheduling imaging and therapy services and managing their authorization is a significant benefit to both patients and physician practices. Spine centers that provide this service can point to the very tangible benefits of increased physician participation, greater patient retention and increased capture of ancillary services. However, the time spent coordinating appointments and dealing with the time-consuming responsibility of managing authorizations with a myriad number of insurance carriers is a significant factor in reducing navigator to patient ratios.
4) Empower your navigator with clerical support.
Other than physician participation, the presence of an effective nurse navigator is perhaps the single biggest differentiator between successful and unsuccessful programs. Teaming your navigator with a competent (and less expensive) clerical support person is perhaps the most effective way to increase your nurse navigator / patient ratio.
Responsibilities such as providing patient education, sending correspondence (letters and faxes) to referring physicians and patients and pre-authorization of treatment and testing are critical to providing a full-service navigation program. However, many of these activities can be handled by a well-trained administrative staff person under the supervision of your nurse navigator. The scatter plot below shows the total FTE level of the same 23 programs above. Oftentimes, the second, third and even fourth hires at these programs are not additional nurse navigators, but administrative assistant level personnel to support the navigation effort.
5) Does your navigator have access to an effective navigation tracking tool?
When I first began working with nurse navigators in 2003, I observed a variety of creative solutions that navigators had devised to track their patients. Over the years, Priority Consult Spine has replaced home-grown solutions ranging from Post-It-notes to complex Excel spreadsheets. What we have learned over the years is that the presence of a software tool designed to support the unique role of navigation will help facilities enhance their navigation ratios by factors of four or five.
Priority Consult Spine Recommendations Concerning Staffing Levels
Whenever we implement a new spine program, we always recommend our clients estimate their new patient volumes prior to opening and continually monitor volume as they progress. Programs with adequate staffing eliminate patient care delays and enhance patient satisfaction. Based on other client experiences, we have developed guidelines for staffing levels within a spine center that provides a moderate to aggressive scope of services.
Throughout January and February, we will continue to review the vital role that nurse navigation plays in an integrated spine program.
Do you have concerns about your nurse navigation staffing levels? I will look for your feedback in the comments below. Contact me if you would like more information on the relationships among patient volumes, staffing levels and scope of service.