The Patient Navigator

by Stefani Daniels, RN, MSNA, CMAC, ACM
Published on Jun 02, 2015

This article was first printed in the May 2005 issue. It’s as relevant today as it was then.

The Patient Navigator article imageMany compelling organizational issues have recently surfaced making the case for a change in hospital case management purpose and operations. It’s a change in the marketplace that signals a change in the role of the case manager from discharge planner (DCP) and utilization reviewer (UR) to that of THE PATIENT NAVIGATOR to advocate for the patients while helping them navigate the progression the care.

* One issue concerns the long-range implications of the nursing shortage. It is argued that in view of the growing shortage, the role of the clinical bedside nurse must and will change. In the presence of case managers, many nursing departments have divorced themselves entirely from any involvement in the discharge planning process. That is bound to change as case managers are expected to work predominantly with selected high risk populations while the bedside nurses manage progression of care for the others.

* The expectations of the retiring baby boomers will change the role of the patient. Their demand for a role in decision-making, their call for quality and value, and their use of the web to research health issue, signals a new relationship between the inpatient and the provider to make sure these patients are satisfied with the care they received, the education that they needed, and the attention they demanded.

* There has been a virtual explosion in the use of employed hospitalists and intensivists. There are two reasons for this: newly minted physicians have an entirely different idea of their profession than their fathers did. As millennials, they want to work without having to sacrifice leisure time, family time, and pursuit of other interests. The old days of expecting a community attending to do ED rotation, on-call, and hospital rounds are quickly disappearing. And because employed physicians generally have incentive compensation contracts and so have a very real stake in hospital outcomes, they typically will embrace their case manager partners to help them manage the ‘business of care.’

* Revenue reductions have placed heavy burdens on hospitals to do more with less. Daily headlines across the nation attest to the growing costs of healthcare and the shift to value. The rapidly growing demand for greater hospital accountability and the introduction of new payment models are placing new expectations on every aspect of hospital operations from quality improvement, financial transparency, and greater efficiency. Hospital Boards of Directors are transitioning from token community representatives with little knowledge of the industry to individuals who often have a stake in the success of the organization and a healthier curiosity about the hospital 'business.'

Now you're asking, "What does all this have to do with case Management purpose and operations?" Those of you who are regular readers of this newsletter know that one of the driving principles of every successful hospital case management is context congruency - the hospital case management program must be in synch with the environment within which it is practiced. Unless it does, it will go extinct and morph into something quite different than what was originally intended. Today, case management leaders must stay abreast of these issues as they relate to the hospital because eventually, no matter how secure or independent you feel, case management will be affected.