Canada's nurse navigators
Canada shares with Australia several characteristics, including population size, wealth and the healthcare challenges posed by geographical vastness. Northern Health, one of six regional health authorities in British Columbia, covers an area nearly the size of France with a population of only about 350,000 people. The challenge it faced was to simplify the steps in the breast cancer field to eradicate unnecessary delays. With limited resources, it is using an innovative mix of stakeholder engagement, technology and multidisciplinary care.
Within the region covered by Northern Health, the biggest urban centre is Prince George with 76,000 residents, but it is at least an eight-hour drive from any major city. In such a rural environment, says LaDonna Fehr, regional oncology leader for Northern Health, “you have to be able to offer a certain level of service yourself”.
The health authority therefore offers ten systemic therapy centres across the region, each staffed by an oncology nurse and a doctor with special training in overseeing the management of oncology treatment. There is also a regional team that uses teleconferencing to give patients access to social workers and specialised pharmacists.
Even with these centres, however, travel times for patients in this sparsely populated area are frequently lengthy, and repeated visits to medical professionals are much more time consuming than in an urban setting. For breast cancer, it often used to take patients numerous, multi-hour car rides over the course of six to eight weeks to go from the first finding that something might be wrong to a treatment plan. In some cases, this period stretched as long as 12 weeks. Even where this did not affect care outcomes, the added worry and inconvenience that it causes at such a stressful time for patients and families constituted an immense burden.
Northern Health therefore looked at creating a “nurse navigator” programme to help patients get through the steps on their cancer treatment process faster. The programme, an initiative of the Northern Cancer Control Strategy (a partnership between Northern Health, the province-wide BC Cancer Agency and the Provincial Health Services Authority), focused on enhancing cancer care in the North. For breast cancer the initial step involved getting together in one place, for the first time, everyone involved in the entire care process in order to map out the stages and consider how to simplify it. A group of 18 people, including patients, medical professionals and even administrative staff who handle bookings, met in four four-hour sessions.
Ms Fehr recalls that their map of the care stages was “a huge document that covered I don’t know how many feet. Everybody found out where the gaps in care were. We found a number of unnecessary wait times that we could eliminate with one decision and no money. Someone would say, ‘We wait two weeks to do that? We could get that decision by picking up the phone’.”
Not all the simplifications were so easy or inexpensive, but the result was a much more streamlined process provided by the breast clinic in Prince George. Although not yet a one-stop shop, the clinic has oncology surgeons, plastic surgeons and oncology nurses. At the weekly clinic, those sent by their doctors are able to see a number of referrals and a surgeon on the same day. If a biopsy is needed, the results are available in a few days so that it is possible to return the following week for a consultation.
Moreover, helping patients to understand what is happening and explaining what comes next have become a part of everyone’s role. Under the new system, the goal is to go from the first worrisome findings to a treatment plan within two weeks, and with at most two trips to the clinic. Ms Fehr says patient satisfaction surveys indicate that they feel better informed and happier with the experience as a result.
The nurse navigators have several ongoing roles in the new system. In Ms Fehr’s words, they are in charge of the “continued maintenance of the journey. We have taken away the silos, but somebody has to make sure that we have people who are fully versed”. Thus, as personnel change, the nurses ensure that new arrivals are quickly brought up to speed on their roles.
Next year a BC Cancer Agency regional cancer centre will open in Prince George. This will help in ongoing efforts to reduce further the time involved in the care process and to create a truly one-stop shop for cancer care in the region.