A Guide to Implementing Best Practices in Person ... - cancerview.ca

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Navigation: A Guide to Implementing Person-Centred Care September 2012Additional Activities in Virtual NavigationAccording to reports gathered from across Canada in the fall of 2011 about developmentsin Navigation, several provinces indicated interest in creating personal healthportals to enhance patients’ ability to self-navigate. The portals are expected to improvepatient engagement and self-management of care, and improve the patient experienceby providing easy access to credible cancer information (Cancer Journey,2011).Chapter 4: Practice ChangeEarly in Cancer Journey’s mandate, a national working group was brought together todevelop the Navigation Grid (see Appendix A). The grid provides a definition and visionfor Navigation, and describes the characteristics, scope of practice, skill and trainingrequirements, and possible outcomes for professional and peer/lay Navigation. Thedocument defines the vision for Navigation as follows:Navigation is part of an integrated system of cancer service delivery.Navigators work with the person and family and their interdisciplinaryteam to assess needs, provide supportive care, answer questions, identifyand address any barriers to quality care, and facilitate access toneeded resources and services. Navigation aims to improve both coordinationin services and continuity throughout cancer care, as well asquality of life for the person and family throughout the cancer journey.To achieve a vision of person-centred care, a change in health care culture is requiredand this change can only be achieved by changing practice. Health care professionalsmust broaden their perspectives to see the whole person and work collaboratively tomeet the full range of each patient’s needs. The interprofessional team needs to workin partnership with the navigator, the cancer patient and their family to ensure thatcare is responsive and tailored to the specific needs of each patient and family.To reach this vision of person-centred care, a programmatic approach to Navigationshould be used. A programmatic approach is the planned and systematic process ofimplementing an evidence-based intervention that engages all relevant stakeholderswithin and outside of the institution. Stakeholders share a common vision and objectiveand have a clear perspective on the results of the initiative. A programmatic approachis a process that aims to embed the intervention in a comprehensive and sustainedmanner, where the final result is systemic change in health care capacity,practices and performance (Swerrison, Duckett and Daly, 2001; Walters, 2011).A programmatic approach is recommended for implementing Navigation because changingpractices is a complex process. Navigation is a means of improving health-relatedquality of life and patient outcomes, while also enhancing professional practice basedon research evidence. Achieving these aims is a significant amount of work that requires24
Navigation: A Guide to Implementing Person-Centred Care September 2012a planned and programmatic approach. The implementation of Navigation can be one ofthe drivers in the shift toward a more person-centred cancer care system.Implementation is defined as “a specific set of activities designed to put into practicean activity or program of known dimensions.” (Fixsen, Naoom, Blasé, et al., 2005) Thechallenge is to craft an implementation plan that takes into account, as much as possible,the known dimensions of the new program and activity, as well as the knowndimensions of the potential adopters and their practice environment. Once the innovationand the local context are well understood, an implementation plan can be putinto place. Enacting the implementation plan requires knowledge, skills and strategiesregarding change management.The purpose of this chapter is to explore the dimensions of the task at hand (implementingNavigation) within the unique context of the local setting. A Navigation ProgramLogic Model has been developed to outline the general components, inputs, activities,outputs and various outcomes associated with implementation (Appendix B).The logic model can be adapted to suit the local context and is a key component ofimplementation planning and execution.The planning and assessment phase is the beginning of stakeholder engagement in theimplementation process, the beginning of field preparation and the beginning ofchange management. A thorough assessment and understanding of local factors arecentral to developing a systematic and well-informed implementation strategy andplan. At the same time, the process of implementation requires constant change management,and the tools and resources in this chapter can assist with assessing the localcapacity for change, and the skills and knowledge required to manage it. The followingsections present some basic principles of change management, followed by sometools to help prepare the management team to lead, facilitate and drive the desiredchange in practice.About Managing Change: Key PrinciplesThe following list is derived from the Change ManagementToolkit (London Borough of Lambeth, 2007), which is a usefulresource for any project.• Think big, act small. Keep the big picture or vision inmind at all times, but make sure that all stakeholdersand individuals have their say and are allowed to contribute.See the ChangeManagement Toolkitfor more tools andtips to managechange.• Go where the energy is. Try to work with the most energetic and enthusiastic staffat the early stages to make sure that things happen. The 30:40:30 rule is often invokedto encourage a realistic focus on change. The leading 30% of staff (proportionsmay vary) are usually prepared to support and participate in change. If theyget convincing early results, the next 40% can probably be persuaded to embracechange and this is where the main effort needs to be applied. For the remainder, it25
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