A cancer center was having a difficult time coordinating the care of its head and neck cancer patients. Services were not scheduled in the correct order and dental clearance was taking two to three weeks, which held up the initial treatment for the patient. The clinical performance group (CPG)—which included surgeons, medical oncologists, radiation oncologists, dentists, prosthodontists, health psychologists, navigators, a social worker, a dietitian, and a speech/swallowing therapist—reviewed the NCCN guidelines, created a process map, and brainstormed best practices for its patients to ensure success, smooth transition, and enhanced patient experience.

The CPG wanted to standardize the care provided for head and neck cancer patients and accomplish its goals of enhancing patient experience and value-based care initiatives. As the team process mapped the head and neck cancer patient journey across the continuum, they identified many opportunities for improvement. The navigator created a standing order set that included referrals to all appropriate physicians and support staff. A patient appointment checklist was developed to educate the patient on the role of each provider and support staff with clear definitions and explanations.

Palliative care education at the time of diagnosis was also a tremendous need for these patients and the team decided to create a palliative care policy, including a script for the navigator’s communication with the patient. The script ensured that patients fully understood the role of palliative care. A palliative care toolkit was developed to set navigators up for success; the toolkit contained the following documents:

  • When and why is it important to discuss the role of palliative care with the patient and their family?
  • What is the Ask-Tell-Ask Approach: discussions with your patients and families
  • Communication pearls for palliative care discussions
  • Triggers for palliative care for healthcare professionals
  • Palliative care fact sheet for patients and their families
  • Definition of terms
  • References/additional resources

To measure its progress, the CPG created a head and neck cancer patient dashboard with metrics that required additional performance improvement initiatives to meet its goal.

Lastly, the importance of dental clearance for the patient prior to treatment is essential. The process was discussed and it was concluded that the navigator would take the lead by asking the patient if he/she had a dentist. The navigator would receive the patient’s approval to contact the dentist to expedite the appointment. A dental clearance form was created and shared by the navigator with the dentist. If the dentist had any specific questions or concerns, the navigator provided the contact information of a head and neck CPG physician. Dental clearance, which at one time took two to three weeks, was now occurring within two days.

The lead physician shared, “our head and neck cancer patients’ care has never been so well coordinated. Our navigator is essential to our program and our goal of delivering patient- and family-centered care. She provides a comprehensive assessment of the patient’s and family’s needs and keeps us all up to date.”


Developing a System-Wide Patient Navigation Program


Cancer Center

What We Did

Care Design. Cloud-based Toolkit Development.