The Importance of Helping Newcomers (Transcript)Click CC for subtitles.

How does my organization create a navigator program?

Focus on solving specific problems. What is the need or gap in services that you identified in the five-step decision making tool? What will you do to solve those problems?

Designing and monitoring your navigator program

Setting your strategy and objectives

Clearly identify your goals. No program can satisfy the needs of all people as problems are too numerous. It is crucial to set the scope and work on goals that are deliverable to the people you decide to serve.

  • The most effective goals are SMART — specific, measurable, attainable, realistic and delivered on time
  • Create a logic model. Use the data you collected from the five-step decision tool to answer “who, what, where, when, why and how.” This acts as the blueprint to document your program plan. This model links your goals, objectives, activities and inputs to outputs and outcomes
  • Properly define the scope and document it to avoid scope creep

Planning your navigator program

  • Select a navigator model that fits your organization
  • Determine the qualifications your navigator should have
  • Do a job analysis for your program which includes the knowledge, training and skills a navigator will be expected to have and what training will you be able to provide after he or she starts with your organization

    Navigator tasks and responsibilities [view PDF version]

  • Develop a recruitment and hiring plan
  • Identify your clients — this process will vary depending on your organization
  • Develop a well-defined referral system
  • Keep track of contacts and interactions between the navigator, staff, stakeholders and clients —this will ensure that staff are aware of the navigator’s efforts with the client and vice versa
  • Immigrants experience a significant change when they come to Canada. Understanding and respecting culture diversity is crucial for all organizations. Identify what client-needs the navigator must address, especially those that may act as barriers to obtaining service such as:
    • Financial needs
    • Transportation
    • Language barriers (the navigator must be familiar with different dialects and linguistic preferences)
    • Literacy skills
    • Fear and anxiety
    • Culture
  • Decide on how your navigator will be supervised

Identifying your performance measures

With well-defined goals and objectives, you should be able to clearly:

  • Quantify the reduction in negative outcomes
  • Illustrate the role the navigator role plays in achieving positive outcomes
  • Quantify the improvement in positive outcomes
  • Illustrate the positive impact of the navigator role on the organization processes
  • Quantify the amount of money and resources saved by the navigation services (cost effectiveness)
  • Highlight positive feedback from service providers and outline cases in which the navigator services were helpful to staff
  • Highlight positive feedback from stakeholders
  • Outline cases in which the navigation services were crucial in ensuring positive outcomes
  • Provide feedback from clients regarding your navigator’s support and recommend changes needed to improve services

Implementing your navigator program

Implementation is based on the needs assessment and program design, refined by thorough and ongoing evaluation. This process should be tailored to fit different clients coming to various organizations.

The following framework should act as a guide to produce a blueprint tailored to the needs of different organizations and services provided.

    STEP I: Recruit, select and educate the navigator

  • Advertise the navigator position
  • Interview candidates
  • Determine the IT system access needs of the navigator and work with IT department to have the proper access set up
  • Once the navigator starts, you should:
    • Orient the navigator to front desk, staff and team
    • Orient the navigator to the organization’s policies and procedures, manuals, required training and schedules
    • Orient the navigator to the IT system
    • Have the navigator complete necessary orientation training and any mandatory training
  • Ensure that the navigator receives privacy training
  • Ensure that the navigator continues to receive competency-based professional training
  • Outline all the stakeholders that could help the navigator efforts and introduce them to the navigator
  • Continue to support the navigator through their role

    STEP II: Inform

  • Hold meetings, educational sessions and open forums with staff to ensure that they are properly informed about the navigation program, that they get the opportunity to ask questions, express concerns and make recommendations
  • Establish an internal advisory group to assist with the implementation plan
  • Inform senior executive team of your implementation plan and ensure their support
  • Outline stakeholders that could help the navigator efforts and introduce them to the navigator program

    STEP III: Ensure competent services

  • Define the scope of navigator’s involvement
  • Avoid overlap with other client services within the organization
  • Coordinate with existing language and cultural interpretation services or arrange these services if they don’t exist
  • Identify program co-champion and point person for problem solving
  • Provide recognition for high performance
  • Continue to support the navigators through their role

How to evaluate your navigator program

Evaluation entails the systematic gathering of data about aspects of your navigator program. The data collected will be used to help decision making. Evaluation can be of the process or the outcomes.

Process evaluations focus on assessing activities implemented and the strengths, weaknesses and challenges of the implementation.

Evaluating outcomes is an important part of your navigator program’s development. Evaluations should be carried out regularly and guide improvements to the program to continuously improve achieving the desired outcomes. Thus, you should:

  • Refer to the goals and logic model to set your evaluation framework
  • Link the navigator program success to measures such as improved client experience, better allocated resources and more efficient use of services
  • Use lessons learned, especially setbacks, for continuous quality improvement — a good tool for this process is Plan-Do-Check-Act
  • Assess the program at regular intervals (quarterly)
  • Monitor stakeholders’ values and if the program is aligned to them
  • Communicate the results of your evaluation through a written communication plan. It is crucial that everyone understands the program’s measures for success.

Your evaluation framework should include:

  • Measures for the success of the program — show the impact of the navigator program on clients, administrators, customer service providers and policymakers
    • What changes are expected
    • What barriers will be removed
    • Will there be added services, different processes or changes in personnel roles
  • Metrics to measure the following for clients:
    • Improvement of overall services
    • Improvement of client experience
    • Improvement of quality of life
    • Decreasing wait times
    • Completing client records accurately
  • Metrics to measure the following for the organization:
    • Reduction in costs
    • Timeliness of services provided
    • Decreased no shows or missed appointments
    • Generate revenues

Benefits of evaluation results

You should use your evaluation results to demonstrate the success, failure and ways to improve the program. Gathered data can:

  • Justify the program’s progress, value and funding
  • Act as part of the organization’s website, annual progress reports, quality improvement initiatives and client-provider engagement tools
  • Reach out for further funding
  • Communicate the program’s effectiveness to clients, service providers and stakeholders

Find more resources about implementing newcomer programs

The CHEO Experience — building our navigator program

By June 2016, the demand for CHEO services from the Syrian refugees normalized — still more than January but manageable and predictable. The Patient Experience team broadened Suelana Taha’s role. The newcomer navigator was to take lessons learned serving Syrian refugees and build a program designed to serve all newcomers, regardless of their country or culture of origin. CHEO is now seeing refugees arriving from Africa and other parts of the world.

Photo of the Mbwile family,  Congolese refugees that utilized CHEO services

“When I was born in Congo life was good. There was no war.” Mbwile Alibaba Rusagara with members of his family.

The newcomer navigator role is expanding to include more outreach and education. If Syrian families can be educated about the role of community clinics and referred to family doctors who speak Arabic, this will lighten the load on the Emergency Department. Syrian children will get faster access to the right health care with family physicians and waiting times in emergency departments will not be additionally strained.

“We have also learned that if no illness is apparent, many families do not bring their kids to their appointments,” Taha says.

For instance, a child seen in the Emergency Department for wheezing may be checked and given a treatment plan. They are sent home with follow-up in the Respirology Clinic. Established Canadians, steeped in Western medicine, know the importance of these follow-up appointments. This is how treatment plans are adjusted and serious conditions are definitively ruled out. Rural Syrians, without similar context, may not understand the importance of follow-up appointments and when their child appears to be okay, they do not attend. Their cultural experience is that unless their children seem very sick and need urgent attention, they keep them home and provide comfort.

Photo of Syrian refugee brothers that utilized CHEO services

Brothers, Ahmad and Zayan Barho.

Taha also found out that some may be worried that they will have to pay. “I had a Syrian man come into Emergency because his son needed to be seen but he explained that he did not have any money,” Taha says. “I showed him his Ontario Health Insurance Plan (OHIP) card and explained to him that this was his money, as far as the hospital was concerned. The look on his face was like I had told him he could fly to the moon.”

The Patient Experience team is now working on making health-care education proactive so that newcomers understand the importance of things like follow-up appointments, their OHIP card and their family doctor.

Taha is also working on formalizing cultural training for staff and physicians who are likely to have contact with newcomers. Knowing what to expect from each other should increase cooperation between staff and families. Some Syrian men, for instance, do not make a lot of eye contact with women. Some female nurses were feeling resentful. Taha heard comments like, “Why is he not looking at me when I am trying to help his child?” Body language in one culture may mean something different in another. The volume of one’s voice may mean different things to different people. Once staff understand silence or lack of eye contact as a way to express respect, that cultural barrier is removed.

Ultimately, the goal of the CHEO Newcomer Navigator is to help integrate CHEO services with community agencies. To take a proactive role in simplifying the newcomer journey through pediatric health care. And to help hospital staff and physicians understand how they can provide the best care.

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