Barbara Tofani: The Old Ways of Coordinating Care Are Gone

The old ways that physicians used to coordinate care no longer work and the idea of just hiring 1 person to do it hasn’t been sufficient, said Barbara Tofani, RN, MSN, NEA-BC, administrative director of the Hunterdon Regional Cancer Center.

What are the biggest mistakes organizations are making when trying to improve care coordination?
Organizations think that 1 person or 1 group of people—care coordinators, nurse navigators, lay navigators, whatever they want to call them—they think, “if we just hire care coordinators or navigators, that will solve all the problems.” And, I think, that has been our biggest mistake. And I have been working with care coordination for about 12 years now, and that’s becoming more and more clear to me, the more I’ve been involved in care coordination, that it is not 1 person who can coordinate the care of the patient. It’s a systems problem, and it needs to be a systems solution, and we weren’t looking at it as a systems solution. We were just looking to say, “Let’s hire a person, and if we hire a nurse that’s even better because nurses can do anything.”

We need to create the infrastructure. We need to make sure that the medical records talk to each other. We need to make sure that the physicians who are in those medical records actually read the information that’s in there. We need to make sure that physicians talk to each other. We’ve gone to a system where we use hospitalists and intensivists in hospitals—physicians don’t admit patients anymore, so they don’t have a mechanism to communicate with each other unless they intentionally make the effort to talk. But the days of physicians just being able to run into each other in the hallways or sit together in the staff lounge and just talk are gone.

And, so, all those ways that we coordinated care in the past, don’t exist anymore. And we thought if we just hired a nurse navigator that that would atone for all those sins that we’ve created over time and it just hasn’t been working.
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