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Table 4 Factors and their elements influencing implementation and maintenance of navigation programs

From: Implementation and maintenance of patient navigation programs linking primary care with community-based health and social services: a scoping literature review

Factors Elements describing each factor
1. Patient Characteristics: • Complexity of clients/patients
• Need to address clients/patients basic needs (e.g., shelter) first
• Caregivers of clients/patients are patients themselves
• Geographic restrictions (e.g., access to services in rural communities)
• Language barriers
• Respect for cultural values
2. Effective Recruitment and Training of Navigators • Recruitment of lay navigators supported by word of mouth
• Maintenance of ongoing training to support:
 o Growth and development of navigators,
 o Role transitions
 o Problem solving for complex cases
 o Collaboration and mutual support among navigators
 o Orientation to the needs of the population being served by navigators
3. Role Clarity • Clear boundaries set for navigators (particularly lay navigators) in their role
 o Clarifying role boundaries with patients/clients as well as physicians
• Valuing role clarification
• Management of anxiety when taking on new navigation role to build confidence
4. Effective and Clear Operational Processes • Careful development of planning processes
• Development of policies and procedures to support program activities
• Establishment of documentation mechanisms such as clinical intake forms
• Use of consensus decision-making approaches
• Provision of clinical supervision and steering committee oversight
• Regular communication between agencies for planning purposes
• Mechanisms to address scheduling and referral challenges
5. Adequate Human, Financial, and Tangible Resources including Technological Resources Provision for:
• Human resources
 o Dedicated, committed, engaged and adequately trained clinical staff
 o External availability of experts such as attorneys
• Financial resources
 o Secured external funding
• Tangible resources
 o Appropriate space for navigator and navigation work
• Technological Resources
 o Internet resources to locate resources and support complex cases
 o Electronic health records (EHR) to support documentation of evidence based care plans, patient assessments
 o EHR to support access to community resources, coordinate transitions, and promote self-management
 o Email or phones to support communication with physicians
• Adequate time to support transitional care and provide comprehensive care to a large caseload.
6. Strong Inter and Intra Organizational Relationships/Partnerships: • Encouraging commitment from all professionals involved
• Establishment of self-governing team environment in the practice (supports role development)
• Development of strong relationships with community agencies by:
 o Development of a community charter
 o Establishment of a community-based steering committee
 o Development of communication strategies with partner agencies
 o Mechanisms to address inter-organizational issues with power differentials and other tensions between agencies
7. Lack of Available Services in a Community • Addressing the problem of “navigation to nowhere” (Inadequate or non-existent local services)
8. Effective Communication between Providers • Encouragement of consistent attendance at regular meetings by staff (monthly)
• Sharing of updates related to patient/client progress (through EHR) regularly
• Involvement of physicians in meetings regularly
• Communication between all care providers
9. Program Uptake and Buy In by End Users of the Program • Selling/getting buy in to the navigation program with consumers
• Use of diverse strategies for recruitment to programs
 o Recruitment strategies are not successful with all population groups (i.e., outreach,) need to be tailored
• Addressing potential stigma in getting participation in mental health navigation programs
10. Valuing of navigators • Valuing navigators by providing them with opportunities to be recognized and heard
11. Evaluation of navigation programs • Evaluation of navigation programs:
 o Developing evaluation plan with team for ongoing evaluation
 o Considering community-based participatory research approaches
 o Focusing on program related processes (degree to which mission/goals are met)
 o Considering using pre-identified indicators
 o Addressing potential problems with lack of access to data, monitoring health status changes over time attribution of outcomes to navigation interventions