Paradigm shift: Navigating to care
is care

Following the strategic care navigation project, I am leading an effort to write a theoretical paper with Kaiser Permanente, to argue that care begins at navigation.

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ABSTRACT

As technology fundamentally changes the way that patients initiate a healthcare interaction, an important question arises: when does care begin? Most healthcare systems see accessing care as infrastructure rather than part of the care journey (whether by booking an appointment, walking into a clinic, or messaging a provider, and other pathways). However, as we built Kaiser Permanente’s Southern California Medical Group’s long-term strategy for appointment selection and booking, an important paradigm shifted for us: Navigating to care is care. 

Clinical leadership realized that if we continued to see care as beginning only when the patient walks into the exam room (or logs on for their virtual appointment) then we overlook a number of care decisions that are made easier or harder by the system and must be negotiated by the patient. 

When the system puts work (e,g. choicemaking, compliance, barriers) onto the patient it creates a cognitive load that can lead to patient burn-out, delays in care, and patient confusion. By understanding that strategizing for good patient care should begin as soon as a person considers how to seek guidance from the medical system, we hope to reclaim responsibility for some of the cognitive labor in researching, assessing, and advocating, even before an appointment begins.

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Explorations in Development

• The traditional model of healthcare understands medical care as beginning at the exam room, with clinical interactions and medical staff. This leaves two important stages of care-seeking— what we call Assessing and Accessing care— to be viewed simply as operational or infrastructure, and not treated as care.

• By “better care” we see improving the early stages of care as opportunities for healthcare systems to 1) relieve the cognitive load on patients, 2) reduce errors that lead to delays in care, and 3) reduce the misperception that care is less available/accessible because it is hard to navigate to, thus improving CAHPS scores.