The Challenge of Effectiveness in a Changing Health Care Environment: Patient Navigators and Holistic Care

• In Event: 074 - Regular Session. Health Care and Care Delivery 2

Abstract

The value of standardized inputs and processing procedures in order to maximize standardized output creates an enduring paradox for organizations that confront variable raw materials, unpredictable employees, and changing external conditions. Health care organizations have long struggled with this conflict between maximizing efficiency in a variable, unpredictable, and changing environment, but this conflict has been exacerbated by the increasing diversity of the patients they serve, the greater complexities recognized in the health care problems they must serve, and the growing pressures for community engagement. This paper focuses on a public health program that changed its mission from an exclusive focus on cancer screening to a broader mission of lessening the burden of chronic disease among in a diverse population that included many immigrants. Semi-structured interviews with staff and phone surveys of patients are the primary methods used to identify the extent to which the desired change was achieved, the way in which services were delivered, and the impact of the change. The findings highlight the difficulties for health care delivery of a less predictable environment. Although the health care program staff was diversified and the program’s mission was broadened, the resulting improvement in ability to deliver more holistic care for chronic disease was balanced by a reduction in effectiveness of the cancer screening program.

Author

• Russell K. Schutt, University of Massachusetts-Boston