Care Teams Need Coordination Tools

Molly is a Nurse Navigator/Patient Care Coordinator at one of the largest elective surgical hospitals in the United States. She spent 20 years as a registered nurse in orthopedics and knows first-hand the challenges and triumphs experienced by patients during and after their surgical procedures. Molly is passionate about patient engagement and now heads up the effort to prepare patients for their surgery and recovery.


Her number one goal is positive outcomes for her patients. She strives for the highest level of patient satisfaction because she knows referrals drive the business. At the same time, her employer insists on everyone “doing more with less” and trying to contain costs as much as possible without sacrificing quality of care. As volumes of patients increase and staff budgets decrease, she knows she will have to manage her patient workload smarter.


Much of her processes are manual. Patients are given paper binders to prepare them for surgery, and if they live too far away to visit for joint class, she has to mail them a binder and DVD of the class. She teaches joint class once a week to the patients who choose to participate (about half of them).

Most of Molly’s time is spent on the phone, she has hour-long phone calls with patients a week before surgery to collect their medication information and answer any questions. She also calls patients one week post surgery to check in on their progress and any concerns. The majority of this work is managed with spreadsheets.

Molly’s story is one that we hear often from patient care coordinators and nurse navigators. They play a critical role in setting and meeting patient and caregiver expectations about major surgeries or episodes of care, but they aren’t armed with tools to help them engage with patients outside the hospital environment. They may only see the patient one time before a surgery to deliver important information. In reality, much of this information may be forgotten or just too overwhelming for a patient to absorb. And, until a patient personally experiences surgery or recovery, they may not understand the importance of each instruction.

Wellbe addresses many, if not all, of these challenges. Wellbe’s CarePath Automation helps Molly see exactly who is accessing patient material and when. She can also see who is on track and which patients are falling behind on their responsibilities. She gets alerted when patients are feeling unprepared to move forward and when they have feedback about their experience. These tools help nurses make decisions based on meaningful data.

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