Centering Healthcare Institute, Inc.

Preparation for the Training Workshop

Centering is built on the basic premise that care is most effectively and efficiently provided in groups that are facilitated rather than taught. We at CHI know from long experience that a shift to group care requires a group commitment from sites. In order to successfully implement and sustain the model, a practice must complete a process of self-study and planning as outlined in these pages.

Pre-Planning Process

  1. Selection of the steering group

It is essential to have a core group of staff who are responsible for the initial planning and implementation of the Centering model, and then continue on with oversight and evaluation. The group should include:

  1. An Administrator who has responsibility for prenatal care
  2. A Credentialed provider who will have direct involvement with the model
  3. A representative from other direct service areas such as: nursing, medical assistant, case worker, social worker
  4. A front desk clerk
  5. A consumer, past or present, if possible

2. Designation of the lead member of the Steering Committee

The agency needs to allocate administrative time for the lead person of the steering committee.

3. Preparation Process : We want your site to become a successful, sustainable Centering site. Before you invest lots of time and money, please carefully judge your readiness and commitment to this change.

  • If you need some background on the Centering model, there is some very helpful information available from two archived web casts, available at (Go to Pregnancy/OB-Gyn in the Archive library, “Redesigning Prenatal Care: CenteringPregnancy Session #1 and Session #2”) Perhaps your steering committee would like to watch it together.
  • The next step in the process is to work as a group to complete the “Planning Guide for Establishment of a Centering Model”. Input from others might be sought in this process and ideally the content would be shared with the entire service group.
  • “System Assessment Worksheet” will provide guidance as to the areas that will need the most focus during the implementation phase. The “Space Planning” handout gives further guidance on issues related directly to space since this is often one of the major early challenges in model implementation.
  • Development of a time-line will help all involved to identify specific components, responsibility, and dates needed. In general, CHI recommends that one to two months of weekly or biweekly planning meetings and educational sessions be completed prior to the workshop, and at least a 4-6 week planning period following the workshop before actual implementation of the first group. A review of the “Implementation Time-Line” and assignment of responsibilities should be done prior to the workshop.
  • Complete the “Demographics Form” and return to CHI at least 2 weeks in advance of the workshop.

The Workshop

  1. Schedule
  2. It is very important to be sure that appropriate schedules are blocked for the workshop. The training workshop is 2 days: the first day is focused mostly on logistics and the 2nd day is focused mostly on group leadership and detailed review of sessions.
  3. Attendance
  4. In a large agency, all of the steering committee should attend both days in order to fully understand the model.
  5. Ideally, all staff that has responsibility for care delivery would attend at least the first day. That often means closing the clinic for a day.
  6. All people who will be involved in facilitating groups need to attend both days. The facilitation team includes a provider and a 2nd person: medical assistant, nurse, social worker or case worker, etc. If the second person facilitating that group isn’t credentialed to do care (e.g. social worker) then a medical assistant needs to be available to the group during the assessment process. It is expected that there be a minimum of two facilitation teams attending the workshop unless your site is small enough to support only one team.

Post-Workshop

  1. The steering committee should plan to meet within a week after the workshop for debriefing and to continue work on the time-line. This group should set up regular meetings, usually weekly/bi-weekly in the early stages of planning and then monthly.
  2. If possible, the entire service delivery team should meet within a month for an update on planning or for any other workshop de-briefing.
  3. The lead steering person should keep in contact with the CHI site support person assigned to you for help with any on-going challenges.

Centering Healthcare Institute. Inc.

Planning Guide for Establishment of a Centering Model of Care

Step lIdentify a core planning group made up of key personnel involved in providing prenatal care. These people should represent: credentialed providers, administration, nursing, front desk clerks, medical assistants and also might include: case workers, social workers, and a present or past consumer.

Step 2Talk together about the following questions as part of your preparation for the training workshop.

  1. What components of our care are working well?
  1. With which components are we most dissatisfied?
  1. What is our vision of “ideal” care?
  1. What are the major obstacles in achieving that vision?
  1. How to we see the Centering model moving us toward that ideal?
  1. How will we know that any changes we make are contributing to improvement?

Centering Healthcare Institute, Inc.

System Assessment Worksheet

Thinking about the situation in your own agency, rate each of the following areas:

1 definite area of strength 2 uncertain 3 definite problem area

ITEM / 1 / 2 / 3 / COMMENTS
Agency administrative support
Nursing support
Physician support
Nurse-midwife/APRN support
Related professional support
Professional group leadership skills
Current personnel satisfaction
Client base
Current client satisfaction
Patient flow
Community agencies
Prenatal/other education programs
Language issues
Child care
Transportation
Parking
Appropriate group space
Audio-visual equipment
Visual aids: posters, models, etc
Video tapes
Essential equipment for care
Storage space
Access to care
System economics
Competition
Start-up funds
System goals
Energy
Other

Centering Healthcare Institute, Inc.

PRE-WORKSHOP DEMOGRAPHIC FORM

We have developed this form in order to get background information that we hope will help ensure a successful workshop tailored to the needs and concerns of your institution. Please take time and thought in filling it out, although brief answers are also welcome. Please return at least three weeks in advance of the workshop date to .

AGENCY

1. Site name

2. Type of institution (hospital, community clinic, private practice, academic hospital, teaching facility, etc)

3. OB deliveries/month

4. Demographic of city/town where agency is located (i.e. near border, rural, inner city urban, etc)

5. What are your agency’s strengths?

6. Describe your administrative support for Centering.

Politics or systems level challenges we should know about? Particular medical climate or current healthcare issues affecting you?

PATIENT DEMOGRAPHICS

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Age range

Ethnicity

Rural/urban

Literacy level

Insurance access

Linguistics issues

Centering Healthcare Institute, Inc.10-07

Particular risk factors or stressors, cultural barriers, challenges or strengths that you would like to address:

PROVIDERS

  1. Who are your providers? (physicians, midwives, nurses)
  1. Is there provider support for CenteringPregnancy? If not, what are their concerns?

3.Will these providers be at the workshop?

4.Who will be the group co-leaders? (nurses, social workers, medical ass’ts)

5. # providers in the agency ______

6. # providers for Centering groups ______

7. potential co-leaders for Centering groups______

SUPPORT STAFF

1. Is your support staff (front office, eligibility workers, community workers, etc) supportive of the Centering concept? If not, what are their concerns?

2. Will these people be at the workshop?

WORKSHOP PARTICIPANTS

1. Type of providers (RNs, NPs, CNMs, OBs, Family Practice MDs, PAs)

2. Administrators?

3. Support staff?

4. Approximate % of total participants of each above, i.e. %admin, %clinical, %support?

CENTERING PROGRAM

1. If you have a Centering program already, how long have you been conducting groups?

2. Current challenges?

3. Anticipated challenges?

4. What is your weakest link in implementing a Centering Program?

5. As a site, what would you like to get out of this workshop?

6. Which topics would you like to prioritize or focus on?

7. What is your funding source for Centering?

Centering Healthcare Institute, Inc.

Centering Implementation Time-Line

Set target start date and then develop a time-line. You can use this grid to help with planning, or modify it for your own planning group needs. Include assignments of specific responsibilities and set regular meetings to assess progress (biweekly works well). Revise time-line if needed. Ideally, the training should take place about 4-8 weeks prior to starting group.

Training date: ______

TargetCentering start date: ______

1-2 months prior to training / Date / Responsibleperson / Date of follow-up / Date complete
Assemble team to watch introductory Centering webcasts at to Pregnancy/OB-Gyn in the Archive library, “Redesigning Prenatal Care: CenteringPregnancy Session #1 and Session #2”)
Plan specifics of the program (i.e. leadership, location, possible schedule, specific start date)
Identify who will attend the training (steering group including two group facilitation teams) and clear schedules
Identify education materials available at your agency. Preview videos for possible use in the program, if desired.
Book group-appropriate space
Begin work on a scheduling grid and computer template
Order equipment/videos or be sure to have all items on hand
Prepare and begin posting publicity
TRAINING OCCURS
Date / Responsible person / Date of follow up / Date complete
4-8 weeks prior to start date
Promote Centering to appropriate patients registering for care
Activate staffing plans, group enrollment, appointment schedule
Monitor group enrollment every week to assure adequate group size. Target group enrollment size should have 12-14 people receiving care (either individually or part of a dyad).
1-2 days before starting
Gather all needed materials, including charts for provider chart review
Call participants to remind them of their group appointment
Arrange for snacks
Start date
Get to room early to have it ready for the group
Bring all necessary materials
Take a deep breath and start!

Notes:

Centering Healthcare Institute, Inc.

Space Planning for Centering Groups

Providing care in groups requires very different space than that required for individual care. Most agencies were not designed to have appropriate group space and often the space that is available is used for staff conferences and/or as a staff lounge. Listed below are the components needed to make the space appropriate for use for patient care groups.

ITEMDISCUSSION

Private / Confidentiality is essential. Staff or others cannot access the group space while group is in process
Quiet / The door is shut and the room should be immune from overhead pagers, phone ringing, etc.
Size / Preferably an elongated square with ample room for up to 20 chairs in an open circle, an assessment mat in one corner, a check-in table, and an area for a snack
Seating / Comfortable seating: chairs, bean bags, pillows, for the total group, with no table/s in the center
Bathroom / Access to a bathroom near the group space
Storage / Storage cabinet for education items, videos, and assessment materials. If this isn’t available then a moveable cart will be needed, with a space to store that. Plan for food storage as well
Lighting/temperature / Adequate lighting, windows are best. Ability to control room temperature
Tables / Tables are needed only on the periphery of the room. If possible, avoid the need to move heavy tables
Floor / Ideally the room would have a rug on the floor. If not, sometimes a small area rug can be used to identify the assessment corner
Easily accessible / The room should be easy for patients to access. Ideally this would mean a direct outside entrance
Other / Appropriate pictures/posters, flowers, nicely painted walls all contribute to the ambience and friendliness of the space

Centering Healthcare Institute, Inc.10-07