Checklist for New Midwifery Practice Groups (MPGs)
Develop Practice Structure and Protocols *
- Develop a code of conduct and a mission, vision and values statement to keep the practice focused on organizational objectives.
- Consider how to structure the MPG, taking into account the MPG’s mission, vision, human resources, coverage, hospital relationship and integration, ability to obtain support from nursing staff, etc.
- Develop a call schedule that meets the needs of the practice.
- Plan for contingencies for call coverage (coverage within the MPG, support from neighbouring MPGs or nursing backup for hospital births). See AOM template protocol under “Midwives Safety.”
- Develop practice protocols and policies. Templates and samples are available on the AOM website to download and adapt to meet the practice’s specific needs.
- Determine when clients will be accepted into care, considering the resources available to individual clients (e.g., access to a family physician).
- Develop a mechanism to assign and track caseload variables and billable courses of care.
- Consider identifying a mentoring MPG for resources, tools, operational tips, etc.
Register Business and Set Up Legal Structure
- Connect with a lawyer – ideally, one familiar with midwifery – to assist with registering the business and other legal matters (e.g., reviewing contracts).
- Determine if the MPG will be set up as a partnership, professional corporation or sole proprietorship, and consider how future members will be integrated into this model.
- Seek legal advice in drafting a partnership or shareholder agreement. Ensure the agreement addresses the “5 Ds” (disagreement, disability, departure, divorce, death). See AOM template agreement for details.
- If operating as a professional corporation:
- If incorporated and operating under a business name that is different from the corporate name, register the business name with the Ontario government.
Notify Relevant Organizations
- Once the new practice is approved, inform the CMO, AOM, AOM Benefits Trust and the MEP(s) within your region.
- Connect with BORN to setup your MPG account and a tutorial on invoicing.
- Provide the MEPs at Laurentian University, McMaster University and Ryerson University with the names of midwives able to precept students and apply for the preceptor program.
- Exercise financial due diligence when recruiting partners to the MPG, as they are ultimately responsible for the MPG’s finances. Consider performing a credit check on all midwives joining the partnership/becoming directors.*
- Open a business bank account and consider a business credit card. If incorporated, the bank will need the articles of incorporation.
- Register with Canada Revenue Agency (CRA) for a payroll account and, if incorporated, a corporate tax account. This process requires only a 5-minute phone call.
- Find an accountant – ideally, one familiar with the midwifery profession – for assistance with accounting and record keeping. Contact the AOM for a list of accountants.
- Find a bookkeeper and develop an internal budget that is separate and distinct from the TPA-MPG budget. This internal budget will be used to plan for and track income and expenditures throughout the course of the fiscal year.
- Connect with the TPA for orientation on the funding of midwifery and the invoicing process.
- Consider requesting an advance from the TPA to cover expenses if billing delays are expected.
- Consider setting up automatic withdrawals for regular payments (e.g., utilities, lease).
Hospital and Birth Centre Privileges
- Reconnect with the head midwife for support, to understand the process of privileging and discuss the goals of the MPG (e.g., planned growth). Some hospitals may require an interview with the Chief of Obstetrics, head midwife and nurse manager.*
- Apply for hospital/birth centre privileges if the MPG does not already have them.
- If there is no head midwife, connect with the hospital chief of staff and Nursing manager to create one.
- Arrange for a hospital/birth centre orientation for any new midwives.
- If privileges are not obtained when the MPG opens, develop a Memorandum of Understanding (MOU) for clients to sign at the onset of care, outlining that care will be transferred to the on-call obstetrician upon admission to hospital.
- Identify a midwife to be the lead liaison with the hospital(s) to support better communication.
- As per the Funding Agreement, MPGs must obtain commercial liability (business) insurance, even before securing clinic space. Although MPGs can contract with any insurer, the AOM has negotiated coverage through HIROC’s business insurance to meet the needs of MPGs.
- If incorporated, provide insurer with certificate of incorporation.
- Consider clinic space early; finding, leasing and renovating a clinic can take time. Consider a unit in a professional building, a home zoned for business use, or a shared space with other care providers. If the MPG plans to share space, contact the AOM to discuss considerations such as insurance.
- If there is a delay in acquiring clinic space, the MPG can start to build its caseload by taking clients into care and offering antenatal visits in a client’s home or in an alternate practice location (e.g., another MPG, hospital).
- Determine the MPG’s present and intermediate-term future needs for space, taking into consideration:
- specific needs of clients in the community (e.g., clients with limited or no access to transportation benefit from a practice located near town or accessible by public transit)
- growth plans (e.g., number of midwives expected to work at the MPG)
- functional use of space (e.g., prenatal class or other programs, Infection Prevention and Control (IPAC) needs)
- Select a security system to meet the MPG’s needs.
- Ensure the following IPAC considerations can be met:
- office space and furnishing can be adequately cleaned and disinfected (e.g., no carpeting or hardwood flooring in care areas)
- availability of space to store clean and dirty equipment/devices separately
- If leasing commercial real estate property:
- retain a commercial realtor, as the process and terms differ from residential property
- consider negotiating with the landlord for needed leasehold improvements if they are unfunded or exceed available MPG funds
- If insured by HIROC, ask HIROC to review lease of premises agreement before signing.
- Whether sharing space or leasing dedicated space, have a contract that includes:
- start and end dates and the notification period to end or extend the lease
- payment rate, dates and responsibility for costs (e.g., utilities, taxes, maintenance)
- insurance coverage by the landlord and the MPG, showing mutual indemnification
- detailed list of valuables outlining what is owned by the MPG and the landlord
- If sharing space with other care providers (i.e., leasing space within an already established practice), have a written contract that outlines the terms of the lease in addition to the above, including:
- number of clinic/exam rooms required
- the dates/hours that rooms will be used by midwives, considering the potential need for to add an extra day as required
- specific rooms that will be used by midwives and areas of the clinic that will be available for midwives and their clients to use (e.g., waiting area, staff lunchroom, reprocessing room, etc.)
- equipment/furniture the MPG is responsible to provide and equipment/furniture that will be provided by the landlord
- what will be shared, what the landlord will provide, and what the MPG is responsible for, including how electronic/paper charts are used and secured, telephone lines, administrative support, receiving mail and laboratory services.
Infection Prevention and Control (IPAC)
- Determine how the MPG will ensure instruments are sterile. Options include reprocessing on-site, contracted reprocessing services or using disposables).
- If the plan is to reprocess equipment on-site, ensure there is a dedicated reprocessing area that is physically separate from direct care areas and areas where clean, disinfected and sterile items are handled or stored. Ensure the reprocessing area layout enables a one-way flow from dirty to clean. Contact the AOM for IPAC considerations and contacts of infection prevention consultants.
- If the autoclave belongs to a landlord and is shared by the MPG, consider who will be responsible for the maintenance of the autoclave and biological indicator checks. If landlord is responsible for reprocessing, develop a MOU outlining standard.
- Determine how, and by whom, the office space will be cleaned (e.g., hired professional cleaners or MPG staff). Ensure cleaners are aware of IPAC standards for cleaning in a health care setting.
Occupational Health and Safety
- Ensure compliance with health and safety legislation.
- Post all required Ministry of Labour materials, including Employment Standards Act, Health and Safety at Work posters, Occupational Health and Safety Act, and names of health and safety representatives and policies.
- Adapt and print AOM template Health and Safety Policy and Anti-Harassment and Anti-Violence Policy and Procedure.
- Institute workplace violence prevention best practices.
- Adapt and utilize AOM template workplace safety documents (under “Midwives Safety”).
- Have available Safety Data Sheets (SDS) for cleaning products stored in the clinic and for products midwives carry in their bags (e.g., disinfectant wipes).
- Design a logo.*
- Design a website. If website design is not yet complete, start with a home page and information about how to come into care.
- If collecting client information on the website (e.g., online intake forms, appointment booking), ensure appropriate website security certificate to protect personal health information.
- Create a Facebook page and/or other social media; ensure appropriate use of social media.
- Design business cards and flyers for outreach.
- Contact the AOM for midwifery promotional materials (posters, brochures, rack cards); place MPG contact labels on materials to hand out.
- Create a practice “admin” email account and determine who will be responsible for monitoring it. Consider creating a practice email account for each midwife
- Consider establishing a route schedule to continually promote your practice
- Adopt a policy for the use of email and create a consent form if email is to be used with clients.
- Connect with neighbouring MPGs to introduce the new practice and schedule peer reviews. Consider MPGs that share a common hospital and/or are within the community.*
- Whenever possible, schedule in-person networking meetings with care providers, community agencies and other stakeholders to introduce new MPG, establish relationships based on referral and build caseload.
- Connect with EMS to introduce the new practice group and set up processes for transport.
- Find practitioners to consult with or refer to as needed.
- Invite hospital staff including ER, diagnostic imaging and lab staff to a “lunch and learn” to share information about midwives’ scope and role in the hospital.
- Consider inviting stakeholders in the community to share information about their services and discuss midwifery services (mutual referral).
- Consider marketing to the specific needs of the community to build caseload.
Set Up Office
- Order Ontario Perinatal Record forms.
- Obtain ultrasound requisition forms.
- Register with a laboratory, providing the billing numbers of all the midwives at the practice to obtain Laboratory Requisition forms.
- Consider registering with ONE Mail, a secure email server through eHealth Ontario, or obtain another secure encrypted email programme to comply with Personal Health Information Protection Act (PHIPA).
- Set up electronic Notice of Live Birth access.
- Determine and set up method of charting (e.g., paper charts or electronic health records).
- Prepare hard copies of all forms, requisitions, etc.
- Make up initial visit packages, home birth packages, and home birth kits.
- Set up MPG telephone/fax line. If sharing space, consider whether to create a separate phone line for the MPG’s exclusive use (e.g., a remote phone line).
- Obtain stationery including letterhead, labels, stamps, etc.
- Determine where documents will be stored (e.g., office computer, server, cloud, etc.); consider privacy requirements and accessibility.
- Set up AOM access for the administrator(s).
- Obtain hospital pre-registration packages.
- Set up courier accounts (e.g., Purolator, FedEx).
- If setting up a lending library, order books and set up a system for tracking signed out material.
Purchase Equipment, Medications and Supplies
- Consider infection prevention and control requirements when purchasing equipment, supplies and furniture.
- Connect with MPGs in the community prior to purchasing equipment, supplies, office furniture and medication for any useful tips. This may be particularly helpful when working in small or remote communities with limited suppliers.
- When selecting information technology systems, consider security, cost and the MPG’s potential for growth.
- Order prescription pads.
- Find a pharmacy (hospital or community) from which to order medication.
- Designate a fridge to exclusively store medications, separate from the fridge used to store food or specimens. See AOM template policy for details.
- Set up a system to monitor and reorder medication and supplies.
- Implement processes to create and maintain a healthy work environment that promotes a “just culture.”*
- Recruit midwives and staff using an equity lens throughout the recruitment process, including in the job posting, interview questions, reference checks and expectations related to over-qualification or interruptions in practice. Contact the AOM to learn more about building a practice that is equitable and free of discrimination.
- Download AOM template agreements (e.g., independent contractor and employee agreements) and review with a lawyer to adapt template agreement to meet the needs of the MPG.
- Provide an orientation to new staff and midwives as per MPG protocol (see AOM template under “Human Resources”).
- Have all midwives, staff, volunteers, students and contractors sign a confidentiality agreement.
- Schedule dates for partner meetings and team meetings.
- Identify the strengths of each partner early and create portfolios/job descriptions to divide tasks; this can be modified later.*
- Consider if the rural and remote program is appropriate for the MPG to enable members to take a holiday without threatening caseload. For example, if the MPG does not have an adequate caseload to retain another midwife but needs coverage for a short period of time, the rural and remote program may be appropriate.
- If second birth attendants (SBAs) are required, ensure they meet CMO requirements or contact the AOM to discuss applying for a waiver.*
- Consider the MPG’s need for administrative support and the feasibility of partners assuming this work (i.e. scheduling, invoicing, bookkeeping, purchasing, etc.). MPGs with 120 or fewer approved courses of care are eligible for $20,000 for administrative support; MPGs with 121-160 approved courses of care are eligible for $10,000 for administrative support.
- Create a document outlining the role and expectations for an administrator and coverage when the administrator goes on holiday.
- Create a protocol/procedure binder (or electronic folder) for the administrator(s).
- If working with another practitioner (e.g., a nurse practitioner) in providing care:
- call AOM Policy Department for guidance
- call CMO to notify them of shared care
- create protocol to identify who is the most responsible provider
- create opportunities to shadow midwives
- review informed choice discussions (ICD), ICD checklist, administrative documents and forms to send
- consider appropriate access to charts/EMR (i.e. access only to shared care charts)
- schedule chart reviews
- Select a paging system that will best meet the needs of the practice.
- Develop a system to share information, ensuring privacy legislation is observed:
- between midwives (e.g., check in, hand-over, status updates)
- between partners for business related communication (e.g., completing CV logs)
- between midwives and clients (e.g., receiving client messages)
- Develop an ambulance registration form for planned rural home births. See protocol page under “Emergency Situations”.
- Have a system in place to address issues/concerns as they arise.
- Develop clear reporting processes for midwives and administrators.
* Consider starting some of the items with an asterisk in advance of the new practice approval.