BUILDING STAFF SUPPORT
When establishing a training program, it is invaluable to build and maintain staff support and involvement. The following strategies have been useful:
- Develop and foster multidisciplinary, team-based care
- Discuss how patients benefit (i.e.: public health implications of improved access)
- Cultivate interest in contraceptive advances
- Use appropriately timed staff surveys and values clarification workshops
- Bring speakers (with an outside opinion) to attest and legitimize the value of services.
NEGOTIATING THE TRAINING RELATIONSHIP WITH STAFF AND PATIENTS
There are various ways to present the training arrangement to staff and patients, reminding them that this is part of the broader process of professional education, and improved access.
- Prior to training initiation, discuss ways for your staff to talk about the training with patients and provide a script. They should feel comfortable presenting it.
- Training can be described as an initiative to address patient access to reproductive health services, extending expertise to more providers.
- Staff can explain, “You will be seen by two doctors / providers today; one from our clinic and one from the university.”
- Consider posting information explaining the training partnership in waiting rooms. One example is “A partnership has been established with the (university or hospital) to expand access to services by training more clinicians in reproductive health. This is a center of training and excellence.”
- Consider including training in a general consent form for care and services.
- Consider introducing yourselves by saying, “We’ll be doing your procedure together today.” Depending on who is undertaking the hands-on role, the trainer could alternatively say, “I’ll be assisting with your procedure today.”
- Emphasize the team approach to care (instead who has more or less experience).
- Allow the trainees to describe the details of their procedural background as needed, focusing on the fact that they do many procedures of this complexity.
PREPARING FOR AND SUPPORTING CHANGE
We all appreciate that change is not easy. Incorporation of new and controversial programs like abortion training is likely to require significant institutional change. Steps might include:
- Building the case for change; identifying and preparing for resistance
- Creating a plan and enrolling others to champion the change
- Recognizing the strengths your setting already has to support the change
- Considering small steps that can be made toward change
- Supporting, recognizing and maintaining the momentum
- Evaluating and openly addressing unanticipated problems
- Redirecting to stay the course
Embracing the concept of ongoing improvement sets a positive tone in a clinic, where trainers, trainees, and staff alike may be part of the learning process. Assure that there an outlet for staff and patient concerns and suggestions regarding the training program.
- Help reinforce the value of staff contribution in training new abortion providers
- Encourage leadership by creating roles for particular staff to be involved with demonstrating counseling, ultrasound, recovery or discharge teaching
- Encourage staff to give feedback to trainees
- Offer periodical updates to staff to broaden their knowledge and buy-in
- Encourage periodic discussion of clinic flow issues, strategies, and patient care with your staff, including huddles, debriefs, and staff meetings
- Share cumulative results of the training program with staff
EVALUATING NEW TRAINERS
Ideally new trainers have the opportunity to work alongside seasoned trainers to gradually obtain the many skills important to quality training. Timing of evaluation and approval to train independently may vary with experience providing and teaching in other environments, as well as needs of the program, but the following will assist in this assessment.
We hope that the above suggestions can help you to more seamlessly integrate training into your practice and to make it a fulfilling means to address disparities in access to abortion and reproductive health regionally and throughout the country. Please don’t hesitate to reach out to us and other colleagues with any questions.