EP33 | Policies and Procedures for Lactation Private Practice

Annie: I'm Annie.

Leah: And I'm Leah.

Annie: And this is Lactation Business Coaching with Annie and Leah, where we talk about the smart way to create a compassionate and professional private practice.

Leah: Let's dive in.

Annie: Hey Leah.

Leah: Hey there, Annie.

Annie: So you might be noticing that we don't sound quite as upbeat as we usually do and that's because we are rerecording this. We had to throw out our original opening for this episode because it was all about us getting excited to see each other in person at LCinPP.

Leah: I know. Neither of us got to go due to the travel restrictions with Covid-19 and we're really, really sad about that.

Annie: I'm so sad. It's devastating. Yeah, and on a lot of levels. So in addition to kind of managing our grief over missing out on what is always one of our favourite weekends of the whole year, we're working our butts off trying to figure out how all of the limitations and restrictions and closures are affecting our private practice.

Leah: Thankfully though, this episode is all about policies and procedures, which is a lot of what we really need to figure out right now and try to work through how we might be changing those due to some of these circumstances.

Annie: So you'll listen to the episode which is all about us talking about policies and procedures and then to keep that conversation going, we've decided to change the topic of our upcoming deeper dive. We were originally going to be talking about how to do intake, but we've decided to shift the focus and now we're going to guide a conversation all about how we are coping, changing and evolving our businesses in response to current events.

Leah: Yes. So join us with your concerns, your questions, your encouragements as we all are working through how our businesses might be evolving and changing in this time. And given that that's quite a lot to talk about, we're actually going to extend the usual time, which is one hour to two hours. So we have plenty of time and space to talk about all these topics together

Annie: So you don't have to be there in person. If you register for the live, you will get the replay. So you'll benefit even if you can't make it at that specific time to actually contribute to the conversation in real time, you'll be able to listen and benefit from what others are sharing, so we really do make this like support group styles. So me and Leah don't have all the answers, but we're going to create a place where we can have a productive conversation that really leaves you with some steps you can take to help your private practice cope with the current situation. So Leah, before we jump into the content of our episode, which is about creating your policies and procedures, I'd love to hear your motivation for today.

Leah: Yes. So on that subject of policy and procedures and just trying to be mindful about where you put your energy when you're thinking about the policy and procedures that you're coming up with, I think it's so important to maybe start at a place where you're finding your processes are kind of sticky, or you're not quite sure how or like something kind of brings a lot of stress in your life, I think that's a great place to start and really try to find processes and procedures and policies that bring you peace of mind. This kind of brings me back to a lot of people have very firm boundaries around follow up care, or around how you're going to do your intakes and these kinds of things and that's so important to respect how you need to work in this space, just as much as respecting how the family needs to work in this space. And I think it's important to remember that these things can be helpful to you. It's not just about the family; it’s about how can we all work together to bring us all the most relaxed and peaceful version of our work that we can. So that is my motivation for this work on policy and procedures because sometimes that just sounds like not super fun.

Annie: That's a great mind set about policies and procedures. It actually makes me think of one, a personal policy I have, which is that I don't schedule people until they have a discharge date from the hospital and that is a very firm policy. And whenever I've tried to work with somebody, whether they're having their scheduled C-section or maybe they've gone post-dates and they're like, well I know if I go any longer past this point, it's not going to go past that point cause I'm going to get induced. Yeah, I mean most of the time you know what you're going to be dealing with or you can kind of anticipate when you might be coming home, but a lot of the times you don't know when you're coming home, and every time I have broken this rule because somebody tugged at my heartstrings with their story. And usually it's people who are like, I've got this specific situation that I'm really worried about and I just really want to make sure that I have somebody there. It's never worked out and it causes me so much stress because what if I have to cancel them and then that's going to hurt them. Nobody wins in this situation because I tried to be nice. So I really like starting from a place of what's going to bring peace of mind. It brings me peace of mind not to have people on my calendar who haven't had their baby yet.

Leah: Yeah, yeah. I could see where that's, and if it's anything like the hospitals here in Houston, they say, oh, you're going to discharge you in the morning and then they don't get home until 8:00 PM because somebody didn't round on time and then they didn't bring the paperwork down and then they needed to do this and oh they forgot to do this one other test. And it seems like it's always inevitable. I tell people that when we do our prenatals. I'll be like, we usually want to come out on the day after you get home from the hospital, never on the day you supposed to be discharged because it's just not going to work. The timing is just too variable. But thinking about how these things could bring you peace of mind certainly changes when you look at it. You're not like, Oh I've got to come up with all these policy and procedures. It's like, okay, I'm going to create my policy and procedures so that I have peace of mind and I can move forward in my practice knowing that this is all decided. This is all figured out for me ahead of time.

Annie: So let's go back a little bit and talk about why do we need policies and procedures in the first place. So what are they? What are your policies and procedures? Basically in a nutshell, they are a document. They're meant to be an internal document you've created outlining all the steps for all the different things that happen from a business side. So these are not your clinical protocols. This is not what you give to a family to say, okay, if you have mastitis, I want you to do X, Y, and Z. These are how you run your business, and the idea being, if you bring someone into your business as a new hire or a new subcontractor, that you could hand those to them and say, here's how we do things. Here's our workflow. If you hire someone as an admin, then they can be trained on how you like to get things done. And also if something were to happen to you and you needed someone to step in and manage things, maybe in the case of illness, maybe you're incapacitated for some reason and some things need to continue happening with your business, this document could show someone acting in your absence how you run things. So it is one of the more boring things that you will ever do in your life is coming up with your policies and procedures. But it is really essential to have. You may never show this document to another person, but when someone asks a question like, but are you sure you won't come to my home the day I get discharged from the hospital? You can go back to your policies and procedures manual and say, I have a policy that I do not schedule consults for the day of discharge. I will schedule them for the next day and this is something anybody who's been to LCinPP knows that we were all trained in this by Liz Brooks, and she is the queen of policies and procedures. So we just want to first of all give all credit and acknowledgement for even us knowing that this exists belongs to Elizabeth Brooks and she has amazing resources on her website. Elizabeth Brooks IBCLC. We will put the actual link in the show notes because you just basically need to read everything she's ever written and buy her book because you need it.

Leah: Yeah, definitely. Definitely. I remember very vividly, I think maybe two talks that I've heard her do on policies and procedures and really kind of set the stage for oh, this is something I need to pay attention to. So several years ago, I kind of started down the journey and then you're always tweaking things over the years. So I've had my hands in policy and procedures on and off for quite a while and I have found it super-duper helpful when you're adding people in. You can just hand it over and say, I need you to read through this and ask questions, but this is kind of how we run things. And then it helps keep the standards where you want them to be and a way to guide you on like, well, is that really that important? Nope. If it's in my policy and procedures, it's that important and I'm going to pay attention to it, and that's my standard. I always thought about, and I think this might be from Liz Brooks, but if anybody ever questioned you in a legal way, like y'all didn't do blah, blah, blah, and maybe there's no other way to prove that something was done, well at least your policy and procedures would say, well this is our policy and procedure for X, Y, Z matter. You have at least something to back up kind of how the standards of what you do, and I think it's such an important document. But yeah, like you said, so boring and so painstaking to go through. It's just tedious.

Annie: So let's talk about how you actually create your policies and procedures. So Leah, I know you just went through this very recently and I did too, cause I brought somebody new on into my practice and I had to look at everything. So how did you approach creating your policies and procedures for babe?

Leah: Yeah, so very early on when we started in her Liz Brooks talk and we're like, Oh, we got to do something. It was definitely more bare bones, but we would just start with somebody calls, let's just write down what happens when somebody calls and request a visit and so we just wrote down the steps for that. And that was one thing and then we wrote down our charting. We wrote down how we do our charting. Where are we charting, what does charting look like, those kinds of things. And then we started just going through what we do on a day to day basis and would just write down the steps for each thing that we did, and that was kind of more your procedures and policies would kind of come out of that. Something would happen. We'd be like, Oh, we need a policy that we're not doing this or that our reports are going to done in this timeline, or we're faxing in this timeline. As we went through we're like, let's make this our standard. So I think that's a really great place to start is just your daily work. Just go through your daily work and start writing it down.

Annie: So yeah, that's basically what I did. I'm a very systematic thinker and so I started by doing a top level outline. Here are all the categories that I want to cover, and then inside each category I came up with here are the sub things in each category. And then I just went in each one and every time I thought of something just like you and I mean I constantly get new things added to it. So I started by ... mine were typed and just kind of step by step and I made lists and then I discovered - I didn't discover, I've known about it for a long time cause I've used it for other reasons - but I was like, oh I could just make a video. And so I do video procedures. So when I am talking with my admin or training the subcontractor who works with my practice and I want to show them something new in our EHR or help explain how to do something, I record a screen capture video. I use two different programs to do that.
One is called LOOM, which is not HIPAA compliance so it records my screen. So I hit play and I'm looking at my screen and I talk over my screen and I use that. I have a test client set up, IntakeQ, my charting platform, so then I can go through everything without showing any actual client data on LOOM. Sometimes we will have to show something specific for a client, like where maybe the procedure wasn't clear and they're confused about what they're seeing in a client. Then I use a different program that records to my desktop, does not store it in the cloud and then I share that with them through our HIPAA compliant communications platform, which is Spruce so they can view it there and I keep it in our Dropbox, which is HIPAA compliance. So that's for anything that might have client information in it. I keep that super locked down. I don't use LOOM for that, but that has worked so well because I can make really bite sized little things and then they watch them and then they often have additional questions for me based on that. Then I just make them another video and it's so much faster and easier for me than typing things out as a list.

Leah: Yeah, I totally agree. And I know there's lots of workbook options is another way to go. If your brain doesn't really think in an outline form, there's a lot of options. Annie's workbook option is really helpful and when we did our latest update, we used that and I think that's really helpful. If you're not a person that thinks really systematically to have that outlet or you're like, I don't even know where to start, I think having a workbook type outline really helps. And I remember when Liz Brooks did her talk, she gave us some things to start with, like where to start and it was so helpful to have that, especially if you're really new into the business, you might not even know what should I even be thinking of, beyond maybe just this is how I run a consult. But even that, if you never run a consult before, you might not even know where to think about that. So I think it's helpful to have that kind of template or outline for you to get your mind jogged. And I found that there was a lot of things like, Oh I hadn't thought of that. Okay, yeah we definitely need to write down what's going to be our policy for this and that. So it was so helpful to use a template. And I know Annie has a great one that I have used myself.

Annie: Yeah. I really kind of try to make it so that it was like a workbook. So it's not here's a plug and play policy, cause everybody works a little differently, so it's more interactive where it's going to actually prompt you to think about how you want to do things and lead you in the right direction. And then it is always, always a good idea to have your document reviewed by an attorney. Can't hurt cause there might be something that you decided is your policy that is actually against the law and you don't know because you don't know what you don't know. So I highly recommend that, or even finding an attorney who can consult with you about how to create something. So reaching out for that professional help, it really is an investment against any problems arising in the future. So the more you set up that solid infrastructure and lay that foundation and know how you do things, the more prepared you're going to be when curve balls come your way and having a legal team to advise you on that, it's super important.

Leah: Yeah, it really is. I think that's a good point to remember. And each state, everywhere you go, there can be different things that you can and can't put in these types of policies and procedures and you really need a professional to help guide you with that. I think you've got to remember that once you get done with this tedious document, that's not the end of it because there's probably going to be, or there's for sure going to be times that you need to be changing and updating it, and this is what happened to us. We just had a lot of changes and so we had to do a full update, but it was really good to go back through it because we found other places that we hadn't thought of that we're like, Oh yeah, we've kind of changed the way we're doing that. Let's go ahead and change that policy, and we were able to kind of just revive the whole document. So you really want to set out a time, I would say at least yearly to just review and make sure that everything is still the same. And then I think also if anything big changes, like have there been times or what are the biggest times Annie, that you've gone back through and like, Oh I need to review this to make sure I'm making changes when needed.

Annie: Yeah, definitely. When I started working with my new admin and when I brought Natalie in, I just needed to train them, and there are some places too where I ask them. I actually also need you to tell me is this working? So there are the procedures and policies that are more about legal stuff or about payment stuff or about client stuff, but then there's also like what happens when somebody inquires for a new visit? What happens if they want to a home visit but we're not available? What neighbourhoods would we go to? When would I want to squeeze somebody in? And I told the admin, I actually don't want to tell you do it this way cause I might be doing it a very inefficient way, so you have freedom. That's a conversation. Let's come up with the smoothest workflow to make all this happen because the more time she's spending on it, that costs me money and that I don't want.

Leah: So the most efficient possible.

Annie: I love efficiency. I find efficiency very hot.

Leah: Everybody works so differently too. You know, what feels and works for my brain and is really efficient for me might not be the same for another person, so it's helpful to have feedback when you add people in so that you can make sure your procedures are working on their level too. So that's a great time to review.

Annie: I like your idea of the annual review and also when something doesn't seem to be flowing well, if you're feeling stress or anxiety around something in your private practice, it's probably a good time to go look at that section of your manual and you might find out, oh, I'm stressed because I never came up with a procedure for this and that's why I'm floundering because I actually don't know what to do and I need to tell myself what to do. And remembering that it feels so good to tell yourself that you have to do something because you made it as a policy, that you have a policy and that really can help temper that impulse that we have as people in this caring profession to override our own instincts and go the extra mile in a way that can be really unhealthy and lead to burnout. And so if you have a policy that says, I will not do more than four initial home visits in a day, which is that's a crazy amount. I could never do that many a lot. Something like that because you know in your life that that fourth one, you do a terrible job because you're wiped out, make a policy, help yourself, and then you use that policy to curb your own instincts that work against you.

Leah: Yeah. It's like that becomes your boss.

Annie: Yes.

Leah: You're creating your best boss and the boss you want to tell you what to do and not let you do too much. It's like your best advocate/boss. I think that's a great way to think about it and it's so helpful to lean on those policies. I mean, we've definitely done that before. It's a nice way to be able to say I'm so sorry. Our policy is this and it kind of just helps give you some backbone to stand in your boundaries and I definitely think it is good for that as well. So everybody needs to go out there and get started on their policy and procedures. I think this is a great way when you're starting your business to start off with this like, so I just encourage you, if you're just getting started, this is a good place to put your energy early on.

Annie: Yeah, dream your own perfect private practice or make it what you want it to be and be good to yourself in the process. I love what you said, be your own best boss. I'm a terrible boss to myself sometimes. So I think I need to do a review of my policies and procedures.

Leah: Be a nice boss to yourself. Yes. Well this has been such a fun topic and I know it sounds tedious, but trust us when we say once you get this done, it's such an amazing feeling and it makes you feel really real. You know? It's like you've got a real business with policies and procedures. So as we wrap up today, Annie, I know that you probably have an amazing tech tip as always. So what you got for us today?

Annie: My tech tip is about your policies and procedures. If you're building them in Microsoft Word or Google drive docs, those programs both have headings. So you might have seen them like a style and you might be thinking it's just about a style. Yeah, it is. I mean they're formatted, but they're actually also for navigation. So you can set them up as headers for the different sections and even sub-headers. So heading one, heading two, heading three, heading for on down, and then you can generate a table of contents that will pull those headers, or you can view it and then when you export it to print, there'll be clickable. So somebody can take that PDF and click on your table of contents to jump right to that section. Makes it really easy to navigate, keeps your documents organized, or if you want to get fancy with fonts you can really go crazy with the formatting and make something super beautiful or branded. There's a lot that you can do, but I really recommend just try those headings out and see how they work for you. So that's the tech tip for today.

Leah: That's an awesome one. Thank you.

Annie: We really hope that you're going to join us on the deeper dives. So until next time I will see soon Leah.

Leah: Alrighty. Take care, Annie. Bye.

Annie: Bye.