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At the Rural Center: Policies and Procedures

October 2006
By: Dinah Monahan
We just received our ultrasound machine through the Focus on the Family Option Ultrasound Program (OUP). A big part of the process was to review our existing Policies and Procedures and to write new ones for the medical program. Our P&P book went from thirty pages to one-half inch thick!

When I started our little rural center, we shared a half of a room with another ministry. I was the counselor, receptionist, and toilet scrubber. Policies and Procedures were not in my vocabulary. But as we grew, so did my awareness that we needed to do things "right." I got Heartbeat's sample P&Ps and went to work. While my Policies were good, my Procedures were a bit over the top. I visualized what we would do and detailed it in outline form. For example, our callback procedure went something like this, "Forty-eight hours after the official contact the lay counselor will make the first contact. The second contact will be within twenty-four hours." We typed them up and put them on the shelf. The problem was that they did not resemble reality. No one followed them.

I have a suspicion that many rural centers are like this. They write the P&Ps, put them on the shelf, and never look at them again. I would have done that if I hadn't gotten some good training along the way. I realized that my P&Ps were crucial to my legal protection, training process, and operations. We went through and re-wrote them to reflect reality. I then made a training video explaining every one of them. That became part of volunteer/ staff training. (We provided lots of coffee so they could stay awake!) This way, we standardized our training and made sure that each volunteer understood the importance of the P&Ps. As our procedures changed, we would change the document. So when the time came for the OUP transition, we were in good practice.


As our team went through each of the sample P&Ps from NIFLA, the temptation was to do what I did in the beginning. I reminded them more than once that we should write nothing in the P&Ps that we don't intend to do. So if they came up with a burdensome procedure, I asked these questions, "Who is responsible for this? How will it be implemented? Is the procedure realistic?" For example, we didn't need a Policy and Procedure on what to do in case of an earthquake because we don't have earthquakes. However, we paid a great deal of attention in our P&P to fire. In our area, there is a constant threat of forest fires. We have evacuated once, so we knew we needed clear procedures for this emergency.

It was a tedious process to look at every Policy and Procedure we have, write new ones we need, and get them in a usable format. In the end, we are confident that we have a document that legally protects us, prepares staff and volunteers to serve at the clinic, and standardizes all training so each person knows what is expected and how to carry it out. Rural centers may do things differently than big centers, but some things we need to do right. Our Policy and Procedures is one of them! (If you would like a copy of our P&Ps, e-mail me at and I will send you the Word documents.)

Dinah Monahan is the Heartbeat International Consultant for Rural and Small Centers. She can be reached at

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