STRATEGIC PLAN for The Midwife Center for Birth & Women’s Health 2007. Updated 2012.

Midwife Center Mission

The Midwife Center provides exceptional woman-centered pregnancy, birth, and well-woman care in southwestern Pennsylvania’s only independent birth
center.

Midwife Center Vision

The Midwife Center (TMC) will provide exceptional, personalized, woman-centered care to a large, diverse clientele while also conducting extensive
advocacy and education. Recognized for providing the highest quality care, TMC will participate in research, provide midwifery education to future
providers, and advocate for improved midwifery regulations and reimbursements. These activities will further the field of midwifery and meet the growing
demand for midwifery services.

Operating Model and Philosophy

 Women and families are active participants in their care at The Midwife Center (TMC). Midwifery care maximizes birth’s potential as a peak
experience for the family by stressing education and personal responsibility of all family members.
 Our staff recognizes that pregnancy, childbirth, and maturation are normal life processes, in which a provider should not intervene without
evidence of a problem.
 TMC maintains licensure, accreditation, and a program of quality assurance for our practice and facility. Our practice is based on the most current
medical knowledge and our model of care fosters continual improvement to our clients’ care.
 TMC’s midwives provide care in accordance with the American College of Nurse Midwives Standards and Code of Ethics.
 TMC recognizes that birth is a powerful and life-changing experience. We provide a trusting, private, and respectful environment for our clients
to be empowered and celebrated.
 TMC provides postpartum support with emphasis on establishing successful breastfeeding.
 The highest standard of care is achieved when certified nurse-midwives are first line care providers in collaboration with excellent physicians and
other area service providers.
 We provide care and education to women of all ages, races, sexual orientations, religions, and socioeconomic status.
 We believe that birth centers are part of the solution to the nation’s crisis in rising rates of unnecessary c-sections and increased infant mortality.
 Each exchange with the health care system should leave the consumer more knowledgeable about maintaining and maximizing one’s health. To
that end, TMC offers education during appointments and classes at the center and in the community.
 Excellent care is best achieved with a financially secure center and a stable, high-quality staff. To this end, TMC combines careful business
practices with fundraising to implement new programs, keep services available to all, and to improve our facility to best serve our clients.
 TMC educates the broader community and maintains a dialogue with policy-makers about the unique benefits of midwifery and birth center care
in order to maintain and increase accessibility to midwifery and birth center services.
 TMC educates future CNM’s and RN’s in the birth center model of care, and participates in research, as appropriate, to further the field of
midwifery and ensure access to birth center care in the future.

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Midwife Center Strategic Priorities

Long-Term (10 years)

 Continue to serve a culturally and economically diverse clientele, while maintaining the agency’s financial well-being
 Continue to improve the quality of care, including both adequate staffing and educational resources to ensure the retention of high-quality
staff, as well as operational improvements with technology and the physical facility
 Position The Midwife Center as a first-choice women’s health care facility that is both highly-regarded and respected by local providers ,
policy-makers and the public at large
 Develop alliances with major Pittsburgh hospitals to provide or supplement their midwifery services and encourage collaboration with TMC
instead of investing in additional midwife facilities
 Changed as of January 2012 Board Retreat to: Continue to partner with hospitals, family practice residency and nursing school programs to
teach upcoming health professionals about the benefits of midwifery and birth center care and while providing training opportunities at
TMC and advocating for more educational programs for midwifery.

Phase I (2008 - 2011) Completed as of 2011

 Building and Technology
 Staffing Model and Compensation
 Advocacy and Awareness

Phase II (2012 – 2015?)

 Staffing model to accommodate growth
 Building expansion to accommodate growth
 Plan for long-term financial stability for TMC
 Fundraising plan for the above

Midwife Center Business Plan:

The Midwife Center (TMC) has outlined five services lines that currently comprise its business model:

Childbirth services, and more specifically birth center births, are the key economic driver to TMC’s business model. These services provide the largest
profit for the organization, as well as providing for mission delivery though women-centered pregnancy and birth care. Attracting more clients for birth
center births, as well as encouraging more clients to choose a BC birth is of primary importance for the sustainability and growth of TMC. In order to

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accomplish this, comprehensive market research and a marketing plan need to be developed and enacted, including developing methods for midwives to
promote the BC birth option to tentative clients.

Well-Woman services are needed services to grow TMC client base as well as to serve the organization’s mission; and are most cost effective when
provided by a Nurse Practitioner. It is important to always have a clear analysis of both insured and uninsured/underinsured clients to determine the cost
of serving each type of client for financial and staffing planning.

Client education services are taught by TMC professional staff, with an emphasis on offering classes that increase the likelihood of clients having births in
the birth center. Additionally, planning for this service line will include market expansion beyond TMC clients, as well as infrastructure needs.

While professional education offerings are needed and necessary to fulfill the mission and vision of TMC, there is currently no direct financial benefit to
providing such programs, although there has been a demonstrated benefit for attracting staff to TMC. Professional education will be focused on providing
lectures at area hospitals, serving as a site for student nurses, midwives and other health professionals. The Ruth Stifel Fellowship will serve as our primary
professional education program as it is a cost effective way to staff for growth and also contributes to the future of our birth center and others across the
country.
Advocacy efforts will be pursued as long as there is funding available and outcomes realized from these efforts, with a focus on joining our sister state and
national organizations to improve regulations and legislation for midwives and birth centers. A fundamental part of TMC’s vision, advocacy is necessary for
the continued functioning of both the birth center and the practice. Funds for these efforts must be strategically placed and traction in pursuit of our
outcomes regularly monitored.

Three goals have been identified to achieve the three strategic priorities of the Phase II Business Plan:

1. Plan for staffing and facility needs to accommodate growth

a. Develop, fund and implement relevant staffing and compensation model to accommodate growth up to 500 births a year
b. Develop a plan for space needs to accommodate growth up to 500 births a year
2. Ensure long term financial stability of TMC
a. Create plan for clearly identifying financial impact of each service line (Carried over from last Business Plan):
i. Include revenues and expenses generated from each operation
ii. Create regular financial reports outlining position of each unit
b. Analyze costs and reimbursements from Bubbe Hannah programs including Adagio and identify current funding gaps
c. Maximize reimbursements for all service lines

3. Fundraising
a. Develop a fundraising strategy to finance the following:
i. Marketing Plan
ii. Programs of the Bubbe Hannah Fund
iii. Fellowship and other Professional Education activities

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 iv. Expansion

The following summarizes the specific objectives of each of the three goals above and how they will be achieved.

Goal 1a: Develop, fund and implement relevant staffing and compensation model to accommodate growth up to 500 births a year.

Objective Data Elements Responsible Process Timeline Outcomes Decisions Evaluation

Persons
Increase salaried List of possible Ann, Cheryl, Tasks identified March Board Done August
nursing staff to tasks from Christine & approval for hiring meeting
give more tasks staff and
to increase client potential Implementation By Summer 2012
contact, reimburseme
satisfaction and nts
organizational
efficiency
Continue to increase 2008 business Christine, Ann, Complete goal for By 2013 budget
compensation to plan Chris CNMs
be competitive “2013 Goals to ED, OM, and RNs By 2016 budget
Reach” Compare TMC salaries Ongoing
Birth Center and and compensation
United Way Wage to other birth
and Benefits centers and
Surveys United Way Wage
and Benefits
Survey
Cultivate diverse Operations Q3 or before next
recruitment strategy Committee hire
reach number goals
and to meet mission

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Staffing Plan up to Midwife time Ann Develop staffing July
420 births – see studies models using the
below* AABC and ACNM fellowship and
staffing increasing PT
guidelines CNMs before
hiring another
permanent
midwife
Staffing Plan up to Same as above Q2
500 births – see
below**
Develop plan for Ann 2013
Centering
Pregnancy for
long-term
staffing /service
strategy
Continue to ensure Bayer Center and Christine, Ann, Ensure adequate Ongoing
adequate funds other Chris funding in budget
for professional resources for every year
development for admin. Requirements for staff
entire staff ACNM, AABC, and to take advantage of
others for clinical trainings
staff

* Current FTE with TS doing .1 administrative = 4.2 FTE

1. Capacity based on 7 births per month per midwife and 4.2 Clinical FTE midwives = 353 births yr
2. With fellow for 9 months: 4.2 FTE + .75 FTE = 4.95 FTE = 416
3. With fellow & 3 mos. w/ fellow appts, increase PT CNM, decrease CNM GYN, & RN or NP do PP visit =5.2 FTE = 437

**Increased CNM with current FTE 7 births per month per midwife configuration
1. Capacity based on 7 births per month per midwife and 5.2 (increase PT CNMS to FT) clinical midwives = 436.8
2. With fellow for 9 months: 5.2 FTE + .75 FTE = 5.95 FTE = 499.8
3. 3. With fellow & 3 mos. w/ fellow appts, increase PT CNM, decrease CNM GYN, & RN or NP do PP visit =6.2 FTE = 520.8

OR

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** Increased CNM with lower births per FTE to accommodate more births IF percentage of call worked goes above current FTE configuration
1. Capacity based on 6.5 births per month per midwife and 6 (increase some PT CNMs plus hire 1 FTE) clinical FTE CNMs= 468 births/yr
2. With fellow for 9 months: 6 FTE + .75 FTE = 6.75 FTE = 526.5
3. With fellow & 3 months w/ fellow appts, decrease CNM GYN, & have RN or NP do PP visit = 7 FTE = 546

Add 1 FTE Billing/Client Service Assistant (when more appointments are added to the schedule outside of current hours)
(Anticipated income for births over #1 with each scenario would go towards funding the fellow. Ideally, births should cover about 50% of the cost of
the fellow, with fundraising to cover the remaining).

Goal 2b: Identify space needs to accommodate growth up to 500 births a year 
Objective Data Elements Responsible Process Timeline Outcomes Decisions Evaluation
Persons
ID Needs Survey staff and Christine and Done – Q1
other birth Chris 2012
centers
Short term for Contact facilities in Christine Done – 4.12 PBT for most of
classes area for CBE, BF, and
possibilities possibly
some
Refresher
Plan for exam rooms Appt. schedule Ann, Christine Survey providers and When we
before expansion is Staff availability front office staff need to
complete for who could increase
work outside clinical
currently FTE
scheduled hours beyond
current
Long term Staff survey Ann, Q2
considerations for Other birth centers Christine
expansion , Chris
Cost estimates Student plans Jason Q2
Current avg. $ per
sq foot
Facility needs for Consider additional Q2
420 and 500 births services;
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 otherwise plan
should be
sufficient for
500
Acquire Lot Research comps in Christine, Determine financial Q2
area Chris, and fundraising
Campaign Board capabilities
readiness survey

Goal 2: Ensure long-term financial stability of TMC

Goal 2a. Implement financial strategies for responsible growth

Objective Data Elements Responsible Process Timeline Outcomes Decisions Evaluation

Persons
Maintain a cash Chris Q1 and Done
reserve of at least 1 ongoing
½ times one month
of operating
expenses
Reduce construction Chris $20K by end $10K paid
debt loans of 2012 down in
All of 2nd loan Q1 2012
by end of
2013
Identify financial Chris Q2
impact of each
service line - Include
revenues and
expenses generated
from each service
line
Analyze costs and Chris and Q3
reimbursements Christine
from Bubbe Hannah
programs including
Adagio and identify

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current funding
gaps
Create regular Chris Ongoing after
financial reports Q2
outlining position of
each unit
Consider impact of TMC client roster Chris and Analysis of TMC Ongoing
insurance and Christine client insurance
hospital and Pgh market
environment
Continue to improve Chris Ongoing
insurance
contracts

Goal2b: Develop a fundraising strategy to finance the following
Objective Data Elements Responsible Process Timeline Outcomes Decisions Evaluation
Persons
Expansion See above Fundraising Q3
Committ
ee

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Fellowship “
Professional “
Education
Programs of Bubbe “
Hannah Fund
Marketing “
Campaign
Determine Organizational Christine and Review to ID Q1 Weaknesses
Campaign Assessments Board weaknesses assigned
readiness Plan to increase Devel. Analysis of donations Q2 to
“treasure” Committe during Beg. Camp. committ
e Q2
and diversity ees to
of board address
Past effect on FR Christine
operating
Readiness Survey Fundraising
Committee
Plan for next Costs of above Fundraising Q3
capital Committ
campaign ee