Operations
Introduction
Operating a school-based mobile healthcare unit requires a combination of healthcare expertise, technical infrastructure, skills, and logistical support to deliver care efficiently. School-based mobile healthcare requires adaptations and daily considerations when you provide care outside of a brick-and-mortar healthcare setting.
It’s important to stay updated with industry best practices as a crucial component for long-term success. Creating and adhering to policies, procedures, and best practices will help your school-based mobile healthcare program to deliver high-quality care, maintain patient safety, and positively impact the communities it serves. Regular training and ongoing evaluation are crucial to consistently applying the policies, procedures, and best practices and adapting when necessary.
Promising Practices
Let’s start with the vehicle. It should have the necessary infrastructure to support the identified healthcare needs and services. The choice of vehicle may vary, but it often includes vans, buses, or trailers modified to accommodate medical equipment and staff.
Before purchasing a vehicle, it is critical to understand the school’s needs, the population you serve, and the types of services that you will make available in the mobile healthcare unit. Taking the time to explore the options will enhance your ability to serve the healthcare needs of the school community because you identify the right vehicle for what you need. Many variables will influence your choice of vehicle.
- The services and number of providers will influence the equipment for services, and layout of the mobile healthcare unit.
- The size of the mobile healthcare unit will impact where you can park when seeing students and store the unit at the end of the day.
- Give thought to the security features of where you store the unit and whether it includes alarms, locks, and surveillance systems. Consider the mobile healthcare unit’s storage capacity to secure medical equipment and supplies.
- When developing the mobile healthcare unit’s layout, consider privacy, soundproofing, and noise masking, for student registration and examination as well as accessibility and the addition of ramps. The layout should maximize space while ensuring easy access to all necessary tools.
- Do not forget about internet connectivity and communication options in the mobile healthcare unit.
- Consider the power supply options when deciding on a unit, generator, solar, electrical hook-up, or propane. Take note of the type of fuel and tank capacity of the mobile healthcare unit.
- Think about the unit’s water supply capacity and storage for clean water, grey water, and black water.
- Consider your plan for the unit’s waste disposal and adequate sanitation facilities and restrooms.
- Always consider your state laws regarding driver requirements and the unit’s registration and insurance.
- Access the Mobile Healthcare Association’s Mobile Healthcare Vehicles Guide for more considerations on types of vehicles, pre-owned vehicles, financing, fuel, and insurance.
Many vendors are available to help you identify your needs and thoughtfully assist you in finding or building the right vehicle for your circumstances. Below are a few examples of vehicles used for mobile health units
There are many other considerations other than the vehicle itself that influence the operation of your mobile healthcare unit. Below are some to consider when using a school-based mobile healthcare unit for service delivery.
Medical Waste Management
Proper disposal of medical waste is critical to maintaining a safe and clean environment. Mobile health units should have designated storage and disposal systems for medical waste in compliance with local regulations.
Data Management System
Mobile health units often use electronic health records or other data management systems to maintain patient records. These systems allow efficient patient registration, tracking, and reporting of services provided.
Refrigeration
Some medical supplies and vaccines require refrigeration. Mobile health units need refrigeration to maintain the proper temperature for these items. The power supply is crucial when operating mobile health units, as different types of refrigeration pull differing amounts of energy to keep consistent temperatures.
Maintenance and Repairs
Regular maintenance and a contingency plan for vehicle breakdowns or technical failures are essential to ensure uninterrupted service delivery. Identify partners for routine and emergency repairs to keep your school-based mobile health unit functional.
Transportation Logistics
Efficient transportation logistics are crucial for timely scheduling and reaching the school communities. Logistics include such things as route planning, fuel management, and coordination with local authorities for necessary permits and permissions.
Inventory Management
Mobile health vans need a system for tracking and managing medical supplies and medications to ensure they are well-stocked and not expired. You will have limited storage capacity, requiring careful planning to restock.
The success of operating a mobile healthcare unit depends on a well-coordinated effort among the school staff, students, families, healthcare providers, support staff, and community partnerships, with increased daily preparedness, responsiveness, and the ability to problem-solve and pivot as necessary.
The sponsoring agency of the school-based mobile healthcare unit may have experience running mobile units, which will lay the foundation for your school-based mobile healthcare program. Suppose the school-based mobile healthcare unit is a new healthcare service delivery method for the sponsoring agency. In that case, you will have additional work to plan and implement policies and procedures supporting the mobile healthcare model. When you are new to operating a school-based mobile healthcare program, you will need the flexibility to adapt, add, delete, and amend policies and procedures at the end of the first and second years of your program’s implementation. Remember to consider the impact of policies and procedures on the school community as you partner with them to implement your school-based mobile healthcare program.
School-based mobile healthcare units must have policies and procedures that address coordination, communication, consent, referral, and follow-up with the schools and supervision of students safely accessing the school-based mobile healthcare unit. Clear communication between school partners and the school-based mobile healthcare unit will increase the integration of the services into the school community. Clarification of roles and responsibilities will be in the policies and procedures and the memorandum of understanding. All parties should review policies and procedures, as applicable, and any agreements yearly. After operating for a school year, gathering feedback from school partners, including all staff, parents/guardians, and youth, is essential. The feedback will help your continued implementation, refine your service delivery, provide insight into utilization, and increase positive health outcomes.
Here are general categories for potential policies and procedures that you may want to consider when planning for your school-based mobile healthcare unit (depending on the requirements of your state, sponsoring agency, school, and community partners, you may have additional categories to consider).
Ensure that the mobile healthcare unit and its staff are appropriately licensed and accredited as required by local and national healthcare and mobile healthcare authorities. Staying up to date with changes in healthcare laws and regulations is critical.
- Will all staff be licensed to drive the school-based mobile health unit?
- What are your state requirements for training to drive mobile units, and what kinds of training are available in your area?
For a school-based mobile healthcare unit, planning for technology that supports telemedicine, online patient portals, and other digital tools is critical. Use QR codes whenever possible, if acceptable in the local community.
- Who will help plan and implement the IT systems that are secure and up to date for the school-based mobile health unit?
- Who is responsible for maintaining and updating the technology in the school-based mobile health unit?
Stay updated with changing healthcare regulations and standards.
- What are the required state requirements that affect the operations of a mobile healthcare unit, including billing and reimbursement, and types of service covered?
Implement policies and procedures to safeguard patient confidentiality and data security, as a school-based mobile healthcare unit will need more protection and privacy awareness given the smaller environment.
- How does the floorplan of the unit enhance or challenge privacy?
- How do you ensure the privacy and security of patient data in compliance with HIPAA regulations?
- What is needed to understand the practical application of FERPA?
- How, when, and what do you communicate with the school about students?
- What are your policies and procedures for parental engagement and communication?
Establish strict infection control measures to prevent the spread of diseases within the school-based mobile healthcare unit. Maintain a high standard of hygiene and cleanliness in the unit. When you operate in a building, you often have janitorial help at your disposal and after hours.
How do you design a mobile unit that complies with CDC Guidelines for infection prevention and control, including ventilation, storage, disposal, disinfecting, and hygiene?
- What supplies and procedures do you need in the unit to address cleanliness issues at a remote location?
- If there is a need for urgent janitorial assistance, do you have an agreement with the school to assist? custodial
- Who oversees the implementation of strict infection control protocols to prevent the spread of diseases within the school-based mobile health unit? What can the sponsoring agency contribute to the process?
- Who will be responsible for cleaning each day? Will you have a custodial service accessing the school-based mobile unit? (see more information)
Ensure that all healthcare professionals and support staff are appropriately trained and certified.
- How can you screen for aptitude to work in a smaller space, requiring flexibility and the ability to work in a school-based mobile healthcare unit?
- What are the ongoing training and development needs for the school-based mobile healthcare unit staff to keep them updated on best practices and new medical technologies?
- What about training for the operation of the vehicle itself?
- Where are the other school-based mobile healthcare units in your state or region, and how can you connect with them to learn from their experiences?
- What specific training can you provide to enhance problem-solving and stress management for the school-based mobile healthcare unit staff to support clinical team health and efficiency? The mobile healthcare environment presents opportunities for the team to work under unique and often pressured circumstances.
- Who is responsible for providing opportunities to engage in OSHA training specific to your mobile healthcare program?
- Is it possible to provide cross-training for staff to teach personnel all the roles in the mobile healthcare unit, increasing efficiency? Staff operate within their license and scope of practice regardless of cross-training.
Clarify with the schools what the staff can and cannot do in an emergency on the school grounds based on the MOU between the sponsoring agency and the school. The sponsoring agency and the school need clear policies, procedures, and expectations regarding emergency preparedness and response. Develop protocols for handling medical emergencies and equip the unit with emergency supplies and equipment as agreed. Most primary healthcare providers are not emergency responders but can assist until emergency responders arrive. Conduct regular drills and training for staff on emergency response procedures.
- What are the expectations for emergency response from the mobile healthcare unit while on school property?
- What happens when the school has emergency drills? Is the school-based mobile healthcare unit included in the planning and implementation?
Work with the school to know ahead of time for the scheduled drills to coordinate student utilization of the school-based mobile health unit or the school-based mobile health unit’s participation in the drill.
Offer health education to students and families on topics relevant to their needs and conditions, including prevention-related education. The sponsoring agency should have policies and procedures for materials development.
- Is there the ability for community-based partners to have resources/flyers in the mobile healthcare unit?
- What can you do creatively to have school and community health education materials and referral information available?
- Can you make the resources available online? You can use QR codes to direct students and families to the resources, which also cuts down on paper materials in the school-based mobile health unit, which is tight on space and has weight restrictions.
- Who can help you develop materials with a health literacy lens and reading levels based on student and family needs?
Develop policies and procedures that work in the school-based mobile healthcare unit, allowing flexibility and alignment with the schools and creating efficiencies for utilization.
- Have you aligned your appointment availability with the school calendar?
- Do you take into consideration the daily class/lunch schedules to improve your scheduling process to minimize wait times?
- Have you looked at each school’s internal demands/schedule to understand barriers preventing students from leaving the classroom (testing, staff workdays, assemblies, etc.)?
- Have you considered the layout of the school-based mobile health unit and the impact on small spaces and possibly no waiting room? What can you do to minimize student’s waiting time and return to class?
- How do you work with the sponsoring agency’s fiscal department to manage the school-based mobile healthcare program’s finances efficiently, including budgeting and revenue cycle management?
- How does the staff work to control costs and optimize revenue streams?
Maintain accurate records of medication inventory. The policies and procedures from the sponsoring agency may need to adapt to reflect a different inventory schedule.
- Space may be more limited in a school-based mobile healthcare unit, so what kind of schedule will you need to keep inventory stocked?
- What weather considerations do you need to consider if you leave perishable medications in the school-based mobile unit overnight or on weekends? Ensure proper storage and administration of medications, adhering to pharmaceutical best practices.
Regularly inspect, maintain, and calibrate medical equipment to ensure its proper functioning.
- Who is responsible for equipment oversight, maintenance, and proper calibration?
- How does that affect daily workflow?
Mobile units require more TLC to keep equipment safe and calibrated to maintain the good working order of the medical equipment. Keep detailed maintenance records. Mobile unit vehicle manufacturers can assist with developing a checklist of daily, monthly, quarterly, and yearly maintenance logs.
- Who is primarily responsible for maintenance while using the school-based mobile healthcare unit?
- Are there some other sponsoring agency personnel who will assist with vehicle maintenance?
- Train staff to understand the specifics of operating a school-based mobile healthcare unit and ensure everyone shares any concerns for the unit’s operation.
Develop a clear and effective referral system for students who require care beyond the scope of the school-based mobile healthcare unit.
- Besides the sponsoring agency’s ability to provide care, who else in the community can provide specialized care?
- Do you have policies and procedures for releasing information, referral protocols, and follow-up processes?
Build relationships and trust within the communities served to encourage the utilization of school-based mobile healthcare services. If possible, include community members, including youth, in the planning, implementation, and evaluation components for the school-based mobile healthcare unit.
- Who are your end users and other community members who can engage in planning and implementation and provide you with timely feedback on the services provided?
- What opportunities do you have to gather feedback and input from community members to improve services?
Invite school staff, community-based partners, and families to open house events and other planned outreach activities.
Establish quality assurance processes to monitor and improve the quality of care provided.
- How can you adapt the policies and procedures from the sponsoring agency to reflect workflow variability and clients served and implement a realistic quality assurance process?
- What system do you have in place to regularly review and assess patient outcomes and satisfaction?
Develop policies and procedures that reflect the options for emergency contact in your different locations or school sites.
- Who do you call for various emergencies, including breakdowns, schedule delays, etc.?
- Where are the emergency contact information and instructions displayed in the school-based mobile healthcare unit for easy access?
- Do staff members save the contacts in their phones in case the mobile unit is not available?
Building awareness and trust creates an environment for reaching students and families.
- What does the sponsoring agency have for outreach and marketing support?
- What are the simplified components of outreach?
- Goal Setting
- Target Audience
- Message Development
- Tailoring Messages and Vehicles
- Evaluate and Adjust
See the Sustainability section of the toolkit for further information and resources on outreach and marketing of your school-based mobile healthcare program.
Stories from the field
From key informant interviews.
‘If you are considering a school-based mobile health unit, consider visiting other units if at all possible. Do your research, see the different layouts, and how they operate the unit. Ask the staff to identify the common challenges and the surprises they encounter when providing services in a school-based mobile unit. Ask them what they would do differently, looking back on their process and choices. Don’t be afraid to be a trendsetter. Partner and collaborate and begin to foster those relationships early. Keep asking and listening to your partnerships, even if you are a well-established school-based mobile health unit. Be open to feedback.’
– Sponsor Representative, California
‘The brick-and-mortar sites are integrated into the schools in a very different way than the mobile units because they are physically embedded into the school structure…. And then sometimes there may be a little bit of reservation about having services provided in a mobile space.’ It’s still a little of a newer phenomenon for some folks, I’ll have parents call. They’re like “Well I’ll just have my child go to their regular Doctor’s office. I don’t want them to be seen on a bus,” but then, when they visit, they’re like, “oh, wait, this is like a real doctor’s office” like yeah, we just have four wheels, [and] we move from site to site.’
– Sponsor Representative, California
Last week, we saw an uninsured little girl who had the largest abscess we have seen at her school. We extracted the tooth and removed all of the infection. Afterward, she fully relaxed like she was ready to take a nap, probably experiencing relief for the first time in months. We saw her a few days later to complete more of her treatment plan. She was so excited to see us. She looked happier and livelier. She hugged our dentist and told her that her other abscessed tooth was hurting. We were able to extract that tooth too. Immediately after lying down on the dental chair to get treated, she felt comfortable. She knew relief was imminent. This is why we do this work.
The West Virginia Experience
FamilyCare Health Centers in West Virginia have been offering school-based health services since 2011 in Putnam County, which provides care when children are sick or hurt, regular check-ups, screenings, immunizations, and physicals for school, sports, or camps.
“We are pleased to announce the expansion of our school-based health services program to the Boone County school system,” says Dawn Grigsby, School-Based Health Coordinator for FamilyCare. “Initially, we will provide services on a limited basis, however, as the program grows and the needs increase, I foresee this program growing much like the program did in Putnam County.”
The model for school-based health is simply a medical office on wheels. The mobile unit visits participating schools throughout the county, following a consistent schedule, allowing students, teachers, and staff the opportunity for quality care on the school’s property.
“FamilyCare’s school-based health program removes barriers to receiving health care – by bringing services to the students and staff while they are in school, says Craig Glover, FamilyCare’s president and CEO. “Additionally, parents do not have to take time off work to take their kids for medical care.” Laurie Linville, APRN, FNP-BC, a board-certified family nurse practitioner, will provide health care services on the mobile unit, such as check-ups, immunizations, treatment of illnesses and injuries, physical exams, and sports physicals.
Parents are encouraged to fill out (and return to the school) the Boone County School-Based Health Services packet if interested in the services offered at the participating schools.
For more information about Boone County School-Based Health Services, click here.
Learn more about the School-Based Health Programs and Mobile Unit Family Care Health Center, WV
Tips
- When serving youth, engage them in making the layout and space feel comfortable and personable, providing feedback during the planning. Include such things as color choice and art that are relevant to your target audience through youth engagement.
- Consider how you will use health education materials during visits and where to store and display the material. You may consider using QR codes, linking to relevant resources, and cutting down on paper materials. Mobile Health Units have weight capacity limits, and every ounce counts!
- Whether you hook up to a supply source at your location or rely primarily on a freshwater tank, you must adapt how you use water, conserving as you operate daily.
- Consider your options for refrigeration. You may not need a complete built-in refrigeration unit but a stand-alone one. Refrigeration units that can draw from different power sources as required increase your ability to keep the correct temperature.
- It also helps to determine the regular maintenance schedule, coordinate with school calendars whenever possible, and create less downtime for serving the students.
- When working with schools, establish the best place to park the unit. You will have to consider the unit’s height – look for overhead clearance issues near schools, the safety of students getting to the unit, proximity to water and electricity if needed, schedule of buses, student pick-up and drop-off, and increased traffic/parking with school events, etc.
- Whenever possible, coordinate with school closures for monthly or quarterly restocking. Keep a daily list of critical inventory supplies for more urgent and timely needs.