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Transformational Impact Rating System: a method to assess the impact potential of hospitals in low-resource settings Cover

Transformational Impact Rating System: a method to assess the impact potential of hospitals in low-resource settings

Open Access
|Aug 2024

Figures & Tables

Table 1

Methods of Existing Charity Rating Systems

OrganizationRates All CharitiesMeasures Impact Based on ≥10 MetricsProvides Transparency to Donors and VolunteersEvaluates Charities Independently from Other Charity Rating Systems
Charity Navigator
CharityWatch
ImpactMatters
GuideStar
GuideWell
GlobalGiving
Classy
Universal Giving
RateYourNGO
The Life You Can Save
Bright Funds
Figure 1

Sample Hospital Data Collection Questions

Figure 2

Sample Category Scores

CJGH-11-349-g003.jpg
Table S-1

Interview List

Serial #TitleOrganization Type
1Executive Vice PresidentGlobal Donor-Advised Fund
2Chief Operating OfficerUS-based Donor Collaborative
3ChairmanCharity Financial Certification Body
4Executive DirectorOrganization Development Institute
5PartnerNon-profit Donor Organization
6CEO/PresidentImpact Investment Organization
7Secretary/Board MemberCharitable Investment Foundation
8FounderVolunteer Coordination Organization
9PresidentHealthcare Worker Training Provider
10Development CoordinatorHealthcare Worker Training Provider
11General SecretaryMedical Fellowship
12Prior CEOInternational Medical Association
Table S-2

Sample Interview Questions

Question #Question
1Please describe the organization you represent and its role in making donations / coordinating volunteers.
2What are the primary factors you or those you work with consider when choosing where to donate / volunteer? These could be particular causes, motivations, or aspects of the charitable organization.
3What is the process you use to find an organization to donate to / volunteer at (e.g., word of mouth, research by topic, recommendation websites, etc.)?
4What types of communications are most effective in informing your decision to donate / volunteer (e.g., online sources, mail, in-person events)?
5What are some factors that might prevent you or those you work with from donating to / volunteering at an organization, or lead you to choose one organization over another?
6What factors determine whether you or those you work with donate to / volunteer at an organization repeatedly versus one time?
7If there were a website that allowed you to search for high impact hospitals in locations where contributions would make the greatest difference, what features would you like to see? What aspects would you like to search for hospitals based upon (e.g., location, cause, safety, etc.)?
8How would an organization’s impact rating (e.g., 1 star to 5 stars) influence your decision or that of those you work with to donate to / volunteer at that organization?
9Would you or those you work with be interested in completing a survey about your donation / volunteer experience on the website that would factor into the hospital’s rating?
Table S-3

Volunteer Survey Questions and Responses

QuestionMean ScoreStandard Deviation
#1: Values / Philanthropy (volunteers' satisfaction with opportunities to express their values of related to altruistic and humanitarian concerns for others)8.781.92
#2: Understanding / Learning (volunteers' satisfaction with opportunities to learn new things and exercise their knowledge and skills)8.351.38
#3: Career Development (volunteers' satisfaction with career development opportunities provided by the program, such as level of training received, preparation for future employment, development of network or leadership skills)7.062.02
#4: Social / Affiliation (volunteers' satisfaction with the level of personal interaction, ease of making friends, ability to work in a group, and ability to develop trust)7.611.93
#5: Achievement (volunteers' satisfaction with having specific goals to work toward, level of responsibility, and challenges to solve)7.651.60
#6: Influence (volunteers' satisfaction with their ability to impact and influence decisions)7.432.04
#7: Job Training Appropriateness (volunteers' satisfaction with how appropriate training was for the tasks they were asked to complete)7.371.70
#8: Recognition (volunteers' satisfaction with friends' or colleagues' recognition of their work)6.202.12
#9: Supervision (volunteers' satisfaction with the level and quality of supervision they received)7.132.00
#10: Volunteer Recommendation (whether previous volunteers would recommend volunteering at this hospital)7.672.21
#11: Expected Volunteer Experience (number of years and type of experience volunteers need to be successful at the hospital)6.301.70
#12: Expected Volunteer Responsibility (volunteers’ responsibility in terms of hours and difficulty)6.801.80
#13: Volunteer Salary (financial compensation)5.032.47
#14: Spousal Opportunities (availability of opportunities at or near the hospital for volunteers’ spouses)6.672.39
#15: Number of volunteers that previously served the hospital5.172.00
#16: Percentage of volunteers that returned to volunteer at the same hospital5.772.17
#17: Environment / Wildlife (how appealing the natural environment is to potential volunteers)5.972.27
#18: Local Safety7.351.99
#19: Visa Requirement (how difficult it is for volunteers to obtain a visa)6.651.71
#20: Specific volunteer needs the hospital has7.451.43
#21: Specific cause the hospital supports7.972.06
#22: Regional Impact Potential (e.g., patient population and square mileage covered by the hospital, health status and socioeconomic status of patient population)8.001.82
#23: Transparency of the Hospital (e.g., does the organization have a website with information pertinent to donors and volunteers?)7.232.34
#24: Volume of Healthcare Services (e.g., number of outpatient visits, inpatient admissions, major surgeries, child deliveries)7.421.93
#25: Efficiency of Operational Performance (e.g., cost per life saved, average cost per patient)7.102.28
#26: Quality of Operational Performance (e.g., patient mortality rate, patient satisfaction, physician performance, staff quality, quality certifications)7.071.88
#27: Hospital’s relations with the local community, staff, and competitors7.312.10
#28: Number of hospital page views on the ratings website (or other interactions such as comments/reviews/recommendations)4.212.04
Table S-4.a

Variable Descriptions and Weights

CategorySubcategoryVariableDescriptionWeight
Regional Impact PotentialRegional Impact PotentialSocioeconomic Status of Patient PopulationInto which percentile of the country's income per capita does the average patient population that the hospital serves fall? The average patient income can be estimated based on all sources of income (including wages, proceeds from sales, etc.). This tool can be used for reference: https://wid.world/simulator.10
Regional Impact PotentialRegional Impact PotentialLocal Population Income MixDoes a mix of incomes exist in the region such that wealthier patients can be charged more to offset charity care for lower income patients? In other words, what is the standard deviation of the local population income?6
Regional Impact PotentialRegional Impact PotentialLocal Patient Population DensityWhat is the local population density within serving distance of the hospital (people per square kilometer)?8
Regional Impact PotentialRegional Impact PotentialAlternative Care OptionsHow easy is it for the patient population to receive care at another hospital?9
Regional Impact PotentialRegional Impact PotentialLocal Maternal Mortality Rate (MMR)What is the maternal mortality rate (number of deaths of maternity patients per 100,000 live births annually) in the region where the hospital is located?10
Regional Impact PotentialRegional Impact PotentialLocal Infant Mortality Rate (IMR)What is the infant mortality rate (number of deaths of infants per 1,000 live births annually) in the region where the hospital is located?10
Regional Impact PotentialRegional Impact PotentialAdditional ServicesWhat services does the organization provide (e.g., hospital, education, agriculture)? Please list each as a way to allow donors and volunteers to search for the organization.4
Financial HealthFunding SourcesDiversity of Revenue SourcesHow many sources of revenue does the hospital have (as a measure of sustainability)?7
Financial HealthFunding SourcesDonations Percent of RevenueWhat percentage of the hospital's annual revenue is provided by donations (as a measure of sustainability)? (To calculate, add the value of all donation sources and divide by the annual revenue.)7
Financial HealthFinancial EfficiencyOperating MarginWhat percent of annual revenue is the hospital able to retain after costs are paid (as a measure of sustainability)?6
Financial HealthFinancial EfficiencyProgram Expense PercentageWhat percent of expenses consist of program expenses (e.g., non-administrative and non-capital expenditures)? (To calculate, divide the average program expense by the average total expense, over three most recent fiscal years.)7
Financial HealthFinancial EfficiencyAdministrative Expense PercentageWhat percent of expenses consist of administrative expenses (e.g., human resources, accounting, overhead)? (To calculate, divide the average administrative expense by the average total expense, over three most recent fiscal years.)5
Financial HealthFinancial EfficiencyCapital Expenditure PercentageWhat percent of expenses consist of reinvesting in capital expenditures (e.g., new buildings / equipment)? (To calculate, divide the average capital expenditure by the average total expense, over three most recent fiscal years.)5
Financial HealthFinancial EfficiencyFundraising Expense PercentageWhat percent of expenses consist of fundraising expenses? (To calculate, divide the average fundraising expense by the average total expense, over three most recent fiscal years.)5
Financial HealthFinancial EfficiencyFundraising EfficiencyHow much does it cost the hospital to bring in each $1 of donations? (To calculate, divide the average fundraising expense by the average total donations, over three most recent fiscal years.)5
Financial HealthFinancial CapacityProgram Expense GrowthBy how much have program expenses grown annually over the three most recent fiscal years? (To calculate: [(Expense in year 3/Expense in year 1)^(1/3) - 1].)4
Financial HealthFinancial CapacityLiabilities to Assets RatioWhat is the hospital's liabilities to assets ratio (as a measure of sustainability)? (To calculate, divide total liabilities by total assets in the most recent fiscal year.)1
Financial HealthFinancial CapacityCharity Care PercentageWhat percentage of annual revenue is given to patients as charity (free) care?6
Financial HealthAccountabilityBudgetDoes the hospital prepare a budget and have adequate processes of budgetary controls? Does the hospital prepare a budget variance analysis?2
Financial HealthAccountabilityAuditingDoes the hospital have audited financial statements prepared by an independent accountant with an audit oversight committee?1
Financial HealthAccountabilityAccounting BooksDoes the hospital maintain proper books of accounts?1
Financial HealthAccountabilityBank AccountsAre the hospital's bank accounts in the name of the hospital, not an individual?1
Financial HealthAccountabilitySafety of FundsIs there any evidence of lost or misused donation dollars, fines, fraud, or the like?5
Operational PerformanceOperational EfficiencyCost Per Life SavedHow much does the hospital spend per lives saved annually? (To calculate, divide total program and administrative expenses by the number of lives saved.)7
Operational PerformanceOperational EfficiencyCharity Care EfficiencyHow efficiently does the hospital allocate charity care dollars (as a measure of accessibility)? For example, does the hospital use an ability-to-pay pricing approach, write off unexpected complications, and/or assess charity care needs using behavioral methods such as the “shared meals” and “vital assets” tests.6
Operational PerformanceOperational EfficiencyAverage Inpatient CostWhat is the average price charged to inpatients (the cost of the stay less any charity care), as a percent above the national average? Average costs can be estimated by selecting your country in the WHO spreadsheet at the following site: https://www.who.int/choice/country/country_specific/en/5
Operational PerformanceOperational EfficiencyAverage Outpatient CostWhat is the average price charged to outpatients (the cost of the visit less any charity care), as a percent above the national average? Average costs can be estimated by selecting your country in the WHO spreadsheet at the following site: https://www.who.int/choice/country/country_specific/en/5
Operational PerformanceGovernanceFormal Governance StructureDoes the hospital have a formal governance structure established?6
Operational PerformanceGovernanceCommitment to MissionHow committed and dedicated to the mission of the hospital are staff and volunteers?3
Operational PerformanceGovernanceStrategic Plan and ImplementationDoes the hospital have a strategic plan to improve and expand services? Are planned strategies and interventions implemented properly?6
Operational PerformanceGovernanceKey Performance IndicatorsAre key performance indicators defined and in place to monitor progress with respect to inputs, activities, outcomes and impacts?3
Operational PerformanceGovernanceAlternate Implementation PlansAre the feasibility and cost-effectiveness of alternate implementation plans discussed?3
Operational PerformanceGovernanceSystems CapacityDo the hospital's systems have sufficient capacity, and are they able to scale?6
Operational PerformanceGovernanceBoard IndependenceIs the hospital's board independent (e.g., board is not comprised of too many staff members)?2
Operational PerformanceGovernancePermanent Board MembersDoes the hospital have board members/trustees that are permanent in nature (with no fixed term) or who have served for 10 years or more?1
Operational PerformanceGovernanceBoard MeetingsAre board meetings held regularly?1
Operational PerformanceGovernanceAnnual General MeetingsAre annual general meetings held? Are statutory resolutions such as appointment of auditors and election of board members passed during general meetings?1
Operational PerformanceGovernanceBoard ReviewDoes the board review itself, systems, processes, and CEO/staff regularly?1
Operational PerformanceGovernanceBoard Donation OversightDoes the board have oversight over how donated funds are used?1
Operational PerformanceGovernanceAppointed CEODoes the hospital have an appointed CEO?1
Operational PerformanceGovernanceLegal SupportHow strong is the hospital's legal support and competency in analyzing a changing regulatory landscape / suggesting appropriate service providers?2
Operational PerformanceGovernanceOperational PoliciesDoes the hospital have and follow documented workplace policies (e.g., human resources, travel, finance, conflict of interest, whistleblower, employee use of assets, records retention and destruction)?1
Operational PerformanceGovernanceCulture of Continuous ImprovementDoes the hospital have a culture of continuous improvement (e.g., staff have agency, quality control systems are in place)?1
Operational PerformanceTransparencyOutcomes ReportingHow well and often does the hospital communicate the loss prevented or gains resulting from donations?3
Operational PerformanceTransparencyDonor Privacy PolicyDoes the hospital have a privacy policy that allows donors to request their name and address not be shared with other organizations?1
Operational PerformanceTransparencyWebsiteDoes the hospital have a website with information pertinent to donors and volunteers?1
Operational PerformanceOrganization QualityAppropriate Standards of CareDoes the hospital use efficient care standards to ensure services are both affordable and nearly as effective and safe as more expensive alternatives?6
Operational PerformanceOrganization QualityEqual Services for All PatientsDo all patients receive equal care regardless of their wealth (as a measure of accessibility)?7
Operational PerformanceOrganization QualityCommunity EngagementHow well does the hospital work with community experts, partners, staff, and patients to build support, plan for the future, and impact the health of their local communities?6
Operational PerformanceOrganization QualityQuality CertificationsHas the hospital received safety and quality certifications?2
Operational PerformanceOrganization QualityAwards ConferredHas the hospital received awards and recognition from third parties in recognition of the hospital's impact?4
Operational PerformanceVolumeMajor SurgeriesHow many major surgeries does the hospital provide (per 1000 population served) annually?5
Operational PerformanceVolumeChild DeliveriesHow many child deliveries does the hospital provide (per 100 women of childbearing age in the population served) annually?5
Operational PerformanceVolumeOutpatient VisitsHow many outpatient visits (per 1000 population served) does the hospital provide annually?6
Operational PerformanceVolumeBed OccupancyWhat is the hospital's bed occupancy rate? (To calculate, divide total number of bed-days during the year by (number of beds available * 365 days), then multiply by 100.)7
Operational PerformanceVolumeWeighted Average Patient Volume CAGRWhat is the average weighted compound annual growth rate over the past three years of outpatient visits, inpatient admissions, major surgeries, and deliveries?4
Operational PerformanceCare QualityHospital Maternal Mortality Rate (MMR)How many deaths of maternity patients does the hospital experience (per 100,000 live births annually), as compared to the local maternal mortality rate?4
Operational PerformanceCare QualityHospital Infant Mortality Rate (IMR)How many deaths of infants does the hospital experience (per 1,000 live births annually), as compared to the local infant mortality rate?4
Operational PerformanceCare QualityPatient Mortality RiskHow severe are the conditions of patients seen, as a measure of patient mortality risk?2
Operational PerformanceCare QualityPatient Readmission RateWhat percent of patients must return to the hospital and be admitted within 30 days of being discharged?1
Operational PerformanceCare QualityPatient Satisfaction - ServiceAs a patient, how satisfied are you with the hospital's service?1
Operational PerformanceCare QualityPatient Satisfaction - StaffAs a patient, how satisfied are you with the hospital's staff?1
Operational PerformanceCare QualityPatient Satisfaction - Hospital CleanlinessAs a patient, how satisfied are you with how clean the hospital is?1
Operational PerformanceCare QualityStaff SatisfactionAs a staff member, how happy are you with your experience?1
Operational PerformanceCare QualityStaff ExperienceDoes the hospital have staff with work experience of 10 years and above in a particular field?1
Operational PerformanceCare QualityStaff MeetingsDoes the hospital hold regular staff meetings?1
Operational PerformanceCare QualityStaff TurnoverIn the past two years, what has been the overall staff turnover rate?1
External RelationsExternal RelationsLeadership CredibilityHow credible and accomplished is the hospital's leadership?7
External RelationsExternal RelationsDonor SatisfactionAs a donor, how satisfied are you with your donation to the hospital?3
External RelationsExternal RelationsCharity Rating OrganizationsIs the hospital rated by large charity rating organizations? If so, how well is the hospital rated?1
External RelationsExternal RelationsCollaborationDoes the hospital have partners that it is are collaborating with, and does it plan to add partners to its network?2
External RelationsExternal RelationsExchange ProgramsDoes the hospital have relationships/exchange programs with other similar organizations or universities?1
External RelationsExternal RelationsRespect of CommunityHow well does the local community respect the hospital?1
Volunteer ExperienceVolunteer OpportunityVolunteer ResponsibilityWhat is the level of responsibility expected of volunteers, in terms of hours and difficulty?1
Volunteer ExperienceVolunteer OpportunityExpected Volunteer ExperienceHow many years and what type of experience do volunteers need to be successful?1
Volunteer ExperienceVolunteer OpportunitySpousal Job OpportunitiesAre nearby opportunities readily available for volunteers' spouses?1
Volunteer ExperienceVolunteer OpportunityChild Education OpportunitiesIs quality education available for volunteers' children?1
Volunteer ExperienceVolunteer OpportunityHousing OpportunitiesHow difficult is it for volunteers to find quality housing?1
Volunteer ExperienceVolunteer OpportunityLocal SafetyHow safe is the area in which the hospital is located?2
Volunteer ExperienceVolunteer OpportunityLocal Safety PerceptionHow safe is the area in which the hospital is located?2
Volunteer ExperienceVolunteer SatisfactionVolunteer RecommendationAs a volunteer, would you recommend volunteering at this hospital?3
Volunteer ExperienceVolunteer SatisfactionOverall Volunteer SatisfactionAs a volunteer, how satisfied are you with your experience overall?1
Volunteer ExperienceVolunteer SatisfactionSkills MatchAs a volunteer, how satisfied are you with how well your skills matched the needs of the hospital and community?1
Volunteer ExperienceVolunteer SatisfactionLearning OpportunitiesAs a volunteer, how satisfied are you with the opportunities for new learning experiences, and opportunities to exercise your knowledge, skills, and abilities?3
Volunteer ExperienceVolunteer SatisfactionCareer DevelopmentAs a volunteer, how satisfied are you with the level of training received, preparation for future employment, the opportunity to develop leadership skills, network development, and references for future employment?2
Volunteer ExperienceVolunteer SatisfactionJob Training AppropriatenessAs a volunteer, how satisfied are you with how appropriate training was for the tasks you were asked to complete?2
Volunteer ExperienceVolunteer SatisfactionCommunity AffiliationAs a volunteer, how satisfied are you with the level of personal interaction, ease of making friends, ability to work in a group, and ability to develop trust?3
Volunteer ExperienceVolunteer SatisfactionStrategy and InfluenceAs a volunteer, how satisfied are you with your ability to impact and influence decisions, respond to the needs of people or programs, and understand the overall goals of the hospital?2
Volunteer ExperienceVolunteer SatisfactionPhilanthropic ImpactAs a volunteer, how satisfied are you with opportunities to express your values related to altruistic and humanitarian concerns for others and to impact the community?3
Volunteer ExperienceVolunteer SatisfactionFlexibilityAs a volunteer, how satisfied are you with the flexibility of your work schedule?1
Volunteer ExperienceVolunteer SatisfactionSupervisionAs a volunteer, how satisfied are you with the level and quality of supervision and feedback you received?2
Volunteer ExperienceVolunteer SatisfactionRecognitionAs a volunteer, how satisfied are you volunteers with opportunities to be recognized for your contributions by friends and colleagues?1
Volunteer ExperienceVolunteer SatisfactionAchievementAs a volunteer, how satisfied are you with having specific goals to work toward, level of responsibility, and challenges to solve?3
Table S-4.b

Hospital Page Description and Search Criteria

CategoryVariableDescription
Page DescriptionHospital NameWhat is the name of your hospital?
Page DescriptionContactWhat is a good e-mail address at which your hospital can be contacted?
Page DescriptionWebsite URLIf your hospital has a website where donors and volunteers can find additional information, please provide the link to the website.
Page DescriptionDescriptionPlease provide a brief description of your hospital that you would like to be displayed on your hospital’s page.
Page DescriptionPicturePlease provide a picture of your hospital that you would like to be displayed on your hospital’s page.
Page DescriptionBeneficiary NarrativeIf you would like, you may provide a story of an individual whose life your hospital has benefited. Personal stories often help donors and volunteers make a personal connection to a charitable organization.
Page DescriptionBed CapacityPlease provide the number of beds your hospital has for the description on the hospital’s page.
Page DescriptionAnnual Patients ServedPlease provide the number of patients your hospital serves annually for the description on the hospital’s page.
Page DescriptionDonation NeedsDoes the hospital have any specific donor needs? If so, please explain, as a way for potential donors to find the hospital. If available, please provide a plan for future funds, including specific uses (e.g., new program or facility), amounts, priority, and alignment to the hospital’s strategic plan.
Page DescriptionDonation UsesHow has the hospital used donations in the past?
Page DescriptionVolunteer NeedsDoes the hospital have any specific volunteer needs? If so, please explain, as a way for potential volunteers to find the hospital. If available, please provide a plan for volunteer work (e.g., specific procedures the volunteer will get to learn or perform, learning objectives).
Page DescriptionVolunteer NeedsDoes the hospital have any specific volunteer needs? If so, please explain, as a way for potential volunteers to find the hospital. If available, please provide a plan for volunteer work (e.g., specific procedures the volunteer will get to learn or perform, learning objectives).
Page DescriptionVisa RequirementHow difficult is it for volunteers to obtain a visa to work with the hospital? Please explain.
Page DescriptionVolunteer SalaryAre volunteers able to receive a salary? If so, what is the average salary or a typical range of salaries?
Page DescriptionAttractionsAre there any features of the hospital’s location that you would like to highlight that might attract short-term volunteers, such as music, wildlife photography, nearby tourist attractions, etc.?
Page DescriptionLocation AccessPlease describe the location in which the hospital is located and how difficult it would be for volunteers to travel there.
Search CriteriaGeographyIn which country is the hospital located?
Search CriteriaCauseDoes the hospital support any specific causes (e.g., leprosy, cancer, maternal health)? Please list each as a way to allow donors and volunteers to search for the hospital.
Search CriteriaChristian MissionDoes the hospital have a Christian-based mission?
Search CriteriaAbility to Accept Foreign DonationsIs the hospital registered with the appropriate bodies required to receive foreign donations (e.g., FCRA in India)?
Search CriteriaConditional DonationsCan the hospital accommodate donations that come with conditions tied to them?
Language: English
Page range: 2 - 22
Submitted on: Jun 23, 2023
Accepted on: Jun 5, 2024
Published on: Aug 26, 2024
Published by: Global Health Institute at William Carey International University
In partnership with: Paradigm Publishing Services

© 2024 Sarah Mayner, Vijay Anand Ismavel, Vraj Shroff, published by Global Health Institute at William Carey International University
This work is licensed under the Creative Commons Attribution 4.0 License.