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

Background: Historically, many Christian mission hospitals were established by home churches from developed countries in their colonies. With countries gaining independence and missionary medical staff leaving these hospitals, the majority have closed. These hospitals provide critical assistance to communities that need their services the most, yet they often lack the financial and human resources needed to realize their full potential for community impact. Existing charity rating organizations rate few charities and lack transparency for donors, and limited resources exist to help volunteers find organizations that would benefit from their services the most. We propose a transparent Transformational Impact Rating System (TIRS) that can be used by funding agencies and volunteer directing agencies to assess the potential for transformational impact of any hospital anywhere in the world. Methods: Research to inform the rating system was conducted via a comprehensive review of existing charity rating organizations, in-depth interviews, and surveys. The rating system was developed by identifying, down-selecting, categorizing, and allocating weights to variables of importance. The rating system was then implemented via a custom-built website. Results: To receive a score, data is collected from the hospital and surveys of donors, volunteers, staff, patients, and the local community. Hospitals receive an overall score and scores in each of five categories: regional impact potential, financial health, operational performance, external relations, and volunteer experience. Conclusion: TIRS provides a proof-of-concept platform through which all hospitals in low-resource settings can make their impact potential visible to donors and volunteers. If TIRS (or modified similar tools) are used by those interested in helping mission hospitals, they will be more likely to adopt best practices, and invisible hospitals that are struggling in remote areas will be more likely to receive much-needed resources. The Christian community has a mandate to serve the poor and marginalized, resulting in a large number of Christian schools, colleges, and hospitals established across the globe. These establishments face increasing threats to their existence, and tools like TIRS can help direct declining funds and manpower to hospitals that have the highest potential for transformational impact.