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Evaluation of Patient Information Center

Country: 
Israel
Partner Institute: 
The Myers-JDC-Brookdale Institute, Jerusalem
Survey no: 
(15) 2010
Author(s): 
Elroy Irit, Gross Revital, Avramov Rita, Halevy-Levin Sarah, Daltrophe Michal Yoran Judy
Health Policy Issues: 
Quality Improvement, Others, Access
Others: 
Information for patients and their families
Reform formerly reported in: 
Information Center on Patients' Rights & Services
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no no no yes no
Featured in half-yearly report: Health Policy Developments 13

Abstract

An evaluation of the Hadassah Information Center highlighted achievements and provided recommendations for enhancing the efficiency and quality of services. The Center adopted many of the recommendations including: improving the computerized data base; special training of volunteers to conduct follow-up calls for further assistance in acquiring care, actualizing rights and benefits; increasing visibility of the Center; and planning for future structured cooperation with external resources.

Recent developments

The Hadassah Information Center, established in February 2008, provides free-of-charge information to patients by specially trained volunteers regarding rights in the health and welfare system, and practical help in realizing rights and accessing community services. After 18 months of operation, the Brookdale Institute was asked to conduct a formative evaluation of the Hadassah Information Center. The objective of the evaluation was to provide center staff with feedback on the functioning of the center, evaluate the intial goals set and provide recommendations for further improvement to better achieve the Center's goals. This report summarizes the evaluation findings and implementation of the recommendations.   

Following the evaluation several changes were made in the Center's computerized system. Computerized recording of the applicants to the Center has been made much more user-friendly for the volunteers and for the organization of statistics of the types of applicants and  frequently asked questions. Volunteers no longer use hard copies of applicants' files. A search engine has been added, providing a more efficient use of information resources. Another significant change introduced computerized reminders to make follow-up phone calls to patients in order to check the status of the realization of their requests and to assess the need for further assisance when bureaucratic and personal barriers are detected.  The center is also giving much thought as to how to improve internal marketing in the hospital and increasing the visibility of the Center. A survey has been conducted, in order to identify the most common barriers in realizing rights in the National Insurance Institue (NII) and determining where direct personal connections with the concerning departments in the NII should be established.

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Characteristics of this policy

Degree of Innovation traditional innovative innovative
Degree of Controversy consensual consensual highly controversial
Structural or Systemic Impact marginal rather marginal fundamental
Public Visibility very low neutral very high
Transferability strongly system-dependent rather system-neutral system-neutral
current current   previous previous

No change from previous report .

Degree of Innovation - The hospital-based information center on realization of rights and utilization of services is the first to be established in Israel. We do not know of similar models implemented in hospitals abroad.

Controversy - There is wide consensus on the importance of the center, and support for its operation.

Systemic impact - The impact is rather marginal since the center operates only in one hospital.

Visibility - Several advertisements have been published in newspapers. Adds are also published internally within the hospital.

Transferabilty - The idea of such a Center is rather system neutral - a similar model can easily be implemented a broad. However, the data base on rights and services needs to be adapted to each country.

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no no no yes no

Initiators of idea/main actors

  • Providers: Position to and influence on the evaluation

Stakeholder positions

Hadassah Social Work Department and the private donor initiated the formative evaluation at an early stage of operation as a means to improve the center's functioning. The private donor provided the funding for conducting the evaluation, enabling the process.

Hadassah Hospital Management was concerned regarding the timing of the evaluation. They preferred to conduct the evaluation at a later time - after the center was better established and the evaluation would thus show positive outcomes.

Center staff supported the evaluation and saw the benefit of receiving timely feedback and recommendations for improving the Center's functioning. 

Actors and positions

Description of actors and their positions
Providers
Hadassah Social Work Departmentvery supportivevery supportive strongly opposed
Hadassah Hospital Managementvery supportiveneutral strongly opposed
Private donor Mrs. Florence Galkin, Mashovvery supportivevery supportive strongly opposed
Center staffvery supportivevery supportive strongly opposed
current current   previous previous

Influences in policy making and legislation

Not relevant.

Legislative outcome

n/a

Actors and influence

Description of actors and their influence

Providers
Hadassah Social Work Departmentvery strongvery strong none
Hadassah Hospital Managementvery strongneutral none
Private donor Mrs. Florence Galkin, Mashovvery strongvery strong none
Center staffvery strongvery strong none
current current   previous previous
Hadassah Social Work Department, Private donor Mrs. Florence Galkin, Mashov, Center staffHadassah Hospital Management

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

The center has been operating since February 2008. The annual report for 2009 shows considerable expansion in operations:  The number of volunteers has doubled (from 20 to 40) and they have handled about 1,260  patients (50 percent increase compared to 2008). 

As planned, the center is open five days a week. Opening hours have  been slightly adjusted to better respond to patients' needs (from 9:00-17:00). The volunteers provide information to patients (from various departments) who come to the center, and systematically visit hospital departments and outpatient clinics providing information to patients and families there. 

In the past year the center has implemented changes in its operation in response to emerging needs and in light of the formative evaluation that has been conducted by the Brookdale Institute (see below):

  1. Emphasis has been given to further care by follow-up phone calls to patients to  ask about the status of the information provided, additional information needs and barriers in realizing rights. In the past year two workshops on this topic were held for the volunteers to motivate and train them to conduct these follow-up calls.
  2. In order to increase visibility and number of patient encounters, much emphasis in the last year had been put on internal marketing of the center, using brochures in Hebrew, Russian and Arabic (dispensed at many locations within Hadassah hospital); Roll ups at the entrance to the hospital, links in the internal and external internet site of Hadasah, and personal communications with social workers in Hadasah as well as during staff meetings. Plans exist to increase the visibility of the Center among medical and non-medical staff all over  the hospital through presentations in the various departments, special meetings open to staff members and to the general public.
  3. In light of the multi-cultural patient mix, the center also assumed responsibility for translation services to Amharic and Arabic to overcome cultural barriers to care. Center staff coordinate the requests for translation services and provide support for the translators. In the near future a pilot project will start for translations by phone, also coordinated from the Center.
  4. Following the evaluation recommendations, a concentrated effort to improve the computerized information system has started in cooperation with the Hadasah Computer Department.
  5. Finally, in December 2009 an additional branch of the center was opened in Hadassah Har Hazofim (a second campus of the Hadassah hospital), with a special emphasis on serving the Arab community. 

Monitoring and evaluation

The formative evaluation was conducted by the Brookdale Institute between June and November 2009. It was based on qualitative methods, including review of Center documents, observations at the Center, interviews with staff members, volunteers, patients who used the Center services, and  hospital staff members working in cooperation with the Center. Ongoing feedback was provided to the Center staff  throughout the evaluation period to enable discussion and early adoption of recommendations. A summary report was prepared in January 2010.

The main findings of the evaluation were: 

Overall success of Patient Information Center:  The launching of this innovative project was successful and within one year there have been many achievements. The volume of patient encounters was considerable - about 120 per month. There was almost no drop out of volunteers. Patients appreciate the service, and hospital management recognizes its value to patients as well as a means to decrease the workload of hospital personnel and improve quality of care. Hadassah management gives high priority to upgrading the computer infrastructure and continues funding the project together with Eshel and Mashov for another year. The success of the Patient Information Center at the Ein Karem campus led to the opening of another branch at the Hadassah Har Hazofim campus. 

Somewhat ambiguous missionThe evaluation revealed ambiguity in the definition of the objectives of the center. In some documents the stated objective was "to help in realizing  rights by providing information" and in others the objectives included  "removing barriers to realizing rights". The interviews confirmed this ambiguity. It was also unclear whether the target population ware the elderly or all patients and staff members. De facto services were provided to all patients (mainly disabled, cancer patients and elderly); however, the first training courses focused on the needs of elderly patients. The third course was adapted to reflect the diverse population of patients that came to the Center, while volunteers from the first two courses were invited to learn more about these other populations.

Unclear role of volunteers: The findings revealed that volunteers find it difficult to clearly separate between providing information and counselling patients or just listening to their problems. Volunteers did not have a clear perception regarding their role in helping patients to realize their rights in the system (e.g., assist in filling out forms), and some did not accept this as part of their role (despite the stated objective of the center). Volunteers did not accept the follow-up calls for further care as an integral part of their roles and did not provide assistance in realizing rights and overcoming barriers. This was also confirmed by patients as well as staff members that were interviewed.   

The volunteers expressed frustration with several aspects of their work that prevented them from working efficiently and independently. The computerized data base was not comprehensive and up to date, and almost in each encounter they had to search for relevant information on the internet. Furthermore, new information could not be added to the data base and thus they had to begin a new search for each patient - which is time consuming and frustrating. They are also very much dependent on information provided by the social worker in charge of the Center and constantly refer to her as a resource instead of independently dealing with patients' questions. Finally, another major problem noted by the volunteers was that the software for follow-up on patient encounters was not structured and therefore they could not retrieve data on the status of a patient's case, creating the need to use paper notes for follow-up (which were not fed into the system).

IT infrastructure to be improved: Volunteers as well as Center staff highlighted major problems with the infrastructure as described above.     

Barriers to realizing rights: Interviews with patients and staff members revealed three types of barriers: 1) Emotional - patients do not feel comfortable to demand income tax exemptions or other material help since it reflects on their image as needy. Some are preoccupied with their medical condition and are not able to absorb information on rights. 1) Bureaurcratic - patients do not know which forms to fill out, where to find them, what additional documentation is needed and how to get it. The process is long and complicated for them to deal with. 3) Resources -  patients have neither the time needed for the process nor the capability to negotiate with the system (do not have sufficient legal knowledge etc). Therefore a multi-faceted approach is needed if Center staff would like to take on the complex task of helping patients realize their rights and overcome these barriers.   

More internal marketing needed: Interviews with hospital staff indicated that the Center is not yet established as an integral part of the services offered to patients. More internal marketing is needed to increase it's visibility. Plans exist to increase the visibility of the Center among medical and non-medical staff all over  the hospital through presentations in the different departments, special meetings open for the staff and the general public etc.

More external cooperation needed: Another aspect highlighted by the evaluation is the need to construct institutional channels with external government agencies, in particular the National Insurance Institute (NII). This will enable the Center to better assist patients in getting information, realizing their rights and overcoming beaurocratic barriers.  A survey has been conducted, in order to check which are the most common barriers in realizing rights in the NII.

Expected outcome

Overall, after a relatively short time of operation, the Hadassah Information Center has established itself as a unique resource to patients, families and staff.  The center has succeeded in building an infrastructure of staff, volunteers and resources needed for its operation and has the continued support of hospital management and private funding for one more year at this time. Additional funding must be sought. The necessity of this kind of  Center is manifested in the establishment of another branch in Hadassah Har Hazofim hospital .  

The center has adopted a "learning organization" approach and is continuously reviewing its operation and looking for ways to improve the quality of services. The center adopted the major recommendations from the external formative evaluation conducted by the Brookdale Institute and is now in the process of introducing changes, which are expected to enhance the efficiency and quality of services provided by the center. 

To date the Center's activities included mainly providing information on rights and services. The main challenge for the coming year is to develop tools and train the volunteers to help patients overcome barriers in realizing their rights in the system.   This aspect of the Center's mission had been ambiguous, and has not yet been fully achieved.

Impact of this policy

Quality of Health Care Services marginal rather fundamental fundamental
Level of Equity system less equitable four system more equitable
Cost Efficiency very low low very high
current current   previous previous

No change from previous report. The evaluation recommendations are expected to assist the center in realizing its potential for achieving these outcomes. 

Quality of care is expected to improve if patients receive help in utilizing community services after discharge. This will enhance continuity of care as well as more appropriate care for special needs such as medical aids and long term care institutionalization. The Center will provide information on support of caregivers which will prevent burnout and consequent medical and psychological illness which is typical for caregivers. It will also provide help in getting f inancial aid which will improve the caregivers' wellbeing and thus positively affect the patients.

Equity is expected to improve because information will empower the more vulnerable populations in particular (patients of low and medium SES). Patients of higher SES usually have more access to information (including their rights) and usually Are more able to realize them in service utilization. Therefore the Center is expected to mainly benefit the more disadvantaged population resulting in increased equity. However, we should note that all patients,  regardless of SES, will benefit from the information and assistance provided by the Center.

Cost-efficiency may improve if re-hospitalizations are reduced. This outcome is expected if patients receive more appropriate care in the community as a result of the help they receive from the Center.

References

Sources of Information

  • Daltrophe  M. (2010), Kivunim Information Center, Summary of activities, 2009. Social Work Department, Hadassah Hospital, Ein Karem, Jerusalem.
  • Elroy I. and Gross R. (2010). Kivunim Information Center - report of a formative evaluation. Myers-JDC-Brookdale Institute, Jerusalem.

Reform formerly reported in

Information Center on Patients' Rights & Services
Process Stages: Implementation

Author/s and/or contributors to this survey

Elroy Irit, Gross Revital, Avramov Rita, Halevy-Levin Sarah, Daltrophe Michal Yoran Judy

Irit Elroy is a researcher at  Myers-JDC-Brookdale Institiute; 

Revital Gross is a senior researcher at Myers-JDC-Brookdale Institiute and Associate Professor at Bar Ilan University

Rita Avramov is the Director of the Department of Social Work Services, at Hadassah Hebrew University Medical Center

Sarah Halevy-Levin is a senior geriatric social worker, at Hadassah Hebrew University Medical Center

Michal Daltrophe  is a social worker, at Hadassah Hebrew University Medical Center

Judy Yoran is a senior social worker at Hadassah Hebrew University Medical Center

Suggested citation for this online article

Elroy Irit, Gross Revital, Avramov Rita, Halevy-Levin Sarah, Daltrophe Michal Yoran Judy. "Evaluation of Patient Information Center". Health Policy Monitor, April 2010. Available at http://www.hpm.org/survey/is/a15/3