Evaluating Your Clinic

Why evaluate?

Evaluation has become an essential ingredient of any successful not for profit organization. The scope and rigor of the evaluation is up to you and can be tailored to fit your priorities, budget, and capacities. In an era characterized by resource scarcity and greater accountability of nonprofit organizations, evaluation activities are needed more than ever to demonstrate that your clinic is a wise investment.

With the enormous demands of establishing and running a clinic, often the last thing on anybody’s mind is evaluation.

But how:

  • Do you know if all of your careful planning and current efforts are working as you intended?
  • Are you able to demonstrate to those stakeholders who support your efforts that they have made a good investment?

The answer is simple: EVALUATE! what and how well your clinic is doing.

Evaluation activities can help you to demonstrate:

  • Volume
    • Number of patients/visits
    • Number of hours of volunteer service
  • Need
    • Percentage of uninsured in community served by clinic
    • Number of persons on waiting list
    • Number of persons who seek care but don’t qualify
  • Value
    • percentage of patients who no longer use emergency room for non-urgent care
  • Impacts
    • percentage of diabetic patients that improve their A1C levels

Contrary to conventional wisdom, evaluation activities (as reviewed later in this section) are not reserved for the long-standing, well-funded clinic that has both the time and resources to undertake an evaluation project. Program evaluation comes in all shapes and sizes, and there is an opportunity for ANY clinic to benefit from doing an evaluation.

What is evaluation?

It is worth underscoring that the primary focus of evaluation is to learn what can be improved. Arguably, learning about where improvements are needed may be more essential to a clinic just starting out than to a well-established clinic because newer organizations are known to fail at much higher rates than older organizations. It’s never too early to think about evaluation!

Where should I begin?

The most difficult step is the first: determining what to evaluate. There is no one-size-fits-all answer. What you decide to evaluate should emanate from the goals you have developed for your clinic. Typically these goals are embedded in your clinic’s mission or vision statement and articulated in your first year operational plan or your consequent strategic plan.

Mission and vision statements are broad statements of what your clinic hopes to achieve and how it hopes to impact your community. These statements are a good place to start because they provide clues about what’s important, a sense of where the clinic is at, and a point of departure for what it is that the clinic wants to accomplish. A review of internal documents, coupled with discussion with key staff/volunteers and Board members, likely will generate many ideas for evaluation. It is helpful to formulate these ideas into questions.

A clinic may ask:

  • Are our patients receiving care promptly?
  • To what extent is the clinic meeting the urgent healthcare needs of uninsured residents in our community?

One tool to help you pare the list of potential evaluation questions is to judge your questions against three criteria.

1. Can the results of the evaluation influence decisions about the program?

2. Is the program significant enough to merit evaluation?

3. Can the evaluation be done in time to be useful?

The potential evaluation question, first and foremost, must be actionable. The answer to the question needs to:

  • Prompt changes in the clinic/program/policy/personnel being evaluated
    • Expansion
    • Greater investment
    • Closure
    • Reallocation of staff
    • Adoption of new policies
  • Not be afraid of exposing weaknesses or shortcomings
    • You should ask questions that will reveal where you can make improvements, doing so will allow your clinic to grow and change
  • Imagine an answer (or range of answers) and describe what future actions you would take if you had the answer
    • If none can be anticipated, then you can conclude that the evaluation would be of limited practical utility

The significance of what is being evaluated. This criterion is designed to help ensure that you measure what matters. In making this assessment, consider whether the question you have posed impacts all of your patients or a (small or large) subgroup. If your evaluation question targets a specific program, consider how much (or little) of your clinic’s financial or human resources (e.g., staff/volunteers) are devoted to the program. In an environment characterized by little (or no) paid staff and a heavy reliance on volunteers, clinics must carefully invest their limited resources in questions that have the potential to improve clinic operations in a meaningful way or establish the value of what the clinic is doing.

Practical considerations, such as whether the relevant data can be collected in the time frame in which it is needed to inform decision-making, also come into play. An understanding of what data are available and a realistic assessment of what would be required to obtain the data and organize it into a usable format are essential.

A good evaluation question has a clear purpose.

Be able to answer the following questions:

  • What do I want to know?
  • Why do I want to know it?
  • What am I going to do with it?

The following sections will show you HOW to plan an evaluation project.