Case study: Using matched-control groups to evaluate a volunteering scheme

Do volunteers in hospitals make a difference? This programme used matched control groups in adjacent hospital wards to capture the impact of hospital volunteers, writes Geoff Mulgan, as part of a series of case studies highlighting different approaches to capturing impact.

No one wants to be admitted to hospital, and a friendly face can often make all the difference, particularly at a time when people can be anxious or feel disconnected from family and community. Volunteers in hospitals can be that friendly face. Millions of people already volunteer in health and care, but tens of millions would consider it. And they can do much more than is often supposed, including things that can really make a difference to people’s experience of hospital (from extra support at mealtimes to helping people to get home safely after a hospital stay).

We hear repeatedly how fantastic volunteers are and the difference they are making yet there is very little empirical evidence captured to really show the impact they are having. We partnered with The Cabinet Office and The Department of Health and worked with 10 UK hospital trusts from 2014 to 2016 to help them build significant impact volunteering programmes. This included increasing both the scale and scope of impact volunteering in hospitals and, critically, measuring the results.

The method

Helping in Hospitals was inspired by the success of King’s College Hospitals’ volunteering service, which transformed the way it mobilises volunteers by involving clinical staff in designing volunteering roles to deliver the tasks that they consider most important and appropriate. For example, sitting with patients while they eat their meals, training volunteers in specialist skills (like reminiscence games for patients on dementia wards) and developing hospital-to-home services to support people to settle in successfully at home.

We wanted to see if this idea could work elsewhere. In doing this we wanted to find the most robust methods possible to capture the outcomes of our work.

The Helping in Hospitals programme worked with 10 hospital trusts to:

• extend their volunteering service into more and higher impact roles
• measure the impact of volunteering more effectively
• share the learning with others.

“Volunteering in hospitals is as important to recovery as medication. Volunteers bring human kindness into busy hospital life, enhance the care we provide and help patients return to an active life post discharge.” – Kingston Hospital

The programme focused on volunteering roles that had a direct and measurable impact on patients and the hospital, and which also got the most out of volunteers. We referred to them as high quality “impact volunteers”.

Over the course of the programme, the 10 trusts in the Helping in Hospitals programme were able to recruit a total of 2,835 new impact volunteers contributing over 200,000 hours of time throughout the duration of the programme. The three hospital trusts which were particularly focused on younger volunteers increased their ratio of young volunteers from one in 10 to one in four. Based on their experiences, we worked with them to create a guide to high impact volunteering in hospitals as a source of detailed advice for people who want to do something similar.

We also partnered with The Social Innovation Partnership (TSIP) and collected and analysed a variety of quantitative and comparative data that could more systematically demonstrate the impact of volunteers. This blog summarises the methods we used to capture impact, the reasons behind our approach, the challenges and limitations we faced, and the overall impact captured.

We wanted our data to paint a rich picture of what volunteers can really do, but our main priority was to ensure that this data was practical to collect in real world conditions. Working with the hospitals involved we recognised the key areas where volunteers could really make a difference to hospital care.

• Patient psychological wellbeing: Improved patient experience, improved mood, reduced anxiety levels, more patient voices heard.
• Patient clinical well-being: Improved nutrition levels, improved hydration levels.
• Utilisation / hospital stay: Reduced re-admissions, reduced length of stay, reduced delayed transfer of care.
• Staff-related: Releasing time to care.

A lot of consideration was needed to ensure groups with similar experiences were compared against each other. In all hospitals, we looked to compare similar groups of patients, for example, focusing impact volunteering on certain wards, while holding off impact volunteering on other wards until the research could establish its actual impact and benefits. Since many of the volunteering services had not expanded volunteer exposure to all wards at the start of the project, comparison groups like this were deemed to be ethical by all stakeholders.

The beneficiary and comparison groups typically consisted of separate wards that, according to the hospitals, were as similar to each other as possible in terms of size, patient demographics, and the types of conditions they cared for. For some outcomes a comparison group was not feasible, and we used pre-post approaches instead.

In some cases, a patient survey question was used instead of having beneficiary and comparison groups on separate wards to determine whether a patient had had interactions with the impact volunteers or not. To ensure evaluation ran alongside service delivery our evaluation leads coordinated with other hospital staff to ensure data collection for Helping in Hospitals fitted smoothly alongside existing data collection activities. This meant, for example, that many of the surveys used to capture wellbeing or hospital stays came from existing hospital surveys.

The impact

Using robust methodologies such as matched comparison group designs, the evaluation of the programme found that hospital impact volunteering shows promise as a way to maintain or improve patient experience and wellbeing outcomes and has the potential to relieve pressures on the healthcare system. In particular:

• Thirty per cent of all outcomes measured produced a statistically significant positive result.
• The majority of hospitals found statistically significant positive results on:
  • patient mood
  • nutrition and hydration levels
  • releasing time to care.
• Some hospitals also found statistically significant positive results on patient experience and anxiety levels.

Considering the early stage of development of many of the impact volunteering roles, and the ambitious evaluation approaches taken to measure them, the results look promising.

We saw that people were having much better experiences at mealtimes, and they had better nutrition and hydration levels. We found significant improvements in patients’ mood and anxiety. And for those returning home after long stays in hospitals, they reported feeling less isolated after their engagement with volunteers. As for the staff, they reported having more time to deliver care to those with more complex clinical needs. Here is the final evaluation report.

Overview of results of the Helping in Hospital evaluation.

In addition to the immediate impacts we were able to measure, the programme has also left a legacy of volunteering in hospitals. A number of hospitals in the cohort were able to secure funding for the continuation of their impact volunteering service. In addition, the work of Western Sussex Hospitals NHS Trust was recognised in an “Outstanding” CQC inspection rating, and Kingston Hospital Foundation Trust won “Best value NHS support service” at the 2017 HSJ value awards.

“If volunteering in hospitals can save staff time, increase patient satisfaction, improve patient outcomes and help improve prospects for young volunteers from all communities, then surely we must all agree that we should create more opportunities for impact volunteering to flourish.” – David Mowat MP Parliamentary Under-Secretary of State for Community Health and Care

The impact of the programme also goes beyond the 10 hospitals involved as we continue to see growing interest and investment in the development of impactful volunteering opportunities in health settings from organisations including the Office for Civil Society, Helpforce (supported by the National Lottery Community Fund and others) and The King’s Fund. For example, since Helping in Hospitals, Helpforce has worked with five hospital trusts and measured a range of impacts. Helpforce also recently ran a campaign with the Daily Mail that led to 33,000 people signing up to volunteer in the NHS in 2019. And as part of the NHS70, NHS England, NHS Improvement and Public Health England formed a partnership with the #iwill campaign and the Pears Foundation to grow and sustain youth volunteering and social action in health and care.

We hope the work achieved through Helping in Hospitals can continue to inspire and support more impact volunteers in hospitals across the country.

“The Helping in Hospitals programme has clearly benefited everyone involved, including: NHS staff, volunteers and of course patients and their friends & families. A key strength of the Helping in Hospitals programme has been its approach to getting people of all ages and backgrounds involved in volunteering, including young people.” – Rob Wilson MP Minister for Civil Society

What we learnt

The programme has created a how to guide for those who are developing and supporting volunteering in hospitals. This provides guidance, practical examples and resources based on the experience of hospitals in the programme of increasing the scale and scope of their volunteering service, and measuring the impact on patients.

The guide offers a four-step framework that can be replicated and adapted:

Our collective experience suggests that volunteers can have a real impact on the health and wellbeing of patients – and, as a result, on hospital outcomes.

The Helping in Hospitals programme has made the initial case for high impact volunteering. The positive evaluation results, combined with momentum from the cohort and size of the potential market in the hospital sector, makes a strong case for further demand and scaling to other hospital trusts.

About the author: Geoff Mulgan has been chief executive of Nesta since 2011. Nesta is the UK’s innovation foundation and runs a wide range of activities in investment, practical innovation and research.

This article was first published by Nesta.

It is one of a series of eight examples provided by Nesta to highlight different approaches to capturing impact they have used in recent years.

Read Geoff Mulgan’s article here about why it’s essential to try and track what is being achieved.

See also:

Case study: Capturing the impact of a challenge prize