United Hospital Fund

Health Care Improvement Grants Promoting Voluntarism

United Hospital Fund

Health Care Improvement Grants

Promoting Voluntarism

The 2014 application package contains the following information and forms:

  • General Guidelines
  • Funding Guidelines
  • Instructions for Completing the Application
  • Contact Form
  • Project Profile
  • Project Summary
  • Work Plan
  • Budget

General Guidelines

Health Care Improvement Grants promoting voluntarism are available to support new programs that improve the quality of the experience of patients and their family caregivers, in both the inpatient and ambulatory care settings. We are particularly interested in new programs that seek to support patient engagement and activation – improving patients’ knowledge and interest in managing their health, and supporting patients in shared decision-making about their care. This may include programs that promote health literacy,support patients and caregivers in the management of chronic illnesses, or help them to navigate the health care system. Grants may also support collaborative projects between hospitals and community-based organizations, including organizations with expertise in health literacy, curriculum development, training or recruiting of volunteers, or other program expertise relevant to the project.Applications that involve collaboration with a community-based organizationmust be submitted by the hospital.

In completing this application, please pay special attention to including an appropriate evaluation plan; and demonstrating the involvement of appropriate hospital staff in the planning, development, and implementation of the program.

Applicants must be a beneficiary hospital of the United Hospital Fund or a hospital of the New York City Health and Hospitals Corporation.

Please forward the original applicationand four copies with appropriate attachments,endorsed by your hospital’s Chief Executive Officer/Executive Director, to the Fund no laterthanJune 20, 2014. You may obtain an electronic copy of the RFPon the Fund’s website at Address your application to:

2014 Health Care Improvement Grants Promoting Voluntarism

United Hospital Fund

1411 Broadway, 12th Floor

New York, NY 10018

To ease processing, staple your application and copies in the upper left-hand cornerand do not insert them in binders or covers. Fax and email submissions are not accepted. If the initial review of the application requires clarification or additional information, you will be notified. Grants will be awarded in October 2014.

The Fund will sponsor a technical assistance session at its offices to answer any questions about the RFP and to assist hospital volunteer programs in developing their proposals. The session is scheduled for Thursday, April 10, from 3:00 – 4:00 p.m. Call-in participation is an option. To register, please send an email to Hillary Browne at ith “Voluntarism Technical Assistance Meeting” in the subject line. Include the names and titles of participants (maximum 2 per hospital), and indicate whether you will attend in person or wish to call in.

For questions about the RFP or the technical assistance meeting, please contact Hollis Holmes, Grants Manager, at 212-494-0761 or email .

Funding Guidelines

1.Applicants may apply for a one-year grant of up to $40,000. Only proposals for new programs will be considered; the Fund will no longer accept applications for renewal funding. All previous grantees, including those awarded grants in 2013, may submit funding requests for new programs.

2. Line items under Personnel Services (PS) may include support for a project coordinator, clinical staff time devoted to the project, trainers, researchers, support staff,etc. No more than 15 percent of the total request may be budgeted for the salary of the director of volunteer services or any staff who functions in that capacity.

3. The following restrictions on Other Than Personnel Services(OTPS) apply:

  • materials and supplies may not exceed 15 percent of the total request
  • equipment including computer hardware may not exceed 15 percent of the total request, and the applicant must explain how the equipment is integral to a proposed service program and is not available within the institution
  • transportation funds for volunteers must be matched one-to-one by the applicant

3. Funds are not available for:

  • activities whose central purpose is fundraising
  • capital construction or renovation of facilities
  • payment for patient services
  • stipends for volunteers
  • video production
  • advertising costs associated with proposed program
  • conferences

Instructions for Completing an Application

1.Letter of Transmittal

An official letter of transmittal, signed by the President or Chief Executive Officer of the hospital, must accompany the grant application. This cover letter should convey organizationalendorsement of the grant proposal.

2.Contact Form

The contact form provides information about the applicant organization and the project director. The applicant hospital’s Chief Executive Officer must endorse this form at the bottom.If the proposal involves collaboration with another organization, please be sure to provide its contact information and include a letter of agreement from its Chief Executive Officer/Executive Director.

3.Project Profile

A complete project profile checklist should include the funding request, activity type, population served, geographic location, service site, and organization type.

4.Project Summary (one page, 300-word maximum)

The project summary should include a project title, a two-line purpose statement, and a narrative not to exceed 300 words that describes its goals, projected objectives, key activities, and major deliverables.

5.ProjectProposal(no more than 10double-spaced pages, 12-point font)

A complete proposal should include:

  • problem/issue statement, including a brief description of the community served by the proposed program
  • a description of program goals and objectives, activities, staffing, and number of individuals to be served
  • qualifications of proposed staff
  • volunteer participation—include plans for the following:

-development of curriculum and/or training materials

-numberof volunteers to be recruited

-nature of volunteer-patient interaction

-total number of hours each volunteer will contribute over a period of time

  • a plan for evaluation of the program’s effectiveness, including patient, caregiver, volunteer, and staff satisfaction,number of people served,ability of program to maintain an active core of trained volunteers, and impact of volunteer/patient interaction on accomplishing program goals
  • a description of howthe program, products, and findings will be disseminated within the institution and to other health care facilities that would benefit from this information.

Instructions for Completing an Application (continued)

6.Work Plan

The workplan (see attached template) should include:

  • schedule of key activities
  • responsible staff/organizations
  • expected products, such as a training manual, resource materials, etc.

7.Budget and Narrative Description

  • Complete the budget form
  • Complete a budget narrative that includes:
  • description ofstaff responsibilities and time allocated for this project
  • description of all expenditures for “other-than-personnel services”
  • sources and amounts of other funding—secured and anticipated—including in-kind contributions
  • your plan for sustaining the program after grant funding is expended

8.Qualifications of proposed staff

  • Include resumes of key proposed staff

9.Evidence of not-for-profit status

Include a copy of the applicant hospital’s IRS determination letter, a completed W-9 form, and a copy of its most recent annual report.

Contact Form

Hospital Name

Address

Telephone ( ) ___ – ______Fax ( ) ___ – ______E-mail

Project DirectorTitle

Address

Telephone ( ) ___ – ______Fax ( ) ___ – ______E-mail

Contact Person Title

Address

Telephone ( ) ___ – ______Fax ( ) ___ – ______E-mail

Director of Volunteer Services

Title

Address

Telephone ( ) ___ – ______Fax ( ) ___ – ______E-mail

______

Organization Endorsement

This application has the full support and endorsement of the Hospital’s Chief Executive Officer/Executive Director and should be considered as the organization’s single application for the 2014 Health Care Improvement Grants Promoting Voluntarism.

Name Title

please print

Signature Date

Chief Executive Officer/Executive Director

Project Profile

Amount Requested: ______

Activity Type (check one)

Education/training Patient advocacy

Community outreach Friendly visitor

Other ______

Population(s) Served

General

Targeted (check all relevant)

Children Caregiver

Adolescent Chronically ill

Adult HIV/AIDS

Older adult/Elderly Immigrant

Men Mentally ill

Women Other ______

Geographic region(s) where activities will be conducted

Brooklyn Staten Island

Bronx Citywide

Manhattan

Queens

Service Site(s) (check all relevant)

Ambulatory care/primary care center Hospital inpatient

Community In-home

Emergency department Other ______

Applicant Organization (check one)

Public hospital

Voluntary hospital

If hospital is part of a health care system, please identify system:

Project Summary

Applicant:

Project Title:

Purpose of Project:

In the space below—in a 12-point font, single-spaced, 300-word maximum—summarize the issue the project will address and its goals, projected objectives, key activities, and major deliverables.

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United Hospital Fund

Health Care Improvement Grants Promoting Voluntarism

Work Plan

Please use this as a guide for designing your own workplan.

Month / Activities / Products/Results / Person(s) Responsible

.

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United Hospital Fund

Health Care Improvement Grants Promoting Voluntarism

Budget

Applicant:

Total
Project Cost / Other Funding (if applicable) / Request from UHF
I. Personnel Services (PS)
Title (%FTE)
1.
2.
3.
4. / $ / $ / $
Fringe Benefits (%)
Subtotal PS / $ ______/ $ ______/ $ ______
II. Other-Than-Personnel Services (OTPS)
  1. Materials/Supplies
  2. Travel
  3. Consultant Services
  4. Equipment
  5. Other (list)

Subtotal OTPS / $ ______/ $ ______/ $ ______
Grand Total / $ ______/ $ ______/ $ ______

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