Hospital Campaign Activity Scorecard

Plan Activities, Register Donors,

and Let Life Bloom

HOSPITAL CAMPAIGN PHASE V CHALLENGE SCORECARD

Plan your hospital’s campaign activities to promote donor registration and then track activities and new donor registrations here. Points earned for each activity and for each new donor registration recorded will determine your level of recognition in the WPFL Hospital Campaign. Return completed scorecard to your donation organization partner (OPO, DLA, eye or tissue bank).

1,000 points =

750 points = 350 points =

Hospital City/State/Zip

Hospital Contact

Name Email

Reporting Donation Organization Donation Organization Contact

Name Email

200 points =

_{POINTS TOTAL 0} DONOR REGISTRATIONS TOTAL ₀

SECTION 1: Hospital Campaign Donor Registration
Earn points for setting your donor registration goal, for reaching your goal, and for each new donor registration.
First, consult with your donation organization partner – organ procurement organization (OPO), Donate Life America (DLA) affiliate, eye or tissue bank – to set a realistic goal for the number of new donor registrations you want to achieve during Phase V of the campaign.	Points Per Activity	List Donor Registration Goal Number	TOTAL Donor Registrations Recorded	Total Points
(a)    Set your goal for number of new donor registrations you want to record through your campaign. Report your goal and progress to your donation organization partner (OPO, DLA, eye, or tissue bank). Earn 50 pts for one-time goal setting)	50
(b)   Reach or exceed your set goal. (Earn 100 pts for reaching or exceeding your set goal for total number of new donor registrations recorded)	100
(c)    Earn one point for each new donor registration recorded. (Example: 328 new donor registrations recorded = 328 to be put in “TOTAL Donor Registrations Recorded” column at right. The number entered in that column – 328 – will automatically go into “Total Points” column.)	1 pt per each new donor reg.			0

SECTION 2: Hospital Communications and Events
			Total Points
Points Per Activity	Number Completed	Activity / Associated Points:
50 65		Hold direct donor registry enrollment events (tabling events) in high-traffic hospital areas. (50 pts each/no max pts)	0
50 60		Hold a Hospital Campaign kick-off event or other large-scale event that is reported by news media; consider featuring a donor family and/or transplant recipient. (50 pts each/100 pts max)	0
50		Implement Give 5 – Save Lives direct donor registration tactic. See materials and tips here. (50 pts per program/100 pts max)	0
50		Participate in a challenge competition among area hospitals. (50 pts per competition/150 pts max)	0
50		Place a campaign web banner and link to the state registry on internal email signatures and web sites for the duration of the campaign. (50 pts for length of campaign/50 pts max)	0
40		Enlist hospital auxiliary/volunteers in donation registry/awareness events. (40 pts for length of campaign/40 pts max)	0
40		Hold a donor memorial service, candle-lighting ceremony, Tree of Life, or other donation celebration. (40 pts per event/80 pts max)	0
25		Hold a donation flag-raising ceremony for employees. Invite community members. (25 pts per event/100 pts max)	0
25		Send email from hospital CEO/other leaders to all staff – announcing the campaign, encouraging participation and registration, providing campaign updates, and including link to state donor registry. (25 pts per email blast/75 pts max)	0
25		Hold a program with living donors, transplant recipients, donor family members, and/or transplant professionals to talk about the campaign and the importance of donation registration. (25 pts per program/75 pts max)	0
25		Include donation education, registry links/opportunities, and information about the campaign and ways to get involved in new employee orientations. (25 pts per session/100 pts max)	0
20		Present at departmental/physician meetings on plans and registration goal of the campaign. Suggest ways that staff can get involved. Consider inviting a representative from your area donation organization to speak. (20 pts per meeting/100 pts max)	0
20		Utilize hospital's internal media to run campaign PSAs, post e-versions of campaign materials, and/or feature short videos on donation and transplantation. Access videos on organdonor.gov or on HRSAtube. (20 pts per posting/60 pts max)	0
20		Add campaign goal challenge marker/barometer to your website and/or post in public area. (20 pts per posting/40 pts max)	0
15		Display campaign posters and table tents with donation information and registry links in hospital’s high-traffic public and employee areas including on bulletin boards, in elevators, cafeteria, lobby, and restrooms. (15 pts per posting/75 pts max)	0
15		Publish donation and transplantation articles, with registry link details, in internal hospital newsletters (15 pts per article/60 pts max)	0
15		Participate in National Blue and Green Day - April 15, 2016 (15 pts/15 pts max)	0
15		Enter a description of one or more your own activities not listed above. (15 pts per activity/60 pts max)	0

SECTION 3: Community Engagement and Events
Points Per Activity	Number Completed		Total Points
		Activity / Associated Points:
75		Provide donation information and registration opportunities at community health fairs/screening events. Partner with your local Health Department, mobile screening units, blood centers, and other community health organizations. (75 pts per event/150 pts max)	0
75		Partner with your municipality, area colleges/universities, chamber of commerce, local businesses, and fraternal organizations (e.g., veterans, Rotary Club, Kiwanis) to engage new partners in the campaign and help host awareness and donor registry enrollment events. (75 pts per event/150 pts max)	0
75		Partner with local police, firefighters, EMS, and other first responders to engage new partners in the campaign and help host awareness and donor registry enrollment events. (75 pts per event/150 pts max)	0
50		Hold direct donor registry enrollment events (tabling events) in high-traffic areas in the community. (50 pts each/no max pts)	0
50		Organize a challenge competition among local medical schools or universities/colleges. (50 pts per competition/150 pts max)	0
50		Host a donation education program or segment with your local television station. (50 pts each/100 pts max)	0
50		Participate as a hospital team in a community walk/run promoting organ donation awareness. (50 pts per event/50 pts max)	0
40		Post donation-related info/story and link to state registry on billboards. (40 pts per billboard/80 pts max)	0
35		Place an ad/PSA about organ, eye, and tissue donation, with link to state registry, in the local media (news, radio, TV). (35 pts per placement/70 pts max)	0
25		Send letter/email from hospital CEO to other hospitals, health organizations, physician practices, or community groups, encouraging them to join the campaign, with links to resources and state registry. (25 pts per correspondence/75 pts max)	0
25		Use social media sites (Facebook, Twitter, LinkedIn, Instagram) to highlight community donation events, provide link to state registry, and encourage registration. (25 pts per posting/150 pts max)	0
25		Create a pro-donation theme and use in community parade, event, and/or health fair. (25 pts per event/50 pts max)	0
25		Submit a letter to the editor of area publication, urging donation registration and providing state registry link. (25 pts per letter/50 pts max)	0
25		Add state registry link to your website. (25 pts for length of campaign/25 pts max)	0
25		Publish donation/transplant articles, with registry link details, in hospital community newsletter or other local print/online publication or forum. (25 pts per article/75 pts max)	0
15		Place donation-related posters with state registry details in local businesses. (15 pts per location/150 pts max)	0
15		Enter a description of one or more your own activities not listed above. (15 pts per activity/60 pts max)	0
TOTAL
			0