AHP Healthcare Philanthropy Journal Fall 2022

philanthropy

Where Have All the Donors Gone?

Shifting Priorities to Focus on the Top of The Donor Pyramid

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Integrated Marketing for Planned Gifts

By Alice Ayres, MBA

Letter from the Chair

By Fred Najjar

CEO Corner Letter from the Journal Chair

By Bob Nolan, FAHP, CFRE

Where Have All the Donors Gone? Shifting Priorities to Focus on the Top of The Donor Pyramid

By Andrew Miller

As families’ budgets shrink and people prepare for an uncertain future, we are left wondering where we will be able to meet our bottom lines. As we look up and take inventory of 2021/2022 and start to plan for 2023 and beyond, some institutions can be left thinking…where have all the donors gone?

/ FORWARD THINKING

CONTENTS 5 8 7 9 14

When the Best Practice in Healthcare Fundraising is to NOT Follow Best Practices

By Howard L. Smith, PhD

Given the tough charitable environment today facing the health sector, best-practice-driven results are especially meaningful to fundraising executives. However, philanthropy leaders should also consider reaching beyond “best practices” to “better practices.”

FORWARD THINKING SPONSOR

How To Maximize Your DEI Efforts22

By Gail Rudolph, CMCT, CFRE

It is simple for a company to meet the “requirements” for a diverse Board of Directors, executive team, or workforce. Inclusion–creating an authentic environment where every person feels welcome, seen, valued, and appreciated for their uniqueness —is a very different matter.

President and Chief Executive Officer: Alice Ayres, MBA

2021 AHP Journal Advisory Council

Chair: Robert Nolan, FAHP, CFRE Sophia S. Ahmad Murray Ancell, MS, CFRE Jewanna Apawu Michelle J. Collins Sarah Fawcett-Lee, CFRE Jolene Francis, FAHP, CFRE Matthew Lang, CFRE Bonnie Jess Lopane, CFRE Andrea Page, FAHP, CFRE Harrison Porter, CAP, CFRE Elizabeth Rottman, CFRE

AHP Board of Directors:

Chair: Fred Najjar

Vice Chair: Arthur J. (Art) Ochoa, JD

Secretary/Treasurer: Pamela Puleo, FAHP

Immediate Past Chair: Randy A. Varju, MBA, FAHP, CFRE

Directors: Julie E. Cox, FAHP, CFRE Shawn A. Fincher Jeanne Jachim Tammy Morison, CFRE

Published by: Association for Healthcare Philanthropy, 2550 South Clark Street, Suite 810, Arlington, VA 22202

Managing Editor: Olivia Hairfield

Business Manager: Michelle Gilbert

About Us: The Association for Healthcare Philanthropy (AHP) is the healthcare development professionals’ definitive source of thought leadership, connections to facilitate innovation, and tools to advance knowledge and elevate philanthropy. As the world’s largest association for healthcare fundraising professionals, AHP represents 7,000 members who raise more than $11 billion each year for community health services. Our mission is to inspire, educate, and serve those transforming healthcare through philanthropy.

The Journal’s Mission: Healthcare Philanthropy will be an authoritative resource for healthcare development professionals by providing a timely, informative, and insightful collection of literature that will raise the standard of individual and organizational performance. Serving as the premier forum for healthcare philanthropy literature, the Healthcare Philanthropy journal will educate, empower, and inspire development professionals and, thereby, help strengthen the case for philanthropic support and the mission of AHP.

CEO Corner

Financial pressures continue to mount for our healthcare organizations. Whether it is the increase in expenses thanks to the higher labor costs and costs of supplies and medication; or for our US members, thanks to a revenue picture that continues to show significant decreases year over year, we are all having a very difficult year.

It is no surprise, then, that our leaders are looking to philanthropy to help. Each of you is being asked to do more, often with less, in order to help keep our struggling organizations able to deliver the best quality care. How do we do more with less? I would argue this is the time to invest in ourselves and our professional development. The pandemic changed so many aspects of our day-to-day work—working in a hybrid environment, meeting donors where and how they want to interact, reduction of live events and in-person interactions, a greater reliance on digital mechanisms —making it critical that we learn from one another in real time to ensure we are the very best philanthropy professionals we can be.

AHP’s mission is to inspire, educate, and serve those transforming healthcare through philanthropy. Throughout these past several years, we’ve worked hard to deliver information to you as you navigate these changes. With this writing, I am pleased to draw your attention to a few new highlights:

• AHP’s On-Demand Learning Hub is designed to make it easier to find resources on such key topics as grateful patient fundraising, major giving, and how to talk about philanthropy with C-Suite and other internal allies.

• All of AHP’s webinars are now all free to members, making it easier to access on-demand learning at any time that is convenient for your schedule.

• AHP has also launched virtual mini-courses on topics like planned giving, marketing and communications, and grateful patient fundraising. Many are now on demand, and we plan to add more in the coming months.

• AHP’s Primer is now available on demand making it easier for new members of the philanthropy team to get up to speed quickly so they are able to start making an impact faster.

• We are also back to delivering educational content, networking, and professional development in person. We had a wonderful gathering in Vancouver for Convene Canada in May of 2022, and a full class of students at Madison in July.

Alice Ayres, MBA President and Chief Executive Officer, AHP

And, of course, we are also back in person for International Conference. We look forward to seeing you all there!!

We are here to help as you and your colleagues transform healthcare through philanthropy. If you ever have a question or need a little guidance to find professional development for yourself or a colleague, please don’t hesitate to reach out.

In gratitude for all you do, Alice

Letter from the Chair

It’s no secret that high-performing teams require high-performing team members. As the definitive resource for healthcare philanthropy, AHP is committed to ensuring you have what you need to sharpen your professional skills and keep current on developing trends. Learning from your peers and their experiences is one of the many ways the articles in this journal support your growth.

In the face of the current difficult financial period in healthcare, our members continue to find ways to improve ROI and make the most of what they already have. In “Where Have All the Donors Gone?” by Andrew Miller, you’ll look at major giving strategies when year-toyear donations are decreasing.

And, finally, Howard L. Smith, PhD, invites you to take a more critical look at how healthcare fundraising best practices fit with your shop. Dr. Smith suggests it may even be time for you to throw those best practices out the window…

Fred Najjar Chair of the Board of Directors at AHP Executive Vice President & Chief Philanthropy Officer at CommonSpirit Health

As Alice mentioned, AHP strives to support you during this challenging time. By publishing resources like this journal or the Report on Giving and giving you access to more digital content than ever before with the Online Learning Hub, we hope you can turn to us to make your life a little bit easier. Your hard work and commitment to making the world a better place is inspirational.

Thank you for your commitment to healthcare philanthropy, and I look forward to seeing you at AHP’s 2022 International Conference.

Best, Fred

Letter from the Journal Chair

Twice a year, I sit down to compose this letter to our membership for the journal and face the issue that confounds writers everywhere, the blank page. That blank slate stares back at me and waits for me to begin. How do I begin? What do I say? What does the reader want to hear.

That same issue also faces me when I begin to draft an annual fund solicitation, a substantial proposal, or the stewardship letter for an important gift. This is a phenomenon sometimes referred to as “writer’s block” or “blank page syndrome.” That feeling of uncertainty and the inability to get started can lead you to abandon the project altogether.

Authors of articles submitted to the journal also report having experienced this predicament. We frequently get questions about the topics we want them to cover, hoping that will trigger the idea that can help them get started. We actively resist the temptation to be prescriptive in “assigning a topic” in order to avoid limiting the universe of good ideas and experiences that can be shared.

Bob Nolan, FAHP, CFRE

Journal Advisory Council Chair Executive Director of Development Indiana University School of Public Health

Your experience as a healthcare fundraiser is unique to your organization and the donors you work with. We want to get your perspective on how you are addressing the issues we all face; finding and keeping the best staff, executing highly production fundraising campaigns, implementing meaningful stewardship programs, and more.

We will help you to identify a unique topic area for your article, as the authors in this issue of Healthcare Philanthropy have done. Please reach out to the members of the AHP Journal Advisory Council and the AHP Communications staff to learn more, and we look forward to seeing your submission in a future issue of the Journal.

Where Have All the Donors Gone? Shifting Priorities to Focus on the Top of The Donor Pyramid

By Andrew Miller, Sr. Philanthropy Officer at Rhode Island Hospital Foundation

At the onset of the global COVID-19 pandemic, the healthcare industry became the focus of the world. Donors poured in donations, volunteered their time, and gave inkind gifts to healthcare facilities all-over North America and the globe. Now, as we inch closer to 2023, our healthcare institutions continue to battle the pandemic; however, the attention has shifted towards the other headwinds that will drastically affect the healthcare sector over the next few years. The future of healthcare is starting down some troubling signs upon the horizon. The continued instability of Europe with the ongoing invasion of Ukraine by Russia, rising inflation that might lead to tougher fiscal policies that can send the US and world economies into a recession, and growing donor fatigue will have a direct impact on fundraising efforts. As families’ budgets shrink and people prepare for an uncertain future, we are left wondering where we will be able to meet our

bottom lines. As we look up and take inventory of 2021/2022 and start to plan for 2023 and beyond, unprepared institutions can be left thinking…where have all the donors gone?

The calendar year end is approaching and nonprofit organizations across the different sectors have had, or are about to have, the conversation about projections into the next fiscal or calendar year. Whether you are planning a campaign, looking to grow projections, or expand your philanthropy team, you have most likely had the conversation that starts with, “who are our top prospects and how can we best engage them?”. The focus on the top of the donor pyramid has progressively become more of a priority. A tool that has been used in the past—and is probably not new to those in fundraising—best outlines the shift of attention to your top current and potential donors. If you are looking at a four-square grid, each quadrant

Donor Capacity and Engagement Grid

High Net Worth — Little/No Engagement

High Net Worth — Engaged

Wealth movement can’t be controlled, but as your donors gain more assets or inherit wealth, having them engaged along the journey can be controlled.

Low Net Worth — Little/No Engagement

Low Net Worth — Engaged

will represent a different type of prospective or current donor. On the top left of the grid, you will have your high-net-worth individuals who have little to no engagement with your institution. On the bottom left, you will have your low-net-worth or younger donors with little to no engagement with the institution. On the upper right and lower right, you have the same categories of wealth as the left side, but an inverse in engagement: Top right are engaged, high net worth donors. Bottom right are engaged, but low-net-worth donors). See figure 1.1 for visual representation.

The goal of any fundraising shop is to focus your attention on getting your prospects from the left side to the right-side of the graph. But the question is, how much time do you spend in each quadrant? We will revisit that question, but before we do so, it is important to understand the trends that are happening right now in the nonprofit industry.

Blackbaud Institute has been tracking the number of households donating since 2011, and they have seen a steady decline in total donations over those years.1 Through 2020, this trend has accelerated. Seventy-five percent of healthcare organization received fewer donations in 2020 than in 2019. In an article written in the

Wall Street Journal in June of 2022 by Ericka Andersen, she talks about the coming charity deficit and notes that, “The wealthiest 1.4% of the country comprise 86% of the charitable donations, according to the Philanthropy Roundtable. Giving is highest among those in their 60’s and 70’s. That means that today’s disproportionally religious baby boomers, who hold a disproportionate amount of the nation’s wealth, are driving charitable giving.”2 Studies have pointed out that the religious community tends to give more to charities, and as younger generations like Gen Z and Millennials start to inherit or surpass the Baby Boomers in wealth, will they continue that trend of driving philanthropy? Ray Foote, executive vice president at National Forest Foundation, points this out in his newsletter published on LinkedIn, “For more than twenty years, participation in US philanthropy has been declining even as total dollars given has risen steadily, and the rate of this divergence is accelerating.” Where does this decline leave our nonprofit institutions? And how can we forge a path to continued success, when there are fewer donors, but continued great need for the institutions in healthcare to continue to serve the community they are in? In the next few paragraphs, I outline some strategies and trends that have become top of mind for healthcare nonprofit leaders.

This shift represents the continued focus on “Ultra High New Worth” or UHNW prospective donors. UHNW are classified as individuals worth more than $30M, and these donors account for a sizeable portion of global individual giving at 36%. In North America, these individuals accounted for more than half of all global UHNW donations in 2020. According to the 2022 report by Wealth-X, the ultra-wealthy donated $85 billion towards philanthropic endeavors in 2020.3

So, what does this mean? Aside from sending unsolicited requests to the known UHNW’s of the world like Bill Gates and Alice Walton, how does this information change the way you look at your donor pyramid and time allocated to potential prospects?

The answer is a shifting of priorities away from the “boil the ocean” approach often used in sales, and towards curated and personalized individual outreach to your wealthy donor database. Going back to Figure 1.1, we want to spend our time on the top of the grid. Those donors who have capacity and are either engaged or not engaged should be the focus of your philanthropy efforts. You can’t control or anticipate accurately whether someone with low net worth will be able to climb into the highnet-worth categories. Therefore, the bottom two quadrants should be the focus of your annual fund, volunteer management, and event committees. Where your return on investment will be the highest is when you focus on donors who have capacity to move the needle in your campaigns or in your fundraising yearly goals. While all donors and gifts are important, we can’t ignore the aforementioned trends. As we see a steady decline in the total number of donors, the competition for funding from our top donor prospects will become greater. Those who are not prepared with the right strategies will lose out on potential major gifts that can make or break a campaign or fiscal year goal.

It, however, is not all doom and gloom! Philanthropy is resilient. We saw that in the 2008 recession as well as during the COVID-19

pandemic. Especially here in the US, we see that charitable donations continue to be strong. In a recent report published by Fidelity Charitable, they surpassed two million donorrecommended grants totaling $10.3 billion. This result is 41% more annual grant dollars than before the COVID-19 pandemic and 13% over 2020.4 Americans gave $484.85 billion in 2021. This reflects a 4% increase from 2020. In 2021, the largest source of charitable giving came from individuals, who gave $326.87 billion, representing 67% of total giving.

So, what does this mean for your philanthropy shop? First, it means that the focus on the individual is now more important than ever. Your wealthy donors are being asked by more nonprofits and stretched thinner than before. There are more causes domestically and internationally that are making the case for donors to support. Being able to properly connect your donor to your mission and tailor your outreach is paramount. Donors are looking for unique experiences, where they feel not only heard but connected to the organization on a deeper more personal level. These trends also further establish that you will receive the largest percentage of total gifts for your campaign or your fiscal year from only a few top donors. We are seeing a decrease in the number of donors giving at lower levels, and an increase of donors giving larger more substantive gifts. Hiring the right people to steward and cultivate these top prospects is crucial to healthcare philanthropy success.

Going back to Figure 1.1, we can now start to see the breakdown of how much time we should be spending on each quadrant of donors. You should estimate about 80% of your time on the top two quadrants, leaving the rest of your time to steward and cultivate your younger or less wealthy donors. This breakdown is from the perspective on the ROI for major gits. There are arguments to be made, depending on the organization, that the other quadrants in this graph deserve equal or more time.

However, for the sake of this article, my argument is that as we head into the next few years of uncertainty, philanthropy will become more competitive, and your top donors will align their giving with causes they feel most connected to. If you do not spend your time and resources creating a stronger bond with those donors, you may miss out on potentially significant gifts. As wealthy donors become savvier in the philanthropy, and their expectations heighten, we in philanthropy need to adapt and meet them where they are, not where we want our donors to be. As we plan next year’s events, engagement opportunities, goals, and metrics, top of mind should be on cultivating and soliciting our top donor prospects and engaging our supporters in ways that align their vital philanthropy dollars with your mission. The goals of any position and any shop should be to move donors along the grid or pyramid and get them to commit what is now, more than ever, their essential philanthropic support.

Andrew Miller is a Senior Philanthropy Officer with the Rhode Island Hospital Foundation focused on major gift fundraising for Rhode Island Hospital. Andrew is a knowledgeable frontline fundraiser with experience working in the higher education and hospital and healthcare industry. His previous positions include working as a fundraising consultant at CCS Fundraising in Boston as well as a Major Gifts Officer at his alma mater Stonehill College. He also previously managed the Walk to End Alzheimer’s in Worcester County for the Massachusetts and New Hampshire chapter of the Alzheimer’s Association. At Lifespan, he works directly for the Rhode Island Hospital Foundation, focused on development activities at the major gift level for all the adult service lines at Rhode Island Hospital.

He received his Bachelor of Arts in Political Science from Stonehill College, a certificate in Community and Social Change during the Washington Semester Program at American University, and a Master of Business Administration-focused in Business Intelligence, from Suffolk University-Sawyer Business School.

Endnotes

1 Trends in Healthcare Philanthropy for 2021.” 2021. Npengage.com. April 30, 2021. https://npengage.com/nonprofit-fundraising/ healthcare-philanthropy-trends-donor-retention/

2 Andersen, Ericka. 2022. “Opinion | America’s Coming Charity Deficit.” Wall Street Journal, June 30, 2022, sec. charity-deficit-giv ing-nones-generosity-crisis-baby-boomers-faith-religion-families-civil-society-11656618437.Opinion. https://www.wsj.com/arti cles/americas-

3 Wealth-X. 2021. Review of The Wealth in the Global Giving Landscape. Wealthx.com

4 Fidelity Charitable. 2021. Review of 2022 Giving Report. w ww.fidelitycharitable.org. Fidelity

When the Best Practice in Healthcare Fundraising is to NOT Follow Best Practices

By Howard L. Smith, PhD, Professor at Milgard School of Management, University of Washington Tacoma

Savvy healthcare leaders are normally quite attuned to cutting-edge management concepts essential for achieving high performance. Pursuit of best practices is a case in point. Well-grounded in corporate settings and applied research that document the promising payoffs possible, best practices are vital for raising a healthcare organization’s philanthropic accomplishments. Given the tough charitable environment today facing the medical/health sector, best-practice-driven results are especially meaningful to fundraising executives. As well, no leader wants to be

caught off-guard when someone from top management or the board drills down into whether fundraising efforts are following best practices and what fundraising results have been achieved.

Forward Thinking article sponsored by

Given the almost axiomatic acceptance of best practices as an enlightened way of leading, it may seem heretical to raise the question of: when is it appropriate to not follow best practices in healthcare fundraising? In this age of challenged assumptions, national/global crises, pandemic-driven lassitude, and economic instability, advancement executives should recognize that almost every healthcare entity is urgently trying to maintain stability and plot a fruitful course forward. Consequently, there is ample justification for embracing best practices as a form of risk reduction.

Nonetheless, obsession with so-called best practices can inadvertently be inimical to achieving high performance whether measured by satisfied clients, thriving friend-and fundraising results, balanced budgets, energized and committed staff, or deeply connected volunteers/supporters. In this respect, advancement leaders should consider informing their boards, colleagues, and staff about the need to reach beyond “best practices” to “better practices;” that is, strive toward an entirely higher level of managing healthcare philanthropy.

“Best practices” are not a panacea. They can lose potency when chaos surfaces or desired results simply do not materialize despite efforts to instill them. If this point is reached, leaders often consider new, imaginative, strategies to address an unusual predicament. In many cases these successful attempts evolve as “better practices” in the sense that they are better aligned with an organization’s new context. The old normal no longer exists and best practices aligned with that former environment prove to be less effective in delivering results. Executives face material risks if they stand around waiting for the old normal to return. It may be better to seek more innovative, ingenious fundraising strategies consistent with the new context…strategies that are often quirky, situation-specific, ingenious, and results-oriented rather than guided by prevailing (prior) standards in the field.

An Agenda of Better Practices

When former best practices gradually fade into being merely good ideas rather than so-called best practices, fundraising managers may sense that the need to experiment rather than passively watch their healthcare organization’s descent. Stephen M. Shapiro, acknowledged for his novel insights on innovation, has perceptively captured the fallacy of over-allegiance on best practices in his book Best Practices are Stupid 1 Shapiro’s manifesto essentially advises leaders to be more cautious about concluding that there is one-best-way, a best practice, to manage organizations. Compelling logic surrounds Shapiro’s thinking given thousands of variables that differentiate companies, especially firms within the same industry, for which benchmarking appears justifiable.

When confusion reigns due to fundamental tectonic shifts in economic, political, sociocultural legal/regulatory, and technological forces, fundamental premises about following best practices should be thoroughly analyzed. And, as competitive turmoil continues to swirl, executives could exercise more caution in blindly following best practices simply because that is what everyone else is doing. At these apex moments, such as the global economic recession in 20082009, or the 2018-2022 pandemic, some, or all, of the following better practices may have merit for healthcare executives, and specifically for fundraising leaders who face one of the most trying periods of fundraising in recent times.

Short-run goals gain higher priority than long-run goals

Whether it is a gut-punching recession, pandemic, or another external factor of overwhelming impact, occasionally short-run goals should, by necessity, take precedence over long-run goals. Yet, focusing on the short-run to the exclusion of long-run aspirations is contrary to traditional management best practices. From

a strategy perspective, the rule-of-thumb is to dutifully pursue a long game embodied in an overarching vision, mission, and strategic objectives. Conventional wisdom dictates that the best practice is to avoid enticing pop-up options that may lead only to one- or two-year accomplishments. These short-run tactics could jeopardize achieving a five-year fundraising vision; but, there may be no long-run if the shortrun is not managed adroitly.

Consider a medical clinic that annually submits a $25,000 grant request to an independent foundation for continuing financial support of a teen health program. For nine years the foundation has funded the teen health program and from all appearances it appears that a continuing commitment can be anticipated. The medical clinic must raise resources to cover a total annual budget of $150,000, so the $25,000 is a substantial percentage of required total fund raising. The best fundraising practice appears to be methodically maintaining the relationship (in the short-run) and demonstrate a high return on the grant funds awarded (over the long-run).

What happens when the scenario changes and the vice president for advancement, who prepares the teen health project grant request, encounters a new possibility and predicament. For example, assume a board member of the clinic opens the door to another foundation that is willing to consider a one-milliondollar gift to the clinic’s ongoing capital campaign. Given the board member’s connection and cultivation efforts, it is quite probable that this request will be approved; an auspicious relationship is established. In the event that these two grant requests must be submitted by the end of the following week, which grant request should the vice president focus on if she only has time to prepare one proposal?

The vice president could work harder with longer hours. She might retain

a consultant to prepare one or both of the proposals. She could seek a volunteer from her board or a staff member to assist in proposal preparation. Alternatively, she could approach the foundation that has funded the teen health program for a submittal extension. These and other approaches normally make great sense in resolving such dilemmas. However, given budget constraints, staff reductions, and full staff agendas, this is one time that a temporary fix is not going to deliver desired results. Add to the dilemma that relationship building with the new foundation is tantamount, so the vice president simply cannot substitute someone else. In such a situation this could be one time that a long-run (9+ years) revenue stream is put on hold in favor of developing a highly desired relationship and grant request; in effect, the nascent relationship dominates because it may produce higher longrun revenue. The best practice of focusing on a long-run grant relationship is halted for a shortrun gamble with potentially high payoff.

Better results can often be derived by completely reversing best practices

A large urban hospital decided that it could improve its client services and add to its revenue streams by better managing parking

on and around its campus. Employees had traditionally been relegated to outlying lots, and they purchased hang-tags or permits to dangle from their vehicles’ rear-view mirrors.

The head of security advocated for a tag-less approach, the latest in parking technology, that relied on monitoring license plate numbers. Applications, payments, permit information, lot assignments, violation warnings, violation tickets, and associated information were conveniently encapsulated in a tech-reliant database associated with pricey computer software. Security was quite proud as the system rolled out with only a few glitches.

Within a month security noticed that patients were inadvertently parking willy-nilly wherever they pleased. This situation greatly annoyed development staff who needed to leave for donor/prospect appointments outside the health campus. When development officers returned from cultivating donors, they burned up time searching for vacant parking spaces. The few premium lots reserved for staff became jammed with hospital clients. Security could easily disseminate tickets to staff (because they were employees and thus part of the broader information system), but corralling patients who parked wherever they liked was an altogether different matter. As the problem intensified, security was beginning to conclude that the best practice system had serious flaws that inadvertently pitted staff versus patients.

Undaunted, the head of security formed a couple of focus groups composed of randomly selected staff. Responses from staff were vitriolic to say the least. They complained bitterly about their permits’ rising cost (necessary to fund the tech-glitzy system) and inconvenience because patients and their families parked wherever they wanted. Moreover, staff pointed out that with the previous “tag system,” employee cars had a visible placard that communicated to anyone (especially patients) that parking required some sort of permit. Furthermore, staff noted that they seldom knew when their e-tags expired

because everything was handled by computer. In the past they easily monitored their permit’s expiration: the document virtually hung in from of them each time they drove. Furthermore, staff protested when appeals were handled electronically–gone was the responsive and employee-sensitive staffer who used great judgment and tact in addressing warnings and violations. She knew when to handle a repeat violator gently, but firmly, by contacting a supervisor.

Security tried to implement a series of fixes that improved parking management, but costs continued to rise which fueled employee animosity. Finally, an ad hoc group of disgruntled employees demanded a meeting with the hospital CEO; the group submitted a set of expectations arguing that the pricey parking software be replaced. Their protest reached such a level that the CEO tossed out the best practice parking system along with the head of security.

Sometimes less is more, and a better practice is to keep it simple by reversing what appears to be a best practice on the surface, but in actuality is a pain-in-the-neck over the long-run.

The idea of one-best-way should be scuttled in favor of multiple good ways

A significant shortcoming of the best practice concept is the belief that only one best way of operating exists…a well-defined process and structure that will consistently deliver the best results. Granted, best practice advocates recognize that some inherent flexibility is essential during implementation; however, best practices rely heavily on a structured and often ingenious design as well as methodical execution. Follow the best practice, and high performance is effectively assured.

A modest-sized, but important, health plan in a rural state was just one of many public, private,

and nonprofit organizations in the state’s main town supporting a community fund. Each year staff from the community fund would work with constituents to unveil the fund-raising program to reach the campaign goal. The community fund favored a well-structured approach that simply worked year-after-year. In many respects it was a tried-and-true program that each year received a little bit of polish and sparkling glitter in the way of a couple of imaginative tactics. Key to the program was identifying a single campaign leader in the constituent organizations who motivated internal staff and galvanized volunteers.

The health plan in question was only weeks into a new chief executive’s leadership; she was full of vim and vigor to accomplish big goals, and she emphatically felt a compelling need to correct, if not reinvent, everything that had shown mediocre results. When the community fund’s new campaign was unveiled, the CEO immediately called the health plan’s previous campaign chair and incoming chair together for a debrief on last year’s campaign. She was startled to learn that giving last year was $197,000…a paltry sum as far as the she was concerned. In her mind it should easily be double that. The previous campaign chair patiently explained the details of last year’s effort and how the results—the $197,000 was the highest amount ever raised, by a magnitude of approximately 40%.

The CEO was incensed and wanted to know why results were not better. The health plan’s new campaign chair explained that he believed their organization could raise giving to $240,000. The CEO guffawed and emphatically demanded a higher goal of $300,000 before asking the incoming chair how she was going to do that.

In defense of the new chair, the out-going chair explained that the community fund had a single model of fundraising in mind, and it balked at lone wolves trying to do something different. Unfortunately, this one-best-way did not fit the health plan’s culture or unique ways for

accomplishing impressive results. Additionally, the out-going chair noted that previous CEOs had never made a five-figure campaign gift as a signal to staff about how important community giving was to the health plan.

The CEO hastily concluded the meeting after realizing that she had effectively just committed herself to a substantial gift, and that her reading of prior results was off-kilter as far as the health plan’s culture was concerned.

Seldom is there one best way for accomplishing a goal or objective. More often multiple pathways exist, several of which are equally advantageous, for reaching difficult and high-aspiration outcomes. Advocates of best practices thinking could benefit from encouraging flexibility in the adoption of specific tactics. As for the health plan mentioned above, the community fund’s strategy for raising gifts simply did not fit with the culture or leadership commitment of the health plan. The outgoing campaign chair had basically agreed to a format advocated by the community fund, but he supplemented it by cleverly using scores of internal teams in competition to reach a new target. The outgoing chair gave the incoming chair this gift of insight, and she promptly fine-tuned the health plan’s funding strategy while also paying respectful homage to the community fund’s best practice way of doing things.

A creative idea du jour is seldom aligned with every setting

Remember Theory Z? In 1981 William Ouchi suggested that a blend of American and Japanese management philosophies could create a nurturing and respectful environment for employees that would lead to higher performance and long-run engagement by personnel. Remember zero-based budgeting from the 1970’s? Zero-based budgeting posited that each year organizations should begin budgeting by using a zero base in order to allow

only justifiable costs to be covered in new annual budgets. Other popular management panaceas over the years include servant leaders, mindmapping, dashboards, ideation, and so forth. Some of these popular ideas were very useful in healthcare fundraising, and as a result, lasted longer than others. However, many had inherent limitations; they could only be applied in certain situations, and thus were far from being panaceas.

The management field has great capacity to surface new ideas to help organizations in pursuing improved performance. These concepts offer hope for those organizations that need fresh concepts to cope with their constantly evolving environments. Some of these ingenious concepts stick and remain vibrant for a considerable period of time; inevitably they become best practices. Many other clever ideas do not deliver promised results; these “best practices” are little more than just another idea du jour.

Discretion is the better part of valor when it comes to adopting a fundraising best practice. Healthcare organizations that prudently examine the latest best practices are more likely to achieve implementation success because they have analyzed both the upside as well as the challenges accompanying each best practice concept. Skepticism is healthy, but only to the extent that it enables an organization to explore the advantages and disadvantages for any socalled best practice. A methodical objective reading can ensure that a best practice does not end up as an idea du jour that sparkles briefly before being extinguished.

Performance Benchmarks Should be Standardized to Account for Resource Differences

One problem with best practices is that they assume a nearly level playing field; that is, every organization is capable of implementing best practices. In truth, healthcare fund- and friend-

raising programs vary significantly in resources at their disposal, the context of their community or regional environment, and their missions. What works for some hospitals, medical centers, or health providers as far as fundraising may be impossible for others.

Healthcare executives can support staff efforts to implement best practices by remembering the issue of scale. The better a healthcare organization is resourced, the more likely it will be positioned to implement a wide range of best practices. Consider a physical therapy clinic in a modest town of 75,000 people that wanted to reach more deeply into the community and make connections with all age demographics about sports exercise and injuries. The sparse managerial staff (a community relations and advancement officer plus a-one-half FTE assistant) in this clinic did everything it could to get the word out about its web-based exercise and rehabilitation programs and its series of lowcost, in-person prevention programs offered at various community centers.

Visually, the community was a treasure due to a river that ran though it and an endearing set of mountain peaks surrounding the town. This idyllic setting drew rich and famous personalities who bought land, built trophy homes and inexplicably tried to import aspects of the cities they worked in to this little rural slice of heaven. The clinic cleverly targeted these same personalities for possible high-dollar donations by offering them the ability to invest not just in the personalities’ impressive mini-mansions and ranchettes, but in the community. Wellintentioned board members of the physical therapy clinic managed to bring three of these new personalities to a community advisory board that guided the clinic’s local and regional reach.

As people of wealth, the new advisory board members immediately argued that the clinic’s aspirations and web-based program were outdated and lacked ambition. Despite using a digital strategy, the clinic failed to incorporate

slick social media as the fundamental structure. Word-of-mouth advertising, brochures, movable placards/billboards formed the full extent of the marketing program. Not surprisingly, within six months the full-time director for community relations and advancement resigned. In his exit interview with the board chair, the director admitted that his heroic effort to create and sustain this community enterprise failed because the advisory board expected that the operation would be run in a best practice manner like those in Boulder, Colorado or Bozeman, Montana. The community relations and advancement director noted that those big city entities had six or more times the number of advancement staff members for programmatic and fundraising efforts. He concluded that the marketing practices of their small town’s clinic was right-sized for the situation…it was a better practice that fit the community, its resources, and cultural predispositions even though it failed to meet the best practice standards of Boulder or Bozeman.

Toward Better Practices

Advancement executives in the health field have their hands full of conundrums like so many other leaders. Tried-and-true strategies enabling their programs to build fruitful relationships with prospects and donors may seem less reliable in these days of uncertainty. Following best fundraising practices still makes enormous sense as a general guide for managing, but it should not be surprising if what worked extremely well in the past is less effective today. The good news is that with every challenge there are correspondingly new opportunities to apply more imaginative thinking that can lead to dazzling results which far surpass funding goals and targets.

It does not take a pandemic or a recession to provide incentive for thinking out-of-the-box about fundraising. Creative and ingenious fundraising efforts are typically inherent underlying pillars of the most successful philanthropy programs. And, a best practices formula inevitably losses polish over time. After all, what happens to best practices when every healthcare entity is following the same best practices? From this perspective, it should be clear that the challenge is to develop the next best practice–a better practice–that will become the aspiration of others.

For more than 29 years Howard Smith has served at several universities in academic executive positions including Vice President for Advancement, Founding Dean, Dean and Associate Dean. Smith has taught university-level courses over 49 years at the Medical College of Virginia, San Diego State University, Northern Arizona University, University of Washington, University of New Mexico, Boise State and Pacific University. He has published over 240 articles on health services, organization theory/behavior and strategic management topics in journals such as the Academy of Management Journal, Academy of Management Review, Decision Sciences, Health Services Research, Journal of the American Medical Association, New England Journal of Medicine, and Healthcare Philanthropy Journal. He has published seven books on prospective payment, staff development, hospital competition, healthcare financial management, strategic nursing management, reinventing medical practice, and higher education strategy and he has published four books on nature literature. His most recent book is: Business Aha Tips on Successful Fundraising published by CCI Press at Boise State University, 2014.

Endnotes

1 Stephen M. Shapiro. “Best Practices are Stupid: 40 Ways to Out-innovate the Competition.” Penguin Books, Ltd. London, England, 2011.

How to go Beyond Gratitude™

A detailed implementation strategy can make your grateful patient program a success from day one, and Graham-Pelton’s Beyond Gratitude ™ can provide even more assistance for getting your program started. These following steps are a reliable way to begin:

1. Engage your key clinical partners.

Securing philanthropic gratitude requires the work of a whole team, including clinical partners. Clinicians and practitioners should be engaged in the process and given active roles, but they shouldn’t be responsible for soliciting and securing donations. That is the job of the fundraiser.

2. Identify the necessary staffing and budget resources.

Decide who will be involved, how many major gift officers will be required, and if other resources will be needed before launching your program.

3. Manage your data with the right tools.

Make sure your donor data is organized and secure by investing in the right tools.

4. Research privacy laws and your institution’s own privacy regulations. It is important to be aware of patient privacy laws and regulations when choosing data management software and setting up your program’s workflows.

5. Get the support of hospital leadership.

If you want to ensure that your program runs smoothly and is accepted by staff, you’ll need hospital leadership on board, even if they’re not directly involved in the day-to-day operations. Red tape and roadblocks can be avoided with leadership support.

6. Plan the program’s rollout.

As soon as you have identified your necessary investments, created a preliminary budget, and gathered all the key players, it is time to plan how your program will be implemented. Define everyone’s roles and responsibilities as well as a timeline for the program’s rollout.

7. Begin screening prospects.

Once you’re up and running, you can start screening prospects. Ensure your gift officers have all the information and resources they need to begin their work.

Find out how you can go Beyond Gratitude ™: www.grahampelton.com/beyond-gratitude

How To Maximize Your DEI Efforts

By Gail Rudolph, CMCT, CFRE, Chief Executive Officer and Founder of Gail Rudolph Collaborative

Diversity, equity, and inclusion efforts should not lead people to feel preached to, admonished, or put on the defensive.

Some people claim that humans shouldn’t have any bias, but that is simply not possible.

Human preconceptions are formed so quickly and primarily without even being conscious of them. Forming biases, making judgments, and assumptions are how our brains rapidly process information.

Once our biases are ingrained, even if it is not what we truly believe or want, they “set up shop” in our unconscious, and we respond automatically and involuntarily. The solution is to slow down, become aware of them, take

accountability for them, and then change the automatic responses that come with them.

Not long ago, two colleagues and I were walking to our car after lunch. A shiny red Corvette zipped into a parking space right in our path of travel. As we walked by, each of us peeked inside the car and got quite the surprise.

Instead of the driver being a 40+ male, the occupants were an older couple, easily in their 80s. And, to top it off, the woman was driving! That stopped the three of us in our tracks. We turned to one another, having realized that we’d each made the same assumption, fallen victim to a generalization–that only men having a midlife crisis drive Corvettes. The irony of

this entire situation was, we had just taught a Diversity, Equity, and Inclusion workshop.

And that’s my point, our brains are wired to form associations and generalizations, to categorize things so that when we come across something similar again, our brain doesn’t have to put too much effort into assessing the information. Even though the three of us understood this and spent hours teaching others about it, our brains continue to serve up these assumptions, judgments, and stereotypes automatically. But what we each did in that moment was RECOGNIZE that our brains jumped to that conclusion.

As humans, we all make assumptions, pass judgment, stereotype, generalize, and label others. Our true power lies in noticing and recognizing these false assessments when they arise. Instead of feeling guilty or ashamed, we can make a concerted effort to retrain our brain with new facts.

Diversity is the easy part. It is simple for a company to meet the “requirements” for a diverse board of directors, executive team, or workforce. Inclusion–creating an authentic environment where every person feels welcome, seen, valued, and appreciated for their uniqueness–is a very different matter.

To offer our best selves to any group or organization, we need to belong, which allows us to feel safe sharing our ideas, providing feedback, and asking questions. That encourages us to do our best work and sparks true creativity and collaboration.

Forbes reports that inclusive teams make better decisions up to 87% of the time and make them twice as fast with half the number of meetings.1 Who wouldn’t like to have fewer meetings?

These teams also deliver 60% better results. Moreover, effective decision-making is 95% correlated with financial performance, according to Bain & Co.2 So, the question remains how do we create a diverse, equitable, and inclusive team?

Here are Five Steps to Help Create an Inclusive, Equitable, and Representative Workplace:

Appropriate education —Understanding how unconscious biases are formed and how to counteract them diffuses defensiveness and opens acceptance of others.

• Education is the foundation for change but can never produce change without action. However, without the proper education around the issues, your efforts will fall short and may even be counterproductive. Understanding how automatic responses hijack our brain allows us to slow down and choose an appropriate response.

Focus on inclusion, not diversity —Create a framework for conversations to move to measurable action.

• Rather than talking about all the “isms” that steer the conversation away from the core issue, it’s vital to focus on why we, as human beings, have a natural tendency to create exclusive environments. Much of this stems from how our brain processes information by creating mental shortcuts. This often results in unconscious labeling, stereotyping, and assumptions about others based on race, gender, and many other factors. In a nutshell, the function of the human brain often hijacks our behaviors and responses.

Build awareness and establish empathy Being open to ideas, perceptions, and experiences outside our own. Awareness of self as well as of others is vital. We only have the power to change ourselves.

I worked with a leader who would go around the room and call on each person by name, asking their ideas on the topic at hand. Although I had seen this before, he was different because he wanted to hear their views, especially if they were different.

•

As a leader, he modeled the way for others to be joyful and unthreatened by someone who thought differently than us because they led us to some of our greatest solutions, which I might add were a combination and creativity of all the thoughts and ideas.

Produce opportunity —Look for ways to discover and celebrate the unique role each person brings instead of highlighting differences.

• One of the easiest ways to do this is to practice blind selection techniques. In a study conducted by Goldin & Rouse, the researchers discovered that the use of a screen that hid the identity and gender of musicians auditioning for symphony orchestra seats increased the probability of a woman advancing in the audition process by 50%. These blind audition methods further resulted in a woman being chosen for an orchestra seat by severalfold. Blind auditions explain a 30% and 55% increase in the proportion of female new hires and a 25% and 46% increase in the percentage of females in symphony orchestras since 1970.

Build buy-in-Cultivate strategies to build a more inclusive environment that demands diversity and equity.

• Don’t make this a top-down initiative. Yes, it needs to start at the top but involve your team, ask what they see or want. I watched a company implement a DEI program that created more division than existed previously. At no point did the leadership team survey the company to measure how it worked. In a year, the company moved backward because there was no way to evaluate the process where employees could give feedback without fear of insulting leadership. Remember the entire team when creating diversity, equity, and inclusion programs or mission statements.

Endnotes

You can’t have actual ownership unless you become part of the solution.

Great teams are maximized when every individual, no matter their role, can effectively harness their power and influence to advance the organization’s goal and mission of creating a diverse, equitable, and inclusive culture.

Gail Rudolph, CFRE, CMCT is the USA Today and Wall Street Journal best-selling author of the book Power Up Power Down, How to Reclaim Control and Make Every Situation a Win/Win. In the book, she helps readers discover how to harness their own interpersonal power and to understand power dynamics present in all situations.

Gail is credentialed to teach the six universal Principles of Persuasion based on the research of the “Godfather of Influence,” Dr. Robert Cialdini. She is one of 12 people globally—one of two women, and the only woman in the United States to hold this distinction.

Gail is a Consultant, Executive Coach, Author, and Trainer with 25 years serving in philanthropic leadership positions across a spectrum of organizations. She holds a Leadership Certification from the Stanford Graduate School of Business, is a Value-Based Leadership Expert, Wiley DISC Consultant, is a Certified Fund Raising Executive (CFRE). She has created and trademarked numerous proprietary trainings and assessments.

CEO and founder of Gail Rudolph Collaborative, Gail is an international expert on fundraising, influence, leadership, interpersonal power dynamics, mindset, and diversity, equity, and inclusion.

1 https://www.forbes.com/sites/eriklarson/2017/09/21/new-research-diversity-inclusion-better-decision-making-at-work/?sh=535c 041b4cbf

2 https://www.bain.com/insights/score-your-organization-ame-info/

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Modern healthcare fundraising demands a bold, fresh approach.