Transparency Talk

Category: "Health" (26 posts)

Glasspockets Find: The Kaiser Family Foundation and JAMA Use Infographics to Inform About the Complex World of Healthcare
July 31, 2014

(Eliza Smith is the Special Projects Associate for Glasspockets at the Foundation Center-San Francisco.)

6a00e54efc2f80883301a511e79ac4970c-150wiAs health policy debates rage, have you ever wondered what story the data actually tells?  How many people are now covered as a result of the Affordable Care Act? Or what data is available about the health needs of recent war veterans? Or how about a non-partisan legal analysis of the Hobby Lobby ruling?  The Kaiser Family Foundation serves as a non-partisan source of facts, analysis and journalism for policymakers, the media, the health policy community and the public. As part of its mission it provides many reports, analysis, and more recently infographics to help make complex health policy more easily understandable and simply more transparent. Currently, in partnership with the Journal of the American Medical Association (JAMA), the Foundation is issuing a monthly infographic as part of their "Visualizing Health Policy" series.

The world of healthcare, from policy and insurance to access and beyond, is confusing and complex. But the Visualizing Health Policy series overcomes the obstacles the content presents.

Infographics have become increasingly popular in the last few years, both in the media at large and the philanthropic sector in particular. They combine information and graphics to create an easy-to-understand visual representation of a set of data. In the case of the Kaiser Foundation and JAMA project, the infographics tackle a different topic each month, from the physical and emotional health of Iraqi war active duty soldiers and veterans, to the impact of the Affordable Care Act on women.

Jama_2014march_us-global-funding1

View the infographic»

Infographics inherently make the data they represent more accessible, and this is essential for understanding the work of the Kaiser Foundation and JAMA. The world of healthcare, from policy and insurance to access and beyond, is confusing and complex. But the Visualizing Health Policy series overcomes the obstacles the content presents. A fantastic example of this is the April, 2014 infographic, "A Snapshot of the US Global Health Funding." It shows not only what percentage of the overall US budget is allocated for Global Health, but also to which countries this money is given. Additionally, there is a breakdown of how much funding is given to various healthcare areas, from maternal and child health to malaria and tuberculosis.

On the homepage of the Visualizing Health Policy project, there are several filters available for finding infographics that cover specific sets of information. For example, you can search a myriad of topics, including HIV/AIDS, Medicaid, and Private Insurance. These infographics are excellent resources for those wishing to educate themselves on any healthcare-related topic; and provide a great example of how the use of data visualizations can help foundations make complex ideas more accessible to the outside world.

-- Eliza Smith

IssueLab’s Collection Offers Important Example for the Field of Philanthropy
June 17, 2014

(Ned Schaub is principal at Ned Schaub Consulting – Social Change Strategy, and has collaborated with palliative care organizations and leaders around the country for a decade. He helps organizations, including foundations and their grantees, articulate the social change they will achieve, and related sustainability, business, and strategic plans.)

1390262883Almost a decade ago I had the good fortune to be asked by a foundation to look into potential grantmaking in the fields of hospice and palliative care, which led to a master’s thesis about palliative care grantmaking and the advancement of the field. I was struck then by the relatively limited ways that foundations working in the field collaborated, and the degree to which many foundations had no idea what palliative care was.

Certainly a lot has changed in the last ten years, but after seeing IssueLab’s newly launched collection, Improving Access to Palliative Care, I had to wonder what might have happened if this collection of documents had existed then? How much faster might the foundation I worked for have investigated the possibilities, and how much more compelling might the opportunities for social change and return on grantmaking investment have been?

Many in the field of palliative care are working hard to foster greater transparency between healthcare professionals and patients, making choices more obvious and decision-making easier for patients and their families. This represents a real shift from the traditional model where doctors held most, if not all, the decision-making authority.

Many in the field of palliative care are working hard to foster greater transparency between healthcare professionals and patients, making choices more obvious and decision-making easier for patients and their families. This represents a real shift from the traditional model where doctors held most, if not all, the decision-making authority. Fittingly, this new collection of palliative care documents from IssueLab also does the same for philanthropy, encouraging greater transparency about what we have learned from years of work in the field of palliative care, potentially helping to make funding choices more obvious and decision-making easier for grantmakers.

The collection includes more than eighty documents that bring together “evidence and insights about the millions of people who are denied access to palliative care and what organizations worldwide are doing to help them.” It was made possible by support from Atlantic Philanthropies, which has invested $58.5 million in palliative care over the last decade and is now considering the best ways to extend its legacy as it prepares to close its doors in 2020.

The documents included in the collection represent knowledge gained by Atlantic, other foundations, practitioners, and nonprofits – as opposed to strictly clinical or academic research entities. The documents offer a vivid demonstration of just how much hard work has gone into advancing palliative care and make obvious the different ways that foundations have contributed to creating change in this field. It is a rich collection, which groups the documents into categories indicated by three key questions about palliative care: Who is affected? What are common barriers? What are some recommended solutions?

While the collection is an asset to the field of palliative care advancement generally speaking, it also has special significance for palliative care philanthropy going forward. Because of the way it has been set up it serves as rich repository for those seeking to initiate palliative care grantmaking, as well as for foundations already working in the field that want to make deeper impact and work in more strategic and sustainable ways. By focusing on what has already been realized by philanthropy – which is represented so vividly in this collection – there is a real opportunity to beat the learning curve and ensure greater return on investment with foundation dollars.  

Just as importantly, the collection is a model for how foundations could better support the gathering of key information, related to their work. It seems that foundations are more likely to reflect, and to invest time and resources, when they are leaving a particular field or closing their doors altogether. While such reflection is valuable, foundations could be learning more from one another and advancing more highly strategic grantmaking with greater collective impact if they built such thoughtfully organized repositories well before they ended their efforts. So much information-gathering and decision-making carried out by foundations is recorded in internal documents that are never shared beyond staff, consultant, and board teams. What if more of these documents were made public through outlets like IssueLab?

-- Ned Schaub

Gripes and Grievances: How An Applicant and Grantee “Complaint” Policy Improves Relationships
April 14, 2014

(Rebecca H. Donham is senior program officer at the MetroWest Health Foundation, an independent health philanthropy addressing the unmet health needs of the 25-town MetroWest region of Massachusetts.)

Rebecca Donham headshotThe MetroWest Health Foundation was created from the sale of a community asset – a two-campus suburban hospital.  As such, we feel a tremendous responsibility to the residents of the 25 towns we serve.  We’ve been entrusted with funds and seek to invest them wisely, both in terms of revenue generation as well as the grant distribution side.

We also embrace best practices. As a health funder, we understand there are programs and interventions that are evidence based, and therefore known to work. Since our founding 15 years ago, we’ve worked to encourage applicants to embrace best practices.

We welcome potential applicants and community members to meet with staff at any time, either before or after grant decisions. Our board meetings are even open to the public, including free dinner!

There are best practices for funders in terms of transparency and we have incorporated those into our work. We have a searchable grant database that allows anyone to see all the grants we’ve made and for what purposes. We post our financials, board and committee members, performance dashboards, strategic plans and other information on our website. We welcome potential applicants and community members to meet with staff at any time, either before or after grant decisions. Our board meetings are even open to the public, including free dinner!

Given the organization’s historical commitment to transparency, it makes sense that in 2007 the foundation’s board of trustees adopted a policy for handling complaints by applicants and grantees. The trustees viewed it as a way of walking the walk and fostering good community relations. The policy makes clear that grant and scholarship decisions are final and not subject to appeal, but that if there are complaints about the foundation’s grant process or work, we have a formal procedure to address them.

We post this policy on our website (http://www.mwhealth.org/Portals/0/Uploads/Documents/Public/Key_Policies/Complaints.pdf), along with ones addressing conflicts of interest, compensation, whistle blowing, site visits and sustainability. The last two go even further than what Glasspockets recommends and they speak to our strong commitment to transparency. Foundations can be seen as secretive and arbitrary, and we frequently are praised for being so up-front about how we do our work.

The foundation recently completed its third iteration of the Grantee Perception Report, the results of which (not surprisingly) are published on our web site. I think it is no coincidence that the foundation was rated higher than 90% of foundations in terms of our relationship with grantees. The results were similar in terms of how fairly grantees felt we treated them (>92%) and how comfortable they felt approaching us if a problem arose (>97%).

I would argue that there is zero downside to having a complaint policy. We’ve never had a complaint filed and having the policy publicly available on our website sends a message to the community that we care about fairness and transparency. Some might think this means grantee complaint and response mechanisms are not worth the investment, but quite to the contrary we find it supports and complements our organizational culture that prizes treating everyone respectfully and professionally. Maybe it’s because we’re a health funder, but we think it holds true that an ounce of prevention is worth a pound of cure.

-- Rebecca H. Donham

Boosting Transparency Through Podcasting at RWJF
March 11, 2014

Lori Melichar is a team director at the Robert Wood Johnson Foundation as well as a labor economist. You can follow her on Twitter at @lorimelichar.

Listen to the Robert Wood Johnson Foundation’s Pioneering Ideas podcast:

Lori-melichar-rwjf-150x150My day job involves finding and supporting innovations with the power to accelerate the development of a culture of health in this country. This means finding ways not only to continually expose myself to new ideas but also to clearly communicate the kinds of ideas that my employer, the Robert Wood Johnson Foundation (RWJF), seeks to fund. Lately, I’m finding that on both counts, podcasting is one of my favorite tools.

I listen to podcasts during my daily run—newsy ones from NPR, political gabfests, cultural explorations. Sometimes I listen to TED Talks or stories from The Moth. Most of the time I listen to WTF, a podcast where Marc Maron interviews other comedians like himself.

A podcast invites a unique type of conversation-based storytelling, one that we hope will stimulate real-world conversation about applying innovation to create a culture of health—and generate some ideas we’ll be dying to fund.

Though most of the podcasts I listen to are, on the surface of things, unrelated to philanthropy, let alone health or health care, I can’t tell you the number of times that something I’ve heard in a podcast has stimulated an idea related to my work. Sometimes I have to stop running to jot down a thought, fact or idea. Sometimes a nugget from a podcast festers in my mind throughout my run and ends up somewhere completely different by the end.

I believe in the power of the podcast medium to reach individuals where it matters: between the ears. Which is why I’m thrilled to be taking the reins as the host of RWJF’s podcast, Pioneering Ideas. We launched the podcast last year and our third episode debuted earlier today (you can listen to it above).

Our goal with Pioneering Ideas is to be more transparent about the way we work and the kinds of ideas we seek to fund—and to do so in a way that’s engaging for others who are interested in exploring cutting edge ideas and emerging trends that can transform health and health care. Sometimes that means talking to program officers, grantees and others in the RWJF network; other times it means having conversations with pioneering thinkers with no formal relationship to the Foundation.

In our latest episode, for example, I interview Barry Schwartz, a former professor of mine and author of The Paradox of Choice: Why More is Less, about how his work on the science of decision-making might apply to health and health care. Another guest on this episode, Sheena Iyengar, author of The Art of Choosing, recently visited RWJF as part of our What’s Next Health: Conversations with Pioneers series, and graciously agreed to spend some extra time with us talking for the podcast.

Of course, our podcast isn’t the only vehicle we have for lifting the curtain on our strategy for exploring and funding cutting edge ideas—we are active across a range of social media, and are always adding and exploring new approaches. But a podcast invites a unique type of conversation-based storytelling, one that we hope will stimulate real-world conversation about applying innovation to create a culture of health—and generate some ideas we’ll be dying to fund.

We’ve been conservative in our promotion efforts so far as we find our legs with this new venture. Just over 250 people listened to our second episode—hardly a landslide, but a very respectable showing for this type of podcast. We’ve been learning a lot behind the scenes, and the feedback we’re receiving is encouraging. A variety of thought leaders in health innovation have shared the podcast with their networks, and we're hopeful that the podcast will ultimately encourage people to tell us about their ideas for health and health care. Our goal is to increase the number of listens by 20 percent with every episode we release and build a high-quality audience that excitedly awaits each episode—just as I await new episodes of WTF every Monday and Thursday morning.

I’d love to know what you think—not just about our podcast (which you can listen to at the top of this post), but about using podcasts to support idea-sourcing and to cultivate conversations that can inform a nonprofit’s efforts at creating social change. Any examples of podcasts that you think do a superlative job of communicating an organization’s interests in a stimulating and entertaining way?

On this morning’s run, I heard Marc Maron say that a philosophy teacher once told him there are two ways to fill your mind: One is to put new stuff in there, and the other is to heat up whatever’s in there so that it expands.

I hope Pioneering Ideas fills your mind.

And if you’ve got any audacious ideas for creating a culture of health in this country, I’d love to hear them. Find me on Twitter at @lorimelichar or email me at lmelichar [at] rwjf.org.

-- Lori Melichar

Glasspockets Find: Blue Shield of California Foundation shares Health Care research through live webcast
November 5, 2013

(Rebecca Herman is special projects associate for Glasspockets at the Foundation Center-San Francisco.)

Herman-100Foundations produce reports and issue briefs every day—and we love them for it. However, not everyone has the time or inclination to read every worthwhile report that funders work so hard to produce. Some foundations take it upon themselves to find new and proactive ways to share their new-found knowledge with stakeholders, colleagues, practitioners and policymakers who can effect change in the field.

The Blue Shield of California Foundation hosted an event at the National Press Club in Washington, D.C. on October 23 to discuss findings and issues raised in its latest report on a timely topic, “Building Better Health Care for Low-Income Californians,” which was developed as part of its Strengthening the Safety Net program.

The foundation’s event at the National Press Club featured a panel discussion with experts in health care delivery, community health centers and health law and policy. Guests who could not attend in person could watch the event online through live webcast, and the program concluded with a question-and-answer session that was open to those attending virtually or in person. The recorded webcast is now available online:

Watch the video»

One particularly memorable moment was when an attendee asked the panelists what kind of research on health care policy they would like to see undertaken in the future. One panelist, Dr. Ron Yee, chief medical officer of the National Association of Community Health Centers, said he would like to understand how co-pays and deductibles will affect low-income patients accessing the health care system, which was also a question raised by an audience member. Dr. Yee commented, “I know from the front line, how my patients handle their money, the little money they have… Even a $10 co-pay is a big deal for my patients.” 

“You know we’re getting serious when we’re talking about money."

Peter Long, president & CEO of Blue Shield of California Foundation remarked, “You know we’re getting serious when we’re talking about money. You know it’s not a theoretical conversation anymore, when people are talking about payment, and about what it looks like, and the end outcomes.… To me that’s very successful, in a progression of a conversation, when we’re starting to get to a point where you take human aspiration and needs, their real experience, and then what the heck do we do with them.”

Another panelist, Dr. Kavita Patel of the Brookings Institution, noted in closing, “I’m very excited to see this study escape the traditional research/beltway/policymaker circles. It is one of the few studies that has this generalizability for regular viewing audiences. What’s wonderful about that is…that movement will often precede policy changes or the public sector doing something.”

On the Blue Shield of California Foundation’s web page for “Building Better Health Care for Low-Income Californians” you can find the PowerPoint presentation from the event and an executive summary of its October 2013 research report. You can also download the entire report and find other issue briefs and research on health care in the foundation’s extensive publications section.

To gain audiences and knowledge beyond each individual funder’s own connections, we encourage all foundations to post their research, reports, white papers and case studies on the Foundation Center’s IssueLab website, which aims to gather, index and share the collective intelligence of the social sector. For those interested in health care policy, be sure to delve into IssueLab’s new special collection of research on the Affordable Care Act.

-- Rebecca Herman

Robert Wood Johnson Foundation Holds Pioneer Pitch Day to Promote Innovation, Transparency, and Entrepreneurship
October 24, 2013

(Emily Keller is an editorial associate in the Corporate Philanthropy department at the Foundation Center.)

Keller-100In an innovative approach to sourcing ideas for funding, the Robert Wood Johnson Foundation (RWJF) conducted an open call for applicants—in 1,000 characters or less—to share an idea and their vision for how it could change the world. More than 500 individuals and organizations shared submissions, which reflected some of our country’s greatest health challenges: access to quality care, the social determinants of health, leveraging the abundance of data available to improve outcomes and accelerating the current pace of discovery.

Pitch-day-team (1)Last week, a team of health care and science experts from RWJF and other organizations gathered to listen and evaluate the resulting set of groundbreaking health care proposals in front of a live audience as part of an effort to open up the philanthropic application process and increase innovation. This first-ever Pioneer Pitch Day took place at the New York headquarters of AppNexus and consisted of eight fast-paced presentations by finalists, followed by questions from a rotating panel of judges and the audience, for a total pitch time of ten minutes each.

A Catalyst for Transformation and Disruptive Change

"We’re looking for disruptive change versus incremental improvements."

The event was part of an effort to solicit ideas for the foundation’s Pioneer Portfolio, launched in 2003 to fund transformative and innovative approaches to dramatically improving health and health care in the US. Lori Melichar, team director for the portfolio, said the event provided her team with an opportunity to clarify the types of proposals they are seeking.

“When we tell people we are looking for innovative ideas that could transform health and health care, they don’t necessarily know what we mean. We’re looking for disruptive change versus incremental improvements,” said Melichar. “We hope that shedding light on the questions we ask when we meet as a team to review a proposal will help applicants develop their ideas and shape the proposals that are shared with us.”

Inquiry as a Means to Help Refine Ideas

Pitch3The judges’ questions helped finalists to refine ideas that incorporated themes of big data, collaboration and aggregation, crowdsourcing, social networks, transparency and accountability, and mobile technology. For example, when presenter Tara F. Bishop pitched a comprehensive and transparent doctor evaluation system incorporating existing patient reviews with qualitative data, Paul Tarini, senior program officer at the foundation, suggested that she needed a data acquisition strategy.

In another presentation, Elise Miller made the case for incorporating the human exposome – a person’s environmental exposures throughout their life – with the human genome to determine personalized health risks and prevention strategies and establish a database for studying correlations between exposure and disease. Nancy Barrand, senior adviser for program development at the foundation, called this a “massive undertaking” and asked Miller how she would chunk it and where she would begin. Judges also noted that people may be unaware of their exposures and big data could be used to gather that information through home addresses.

Opening Up the Foundation to New Participants

The finalists were chosen from 521 applicants who responded to the open call for proposals in September through an online system that allowed applicants the unique opportunity to see the competition and view others’ submissions. The Pioneer Portfolio is the only portfolio at the foundation that accepts brief unsolicited proposals but they are not usually posted publicly. According to Melichar, most of the submissions came from people and institutions that had never applied for funding from the foundation before.

At the end, three winners were chosen to engage in further conversations with the foundation to develop full proposals for funding. They were:

Tracking Medical Student Searches to Gather Data

Not Only Development and co-author of the book Hacking Healthcare, presented Breaking Barriers in Medical Knowledge, an initiative to use medical students’ web browser histories to spread emerging information with the goal of improving medical translation and reducing communication layers between patients and experts. Trotter, a healthcare data journalist and advocate of open data and transparency, has 5,000 medical students committed to donating their data.

Transforming Breast Cancer Screenings

LauraLaura Esserman, MD, MBA, presented Implementing Risk-Based Cancer Screening Using an Adaptive Learning Engine, a proposal to draw on personalized biomarkers and biology to establish a risk-based breast cancer screening process integrated with prevention.

“By profiling tumors that arise, we will learn who is at risk for what type of cancer and facilitate tailoring treatment to biology. Using an adaptive learning model, we can accelerate and implement effective change and precision medicine,” said Esserman, director of the Carol Franc Buck Breast Care Center in San Francisco. Margaret (Peggy) O'Kane of the National Committee for Quality Assurance and Clarence So of Salesforce also contributed to the proposal.

Using Social Networks to Improve Hospital Safety

MedStar HealthSarah Henrickson Parker, Allan Fong, and Raj Ratwani of MedStar Health presented Creating a Social Epidemic of Safety – an initiative to examine the social network of a hospital, identify staff members who influence others, and train them to spread safety information to reduce preventable errors. The team members described their project as a data-driven, multi-pronged approach using sociometrics and offered an example in which a persistent nurse influenced doctors to double-check a patient at the end of a surgery and found a medical sponge that was accidentally left in the patient’s wound; thereby preventing post-surgical complications.

Melichar said the event was educational for the foundation and could be repeated. “We learned a lot from Pitch Day, including ways we can apply elements of the event to other sourcing activities. We haven’t made any final decisions yet, but we think that we will do something like this again in the future,” she said.

What do you think foundations should be doing to open their applications processes to innovative ideas, greater transparency, and new applicants? Please provide your suggestions below.

-- Emily Keller

Glasspockets Find: Ask Me Anything
October 3, 2013

(Rebecca Herman is Special Projects Associate for Glasspockets at the Foundation Center-San Francisco.)

Spreddit8You may know the social news website Reddit for its humorous photos, videos and links to articles about hot topics. One of the most popular content areas is IAmA (or "I Am A…"), where users may participate in "AMAs" (for "Ask Me Anything"). AMAs are a forum for interviews on any topic, and there are several live AMAs scheduled everyday. Any Reddit user may post a question or comment and vote topics “up” or “down”, so the collective response informs how the Q&A appears, and how it is ranked within the Reddit site.

The topics and seriousness of the Reddit users’ questions vary widely, but it is great to see some very direct inquiries that touch on challenges in the nonprofit sector.

A few foundations and philanthropic organizations have participated in AMAs in the past few years—most notably Bill Gates, of the Bill & Melinda Gates Foundation, as reported on our blog earlier this year. Among the recent Reddit AMAs from the nonprofit and philanthropic sector are the Himalayan Cataract Project and Give2Asia. The topics and seriousness of the Reddit users’ questions vary widely, but it is great to see some very direct inquiries that touch on challenges in the nonprofit sector. Here is an excerpt from the AMA with Dr. Matt Oliva, a Himalayan Cataract Project board member:

redishhead: What types of resistance, if any, do you come up against when providing healthcare in other countries with laws and values?

mattoliva: Good question. It is important that US doctors working in other countries work within the current medical system and the local providers. We always get a local medical license if possible. We also strive to "never leave a patient behind" and ensure that the local partner can provide followup if there are any complications. Long term success requires a collaborative relationship with the local medical team and empowering them. If the quality of the service is high, even the poorest people will recognize this quality and seek the service. Many organizations and doctors can do more harm than good with the "fly in/fly out" model of care.

Give2Asia participated in a Reddit AMA about earthquake and tsunami recovery work in Japan that included advice on disaster giving and real-life lessons from the field:

macdaddy0086: How difficult was the whole thing?

give2asia: Every disaster is different, but this was one of the most difficult disasters I’ve worked on. It was a triple disaster (earthquake, tsunami, and nuclear) that affected over 420mi of coastline.

In the beginning, it was made even more complex because many NGOs and NPOs were waiting to hear the government’s response, so there was a fair amount of waiting, and a lack of coordination between them. For a time, they were limiting access to the area, and permits were required to enter. Even the humanitarian response was strictly measured, since the country has such a strong focus on equality. We’d never seen that before in any disaster, and it added a measure of complexity.

Only three days after the MacArthur Foundation announced its 2013 Fellows last month, new fellows Kyle Abraham and Jeremy Denk participated in an AMA. Here is the most popular exchange, as voted on by Reddit users:

aedwards044: What do ya'll intend to do with the Fellowship stipend?

MacArthurFellows [Kyle Abraham]: I still owe over 100k in student loans :-/ I'm hoping to get rid of those completely... Other than that, I'm hoping to work with a financial advisor to see how I can really work on building my company structure for the long haul. We recently found an affordable plan for health care for our company and plan on implementing that as of October 1st. That was already in the works, but now I know that we'll actually be able to pull it off for sometime to come!

Do you think AMAs are a tool that can make philanthropic work more accessible? Let us know if you have participated and what you have learned. And if you would like to read the Reddit AMAs without the extensive comments, I definitely recommend skimreddit.

-- Rebecca Herman

Part 2: Top 10 Lessons Learned on the Path to Community Change
June 25, 2013

(Robert K. Ross, M.D. is President and CEO of The California Endowment. Yesterday he shared three aha moments from the Endowment’s first two years of work in its Building Healthy Communities plan.)

Ross-100Okay, at times I step back and look at the BHC initiative and wonder—could we have made it more complicated? 14 sites. Multiple grantees in each site. A core set of multiple health issues. Multiple state-level grantees. And the expectation that the parts will add up to something greater and catalyze a convergence that builds more power and leads to greater impact.

But then again, supporting an agenda for social and community change does require multiple strategies, operating in alignment: the use of data, message framing and story-telling; innovative models; a variety of influential messengers; convening and facilitating champions; “grassroots and treetops” and coordination; meaningful community engagement. Power-building requires multiple, aligned investments.

Our Top Ten Lessons for Philanthropy

Finally, I want to share some lessons with partners in philanthropy regarding planning and implementing a community-change initiative. As we engaged in the planning process of BHC, we tried in earnest to stick by a key aphorism, one I learned from colleague and mentor Ralph Smith at the Annie E. Casey Foundation: make new mistakes.

The track record of community change work by philanthropy is not a work of art. Tapping into the wisdom of institutions such as the Aspen Institute, the Annie E. Casey Foundation, the Hewlett Foundation, the Skillman Foundation, the Marguerite Casey Foundation, and the Northwest Area Foundation, we incorporated the lessons of success and struggle from our colleagues in the field. Learning from these and other colleagues, we were able to avoid hitting major rocks as our BHC ship sailed out of harbor. So, we learned the following:

Community engagement in planning processes will be simultaneously exhilarating and messy.

1. Take time to plan, and plan to take the time. We embarked on a 9 month community engagement process in the 14 BHC sites, and we ended up taking 12-15 months. Nobody died, and nobody got fired. Community engagement in planning processes will be simultaneously exhilarating and messy. If it is going too smoothly and too well, then something may be terribly wrong – like the possibility that a foundation is not receiving candid, meaningful input from local leaders. If it is bumpy and messy and getting to consensus, and clarity is taking much longer than originally planned, it may very well mean that you are gaining the trust of leaders to raise thorny, difficult issues. As a general rule, we just took the time that was needed for local leaders to develop their local BHC plans, and we did not pit BHC sites against one another to race by the foundation’s clock. Community leaders want a compass more than they want a clock.

2. Don’t lead with the money. The issue of whether to announce “how much” the dollar commitment is in a foundation initiative is a tricky path. On the one hand, a major dollar-commitment announcement by a foundation can provide excitement, anticipation, and mobilize civic and community support. On the other hand, “leading with the money” can instigate all manner of posturing, control issues, manipulation, and political grantsmanship among potential grantees. We decided to quietly announce the breadth and scope of our commitment -- $1 Billion over a ten-year period in local and statewide policy funding – but veered away from formally announcing precise budget commitments in each site. In other words, we wanted to send a message that our commitment was serious without leading the conversations with grant dollar puppetry.

3. Date logic models, but get married to learning. There is no doubt that engaging in the disciplined exercise of how you think – and how community leaders believe – positive change and results will happen is a sound practice. But it is also important to recognize that community change and positive results in the context of complex social and political systems often defy tidy, linear models. If you want to get married, it is wiser to commit to the process of active, dynamic, real-time learning. We provided logic model training for leaders in the 14 BHC sites, with varying levels of effectiveness across the sites; we have been clear, however that learning is not optional, either for grantees or our own program staff.  

4. Be transparent about desired results. There are written and unwritten axioms about the need for philanthropy to be completely community driven in community-change work. Our experience is that this thinking is a truism without being entirely true. For starters, our foundation is legally chartered as a health foundation, and although we employ a broad definition of the word “health”, there are limitations and constraints about what we can and cannot fund. This issue led to some considerable tensions within the foundation (at the board and staff level), as well as with grantees and stakeholders, about prioritized community needs that were outside the scope of our health mission. The most obvious and recurrent tension-generating themes, in the context of a pervasive economic recession, were issues of economic development, job creation, and mortgage foreclosure across the sites. The battles over if and how we should enter “the space” of economic development as a health foundation were intense and emotional. We ultimately landed on a framework (utilizing mission-investing in our investment portfolio) for how to move forward without “mission drift”, and have been communicating our approach to our own program staff and stakeholders, but it has not been easy. But the worst of all worlds would have been to promise community leaders a course of action that we would either abandon or renege upon later on. We decided to stick to our mission and results (the right move, however discomforting for foundation-community relations).  

5. Be dogmatic about the results, but flexible about the strategies. The work of community change is noble, but funders cannot afford to fall in love with the process of the work at the expense of meaningful results and impact. Once community leaders and funders agree on a set of outcomes, objectives, or results, these must represent the “true north” on the compass. In the BHC planning and early implementation, we gave community leaders and organizations in the BHC planning process a blank slate on strategies, but insisted on being results driven and logic-model supported. The good news is that across our 14 BHC sites, there is community and resident ownership about the priorities and the strategies to achieve healthier community environments for young people. While these strategies vary, we are seeing growing convergence as the sites engage and learn from one another.

6. Listening is a form of leadership. Irish poet David Whyte underscores the importance of “leadership through conversation.” We have been quite intentional about active listening at all stages of the planning and implementation, and being mindful of closing the feedback loop with community leaders and grantees. We utilized a fairly simple “what we said, what they said, what we heard, what we’ll do” format. At the conclusion of the one-year planning process, our past Board Chair (Tessie Guillermo) and I co-authored and co-videotaped messages to the 14 sites summarizing the key themes and priorities we heard from community leaders in the sites, and what to expect in support from our foundation in the months ahead. We have now begun to bring site leaders together twice annually with foundation staff, so that leaders and staff can share stories of progress, struggles, and inspiration. All of this in service of the all-too critical “t-word”: trust. Trust is the mother’s milk of community change efforts by philanthropy, and active, engaged listening is the foundation.

7. Make “patient” grants, and “urgent” grants. Investors engaged in place-based, community change efforts encounter several tensions to manage. Among them is the tension of patience versus urgency. As efforts such as the Harlem Children’s Zone, Market Creek Plaza in Southeast San Diego, the Skillman Foundation’s work in Detroit, and the Dudley Street Initiative in Boston have demonstrated, positive community change takes time. A two- or three-year grant just won’t do it, and most successful efforts require 7, 10, or 12 years of “patient money.” The most thoughtful investments on this front involve leadership development, organizational capacity building, and collaborative efficacy; but “impact” yield from these investments will typically take years to bear fruit. “Urgent” money involves investing in short-term campaigns or capital projects where tangible results are realized within 12-18 months. Community change, place-based philanthropy will require both types of investments, and too heavy a bias or tilt towards “patient” investments will leave the investor and the partnership vulnerable to allegations that some money has been spent, some meetings have occurred, but nothing “tangible” has been produced. As a result, confidence in the effort will dissipate. Our BHC effort in the early going has been appreciative of the need to simultaneously make “patient” and “urgent” (which we also call “early wins”) grants.

8. Story-telling is part of the doing. The two-most under-appreciated and under-invested themes in social-change philanthropy are power-building and story-telling. Having been at the helm of a large-asset foundation for more than a decade, I am guilty-as-charged on this front; in retrospect, I would gladly trade in half of the (often expensive) academic and research-oriented reports we have commissioned in my twelve years as CEO for more compelling, interesting, and impactful “stories” of community-level change that illuminate the path towards a healthy, more vibrant community. Story-telling by community leaders, youth, or community-based organizations can be powerful tools on multiple fronts: local residents and youth experience the power and passion of their own voice; local media are inspired to re-tell the story in a way that scales up the audience; policymakers pay greater heed and attention to the issue being raised; civic engagement and participation is served; cynicism, disengagement, and disempowerment are reduced. Utilizing multiple forms of story-telling, from social media to flip-cam videos to traditional approaches, we have been assertive in support of community leaders and youth on this front, and it has been inspiring to witness.

Why build, preserve, and protect our respective brands and reputations if we are not going to spend it? Spend that damn brand.

9. Spend the damn brand. Institutional philanthropy is risk-averse. We tend to worry and fret about how our institutional brand, reputation, and civic standing might be sullied by associating with potentially controversial efforts or organizations, and as a general rule, we keep our heads and our profile low. But we have discovered, in the early years of the BHC effort, that thoughtful, surgical application of our civic standing and reputation matters to community leaders – and that they want us to spend “it” on their behalf. Sometimes it comes in the form of convening a meeting, writing and placing an op-ed, placing a phone call to a civic leader, or taking out a full-page ad on an issue in the local newspaper. We have done this with regards to healthy food options for youth and families, health insurance coverage for the uninsured, gang prevention and intervention strategies, and school health efforts. There is a school of thought among philanthropy that our job as funders is “to make the grant and get out of the way.” We would argue that our job is to achieve our respective missions, and by any means necessary. On occasion, this requires stepping out of character on behalf of grantees, and utilizing our voice as well. Why build, preserve, and protect our respective brands and reputations if we are not going to spend it? Spend that damn brand.

10. A Highly Engaged Board. In the earliest planning stages of BHC with our Board of Directors, the Board made it clear that they understood the value and importance of a ten-year commitment, but they also made three points clear. The first was the importance of honesty, candor, and trust about the progress of the effort. The second was a complete commitment to an evaluation approach framed by “learning through impact.” And thirdly, they wanted to be engaged for the purposes of learning, and governance, but not micromanagement. We accomplished the latter by organizing our quarterly Board meetings in or near a BHC community site at least three times a year, and each Board member accepted an assignment of one community site for more in-depth and richer learning. Board members share their observations over dinner at our Board meetings.

In closing, we have found the work of community change to be an exhilarating journey in pursuit of our health mission. We have gained an appreciation of the importance of the “right brain-left brain balance” in this work: having a Theory of Change, and Logic Models, and metrics are important, but trust-building, power-building, and the spiritual dimension of the work constitutes the real glue to hold partners and relationships together over the long haul. And finally, a special note of thanks and appreciation to those foundations who have traversed this path before us, sharing tidbits of lessons and wisdom so that we can “make new mistakes” in the battle for community improvement and health justice.

--Robert K. Ross, M.D.

Part 1: Aha Moments on the Road to Building Healthy Communities
June 24, 2013

(Robert K. Ross, M.D. is President and CEO of The California Endowment.)

Ross-100We are now two-plus years into the implementation of The California Endowment’s 10-Year Building Healthy Communities plan, and I can safely say that it has been the two most exciting years of my career in community and public health. It has already been quite a ride.

This is the first of periodic reports we will produce to share our progress, observations, mistakes, and lessons along the way as we support the efforts of community leaders to create healthier environments for young people in distressed and underserved communities.

Building Healthy Communities – we call it BHC for short – is a commitment of our Board of Directors to a two-pronged strategy. We have “dropped anchor” in fourteen distressed California communities for a 10-year period to work in partnership with community leaders to improve the health and life chances of young people. In addition, we are supporting change at the regional and state levels through funding advocacy, organizational capacity building, and communications on our key health issues.

Watch the video »

It is our intent to have these place-based and "bigger than place" strategies complement one another, and for the moving parts to develop a powerful synergy. At the local level, the BHC communities are engaging multiple sectors to develop innovative efforts to advance health. As these innovative strategies emerge, we’re looking for ways to scale the ideas up through policy change and communications at the state and regional levels. Through acting on multiple levels with complementary strategies, we expect to make a greater contribution than if we were to work only at the place level or only through supporting statewide advocacy. This is central to our theory of change. In a sense, it is fair to consider BHC as a “place-based plus” community change campaign.

In the spirit of the knowledge sharing that is one of the central aspects of Glasspockets and Transparency Talk, I will lift up three “aha” moments we’ve had so far, followed tomorrow by a second post listing key lessons for philanthropy.

Aha #1: The message matters
As we all know, when one talks about the “social determinants” -- the roles that poverty, education, and housing play in health status -- outside the public health world, eyes glaze over. We experienced this communication gap early as local communities strived to decipher our jargon-laden list of 10 targeted outcomes and 4 Big Results. Our communications team, inspired by the engagement of community leaders and residents in the planning process, took this obstacle head-on, and have created what I believe is one of the first successful decodings of the social determinants research: Health Happens Here.

Health-happens-here-250Health doesn’t just happen in a doctor’s office; health happens where we live, work, learn and play.

If you put the phrase Health Happens Here on a photo of a healthy school lunch, or a bike path, or a father and daughter hugging each other, we immediately communicate the norms change we are promoting. We took this message a step further by incorporating it into our internal structures. In looking at our grant-making, we found that 80% of our grants were focused around three areas: neighborhoods, schools and prevention. This led us to create three themes – Health Happens in Neighborhoods, Health Happens in Schools and Health Happens with Prevention – that have become the essential building blocks for our work. In fact, we call them campaigns, another use of language that communicates our intent as a foundation to use our brand to push for policy and systems change. And we are investing in aggressive media strategies to promote this message—through television, radio, print and social networking and through partnerships with influential messengers including First Lady Michelle Obama, Dr. Oz, and Jamie Oliver. A simple, compelling message carried by influential messengers, can shape a new narrative of change.

Aha #2: Trust young people to lead
Early in our BHC process, we chose to bring young people into leadership roles in BHC. Little did I know that this decision would not only impact community efforts but would impact how we view our work. Young people and adults view health issues differently, and it makes perfect sense to engage young people directly in developing strategies to improve their health. It makes sense but in the past, we didn’t. We operated like most adult organizations and didn’t engage young people in our thinking.

We’ve seen first hand that young people can be powerful leaders for social change. When they tell their stories through the arts, spoken word, social networking and journalism, they compel action. They are not only about our future; they are leaders of today.

Now that we have taken this step, we’re learning a lot. Young people brought to our attention the scandalous epidemic of suspensions and expulsions in our schools, and helped us understand how this issue connects to their health. Young men of color led us to a greater understanding of the role of trauma in the lives of youth growing up in homes and neighborhoods plagued with violence and gangs, and lifted up the need for social/emotional health and healing. And we’ve seen first hand that young people can be powerful leaders for social change. When they tell their stories through the arts, spoken word, social networking and journalism, they compel action. They are not only about our future; they are leaders of today. We’re evolving into an organization informed by adult and youth perspectives.

In addition to the numerous youth organizing and development efforts in the sites, I’ve created a “President’s Youth Council,” consisting of 14 youth leaders across the state, who meet with me at least twice annually in my role as President & CEO. In this way, I have the privilege of  hearing directly from youth leaders themselves about the progress and struggles of BHC, and how our foundation can be more responsive to and supportive of young people’s distressed neighborhoods. I believe this represents a fundamental culture change that will influence our work in the years to come.

As of this writing, BHC youth leaders, working in coalitions with the organizations that support them, have begun to rack up a series of policy victories that will put a check on the epidemic numbers of school suspensions, calling for alternative, common-sense discipline practices (like restorative justice approaches) that keep kids in school. This was an issue, by the way, that was nowhere on our radar screen in the early planning of BHC. It emerged from the youth voices in the BHC sites.

Aha #3: Build power, not just knowledge and innovation  
Frederick Douglass said that power concedes nothing without demand. The world doesn’t change because of the release of new data. It responds or concedes when people demand change.

Institutional philanthropy tends to worship at one of two altars: new knowledge, and innovation. Both are overrated, over-hyped, and over-subscribed to in our field.

Institutional philanthropy tends to worship at one of two altars: new knowledge, and innovation. Both are overrated, over-hyped, and over-subscribed to in our field. It can be argued that the primary value of philanthropy to civic society is the issue of problem-solving at scale. In a wonderfully linear, logical, and intellectually-driven world, good data, research, and new knowledge would be king. But that is not the world we live in. Recently, I noted that the state legislature in North Carolina effectively banned the use of scientific projections on global warming-induced tidal changes because they stand to impede the path of business development. More recently, the NRA-led prohibition against gun violence research by the CDC was recently challenged by President Obama after Newtown. I wish these represented isolated events, but history has shown that good science is frequently set aside by political and economic forces to the detriment of civic society.

The best public health example of this issue is the 80-year-plus war against big tobacco. The medical and public health communities have had the science about the detrimental effects of tobacco use since the 1920’s; but big tobacco had the power. We lost the battle decade after decade, and it was not until we discovered the merits of political and grassroots advocacy which, in combination with the science, led to a strategy where we began to rack up some victories.

On a related front, philanthropy seems hopelessly in love with “innovation” as well.  In the corporate, for-profit world, innovation quickly scales through profit – the I-phone being a classic example. In the social sectors, innovation rarely paves the way towards scale on its own merits. Too many politically powerful forces are in play. Power, voice, and advocacy matter, and matter greatly. Data and innovation, without the recognition of political power and advocacy, is in vain. The school suspensions battle was a perfect illustration of this point, as youth leaders and youth advocacy organizations utilized suspension data that demonstrated a disproportionate impact on African-American and Latino young men as a result of the practices.

In Building Healthy Communities we’ve decided to be clear; we want to help community leaders and residents build the power they need to promote healthier places for young people. We want to support people and organizations that think power, act with power and demand change. Power concedes nothing without demand, and as Douglass added, it never has and it never will.

Tomorrow, in part 2 of this series, Dr. Robert Ross discusses 10 lessons learned on the path to community engagement.

--Robert K. Ross, M.D.

Glasspockets Find: 2013 Annual Letter from Bill Gates
February 12, 2013

Gates Foundation Annual Letter

In previous annual letters, Bill Gates has highlighted the power of innovation to reduce global hunger, poverty and disease, and improved educational outcomes in the U.S.  In the fifth Annual Letter from Bill Gates, he notes that any innovation will fall short if it cannot reach the people who will benefit from it.  That’s why he shifts his attention this year to examine how innovations in measurement are essential to discover better ways to deliver the solutions that the Bill & Melinda Gates Foundation seeks to push forward.

“You can achieve amazing progress if you set a clear goal and find a measure that will drive progress toward that goal…”

Throughout the letter, Gates provides examples from the foundation’s experience that may inspire others to think critically and honestly about choosing the proper measurement to better gauge whether progress is happening—and, if not, what adjustments might make sense.  In northern Nigeria, he describes how digital technology has vastly improved the ability to map the distances between villages so that polio vaccine can more effectively be distributed to children at risk for the disease.

In Ethiopia, well-stocked health clinics have been set up in the vast rural stretches where most of the people live, enabling, among other successes, a significant reduction in the rate of child mortality and an increase in vaccination coverage.  Unlike ten years ago when it was unusual to document a child’s birth or death in rural Ethiopia, today there are much better official records that provide data to track progress and allow for adjustments to be made in order to address remaining—or new—needs.

In Colorado, the foundation initiated a project in 2009 to better understand how to build an evaluation and feedback mechanism to help teachers improve.  Final results of this project were announced last month, concluding that there are “observable, repeatable, and verifiable ways of measuring teacher effectiveness.”  The lessons learned may be used to improve teacher education which may open doors to re-creating a much more effective education system in this country.

Gates, in closing, expresses an overall sense of optimism, but shares two challenges that most concern him for accelerating progress over the next 15 years: the possibility that sufficient funds will not materialize for essential global health and development projects and that agreement will prove elusive in identifying clear goals to help the world’s poorest.

The 2013 Annual Letter from Bill Gates serves as a reminder to us all of both the importance of measurement and the challenge of determining the right things to measure to make transparent the difference we are making in the world.

To read or download the letter, click here.

 -- Mark Foley

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  • Transparency Talk, the Glasspockets blog, is a platform for candid and constructive conversation about foundation transparency and accountability. In this space, Foundation Center highlights strategies, findings, and best practices on the web and in foundations–illuminating the importance of having "glass pockets."

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