The Role of Foundations in Improving Health Care
Susan Hassmiller and John Lumpkin
“Philanthropy is commendable, but it must not cause the philanthropist to overlook the circumstances of economic injustice which make philanthropy necessary.”
—Martin Luther King, Jr.
A patient was asked about her experience as part of the discharge process during a recent hospital visit. She responded, “Do you mean did I notice that the same nurse took care of me every day? Yes, I noticed, and it was wonderful. The last time I was here, I had a different nurse every day.” The impetus to develop a consistent working relationship between individual nurses and patients came from the regular quality-improvement meetings of the staff on the hospital unit participating in a Robert Wood Johnson Foundation (RWJF)–funded program called “Transforming Care at the Bedside” (TCAB). In this innovative program, frontline nurses are empowered to work with other frontline staff to develop and present ideas to improve the quality of patient care and their own satisfaction with the work that they do. In several of the TCAB units, the time that floor nurses spent doing nursing tasks (e.g., assessing patient status) as opposed to non-nursing tasks (e.g., hunting for supplies and equipment or emptying garbage cans) on the experimental unit went from 35% to almost 70%, and turnover dropped to near zero—and this was in 2006, before nurses were holding onto their jobs due to the economic downturn that began in 2008. Many of the TCAB units in the original 13 participating hospitals had waiting lists to work there. For many of the nurses in the program, it was the first time that they felt as though their needs, concerns, and ideas were valued by management at the hospital.
By 2010, TCAB had spread to hundreds of hospitals in the United States and globally. This is just one example of the role that foundations can play in providing the financial, technical, and knowledge-related resources to help nurses change their environment and improve the quality of care.
The mission of the RWJF is to improve the health and health care for all Americans. Following in the footsteps of Robert Wood Johnson II, the RWJF has been engaged in programs to strengthen nursing, from support for nurse education to the development of interdisciplinary training vehicles in quality improvement at academic health centers. Recognizing the critical nature of the nurse staffing shortage and the central role that nurses play in the delivery of health and health care services, the RWJF made nursing one of eight focus areas in 2002, and it is still a major funding area today. The goal was to reduce the shortage in nurse staffing and to improve the quality of nursing-related care by transforming the way care is delivered at the bedside. The TCAB program has remained an integral piece of a nursing effort that has included work to improve hospital work environments in an effort to improve nurse satisfaction and ultimately the quality of patient care. The foundation has since expanded its funding to address the nurse faculty shortage. With funding support over $200 million, the foundation has been addressing nursing programs in four areas, including: (1) building leadership capacity, (2) addressing the nurse and nurse faculty shortage, (3) stimulating research that links nursing care to high-quality and safe outcomes, and (4) identifying solutions to more effectively and efficiently deploy nurses to meet the demands of a reformed health care system. The Institute of Medicine (IOM) recently released a report on the Future of Nursing as part of the RWJF Initiative on the Future of Nursing. See www.thefutureofnursing.org for further details on the IOM recommendations and the RWJF Future of Nursing national campaign. Additionally, to further leverage the foundation’s investment in nursing, the RWJF founded the National Nurse Funders Collaborative, a group of approximately 90 organizations nationwide committed to engaging new funding partners so that nursing issues across the spectrum may be strategically addressed.