The Role of Foundations in Improving Health Care

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 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.

Foundations: what They are and what They Fund

A foundation is an organization that is established as a non-profit corporation or a charitable trust under state law, with a principal purpose of making grants to unrelated institutions or entities or to individuals for scientific, educational, cultural, religious, health-related, or other charitable purposes (Schlandweiler, 2004). Foundations are regulated by the Internal Revenue Code—refer to 501(c)3 status—and most can give grants only to non-profit charitable organizations, and sometimes to individuals in the form of scholarships. By federal law, most foundations must spend at least 5% of their average assets each year. Although foundations can use their funds to inform or educate on any issue, lobbying or engaging in political activities is significantly restricted and, in the case of private foundations, it is prohibited.

In general, foundations have great freedom to fund what they want, consistent with their mission. The mission is generally established by the wishes of the individual or individuals who donated resources to the foundation, the original charter, the direction of its board of directors, or a combination of these three. Some foundations are sharply limited in the categories they can fund or the geography they can serve by the enabling donation or at the direction of their board. They are instrumental in funding ideas that are new, innovative, and otherwise untested. If it were not for foundations, many of our country’s most pressing social problems, such as improving the quality of care for those at the end of life, would never get the attention they deserve. Most of the philanthropic dollars in this country go to causes that support education (25%), but health care gets the second largest number of dollars at 20% (Foundation Center, 2009).

There are over 75,000 grant-making foundations in the U. S. that generally fall into one of the following four categories (Indiana Grantmakers Alliance, n.d.). See Box 36-1 for more suggestions about working with foundations.

BOX 36-1

Important Things to Remember When Working with a Foundation

• Know your own program and funding needs. Does the entire program need funding? Are there any partners that can be brought on to help fund segments?

• Do not chase money for money’s sake. Know what you want to accomplish, and do not let a foundation or other funder dictate your mission. Foundations can have constructive ideas about shaping a program, but it should be your program.

• Be familiar with the foundation’s website and the possibility of a programmatic match before making any contacts. Understand the funders’ needs and expectations.

• Know who you want to talk to, their funding priorities, and their areas of expertise.

• Prepare a sound byte version, a paragraph version, and a one-page version of what you hope to accomplish with foundation support. The foundation will ask for a full proposal if they want it.

• Know the following about your proposal off the top of your head: intent, anticipated outcomes, measures of success, approximate funding required, duration, deliverables, potential for matching or in-kind funds, and sustainability plans.

• If you submit a proposal, have someone who knows nothing about the topic read it and then describe in three sentences what you are asking the foundation to do. If they cannot, you have probably written it in “nurse” jargon instead of English.

• Never turn in any piece of work without first having a trusted editor review it.

• Nurture foundation relationships. Be of service to the foundation; let them see your talents and skills by serving on advisory panels or reviewing papers if you are asked. Foundations are always “trying out” experts to see who might be useful for meeting their objectives. Foundations want to be successful, and just like any other organization they prefer to work with someone with a track record of success.

• Think about what else local funders offer besides money—for example, access to political or business leaders, technical assistance workshops for prospective grantees, convening capacity, and so on. Talk with the people you identify.

• Always look locally for funding first. If you can pilot something with local funding, you are in a better position to get national funding to bring your model to scale. Think about and work with others in the community on the same issue, as evidence of collaboration is always considered a plus by funders.

• “Toot your own horn” about your agency and its good work. It’s better for the funder to hear about what you have been doing before they get the proposal.

• Don’t give up. You may not be funded the first time around, but following the above recommendations will definitely get you closer to your goal.

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Mar 18, 2017 | Posted by in NURSING | Comments Off on The Role of Foundations in Improving Health Care

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