By JULIE MINDA
It is common for even the largest health systems in the U.S. to concentrate fund-raising and fund-giving activities almost entirely at a local level. This approach has individual hospital foundations building relationships with local givers, securing donations and bequests and hosting fund-raising galas, charity golf games, celebrity appearances and the like.
And this model can be very effective for raising money for building campaigns and new equipment, service expansion and community-focused programs. But it is generally not an effective way to create a reliable income stream for long-lasting initiatives with the potential to impact large populations of people across a big health care system.
For that type of muscular programming, San Francisco-based Dignity Health is building a system-wide foundation. The foundation will fund large-scale programming, over a multistate area, aimed at preventing disease, educating people on healthy living and improving access to care for underserved populations. The foundation's strategy is to originate initiatives at the system level or to take initiatives that have been successful in one of the communities Dignity Health serves and spread those programs to other Dignity Health communities. The system has 39 hospitals and more than 380 other sites in 20 states.
A child uses an inhaler enhanced with technology that provides data on the device’s use. Patients and their clinicians can use the data for managing asthma. Dignity Health’s system-level foundation will provide the devices and support services to low-income patients in communities served by Dignity Health hospitals.
The foundation's priority is to further the goals of health care reform, said Nancy Bussani, vice president of philanthropy for the Dignity Health Foundation. Reform "is about prevention and education, but preventive care is not always paid for (by patients and their payers), so we need partners," she said. The foundation's role is to identify and secure funding partners for initiatives that hold the most promise to impact the health of large populations of people.
Lining up dollars
Established in February 2013, the foundation has a 10-member board headed by Dignity Health President and Chief Executive Lloyd Dean. Dignity Health provides foundation funding and the foundation is seeking commitments from private and corporate foundations and government grant programs — negotiations with potential funders are under way now. While just two Dignity Health staff members are dedicated full-time to the system-level foundation, numerous staff from throughout the system will provide their time and expertise on a project-by-project basis.
Dean, Bussani and the foundation's board evaluate programming opportunities for their potential to address health care issues in Dignity Health regions, and to attract seed or sustainable funding from philanthropists and grantors.
So far, the foundation has identified six programs that it will fund. They include efforts to:
- educate student athletes on the risk of head injuries in order to reduce the incidence of concussions.
- provide asthma patients with inhalers and case management to assist them in controlling their symptoms and preventing acute episodes. That program will be offered in communities with high percentages of low-income people.
- provide a path to health care careers for low-income, minority students.
- deliver simulation training in a mobile lab to frontline caregivers in order to improve patient care.
- create community gardens in communities with limited access to nutritious food.
- combat human trafficking by educating frontline caregivers on how to identify victims and by expanding the scope of programs to help victims.
There are an additional dozen-plus projects being evaluated for their feasibility, according to Bussani.
She said most programs will start in a pilot phase before being scaled up; all will include tracking systems so that Dignity Health and other funders can gauge their impact, and so that Dignity Health can make informed decisions to maximize program effectiveness.
Dignity Health is not yet disclosing projected program budgets, nor is it naming committed or potential outside funders.
The system foundation does not replace Dignity Health hospitals' foundations, which will continue to raise money for capital campaigns and other local community-based initiatives. Bussani said the system will not contact potential funders that Dignity Health's local foundations are approaching for donations.
Bussani said the establishment of Dignity Health Foundation comes as a shift is happening among many philanthropic organizations. While many still fund projects on a local, small-scale basis, increasingly organizations are funding programs that can benefit large numbers of people and are designed to become self-sustaining. The organizations are increasingly concerned with the social impact that their philanthropic investments will have, and so there is an ever-greater focus on tracking and evaluating results.
Bussani said with a system-wide structure, it is possible to set up programs that fit expectations for more expansive, far-reaching impact.
The system-wide approach also allows fund-raising on a scale not usually possible with individual hospitals. System representatives may have the clout to gain access to philanthropies that operate on a nationwide scale and to government representatives who control federal grant dollars, Bussani said.
There are other benefits-of-scale to be leveraged from a system foundation, too. Bussani said eventually the system foundation will take on some of the routine campaign funding and planning functions of Dignity Health hospital foundations, freeing more time for local staff to raise funds in their communities. The system might identify preferred vendors for local hospital fundraising campaigns and negotiate pricing discounts based on the volume that will drive.
Bussani said building a foundation "takes patience and persistence. This is more complex in a large system. But the long-term pay off will be greater."
She added, "There has to be a commitment by top leaders" to make a system-level foundation successful, "and we have that long-term commitment here from our system's leaders."
Confirmed initiatives seek to address priority community concerns
The system-wide foundation of San Francisco's Dignity Health will take on these six initiatives:
- The concussion initiative. The Barrow Concussion Network at Dignity Health St. Joseph's Hospital Medical Center in Phoenix offers an online tool for educating high school athletes about how to avoid concussions, why concussions are a serious concern and what a person should do when a concussion occurs. The network also offers Brainbook, a pre- and post-injury test for determining the seriousness of a concussion. Starting in January, Dignity Health's foundation plans to use upwards of $1.5 million over three years to use the tool and tests with nearly 200,000 student athletes in the San Francisco Bay area before expanding the program throughout Dignity Health's California network. Dignity Health aims to increase the number of students educated and to reduce the incidence of concussion, as measured on a registry from the concussion network.
- Technology and education for asthma management. Asthma is a top health concern in California. But it can be difficult for health care providers to help asthma sufferers to manage the condition. A company called Propeller Health has developed an inhaler that uses wireless technology to feed data on asthma sufferers' use of the device -- such as when and where they use it -- to them and their doctors in real time to help with asthma management. The Dignity Health foundation is partnering with Propeller to give these inhalers to low-income people and provide supportive services to help them understand how to use the data they receive. A Dignity Health facility in Woodland, Calif., is piloting the initiative. In early September, Dignity Health expanded the pilot to some of its facilities in California's Bakersfield, Merced and Sacramento. The facilities will track the experiences of an estimated 2,100 patients; and Dignity Health will evaluate the impact of the technology and case management. Dignity Health then plans to expand the project to more of its facilities.
- Health care careers for students in underserved communities. In many low-income communities Dignity Health serves, there is widespread unemployment, but at the same time there is a shortage of qualified people to fill health care jobs. At least half of Dignity Health's hospitals currently offer some type of internship for high school students interested in health care careers. But, those programs don't always get at the problem of unemployment and health worker shortages. Last month, Dignity Health began rolling out to its Bakersfield, Merced and Sacramento facilities a comprehensive workforce development program for high school students in low-income communities. Unlike many such programs, this initiative aims to provide a career path for students. It works with universities to show students exactly how they can prepare for a health care career. Different Dignity Health facilities will use different training models -- all will track students' participation and experience with the program. The tracking will help Dignity Health understand which training models work best; and those best practices will be spread to other Dignity Health facilities.
- Mobile simulation lab. It is difficult for health care providers to get the training they need to improve the care they offer patients, and this is particularly true when it comes to cultural sensitivity training and other "soft sciences." Also, many low-income areas cannot afford the simulation lab programs that are helpful for teaching soft sciences. Beginning around spring 2015, the Dignity Health foundation will begin deploying a simulation lab vehicle to three rural and three urban areas around Sacramento, to train nurses and other health care providers. The initiative will track the impact of the training on patient satisfaction and the reduction of risk events. Dignity Health plans to expand the program beyond Sacramento.
- Community gardens. Community gardens can provide low-income communities with healthy foods, an opportunity for community pride and camaraderie and an educational outlet on healthy cooking and eating. Last month, Dignity Health began using system-level foundation funds to design and construct and provide supplies and project management to expand gardens at Dignity Health's Santa Cruz and Stockton hospitals in California and to build new gardens at the system's Bakersfield, Merced and San Bernardino hospitals. Dignity Health expects to improve nutrition and eating habits through the gardens.
- Human trafficking. Human trafficking is a public health concern that can result in unplanned pregnancy, the spread of sexually transmitted diseases, post-traumatic stress syndrome and many other health concerns for victims. Beginning in spring 2015, Dignity Health will roll out a program to three or four of its hospitals to educate front-line providers on how to identify victims of this modern slavery. The effort also will build coalitions of community agencies to fight trafficking and to advocate laws protecting victims. The initiative will track the number of victim referrals and the program's success in linking victims to support services.
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