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E-Briefings – Volume 13, No. 3, May 2016


Welcome to The Governance Institute’s E-Briefings!


This newsletter is designed to inform you about new research and expert opinions in the area of hospital and health system governance, as well as to update you on services and events at The Governance Institute.

Click here to download the full PDF version.

The CEO’s Crucial Role in Healthcare Philanthropy

The CEO’s leadership and participation is essential to establish an enhanced and high-performing philanthropy program. Philanthropy can boost financial resources when those in leadership positions foster a culture of philanthropy and gratitude that permeates the organization at all levels. In this article, William C. McGinly, Ph.D., CAE, looks at the CEO’s role in driving successful philanthropy, as well as ways the board can help in these efforts.

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By William C. McGinly, Ph.D., CAE, McGinly & Associates, LLC


Healthcare philanthropy is all about gratitude that motivates giving. The healthcare CEO is the key executive providing leadership for philanthropy for the hospital or health system. The CEO’s leadership and participation is essential to establish an enhanced and high-performing philanthropy program.


Hospital CEOs face a myriad of issues revolving around finances and more, including infrastructure that must be replaced, staffing shortages, and costly advances in treatments and technology. Higher operating expenses continue to grow while the adequacy of reimbursement from private and third parties continues to lag. Complicating matters are concerns and costs related to patient privacy, changing relationships with physicians, and the need to demonstrate value and community benefit.


Philanthropy is and has emerged as a significant means by which hospitals and health systems can enhance financial resources when those in leadership positions foster a culture of philanthropy and gratitude that permeates the organization at all levels.


Setting the Foundation for High-Performing Philanthropy
The program intensity for achieving high performance in healthcare philanthropy must be led by the CEO. What is the CEO to do to increase philanthropy to significant, meaningful levels—levels at which transformational change is possible for the delivery of quality and crucial care?


To begin, the CEO must drive the sense of urgency and engage in supportive leadership activities focusing on philanthropy and participating with hospital and foundation leaders. Three important factors surrounding the development of philanthropic sources of income are driving the essence of philanthropy and the CEO must acknowledge these in order to structure and communicate the thought-provoking vision that captures the hearts, hopes, and imagination of employees, and most importantly, patients, their family members, and the community:


1. The increasingly high cost of upgrading hospital infrastructure, including new technologies
2. The rising expectations among the public that they deserve and will receive healthcare services of the highest quality
3. The financial burden placed upon hospitals and health systems from uncompensated costs and inadequate reimbursements by Medicare, Medicaid, and third-party insurance groups


While the CEO must address these factors as a significant part of the reason and necessity for philanthropy, they are not the motivator behind the larger support philanthropy can provide nor will these alone result in the development of high-performing philanthropy. The vision of the hospital and focus on providing quality, superior care and communicating that to the public and those invested in the community will carry the day.


CEOs have the ability to set the tone for the organization through their oversight, influence, and contacts with board members, physicians, staff, patients, individual donors, donor organizations, and the community. When the CEO is successful in promoting top-to-bottom engagement, a sound base can be formed for the development executive’s day-to-day operations and for the acceptance by external and internal stakeholders for the proposition that the healthcare organization is an enterprise worthy of philanthropic support.


Thus, philanthropy and fundraising become essential to the well-being of the non-profit hospital or health system. Decision makers at all levels, through the leadership of the CEO, can now focus and build philanthropy as an integral pillar of support. The CEO, board of directors, physicians, and staff will recognize the need to involve their foundation/development office in the earliest stages of the core strategic planning process and provide the foundation boards and development executives a proactive voice in establishing priorities for the hospital and its fundraising priorities. Additionally, this involvement flows to setting priorities and determining methods that will be pursued along with the allocation of resources essential to support fundraising programs.


Acknowledgements on the CEOs part include conveying, embracing, and providing for the following tenets:

  • It takes money to raise money (and the return [ROI] is beyond any in the operation). Treat the fundraising foundation as a profit center worthy of appropriate investments that yield high net returns and balanced efficiency.
  • Plan, be patient, be persistent, and execute. Concentrate on major gifts from individuals, corporations, foundations, and public sources. These yield the best production, especially when campaign activities stimulate major giving. After a capital campaign, ensure that the foundation is building on the relationships from gifts and connections that resulted. These relationships must be nurtured in order to build major gift programs with high returns for the community.
  • Invest in operational and human resources for fundraising. Total resources directly devoted to the fundraising operation—including fundraising expenses and direct staff size, experience, and compensation levels—show the strongest link with bottom-line fundraising returns and effectiveness.
  • Keep staff members focused, efficient, and effective. Compensate fundraising executives well, give them responsibility and authority to direct giving programs, and expect and demand high-performance results.
  • Maintain attention on the ROI and the dollars raised. ROI speaks to effectiveness of your fundraising and allows for investment in higher results programs rather than “nice-to-have” efforts or programs (i.e., special events and others with low ROI) that return little by way of the fundraising dollar. The full scope of fundraising programs can be built over time.
  • Be creative and challenge the norm. Wise fundraising investments pay off, and well-rounded fundraising programs will reach a broad base of donors and are more successful.
  • Capture the imagination of donors. Focus on the “impossible” and be amazed at what is achieved.

Key Activities for the CEO
There are also many practical things the CEO can do and provide on a day-to-day basis for philanthropy. Much attention is focused on the CEO’s role in achieving high-performance healthcare philanthropy. Donors providing contributions expect to have communication and a relationship with the CEO when they are participating in the hospital’s philanthropy. In my experience over 30 years, high-performing hospital fundraising programs are just that because, in large part, CEOs are supportive and participate in the effort to grow philanthropy. The CEO is positioned to communicate the hospital’s challenging vision and to provide assurance of the organization’s commitment and ability to advance its vision and mission to the communities it serves.


The CEO’s critical role is in prioritizing philanthropy within the organization. This CEO responsibility is paramount. How does the CEO practically establish that priority internally and externally?


Across North America and throughout my experience with the Association for Healthcare Philanthropy’s hundreds of hospital and foundation members worldwide, there are key elements contributing to the fundraising endeavor. The emphasis on major gift donors, experienced fundraising executives, meaningful compensation, and total fundraising expenses (investment in the program) along with attention to the dollars raised, are all elements the CEO should support and provide if fundraising is to become meaningful.


Of all the elements CEOs can embrace, below are 12 I have seen employed effectively and that have ensured productive leadership for philanthropy:


1. Communicate the organizational importance of philanthropy.
2. Provide for significant investment in development to ensure capacity and growth.
3. Show up! Serve as a role model as a donor and in donor cultivation.
4. Include giving metrics on organizational scorecards, dashboards, and more, and report to both the hospital and foundation boards.
5. Celebrate and acknowledge widely key gifts and donors.
6. Confirm engagement of physicians, clinicians, boards, and executives in the philanthropic efforts—their participation/support as more than just donors.
7. Publically promote the active and positive influence of physicians and boards.
8. Ensure that philanthropy is part of employee orientation.
9. Articulate the organization’s compelling vision to donors and prospects.
10. Focus on the hospital/health system as a non-profit, community benefit organization.
11. Promote the foundation office as the single way to give.
12. Meet with the chief development officer (CDO) with regularity; ensure the CDO is one of your direct reports and plays a major part in the hospital’s strategic planning.


The Board’s Role
While CEOs play a powerful role when it comes to providing focus, energy, and the important sense of urgency for philanthropy, no one more than the hospital and foundation boards of directors are of vital importance for success.


These board members can introduce and build relationships through their engagement of crucial networks, while providing leadership for philanthropic efforts, marshalling internal and cultural support, and connecting the foundation with donors and the public. The foundation board members have a primary level of responsibility for philanthropic efforts, but the hospital and system board members are major key influencers as they offer validation for the importance of philanthropy.


Governance has a role in philanthropy as organizations must engage both the foundation and hospital governing boards to achieve the breath of leadership commitment. Hospital governance board members balance the necessity for expanding community healthcare needs with the reality of reduced financial resources. Strategic and fiduciary responsibilities mesh as the hospital governing board establishes and executes strategies that require adequate financial resources.


The combination of leadership contributions by both board groups, carefully defined, increases the focus on consequential activities for philanthropic growth. Philanthropy requires a governance role in which the hospital governance board adds value to the work and outcomes of the enterprise of giving. There are specifics that must be decided for the hospital governance board as it contributes to the philanthropy effort. The work, contribution, and leadership of the governance board requires diligent, well-intentioned people who are capable of creating high-impact results.


Among the specifics that I have seen evolve for engaged hospital governance, the following are those that contribute to long-term high performance for philanthropy:


1. Acknowledge philanthropy as a valued role for the CEO, executive leadership, and the organization. Consider goals and evaluation of philanthropic success in the CEO position.
2. Recognize philanthropy as a significant strategic revenue resource for the activities and programs the hospital provides the community. Stress reporting of results at each board meeting and assess individual board members’ leadership activities supporting philanthropic goals.
3. Define and communicate the unique, valuable, and specific role(s) for giving. Hold board discussions, however brief, about resources dedicated to growing philanthropy. Communicate hospital program activity with the foundation board and executive leadership.
4. Provide contacts and leverage for opening doors and securing donor commitments through the foundation. Work specifically on efforts to identify and embrace grateful patients and family members through clinician (physician, nurse, and others) engagement.
5. Give at a level commensurate with your ability and interest. Ensure that members of the board, the foundation board, and executives at all levels are given similar opportunities to financially support the enterprise. This gives board members and others the “credibility to ask.”


With a high-performing philanthropy program, leadership will be prepared to celebrate success and launch transformational change providing high-level care and superior quality of life for the community.


The Governance Institute thanks William C. McGinly, Ph.D., CAE, President, McGinly & Associates, LLC, and President Emeritus, Association for Healthcare Philanthropy, for contributing this article. He can be reached at billmcginly@gmail.com.


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Leading in Healthcare: A Personal Choice

The word “leadership” is used a lot in healthcare. Leadership is one of those things that when done well, we know it but when done poorly, it is the root of much of what ails us. In this article, Richard Corder, M.H.A., FACHE, looks at the history of leadership, where it is today, and lessons for healthcare leaders as they work to create an environment and processes that support safe, effective, patient-centered care.

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By Richard Corder, M.H.A., FACHE, Wellesley Partners, Ltd.


“An organization cannot be what its leader is not.”


Leadership is one of those things that when done well, we know it, but when done poorly, it is the root of much of what ails us in healthcare. When done well, we see leaders that walk the talk, can articulate their organization’s vision, and can be human, vulnerable, authentic, and truly elevate the environment to one that is respectful, safe, productive, and caring. When done poorly, we see results that are mediocre, people afraid to speak up, high staff turnover, complacency, and much worse.


Leadership is frequently used to describe a position of authority, or an activity reserved for certain people or roles in an organization. We hear reference to “leading culture change” and the notion of “leading an improved patient experience” is getting more and more airtime. It is not unusual to hear individuals or groups state that if leadership or the leaders of the organization were doing a better job, really understood the work, or “walked a day in my shoes” that our delivery of care would be safer, more efficient, and more human. There are a plethora of leadership courses, classes, books, retreats, and self-help guides.


It strikes me that the word "leadership" is overused and not very well understood. I would like to propose that part of the problem is a lack of understanding of the word(s) we are using.


What is leadership anyway? Let’s start with what it is not. Leadership has nothing to do with seniority or position. I hear too much talk about leadership referring to the senior most executives or clinicians in a hospital. I have seen examples of more authentic leadership from a third-shift oncology nurse, a first-year medical student, and a 30-year housekeeper than I have from some seasoned (long tenure) occupants of the C-suite.


Nor is leadership about managing people. For sure, managing is critical to running a safe hospital; we surely need to support managers to plan, measure, coordinate, hire, and fire, and develop a myriad of other competencies to manage resources. But this has nothing to do with leading people or leadership.


Leading is a verb, not a noun. Put another way, you have to do it.


I subscribe to the notion that leading includes a personal commitment to change the world (however you define the world—yourself, your church, your home, your hospital, your practice) through influence and example that maximizes the efforts of yourself and others around you and that achieves the change as you’ve articulated it.


According to Steve Farber,1 author and business leadership expert, “extreme leaders approach the act of leadership as you’d approach an extreme sport: learn to love the fear and exhilaration that naturally comes with the territory.” Steve goes on to suggest that to really be a leader, you need to seek opportunities that will stretch you, enable growth, and ultimately cause a certain amount of fear (within you).


This way of thinking resonates for me in the work of leading to improve the patient and caregiver experience in healthcare. As we complete organizational assessments and listen to hospitals and health systems describe their current state, much of what we hear is about the fear of speaking up and having a different opinion, the fear associated with disagreeing with the establishment and suggesting changes to how we provide and support patient care, and the fear of having that difficult or clarifying conversation.


A Brief History
There are as many theories on leadership as there are those who have studied and published their theories. The history of leadership in healthcare mirrors the most widespread theories of leadership since the mid-1800s: Great Man theory, trait theory, behavioral theories, contingency theories, transactional theories, and transformational theories.


In a nutshell, we have evolved from the suggestion in the mid-1800s that great leaders were born not made and that leadership was intrinsic (and as the Great Man theory name suggests, only a man could have the characteristics of a great leader). This gave way to the trait and behavioral theories of the mid-20th century when we began to understand that with the right “conditioning,” anyone could have access to the once before “birthright” of naturally gifted leaders. In other words, over the past 150 years, we have woken up to the realization that leaders can in fact be made, developed, and nurtured.


Governing boards, executive leaders, caregivers of all disciplines, middle managers, and frontline staff of healthcare delivery organizations are being increasingly encouraged to think in terms of building high-reliability organizations, leading cultures and environments that are more inclusive of different opinions, and embracing ideas, approaches, and methodologies that continue to inform us as we learn, develop, and grow as leaders.


Leadership: Current State
By current estimates, there are over 55,000 books with the word “leadership” in their titles available on Amazon.com. Last year alone, it is estimated that more than four new books a day were published on the subject, and there is no indication that this is going to let up or change any time soon.


Nowhere has this growth in the interest of leadership been more apparent than in healthcare. Perhaps this is due in large part to the fact that while we have clearly established that leadership can be learned, we have also, perhaps a little too slowly, been awoken to the fact that our current approaches and systems in healthcare are not creating environments and processes for the most effective, safe, patient- and family-centered delivery of care.


While there are pockets of highly reliable, safe, patient- and caregiver-focused systems throughout North America, these remain “pockets” and the prevailing norm is one of mediocrity. There are still too many stories of situations that could have been prevented, stories of people harmed because of failed systems, and examples of disrespectful and threatening behavior directed at patients and caregivers.


There are still too many examples of people not leading with humility and respect, not listening to the opinions of others, and treating a dissenting point of view as a disruption to be ignored, or worse, eliminated.


Lessons
We have established that leadership is a choice, that it can be learned, that it evolves, and that as leaders, we are forever learning, changing, and adapting. I think it is also worth reiterating and remembering that leadership is not reserved for those with title, authority, or position within our hospitals and health systems. This is of critical importance when reflecting on this issue of the needed shift of power, away from the establishment (the doctors, nurses, and others on the care team) to a more informed and balanced model that includes the patient and the family as an equal partner in care.


“Nothing to me without me” should not only be the mantra for how we think about delivering patient care but also how we lead and collaborate with others.


Leader, Know Thyself


Taking the time to understand our own motivations and remembering that we are unique individuals, although all called to similar work, is an important part of developing our leadership skill set and competencies. It is time to abandon the “Pygmalion Project” of the endless, and frankly fruitless, work of trying to make everyone conform to our way of thinking or doing. So as leaders it is important to self-reflect and then frame (articulate and write it down) what success looks like for us.


In her book The 85% Solution, Linda Galindo is explicit about crafting your “definition of success” as a non-negotiable—the idea being that if you don’t know where you’re going or don’t know what you want, then how do you know whether what you’re doing is aligned, purposeful, or meaningful.2 Linda also reminds her readers that our definitions will, and should, change over time. What you aspired to be and wanted as a 25-year-old in your first job and what success looks like as a 55-year-old mid-careerist are likely very different.


There are other important elements to consider in this space of self-awareness—a checklist of sorts:


1. Self-assessment: a wide variety of tools are available such as the Meyers-Briggs Type Indicator, Prevue, DISC, and others.3
2. Feedback from others: 360-style tools that invite confidential feedback from a variety of different “levels” around us. This should be carefully supported with coaching to ensure as healthy a process as possible.
3. A mentor: an internal trusted colleague that you can turn to and ask for feedback from.
4. An external coach: a fresh “set of eyes” that will push you with a bias for action and no burden to be politically correct or afraid of “upsetting” you.
5. Go to your mountain: take time as a leader to disconnect and think—time to “look in the mirror” remembering that leadership is a personal choice.


With self-reflection in hand (and forever evolving and changing) we can now work to achieve the necessary clarity required to lead, especially when it comes to the work of making healthcare safer and more patient- and family-focused. Without clarity about what we want, how to get there, the work we want to do, and why, highly effective leadership will be elusive.


Remember through the self-reflection and getting to clarity this point about everyone being different, with different emotions, backgrounds, triggers, values, beliefs, and norms.


My colleague, mentor, and now business partner, Tim Sullivan,4 refers to this as “the 94 percent.” He crafted this rubric after reading a magazine article where a psychologist stated that 94 percent of the time people view events through how it impacts them personally. Tim’s interactive model of behavior helps two individuals through a process where each can be heard and, in turn, listen to the other person’s 94 percent on the way to building one inclusive shared reality.


This model is frequently observable in the workplace when individuals are at odds over a goal, process, or “territory” because they are personally invested in their own view or opinion being right, have stopped listening to others, and are no longer open to new or competing ideas. This preconceived and invariably subconscious bias results in leaders making assumptions, jumping to conclusions, and even assuming that because those they work with don’t react to or see things their way, they are deemed to be adversarial, unclear, and unproductive. The ramifications of this behavior for healthcare leaders and their teams are serious and potentially dangerous.


Leader, Care for Thyself


If leadership is personal, then we must bring our best selves to this work, especially in the crucible that is healthcare—with its stressors, restraints, counter-intuitive payment models, and our continued appetite as a society to want to discover and cure faster.


As pedantic as it may sound, it is imperative that leaders take care of themselves by:

  • Getting enough sleep/rest
  • Getting enough exercise
  • Getting enough good nutrition
  • Getting enough social interaction (put the phone away…)
  • Getting uncomfortable—challenge your assumptions, learn, and grow
  • Getting enough laughs

Through several different industries, from frontline employee to chief operating officer, from Europe to the United States, from those I work with, learn from, and listen to each and every day I have been blessed to bear witness to leadership examples that run the gamut of skill, competence, civility, and effectiveness. In every single case I have been struck by the fact that leading is a deeply personal commitment, regardless of how effective the leader is perceived.


Leading and the work of leadership, when examined closely, is about courage, perseverance, and love. Love of oneself, the work one is called to do, and the space and place that you find yourself doing it. If called or drawn toward leading in healthcare, toward work that is human beings caring for other human beings, there is no deeper personal connection. As Steve Farber would remind us, leadership is indeed a personal decision to change the world, as you’ve defined it. It starts with truth-telling to, and with, one’s self.


The following is the end of a poem attributed to a Hopi Elder in Oraibi, AZ: “The time for the lone wolf is over. Gather yourselves! Banish the word struggle from your attitude and your vocabulary. All that we do now must be done in a sacred manner and in celebration. We are the ones we've been waiting for.”


The Governance Institute thanks Richard Corder, M.H.A., FACHE, Partner at Wellesley Partners, Ltd., for contributing this article. He can be reached at RCorder@wellesleypartners.com.


1Steve Farber is the author The Radical Leap, The Radical Edge, and Greater Than Yourself, see www.stevefarber.com.
2Linda Galindo, The 85% Solution: How Personal Accountability Guarantees Success—No Nonsense, No Excuses, Jossey-Bass, 2009.
3For methods for evaluating individual board member performance, see Individual Board Member Assessment, Third Edition, Elements of Governance, 2015.
4J. Timothy Sullivan is Founder of Wellesley Partners, Ltd., see http://wellesleypartners.com.


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