According to the most recent numbers released by the Giving USA Foundation, philanthropic support of health care rose 3.8 percent between 2008 and 2009 and represented 7 percent of the total giving of $303.75 billion in 2009. This is good news considering that overall giving was down 3.6 percent. As we look to the future of health care, even with all the uncertainty regarding reform and our economy, it is clear that philanthropy will play an increasingly important role in meeting our organizations' needs.

For trustees, four questions emerge:

  1. To what degree will philanthropy be a necessary income stream in mission fulfillment?
  2. What role will philanthropy play in closing the gap in funding unmet community needs?
  3. As access to capital becomes a challenge, can philanthropy provide the funds necessary for capital renovation and expansion, as well as specialized equipment?
  4. To what degree will philanthropic resources for annual funding, as well as endowed funds, be a significant factor in access to borrowing?

With these questions in mind, strategic plans must incorporate the following four pillars to ensure philanthropic success.

Aspirational, Unifying Vision

In consulting with the boards and senior management of hospitals that are launching aggressive initiatives, a bold, aspirational vision has been at the heart of the philanthropic value proposition.

The ability of volunteer leaders to articulate the vital role philanthropy plays in enabling the institution to deliver its unique, high-quality, affordable health care has been a critical element of commitment and engagement.

In considering your organization's philanthropic value proposition, you may want to consider the following questions:

  • Where do gaps exist in current care delivery in the community?
  • Is there an unmet clinical or demographic need, such as an oncology center, a cardiac center or a women's health center?
  • Are there stakeholders such as board members, grateful patients or community leaders who show special concern for the organization's area of philanthropic need?

Leading by Example

The unique role of those in health care governance is to demonstrate through their actions the axiom that "we cannot ask others to do what we are not willing to do ourselves." Leadership is more than the rational acts of planning and fiduciary oversight. It is also demonstrating passion, commitment and a willingness to invest in the future of those that leaders have pledged to serve. In addition to their professional and oversight expertise, those with governing responsibility must also be willing to serve as a key bridge to others in advancing the mission of their respective health care organizations.

In drafting job descriptions for their members, we encourage governing boards to include the following: Board members will support institutional special events; identify and access three to five key relationships to cultivate on behalf of the institution; offer their talents and expertise to benefit the institution; and consider making a financial gift commensurate with capacity. Board members will have different levels of financial ability to support the organization. There is frequently a discussion of whether there should be a "give or get" policy for board members. The critical point is that there should be a clear and defined expectation for financial participation.

Stakeholder Engagement

From grateful patients to clinicians and employees, the challenge is the same: With almost 1.5 million organizations asking for philanthropic support, competition is intensifying. A clear, compelling message to stakeholders is essential. Philanthropic action comes as a result of the unique selling proposition, as well as the perception that a donation will make a true difference.

Persuasion theory, which is commonly used in sales, also applies in philanthropy. In training volunteers to reach out to others on behalf of the institution, the following elements can enhance success:

  • Authority: Board members have first-hand knowledge about the organization's activities and trustworthiness. Therefore, a trustee's key relationships will allow for a support decision to be made more quickly.
  • Reciprocity: People try to repay in kind what another has provided to them. Grateful patients giving back is one example. Managing the approach to those patients who have the means to be supportive is crucial. Pointing out the services, benefits and advantages that have already been realized is most effective.
  • Scarcity: Scarce opportunities seem more valuable. Highlighting a unique naming opportunity or the chance to support something that is one-of-a-kind will help differentiate an organization.
  • Consistency: Donors tend to continue to support the same causes and to give larger gifts to organizations with which they've already been involved. Therefore, engaging and stewarding current donors—helping them to continue the habit they have developed—is crucial.


Ensuring that a donor feels his or her gift has truly made a difference and is deeply appreciated is at the heart of good stewardship. It isn't as much about the size of a gift as it is about emphasizing the gift's impact. Philanthropy reflects a self-selection process; donors' philanthropic commitments center around their own experiences and what they value. Philanthropic reciprocity is often reflected in the unique transformational experience that individuals have in a particular situation: Gratitude for the extraordinary care that led to recovery, for the ability to cope with a major illness or for the comfort and support given to a family member. If the donor feels that his or her gifts are recognized and valued, it can lead to an ongoing relationship with an organization.

One of the most critical responsibilities in governance is planning and managing the future of the organization. Answering critical questions about the essential impact of philanthropy for a hospital may in fact make the difference in becoming an outstanding organization. Assuring the stability of these four key pillars can exponentially increase philanthropic giving.

Jimmie R. Alford ( is founder and chair of The Alford Group, with offices in Seattle, Chicago and Hartford, Conn.

Sidebar - Seven Stages of Stewardship