Archive for the 'Healthcare' Category

Debunking “Accountability to Donors” Part 6

Published
by
Hildy
on May 15, 2008
in Donor Rights, Funders, Fundraising, Healthcare and Stop Signs on the Road to Changing the World
. 0 Comments

Is the Donor Accountability movement correct? Should community organizations be aiming their primary accountability squarely at their donors?

Having spent the week throwing grenades at that notion, today’s is the last argument I will make before wrapping up this subject tomorrow.

(If you have not read the posts leading up to this one, you can start at the beginning here.)

Accountability for “The Money”
Now we’re at the heart of the matter. If organizations are to be held accountable to their donors, the only logical thing they could be accountable for is “The Money.” And if you ask a room full of nonprofit board members what they are primarily accountable for, that is the response you will get from many, if not most of them. “The Money.”

We know this because we have asked board after board. And almost always, that is their first reply - “The Money” - as if “The Money” were some special deity deserving of capital letters and quotation marks.

And as you have probably guessed by now, that is just not true.

As we saw in yesterday’s post, the corporate model actually points away from nonprofit accountability for “The Money.” So, then where does the logic behind “Accountability for The Money” come from?

Perhaps it comes from the law. Aren’t community organizations LEGALLY accountable to donors and funders? Aren’t they LEGALLY accountable for the money?

Well, no. Legally, community organizations are accountable for upholding the law. That’s it.

Now in some cases, the laws they must uphold may include contract law. For example, if there is a contract between an organization and a donor / funder / government contracting office, the organization must legally uphold its end of that contract, just as it would be legally bound to uphold any contract. But in those cases, it is not because the other party is a donor, but because there is a contract involved.

And so, short of ensuring that money is not used for an illegal purpose, the “legal accountability for the money” argument doesn’t hold any more water than the corporate argument.

Well what about tax exemption? In exchange for their tax exemption, community organizations must be accountable for the money, right?

Sorry - wrong again. Organizations receive their tax exemption for one reason: to provide community benefit. The prime example of that is tax exempt hospitals in the U.S., who often find themselves scrambling to put a cash value to the benefit they provide to the community. The IRS wants to know that the community is receiving at least as much in “community benefit” as the hospital is saving by not paying taxes.

Again - not the money; Community Benefit.

But just because it is fun to do, let’s take the tax exemption argument one step further.

If the reason an organization would be accountable to its donors has anything to do with the tax exemption the organization enjoys, then it stands to reason that the reverse is true as well - that donors are accountable to the organization.

Why? Because the organization is not the only one getting a tax advantage; the donor will receive a tax deduction for his/her gifts. And depending on the net worth and sophistication of the donor, he/she may get tremendous personal tax advantages for giving a particular gift in a particular way. So perhaps we should just leave the “tax exemption” issue alone…

Which all combines to leave us here:

IF accountability for the money is not an issue of legal accountability or the tax code; and
IF corporate accountability actually proves that organizations are accountable primarily to the community, rather than primarily to donors; and
IF it is almost impossible to discern to whom an organization would owe its accountability for a government grant; and
IF we have to think hard to determine why a cash donor should be the object of accountability over an in-kind donor or volunteer; and
IF we have to think just as hard, if not harder, to determine cut-off donation levels for varying degrees of accountability - and again determine what exactly that means;
And if we cannot for the life of us figure out to whom an organization would be accountable if it was fully endowed and did not have to raise money through donations or grants…

Well then maybe it is time to put to rest the notion that our primary accountability is for the money, and that we are primarily accountable to our donors.

Perhaps it is time to start looking not at the issue of accountability for the means - the money - but for the end results: community change. And perhaps it is time to start considering what could be accomplished if boards held themselves first and foremost accountable to their communities, rather than to their donors.

Tune in tomorrow, when I will wrap up this thread, by considering what is possible when we start governing for our potential to do amazing things in our communities, and stop aiming our boards’ accountability myopically at dollars and donors.

Republicans and Debt

Published
by
Hildy
on March 9, 2008
in Changing the World, Education and Healthcare
. 3 Comments

Ben Stein is no liberal. A speechwriter and attorney for Nixon and Ford, a devout believer in the legacy of Ronald Reagan, Stein writes a column in the Business Section of the NY Times as a Republican economist.

And that is why you will absolutely want to read this column, and send it to everyone you know.

Here is just a smidge of his amazing advice to John McCain re: tax cuts:

To put it even more starkly, the government - which is us - needs the money to keep old people alive, to pay for their dialysis, to build fighter jets and to pay our troops and pay interest on the debt. We can get it by indenturing our children, selling ourselves into peonage to foreigners, making ourselves a colony again, generating inflation - or we can have some integrity and levy taxes equal to what we spend.

Thank you, Mr. Stein, for sharing what no candidate will ever share - the Tax Cut Emperor has no clothes.

Stop Sign: Competitive Funding

Published
by
Hildy
on July 8, 2007
in Changing the World, Funders, Fundraising, Healthcare, Stop Signs on the Road to Changing the World and Tools to Use Now
. 0 Comments

If this is the sector that was supposed to change the world, how come the world has not changed?

Part 1 of this Stop Sign addressed the first of these related questions: How can we develop a community-wide spirit of cooperation, rather than merely the window dressing of collaboration? And to encourage real cooperation, how can funders provide grants that don’t require competition?

This week, we will tackle Part 2 of that question. (To see other Stop Signs along the Road to Changing the World, just click here.)

STOP Sign: Competition and Collaboration (Part 2)
Are funders actually causing competition? And if so, how can funders provide funds in ways that do not encourage competition?

Picture this:
A funder wants to address a particular issue and create as much impact in the community as possible regarding that issue. The funder announces the following:

During this grant round, we have $150,000 to address X issue in our community. We will have another $150,000 next year, and another $150,000 the year after, for a total of $450,000 over 3 years.

If you are interested in addressing X issue, please attend a meeting on June 5. We will fund absolutely everyone who is interested in participating. Everyone. No kidding.

There is just one condition: You must all work together as a team, to comprehensively address the issue.

We will offer facilitation, conference space, and other types of support to assist this effort. And we will learn along with you, to be part of the solution.

Think that is outrageous? It happens. We have seen it. We have seen it create incredible results, faster than anyone thought possible.

In Lincoln, Nebraska, the Community Health Endowment did it with 3 area hospitals. One of those hospitals had applied for funding, to address an issue common in hospitals around the U.S. - use of their Emergency Room as primary care for folks with no other healthcare support. CHE knew that if they helped only one hospital fix its own ER problems, that solution would likely cause the other 2 local hospitals to absorb the overflow.

So CHE said, “We will fund you and support the effort with facilitation and other assistance. But we will only do so if the effort includes all 3 hospitals.”

The result? All 3 hospitals jointly created solutions. And within one year of instituting those solutions, there has been a 65% reduction in the number of non-emergency visits to those emergency rooms, and a 63% reduction in the costs related to those visits - a savings of more than $600,000 in one year. Best of all, 100% of all individuals who arrived at the hospital seeking non-emergency care now have a primary care provider. And 100% of those individuals now have prescription assistance. (For more info, check out CHE’s annual reports for 2005 and 2006.)

A win win win - for the hospitals, for the funder, but mostly for the patients, who can now receive more attentive care. And those results occurred in just the first year of the program!

Lincoln’s hospital scenario is not the only example. We have seen other instances of truly collaborative funding, where everyone who shows up gets funded. And we have even seen it in the seemingly proprietary area of capacity building. (Click here for a look at the subject of Shared Capacity Building from the provider perspective).

If funders are going to make collaboration a condition of funding, this is real collaboration. This is not just the mechanics of collaboration, but collaboration in spirit. It is collaboration that creates something stronger, and involves everyone. It is collaboration that builds trust and leads to other collaborations (which is exactly what is happening in Lincoln, BTW - those hospitals are now getting together on other projects, to address other issues - together!) And best of all, this is collaboration that will make our communities far better places to live.

Funders and Community Results
Part 1 of this post talked about the funder roundtables we host, facilitating funders in discussions about what it will take to create more significant impact in their communities. During those sessions, most of those funders walk into the room blaming the organizations they fund for the lack of more visionary, comprehensive impact in their communities.

By the end of those sessions, in part through the reasoning shared in these posts, they begin to see that blame doesn’t get us anywhere. And that funders can be creating significantly more impact, if they change the way they see things, and make small changes in the way they do their own work.

So what might be different if funders held themselves accountable for results in their communities? What might be different if funders dedicated themselves to learning along with the organizations they fund?

And what might be different if we ran over this Stop Sign of competitive funding once and for all, and dedicated ourselves to working together - all of us together, funders and providers side-by-side? What if instead of letting competitive funding stop us, we worked together to build an amazing community?

Click here for 11 Ways to Encourage Noncompetitive funding!

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