To bring to life the concepts and ideas discussed in the Future of Philanthropy series, we bring together experts in the field who can offer first-hand experience and important insights on these topics. This Q&A focuses on the Healthcare nonprofit sector —and how a rapidly changing world is placing new and different kinds of demands on the fundraising leaders and teams within those organizations.
Panelist: Michael ‘Mike’ Delzotti, FAHP, CFRE, is the President and Chief Operating Officer of the Huntsman Cancer Foundation. He brings decades of experience in leading philanthropic teams, with a special focus on cancer fundraising. In his most recent role, he served as President and Chief Executive Officer of Markey Cancer Foundation, where he was part of the leadership team that secured designation as a National Cancer Institute Comprehensive Cancer Center for the University of Kentucky Markey Cancer Center. His past nonprofit roles include service at the Special Olympics and the University of California, Los Angeles. His track record of success in cancer center philanthropy includes positions at Rice University and MD Anderson Cancer Center, where he has led multibillion-dollar fundraising campaigns. He directed the Neurodegeneration Consortium campaign, raising $65 million with the Massachusetts Institute of Technology and the Baylor College of Medicine. Mike is also a national thought leader in cancer philanthropy, including serving as a past chair of the National Association of Cancer Center Development Offices (NACCDO). He also served as treasurer and executive committee member on the Association of Fundraising Professionals (AFP) International Board. organizations.
Panelist: Laurie Kelley currently serves as Senior Vice President and Chief Philanthropy Officer at Providence. Her role includes leading the Providence St. Joseph Health Foundation, the system office of philanthropy, Providence’s central division of foundations; and developing strategy, providing oversight and collaboration with system, regional, and local leaders throughout Providence, as well as enhancing the understanding, brand, and culture of philanthropy. She has spent her career in executive roles in the non-profit sector. She served as President & Chief Development Officer at Providence Foundations of Oregon, Vice President for University Relations at the University of Portland, and Vice President of Marketing and Strategic Planning at Oregon Public Broadcasting (OPB). She also held leadership roles in finance, marketing, and strategic planning at Legacy Health and Southwest Washington Medical Center. Her career began at Accenture.
Moderator: Steven Wallace brings 28 years of philanthropy experience to his work in executive search and leadership consulting with ALG clients. His expertise covers a wide array of disciplines, including: fundraising; team building; donor relations, recognition and stewardship; board management; and the increasingly important field of Diversity, Equity & Inclusion (DE&I). Throughout his career, Steven has helped some of the nation’s most prestigious healthcare and higher education institutions expand their programs and achieve their philanthropic goals, including City of Hope, Providence Health & Services, University of Chicago, Columbia University, and California State University, Northridge. A frequent presenter at Council for Advancement and Support of Education (CASE) in Donor Relations conferences, Steven received his bachelor’s degree in Mass Communications from the University of California, Berkeley and master’s degree in Public Administration from the University of San Francisco.
Steven: First of all, thank you both for doing this. As you know, we’ve covered a lot of topics related to the future of philanthropy, from the narrowing pyramid to changing demographics and engaging younger donors, to challenges of recruiting and developing talent, to the changing role of boards. My question to both of you is, when you think about the future of healthcare philanthropy and all the forces shaping the future, what keeps you up at night?
Laurie: To be honest, it’s a really tough time in healthcare. We’re facing increased costs in labor, supplies, medications, just about everything. At the same time, we’re seeing lagging and declining reimbursement. So, philanthropy is playing a bigger role than ever before.
Just five years ago, philanthropy was not nearly as necessary for funding all sorts of initiatives. Now we’re fully funding large initiatives at our medical centers with philanthropic gifts from donors. We’ve just completed two brand new emergency rooms for $90 million in Portland, Oregon, completely paid for by philanthropy. So, it’s a really exciting time to be in philanthropy and to focus on that sense of urgency, because it is really true right now that we do need philanthropy more than ever.
Besides the immense need, what keeps me up at night is making sure that we’re retaining all our best people. We’ve worked really hard to create career pathways for people. Sometimes that’s difficult, even in big organizations like ours.
The other issue is keeping up with the pace of the demand, and the need is out there for philanthropic investment. We’re in varying markets—some with great wealth and others where it is more difficult to fund large projects. There are so many fabulous nonprofit organizations doing really good work. So, how do we tell the story of our needs, and really thank people appropriately, because it definitely takes a village for this work?
Steven: Mike?
Mike: First of all, I like Laurie’s expansive and higher-level answer. It’s one of the questions we’re going to tackle a little bit later, about whether you are simply a fundraiser or a leader who fundraises. And where do you sit around that table? I really like the bigger-picture look at this. As we come to that leadership table to actually advance the philanthropic agenda, we have to understand that the people around it are really time-constrained. They’ve got so many other issues.
But to Laurie’s point, while philanthropy is clearly still an enabling piece, at the same time, it’s also funding a lot of day-to-day operational stuff that needs to be taken care of, filling gaps that can’t be filled in any other way. So operationally, philanthropy is being included in a lot more strategic discussions and planning within our institutions. And it’s causing us to be much more thoughtful about our role as the philanthropy leader at that table—so that we are no longer our own little portfolio.
Steven: So, in terms of strategic planning, it sounds as though both of you are much more integrated into those discussions now. Is that different from how it was over the course of your career?
Laurie: Well, when I first came to Providence, I came from a small university that didn’t have a huge endowment, and philanthropy played a big role and had to cover most of what we did that was outside of operational needs. So, I was shocked when I came to Providence ten years ago, and I was leading philanthropy in Oregon, but I wasn’t a member of the Oregon Executive Council. I was told, “Just go do your thing.”
Today, I’m in every meeting. I’m in every strategy session. And somebody from our team is at the table at every one of the medical centers, too. Today, when we do a feasibility study for project cost, we also do a donor feasibility study. We know a portion of those funds is going to have to come from philanthropy. Our leadership teams across the enterprise have gotten a lot more sophisticated, and the role of philanthropy has become really integral.
Mike: I would follow on Laurie’s comment about what it means to be fully integrated—that is, being part of something that cannot be separated. In my role here as President and COO, and in my previous role as President and CEO of the Markey Cancer Foundation at University of Kentucky, I required that I was on the director’s council and the clinical leadership oncology council.
And it was a surprise question to both institutions. I said, very politely, that I wouldn’t take the job unless I had access to both of those groups because I needed that in order to do the job. But also, because you’re going to want me there. Anyone who is in this position, you’re going to want that person in those rooms. It used to be that we’d show up to those meetings for our little segment and do our little thing. Now, we’re looked at as the most efficient department and the best ROI out there.
A lot of our work now is speaking truth to power. Because we have to be donor-centric; we have to follow a canon of ethics; we do our work on the donor’s timeline. And yet, the pressures are so high on everyone around that executive table that it’s easy to look at philanthropy as simply another production line. Even though it’s not the same as pushing a button or pulling a lever that might get something done in a different department. Sometimes, we need to push back, and it’s important just being in the room to elevate the planning discussion.
But again, it goes back to that concept that the philanthropy leader has to be at the table, not simply as a fundraiser. Gone are the days when you had a foundation president who led things but wasn’t a fundraiser—now they have to be a full-on fundraiser in addition to being a healthcare executive.
Laurie: Yes, exactly.
Steven: How much education have you had to do with the executive team around philanthropy, and how it works, and how they can play a role in that?
Mike: Well, one thing I’m trying to do is to learn, as my friend Mark McCampbell coined, how to “speak CFO.” I’m trying to get away from some of the philanthropic idioms and terms of art and adopt theirs, trying to understand the way they speak. A lot of it has been trying to educate myself on how I can become a fully enfranchised leader at that table and speak their language. At the same time, not only speak it, but understand it and find our niche in that conversation where we can get in there and provide that net positive.
Laurie: At Providence, there’s been a lot of opportunity to provide education. We have a whole system, almost like a mini AHP, where we bring our executive leaders to talk to our Foundation Boards. And with that, we’re educating them and they’re educating us. In terms of our staff, too, I think working closely with our leaders throughout all of the ministries that we have creates a lot of great collaboration.
And while philanthropy has gotten a lot more sophisticated in terms of the tools and techniques we use, it’s still a people/relationship business. You have to demonstrate the need and then set expectations about what can be raised. At Providence, it starts at the top, and we’ve had really great leaders who understand philanthropy—they believe in it and lead by example, also with their giving. So, I think that’s been very helpful.
Steven: In terms of gifts, have you seen an increase in the importance of big gifts at your organization, and if so, do you expect that trend to continue? And what are the implications for fundraising and stewardship?
Mike: We have seen what everyone else has seen. Fewer people giving larger gifts, and I worry about the societal piece in that we’re seeing what I would call a de-democratization of philanthropy, which doesn’t bode well for the fabric of society, and it doesn’t bode well for the future.
And yes, I think we are getting a new generation of donors, which reminds me of The Seven Faces of Philanthropy, even though it was written more than thirty years ago. There are different personalities coming up through the pipeline now; they have a different view of things and their involvement; they’re much less institutional investors and much more project-oriented and want that ROI. So, it has been interesting trying to educate our leadership about how philanthropy works today—explaining what this new wave of donors wants, and that we need to provide it. Sometimes, there’s a little bit of a collective sigh I hear out of leadership, because it’s something new and a deeper challenge.
Laurie: Yes, and to your first question, Steven, the importance of the large gifts cannot be underestimated. We had over 200,000 gifts last year, systemwide, and 51 of them accounted for 97% of our net production revenue. So, those transformational gifts certainly make a huge difference.
Now, the way that we honor and steward those people is really important. It’s important how you steward every donor, because each donor comes to the table for different reasons. Some want to be recognized. Others want to stay under the radar. There’s also the question of donors who may be giving every year at a modest level, and we have no idea down the road what a planned gift could be, or if they’re testing us, for some greater gift to come later.
And even if you can’t steward every single person individually, there are things that you can do to make sure they’re informed about what’s going on at the institution. More than ever, it’s actually really hard to get in front of people. Many of the cities we’re in don’t have big newspapers anymore. So, how do you get out your big stories? That’s a challenge right now when there are so many competing forces for a donor’s time, passion, and money.
Finally, I’d note that we spend a lot of time working with our physicians, and that’s been a really big boost to our work. Many physicians didn’t even realize the impact of our work—that the cardiac-cath suite they’re working in was paid for by a donor, for example. Physician involvement has been very helpful because sometimes people will make a comment to a physician, ‘How can I help? Do you have any big projects?’ And the physician can refer the person to our team to learn more about the opportunities at hand.
Steven: Mike, that resonates with the point you made about donors being project-focused and focusing on ROI and more specific giving. Can you say more about what you’re seeing?
Mike: I think the project piece is part of philanthropy’s increasing complexity, on a couple of levels. Oftentimes, people who want to fund projects have it in their mind that they’re funding a standalone niche. And that misunderstanding can create difficulty with donors, because you need to have an elongated conversation and communicate that these projects are part of an ecosystem. They may want to fund this small lab, but the gene sequencer down the hallway that’s not in that lab is so expensive that it can’t be dedicated to that lab alone; it needs to be used as a force multiplier across many groups.
That gets to the second point—highly related to NIH funding—is that “overhead” has become a dirty word. That gene sequencer, because it’s a shared resource, becomes part of “overhead.” So, sometimes we have to get project-focused donors to see the bigger picture, to understand how it all fits together. It’s certainly a more nuanced conversation for those types of donors.
Laurie: During COVID, people wanted to give wherever the need was greatest. Right now, we have a “greatest need fund” that’s discretionary and can be put toward the most pressing needs among all the projects. But the spirit of giving still really does depend on the individual. We’ve had people who say, “We trust you. What do you need?” And then there are people who really identify with one area of practice and want to give to that.
Steven: You’ve both talked about the growing demands on the philanthropy team in terms of working with both senior leaders and donors. In a resource-constrained world, how do you envision healthcare organizations addressing the need to build, train, and retain effective teams to do this work? Laurie, you touched on that a little bit in an earlier answer. So, why don’t you start?
Laurie: We have 44 foundations across seven states. Some are huge and some are smaller. What we have tried to do is build career ladders, supported by new titling structures and pay ranges, and some other components. We want to be very competitive in every market that we’re in.
We also provide a lot of training. If people want to get extra training, if they want to get credentials like a CFRE, or if they want to apply for some specialized training in Planned Giving, we have resources to do that. Now, in a resource-constrained environment, we’re making sure that people who apply for training are going to stay with us. We want to keep investing in their progress because, as we all know, when people are in a community for a long time, they build stronger relationships. And that’s really helpful to our fundraising efforts.
But it’s challenging. Fantastic people can probably land another job somewhere, even in their own community. So, I want to make our teams the best experience that you can have—we want people to come to work here, and we’ve really been able to recruit great people from other organizations because they have colleagues who have come over and say Providence is a great place to work.
Mike: I would certainly say that I love the idea of a career ladder. We always want to work with our staff and have them feel confident that we envision them in a long game in their career with us. Yes, we fulfill our mission through the strength of our science, but also through the excellence of our people. We have an excellent team here. So, we want to keep them.
I love Laurie’s point about credentialing. As fundraisers, we are the only people in the healthcare space who have no requirement for continuing professional education, certification, or licensure. And yet we work in an environment where we’re partnering with highly credentialed physicians and clinicians to refer patients to us. So, how do we show that we’re respectful to the environment?
We’re dealing with people’s hopes and dreams, and their values and morals. Not many of us would go to a doctor who graduated from medical school in 1990 and hasn’t cracked a book since then. I love the idea of trying to bring on board people who are lifelong learners, who play that long game with their career. Because if we’re interested in them, I think they’ll stay interested in us.
So, we make sure we pay for your CFRE, your CSPG, whatever it may be. If you get a certification, you get a $1,000 bonus here, and we did it at my previous institution as well. We do it in a public award, to make sure that people take credentialing seriously; we even made the case to leadership and fought for the CFRE credential to be placed on an employee’s ID badge.
We also work really hard to ensure staff feel a closeness to the mission. We are in a building that is separate from healthcare provision, so we make sure to get over there as much as we possibly can. Even stuff like volunteering at the Hope Lodge.
Laurie: One other piece, too, is that people who might not be eager to move up the career ladder—but are happy and really good at the job that they’re doing—need to be appropriately paid and recognized. Those people are worth their weight in gold. We need to make sure that just because they may not want to move into a larger role, we’re still recognizing them for the talents they’re bringing.
To support that, we’ve been making sure that we have appropriate pay ranges and titling, especially since we have so many people across the western states. When you’re comparing, say, Montana versus Oregon versus California, you have to level-set for the cities that you’re working in; over the last 10 years, we’ve gotten a lot better at standardization.
Steven: So, would you say that making a case to your institutions that philanthropy needs resources is still a tough argument, or has that changed?
Laurie: I feel it has changed. As Mike said earlier, philanthropy is the highest ROI in the company. Our CFO has spoken about philanthropy in front of the Board. I think the advantage that philanthropy has is well-recognized, so making the case for resources is not difficult.
Mike: I would say it has changed as well, and I believe that’s due in large part to the continuing professionalization of our field. We’re getting better and better at our jobs, where we’re producing a larger piece of the pie. And as I said before, some of it is learning to adapt our language a little bit and really understand that there are better ways to express the value and virtue of what this field does and the ends that it achieves.
Steven: Great, so let’s turn our attention towards candidates and people who are actually out there looking to work with organizations such as yours. What specific skills are you recruiting for? I asked this because we want to paint a picture of what the future philanthropy team might look like and what skills would be most valuable.
Laurie: We’re always looking for smart people who play well on a team, because especially with bigger gifts, so many departments within philanthropy and the hospital have touched that. We also want people who are eager to learn—as Mike said earlier, people who are lifelong learners.
We’re looking for candidates who are really adaptable because you might hire them for one role, but as they progress on that career ladder, they may find other possibilities. Candidates always think that they’re hired for just one thing, but then sometimes the job stretches, or conversely, it may be more structured than they thought. So, it’s important to be both adaptable and communicative about what your needs are, and what you what you need moving forward.
Also, for us, the mission orientation of Catholic healthcare is something a candidate needs to be comfortable with, but I think those values hold true no matter if you’re a religious person or not at Providence. A lot of people can fit in very well, even if they do not have a faith tradition, but making sure you want to work for a mission-based health system is important here.
Steven: So, in terms of the team that you’re hiring for now, do you see a difference in what the fundraising team of the future might look like?
Laurie: We’re a very matrixed organization, and I think there will be more changes as we’re more resource-constrained. It used to be that every hospital foundation had its own events person, and marketing person, and finance person. Now those functions are shared services and might not even be based in your town. So, people need adaptability to work at a large matrix organization, and for some people, it’s a challenging learning curve. But I think there’s going to be more of that.
Steven: Mike, any thoughts?
Mike: We need to look at donors very holistically. A development officer shouldn’t show up with only one tool or one skill set. We have to look at donors in the round, just as healthcare institutions look at caring for the whole person. We need staff who come to the table with adaptability, who can see that larger holistic picture.
Most people are hired for skill and fired for fit, right? They know how to work in their silo, but can they play with others? I think what we really try to do in the hiring process is, first of all, try to look at character as much as we can discern it, then look at culture, and then skill. A lot of people look at it the other way around, so to combat this, we build in a mechanism for our teams, where we require a unanimous consent to hire someone, so that everyone gets a feel for that candidate. Our approach is to focus on character, culture, and then competence. That order is important.
We’re also looking for people who are natural relationship builders and excellent communicators. While we are not in sales, I do love the discipline that sales would bring to our field. So, someone who knows about execution and understands how to live in a goal-oriented world. Further, we strive to make sure all of our goals and their reporting are very transparent.
For example, everyone sees my proposals, my visits, and my dollars. And I think that transparency builds a culture of achievement. So, you need to want to be in that kind of culture—one that’s completely transparent about where we are, how we’re moving forward, and how we can help each other. People who don’t feel comfortable with that and want to do something different will self-select out. And then you continue to build that team with people who want to be in that graceful, respectful aspect, where we still focus on execution.
Steven: Let’s talk a little bit about Boards, how important they are, and the evolution of the role of Boards in fundraising over your career—where do you think that’s heading?
Mike: I do worry because the negative side of the professionalization of our field is that it can push out volunteers. It’s a much more command-and-control culture, and a much more linear culture. That makes it more predictable and manageable, but there still needs to be room for volunteer involvement. I want us to get back to where we do have roles for volunteers and their ability to open doors. Volunteers can provide that connection, that articulation of a need, and that personal story that resonates in a deeper way than coming from one of us as a professional fundraiser.
As for Boards, even though they are volunteers, we still need to be super clear about their responsibilities; we need job descriptions for our Board members that spell out exactly what we’re looking for from them. That may mean providing access or connections to other potential donors, or participating in solicitations—we need to talk about that from the beginning. And I do not believe that recruiting someone to a Board is the cultivation way to a gift. I think it’s the giving that predates the role on the Board for us.
Laurie: I feel like our Board members are still our best ambassadors in the communities we’re in, and I think we’ve done a really good job in recruiting really top-notch people and making them feel informed and appreciated, so that they’re able to speak on behalf of the organization. We’ve spent quite a bit of time making sure we provide Board education; they know their role is to help us in fundraising. We do a lot of communication with our various chief executives at both the hospital level and the system-wide level. We do one or two where our CEO of the system comes and talks to the Boards.
Mike: I’d just follow up that it’s wonderful to have super wealthy people with a lot of connections on our Boards, but I’m heartened to see wider Board participation, too. That is, representing communities that might not normally be at the table. I remember when I ran fundraising for Special Olympics, we had athletes on our Board who had intellectual disabilities, and it was an internal fight to have the organization allow us to sit with them and their families and ask if they would want to make a contribution commensurate with their ability and equal to their passion.
The organization kept making decisions for these Board members and told us, “No, you can’t talk to them.” We had four athletes on our Board at the time, and the family of one of our Board members was brought to tears at the chance to be able to make a contribution that mattered to them. Because it was another exercise of their child’s agency. So, I do like that we’re more sophisticated now at being able to determine wealth and philanthropic potential. But our Boards also need to be smart about community investment, community involvement, and looking beyond that to bring those additional resources.
Steven: Beautifully said. So, as a last question, when you think about the future of philanthropy specifically in the healthcare sector—what, in your mind, is one of the most important issues to tackle?
Mike: We could point to a number of issues, but I think a central issue for healthcare philanthropy is our ability, in this current climate, to articulate our cause in a way that resonates with people effectively. Not just from our perspective, but from theirs, continually reminding people why we matter to them.
For cancer centers, the highest rating we could achieve would be the National Cancer Institute’s comprehensive cancer status. We as a body need to be much better at articulating why that matters to a population, why that matters to the people in our catchment area, in our community.
Even as the world gets more complex, as people get busier, as we’re less trusting in information and media sources, we need the support of stalwart members of our community, and we need to be able to tell our story in a way that resonates with people—using all the assets at our command to be able to connect people to this cause greater than themselves.
Laurie: I’d riff on what Mike said and add that we need to continue building the culture of philanthropy internally, within our own organizations as well as in our communities. The need is great. It’s going to get greater, especially in the next few years. We’ve got a big role to play in society right now, and we need to elevate that story and get people focused on the needs.
Steven: Wonderful, this was great. You’re both doing such important work. Thank you for sharing your experience and insights. The future of healthcare depends so much on philanthropy, and it’s important that we continue to advance the profession so that it can continue advancing the mission. Thank you.
NEXT UP on July 1: Steven Wallace will offer closing thoughts for Healthcare organizations, based on his decades of experience as a fundraising leader and executive search consultant. The piece will summarize overall trends from all the articles in the Future of Philanthropy series and offer a brief overview of what may lie ahead for Healthcare fundraising teams.
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