I spoke about the foundation’s response to economic downturn in a previous post. My colleagues from other foundations have been talking about the fact that the economic downturn and scarce resources will create an urgency for nonprofits to “figure out ways” to merge and collaborate better. On January 13th Cleveland’s WCPN public radio show called, The Sound of Ideas held great conversation on a topic called When Charities Can’t Afford to be Charitable.
The concept is great and I support my respected colleagues comments. I once heard it said, “Everyone wants collaboration, but no one wants to be collaborated on.” In my work at this foundation, I have seen redundancy in programs in both nonprofit and public sectors, many of which have received grants from us. I see an awful lot of waste in private and taxpayer dollars, but I must be careful not to appear the perennial town crier. I, like many foundations and their board members, like to consider ourselves social innovators on the lookout to support like-minded social innovators and social entrepreneurs. After all, that’s what the philanthropy industry is supposed to promote. The fall 2008 edition of the Stanford Social Innovation Review an article called Rediscovering Social Innovation by James A. Phillis, Jr.; Kriss Deigelmeier, & Dale T. Miller describe what many foundation directors, program officers and their boards hope to be in their service to the community,
The underlying objective of virtually everyone in the fields of social entrepreneurship and social enterprise is to create social value (a term we define later). People have embraced these fields because they are new ways of achieving these larger ends. But they are not the only, and certainly not always the best, ways to achieve these goals. Social entrepreneurs are, of course, important because they see new patterns and possibilities for innovation and are willing to bring these new ways of doing things to fruition even when established organizations are unwilling to try them. And enterprises are important because they deliver innovation. But ultimately, innovation is what creates social value. Innovation can emerge in places and from people outside the scope of social entrepreneurship and social enterprise. In particular, large, established nonprofits, businesses, and even governments are producing social innovations.” p. 89
I can think of one crisis in particular our foundation has taken on and has asking for community leaders to explore innovative ways to better serve the needs of the medically uninsured and under insured in our community. I have discovered that is a huge task and one wrought with landmines.
In 2008 the foundation provided funds to facilitate conversations and strategies to address the growing number of uninsured and under-insured people in the county. The foundation paid a consultant to assemble representatives of “established nonprofits, businesses, and even government” with the purpose of providing an “idea mart” to see if we could come up with innovative solutions to the crisis at-hand. The conversations continue but I observe a decrease in interest and engagement especially when the conversation gets a little too close for comfort.
You see, I think we at foundations do a good job of convening meetings and encouraging people to submit themselves to be collaborated on! It is clear to me however that convening people who represent long-standing institutions often with a history of relative financial stability, go into protective mode very quickly when it becomes clear their entity is being critiqued. Too often, the jobs in public health institutions, federally funded agencies and nonprofit organizations develop around an administrative personality. In these cases, I have found very often that critique of the organization and perhaps a questioning of its relevance is interpreted as a criticism. The individual in charge of that agency becomes defensive; feeling vulnerable to the exposure that peer-to-peer conversation can produce.
I have learned that making collaboration work depends in great measure to sustaining urgency. Urgency is fueled by passion – a passion that derives from visiting places like the Lorain Free Clinic or, emergency rooms at the charity hospitals. It is a passion that derives from knowing people for whom the economic downturn is proving not just a misfortune but a disaster. Any healthy human being to wants to “do-something” when one touches that level of suffering.
A person with a sense of social entrepreneurship and the funding to support innovation, will by nature want to ask, why the system seem to not be working well and how can a constituency be served better. The response means more than just convening the meetings. The convener must have the expertise (in-house or external) to keep the conversation and going and to keep the participants focused on the passion and urgency. Foundations typically hire consultants to take on that task. Although consultants do their jobs very well, it is my experience that “hiring” the consultant removes the foundation one step from the center of the activity. If the foundation convenes the meeting to address and urgent problem, then it is my opinion that the foundation (or collaborative of foundations) should try to maintain a visible role and presence in the conversations. If not, the sense of urgency may dissipate. I believe fully that foundations can serve to keep passion buoyant in rational civic discourse.
Too often, people come to meetings, agree on the urgency of the problem and are sincere in their desire to find solutions. They come willing to contribute and discuss. Few come prepared to really think about giving up they way they have been doing things.
The public health disaster in our county is a good example. The county which is 25 miles west of Cleveland has a population of 280,000. There are three separate public health entities – two city agencies Lorain City Health Department and the Elyria City Health Department as well as the Lorain County Health District. These entities were created in the 19th century when the cities of Elyria and Lorain were rapidly increasing in population due to the need for labor in the steel industry, auto industry, shipbuilding and manufacturing. Immigrant labor poured into the region. Public health agencies were created to address the reality of contagious diseases. The hospitals, (primarily charity hospitals run by orders of Catholic religious women) were created to deal with chronic disease and tertiary care.
Today, the cities are emptying out as the industries that sustained families have left the area. The second and third generation of the immigrant families have left town, or move to subdivisions that were once farms outside the towns. The cities now have families and elderly who live at or below the federal poverty level.
As we explore ways to reinvent health care delivery in the county, one of our questions has been, “In an age of technology and rapid information exchange, are three separate public health offices really necessary and relevant?” We agree, they continue to serve medically indigent populations in very specific state funded programs, but in most cases they deal with people suffering chronic disease – something public health agencies were never really created or equipped to do. Also what is the role of a public health agency when down the street, Walgreens (“America’s Online Pharmacy”) offers patients in-store clinics. If you can come up with enough cash, you can be seen and treated by a health-care affiliate and given a prescription for your illness and pick it up at the in-house pharmacy conveniently located next to the health clinic.
In the case of the health care coalition the foundation convened, the catalyst was the sense of urgency around the news that the Lorain County Health and Dentistry – which provides significant health care to medically uninsured or underinsured – did not recieve a $700,000 operating grant from the Federal Government. The charity hospitals gave compelling evidence of the number of patients flooding their emergency rooms to treat the uninsured. The Nord Mental Health Center, which treat patients with mental and behavioral diseases. reports a steady increase in the number of new patients requireing services, attirbuted in some measure to sresses associated with the economic depression.
The health situation is in crisis but after a year of conversation, it was difficult to get people to really change the way they did business. In particular, it was hard to have the public health agencies roll-up sleeves with the charity hospitals to explore possible innovations in combining services. Perhaps this can be attributed to the realization that such a move would constitute the elimination of the public health service system as it is currently structured. Similarly, the Nord Behavioral Health Center, which is a nonprofit agency with almost 85% of its revenue channeled through the Lorain County Board of Mental Health has undergone convulsive administrative challenges with board members spending tax dollars to sue each other. Conversations to explore how the charitable hospitals could take over many of the emergency services and need for in-patient beds is too threatening for people to contemplate. So, after the initial good-faith effort to talk, the parties go into protective mode. The desire to collaborate is threatening when one realizes one is about to be collaborated on! Meanwhile people that need the services are hampered by services that are difficult to access which is why people still flood the emergency rooms when they need health care.
The Fund for Our Economic Future is a collaboration of virtually all the grantmaking institutions in Northeast Ohio. For more than four years FFEF has gathered regularly to address the need for economic transformation in the Northeast Ohio region. Aside from is main function which is to pool funds to provide early stage venture capital for organizations that promise to create new businesses for the region, the Fund has hosted several meetings of “stakeholders” to provide a strategy for how the region can move out of its economic stasis. The first was the incredibly expensive and nominally productive engagement with AmericaSpeaks which evolved into the highly productive and provocative arm of the Fund called Advance Northeast Ohio. Aside from pushing the public to engage in conversations about how to move the economy forward, Advance Northeast Ohio, the fund, as well as several foundations funded the production of a study demonstrating the cost inefficiencies in doing government in NE Ohio. The document is called, Cost of Government Study for Northeast Ohio. Subsequent feedback from the larger community in NE Ohio shows that citzens want to see more collaboration among government agencies. Few know how to get there. All realized there are too many separately incorporated towns and small cities in the region, each with very expensive infrastructure. These towns developed in the mid 1800’s when transportation and communication infrastructure were primitive and it made good sense to have government pockets serve scattered populations. Today is makes no sense whatsoever to have separate jurisdictions when collaboration and shared services would probably result in costs savings to taxpayers.
Unfortunately, getting public entities to change their administrative structure (which would mean eliminating some jobs) or, to give up power (probably the MOST guarded treasure for elected officials) is practially an impossible task.
As long as tax dollars and State and Federal monies continue to support these organizations, there is little incentive for people to change. The reality is that the economic crisis may result in drastic cutbacks that will force agencies to close and services to be eliminated.
As foundations look to encourage collaboration, they might do well to read a great new book by John Kotter, Professor Emeritus at the Harvard Business School. Dr. Kotter does a great job describing how business loose their sense of urgency. The same applies to public and private entities when they begin an initiative to make change in society.
In addition to Dr. Kotter’s call for groups to understand the role of Urgency in social interaction, a recent article in the December 2008 edition of the Harvard Business Review, called Which Kind of Collaboration is Right for You by Gary P. Pisano and Roberto Verganti. This is a great article best described by as side script that says, The new leaders in innovation will be those who figure out the best way to leverage a network of outsiders.” The authors describe four modes of collaborative innovation which are:
The Elite Circle in which one company selects the participants, defines the problem and chooses the solutions.
The Innovation Mall where one company posts a problem, anyone can propose solutions and the company chooses the solutions it likes best.
The Innovative Community where anybody can propose problems, offer solutions and decide which solutions to use.
The Consortium Which operates like a private club, with participants jointly selecting the problems, deciding how to conduct work and choosing solutions.
Each of these models have correlates in the public sector. I will end this post with a quote from the article in question. Although it is directed to companies, I suggest foundations that urge collaboration read it with an eye to their admonition that non-profits and the public sector figure out ways to merge and collaborate. It is – no doubt – easier said than done.
All to often firms(foundations?) jump into relationships without considering their structure and organizing principles – what we call the collaborative architecture. To help senior managers (read public officials and nonprofit leaders?) make better decisions about the kinds of collaboration their companies adopt, we have developed a relatively simple framework. The product of our 20 years of research and consulting in this area, it focuses on two basic questions. Given your strategy, how open or closed should your firms network of collaborators be? And who should decide which problems the network will takle and which solutions will be adopted?” p.80
I am encouraged by the fact that many people I make reference to in this post continue to come to the table to discuss the issue because they do have the best interest of the community at heart. The fact is this economy is only beginning to reveal the hard choices and sacrifices we face as a community. People are meeting that challenge overcoming a fear of the unknown.