Lessons Learned 1996 — 2001
1. For Grants, More (Often) is Always Better
Some funders disperse grants twice per year or even just once per year, but from day one we felt that approving grants every quarter would best position our grantees for opportune intervention and impact. Admittedly, awarding grants four times per year can sometimes put a strain on our small staff and all-volunteer board, as on any given day reviews of letters of intent, proposals or grant decisions are always in motion. It’s worth the effort, however, as the grantee feedback we received in 1996 is the same as we receive today: quarterly grants allow the needs of Chicago’s medically underserved to be addressed in a consistently timely and responsive manner.
2. For Want of a Nail
Paying for CTA tokens, childcare, or culturally appropriate health education materials are hardly, at first blush, the stuff of a foundation board’s dreams. In our first years of grantmaking we saw too many clever programs fail due to the “for want of a nail” syndrome, however, to turn a deaf ear to requests richer in impact than sophistication. “Nuts and bolts” needs are easy to overlook, but an upfront assessment of practical and logistical issues can be time well spent, and we quickly learned that funding such needs can often be a sound—and key—investment.
3. While Developing New Solutions, You Still Need Soup on the Table
Like most funders, we hope that through our grantmaking we can help develop new solutions to some of the challenges facing underserved populations, and address and attack the root of problems. An early tenet of our grantmaking philosophy, though, was that while innovations are being tested and novel approaches developed, disadvantaged children still need health care and counseling at their schools, medically underserved young mothers still require the key health services to improve their lives and those of their babies, and the homebound still need to be able to rely on the crucial treatment provided by a visiting nurse. In short, we came to believe that grantmakers cannot afford to ignore the present in pursuit of the future. From 1996 on, therefore, we’ve tried to achieve a balance in our grantmaking that reflects a combination of proactive and reactive, pilot and time-tested, and innovation and tradition.
4. Bring the Mountain to Muhammad
Many of our most successful grants during our first five years provided services on-site at a familiar and trusted location where the target population was already present or used to gathering. From school-based health centers to homeless shelters to a groundbreaking program delivering integrated primary care and mental health services to the chronically mentally ill, we found that new efforts were most likely to succeed when they drew upon existing relationships between sites and clients.
5. It’s Worth the Risk: Foundations Should be Trailblazers
VNA has always believed that foundations should be risk-takers, willing to take chances on innovative programs, grassroots agencies, and new models of service delivery to address societal ills. In fact, we feel that private foundations are uniquely positioned to take risk, because they don’t have to rely on tax dollars, individual largess or business profit to fund worthy needs. For these reasons, if we feel that an inventive program or little agency with a big idea has a chance to succeed, we’ll give it support to see it either blossom or wither on the vine—and know we will learn something helpful from either outcome.
Lessons Learned 2002 — 2006
6. Grantor & Grantee: Partners in Progress
Without the financial backing a grantmaker provides, even the best project at a nonprofit may not be developed, and even the most successful program may fail to be sustained. Similarly, however, even the most astute foundation board or staff can not make informed decisions in isolation: they need their nonprofit partners to share firsthand knowledge and vision. In short, when funders and applicants work together, toward mutually agreed-upon goals, the best results are achieved. As our grants during 2001-2006 indicate, when this true partnership model is followed, grantmaking can be one of the best examples of the whole being greater than the sum of its parts.
7. It Pays to Reinforce the Backbone
VNA Foundation proudly supports several free medical clinics in and around Chicago, as well as the Illinois Association of Free & Charitable Clinics. Free clinics, staffed primarily by volunteer physicians, nurses and other healthcare providers, offer badly needed health services to the working poor and impoverished. Although these programs could not exist without the selfless efforts of those who donate their time, VNA learned that care is both more impactful and more efficient when a paid, full-time RN provides coordination, oversight and follow-up duties at free clinics. The very purpose of these clinics is to offer an effective alternative to episodic, irregular care; when the efforts of alternating volunteers are supplemented by the steady presence of a full-time case manager, that promise is fulfilled.
8. The Best Help May Not Involve Grant Dollars
Although we know that the primary role of a foundation like VNA will always be as grantmaker, during our second five years of grantmaking we saw the value of another role a foundation can play—that of a convener, facilitating opportunities for grantees to share issues and ideas with their peers. Our first such convening involved health providers who care for homeless populations, during which participants shared common challenges and needs, and explored potential methods and solutions. The healthcare providers found the meetings to be so fruitful that they soon began meeting autonomously, and VNA was inspired to convene other groups including community health worker leaders. Relationships between foundations and nonprofits are commonly bridged by dollars, but we are committed to continuously exploring other ways to add value, strengthen relationships and capitalize on common vision.
9. Outcome Measures Have Value Beyond the Immediate Grant
Sharp reductions in emergency room visits due to asthma attacks, dramatic upturns in completed referrals from a free medical clinic, and increased birthweight for babies born to teen mothers: these are only three examples of the impressive outcomes reported to us by grantees over our second five years as a grantmaker. Although VNA had always required its grants to have objective and measurable outcomes demonstrating the grant’s effect, by our second five years of grantmaking we’d refined the process and posted on our website examples, taken from actual VNA grants, of strong outcome measures. We found that requiring outcome measures maximized the impact of our grant dollars and allowed us to share with other nonprofits and foundations objective information about successful–or not so successful–approaches to assisting the medically underserved. In addition, because they showed objective measures of impact, our grantees’ programs often became more attractive to future funders and were more easily duplicated in other neighborhoods.
10. Two is (Good) Company
Although VNA is proud of its distinct mission to enhance the health of Chicago’s medically underserved, we also recognize the benefits of collaboration with other funders. We were very fortunate, in the years covered by this synopsis, to work in partnership with many of our local peer healthcare foundations, and three times partner with the nation’s largest health philanthropy, the Robert Wood Johnson Foundation (RWJF). By collaborating with RWJF through its Local Initiative Funding Partners program, we were able to get RWJF to match, dollar-for-dollar, our grants in support of innovative community-based projects to improve healthcare for vulnerable populations. Via these collaborations VNA was able to leverage substantially higher levels of funding for some of our most inventive and impactful grants, and plant the seeds for further collaboration in the years to come.
Lessons Learned 2007 — 2011
11. Spelling Counts, But Not for Everything
VNA has never been a “spelling counts” foundation, where applicants live or die by a single written submission. By the start of our second decade of grantmaking in 2006, we’d come to rely on open communication with our grantseekers and had fully developed the partnership-based approach by which we still operate today. We oftentimes discuss proposal ideas on the telephone with applicants before they submit anything in writing, and we always review a letter of intent before requesting a full proposal. Similarly, whenever possible we try to help grant applicants “think through” proposals or prioritize needs, suggest possible additional or alternative funding sources and share lessons from other grantees. We learned that allowing multiple avenues of communication, in as interactive a process as is feasible, results in better partnerships–and ultimately, more impactful grants.
12. Even a Small Investment, Well-Placed, Can Make an Impact on an Entrenched Problem
Based on the success of our first Special Initiative with the Illinois Maternal and Child Health Coalition, which provided core funding for the Covering Kids and Families Illinois Program, VNA staff began reviewing other opportunities that weighed need, population, impact, expense and partnership. In the end, we made the decision beginning in 2004 to undertake an oral health initiative, as at that time oral health was overlooked, underfunded and desperately needed among Chicago’s underserved. Our planning partner was Erie Family Health Center, which had already begun to consider expanding dental services and was located in an area with a documented lack of resources for uninsured residents.
After several months of planning and coordination, including meeting with experts, garnering FQHC approval, and building collaborations with other local health foundations, the VNA Oral Health Initiative (OHI) was launched and services were piloted. With continued VNA support, Erie was able to fully integrate oral health and primary care services at its main Humboldt Park clinic, more effectively serving its patients through a combined medical and dental home.
13. Nurses are Winners, and We Made it Official
Recognizing the long-term negative impact of the nursing shortage, particularly in community/public health nursing, we designed two programs in the mid-2000’s to help address the problem. Our Super Star in Community Nursing Award gave an unrestricted $25,000 award to an outstanding “frontlines” nurse. It was created to honor the service provided by Public Health/Community Health nurses , and—via publicity associated with the award and the nurse’s work—encourage nurses in training to consider public health and community health nursing as a career choice. During the seven years the award was offered, almost $300,000 was awarded to seven winners and twenty-three finalists. Additionally, the award received coverage in both nursing publications and general media, achieving the publicity for nursing for which we had hoped.
Our second nursing initiative, the VNA Nursing Scholars program, provided full-tuition scholarships for nursing students in accelerated baccalaureate, and later, master’s preparation programs; and in return, recipients agreed to practice for at least two years after graduation in a Chicago organization serving the medically underserved. The goals of the Scholars program were to encourage and support qualified candidates who might otherwise not attend nursing school due to financial considerations, and to promote community nursing via the requirement to treat the medically underserved in a community setting after graduation. Over the five years that the Nursing Scholars program was offered, a total of $369,100 was awarded to support 11 nursing scholarships, and underserved communities benefited from over 20 combined years of nursing services.
Although VNA Foundation’s desire to promote and support the role of nursing in the community is as great as ever, the uncertain economy and rising need for primary care community nurses forced the VNA board to make the difficult decision to suspend the nursing initiatives and direct all available dollars to support home- and community-based healthcare to Chicago’s most medically needy underserved communities. In this way, we are fulfilling the Foundation’s primary mission during a period when its assistance is vital, while also continuing to support community nursing by awarding about 50% of our annual grants toward nursing salaries and services.
14. Smaller Staff = Bigger Grants
Over the years, VNA has been fortunate to receive generally excellent investment returns, allowing our endowment and grants budget to gradually increase. As our grantmaking—and demand from grantseekers—grew, however, so did the challenges of operating as a small-staffed foundation. As a small foundation tackling big problems, we are always conscious of the need to maximize the reach of our staff and the impact of our limited grant dollars. We have done this by using a team-based approach both within the foundation sector and with our community partners, and we are always on the lookout for opportunities to leverage our grant dollars or fill a smaller yet important gap. We also do our best to provide assistance beyond the grant dollar—whether it is building a network, assisting with evaluation, or thinking through a program idea.
VNA has always strived to operate on a lean administrative budget, putting maximum dollars into the Chicago communities where it’s needed the most. By working collaboratively and leveraging our grant dollars, we are doing our best to achieve uncommon results—results that represent our most sincere and thorough effort to make a meaningful difference in the lives of Chicago’s medically underserved.
15. What’s Good for the Grantee is Good for the Grantor
A peer-structured, partnership-oriented approach is the core of VNA’s grantmaking philosophy, and by 2006 we’d formalized a similar mindset for our internal relationships. The start lies with the VNA Foundation Board of Directors. Our board members do not receive compensation of any kind; they are motivated only by their commitment to improve the health of Chicagoans without adequate resources. Since our first grant in 1996, at least one board member has accompanied VNA staff on most pre-grant site visits, and their input, perspective and expertise have often proven to be invaluable contributors to the process. Their involvement in site visits and proposal reviews also make them active and informed participants when proposed grants are discussed at board meetings.
Interactions among VNA staff also adhere to a partner/colleague model. Each staff member has an area of expertise and prior experience as a grantseeker, and we believe the respect and cooperation we show each other, and our vivid memories of what it was like “on the other side of the table,” are reflected in how we interact with grant applicants. With a small staff, there’s little room for an “it’s not in my job description” attitude—so we do our best to work freely and honestly with both each other and our community partners. We hope and believe that the end result is more honest discussions and more impactful grants.
Lessons Learned 2012 — 2016
16. Watering the Roots so the Grass May Grow: the Benefits of Funding Agencies “of and for” the Community
Many foundations are reluctant to fund smaller, community-based agencies. These agencies are often perceived as lacking the infrastructure to manage grants or collect impact data, and some can succumb to stagnation due to a reluctance to stray from original programs or leadership. VNA quickly discovered, though, that supporting “grassroots” agencies, developed by and headquartered in the communities they serve, was often the best investment. Such organizations are generally led by passionate directors deeply committed to their communities, and their size and targeted service areas allow them to readily adapt to changing needs. We also found that they were often amenable to working as true partners, the result being that VNA’s grants were often especially impactful because the agencies were open to our technical assistance to help them grow, network and strategically plan rather than merely scrape by from year to year due to funding inefficiencies and uncertainties. As we look towards our 21st year of grantmaking, our commitment to grassroots agencies, and the communities they serve, is as strong as ever.
17. The Best Results are Achieved by a Careful Blend of Reactive and Proactive Grantmaking
VNA believes that those at community-based agencies, delivering services each day to their fellow community members, are generally very well positioned to know what programs or purposes are best addressed by grant dollars. For this reason, the bulk of our funding is awarded via reactive grants, made in response to applications received by VNA. Sometimes, however, self-initiated, proactive grants (“Special Initiatives” in VNA nomenclature) are the only way to achieve maximum impact. During our first 20 years VNA awarded over $1.67 million in Special Initiative (SI) funding through eight unique grant programs—three of them occurring in the last five years. For each SI, we identified especially pressing but inadequately addressed problems facing the underserved, and researched how best to target proactive grants to achieve priority goals and fill key niches. In every instance the result, we are pleased to say, was increased effectiveness and impact for VNA, and improved health for the target population.
18. There Will Always be the Medically Underserved and They Will Always Need Help
For most foundation boards and staff, running a grantmaking foundation can be an exercise in distraction: there are usually a plethora of needs that fall under a foundation’s general funding guidelines and a wide variety of proposals competing for attention. Even for the most focused funders, it is easy to go off on tangents. At VNA we have worked hard to maintain a consistent concentration on improving the health of the medically underserved, acknowledging that the definition of the “who” and “how” of underserved may change, but the pressing need does not. In recent years, for example, which populations are most in need has often changed via political whim as budget cuts and freezes killed effective health programs, and the “underinsured” (those with health insurance but with deductibles or out-of-pockets so high as to make the policies unusable) also became medically underserved. Throughout these recent changes and the many that preceded them, we found that staying true to our commitment to the underserved via unwavering grant support has helped many agencies that serve this population remain focused on service rather than fiscal crisis, to the benefit of all.
19. Small = Nimble and Communicative, Yes; Bureaucratic and Silent, No
The original reason why VNA chose to operate a very lean staffing model was quite simple: we wanted the maximum possible dollars to go towards grants. Over the years, however, we’ve discovered some other benefits to a smaller staff. First, just like the smaller, grassroots agencies we like to fund, our small staff can be nimble and responsive, able to pivot quickly from one project or need to another. And, with only 2.6 FTE employees, when you call VNA you will never hear “using your touchtone pad, please enter the first three letters of the last name …” or wonder exactly which of the many staff members you should contact. Having a smaller staff also allows us to be health generalists, each knowing at least a little about every pressing health and healthcare access issue, and to foster—and depend on—an active and engaged board. Lastly, the growth of the internet has allowed us to overcome the main challenge to our smaller staff: limited feet on the ground. Websites and social media have helped smaller-staffed foundations like VNA be transparent and communicative—a mindset to which VNA is deeply committed and for which we have been awarded, eight times, the Wilmer Shields Rich Award for Excellence in Communications (a national award administered by the Council on Foundations, www.cof.org, and the Communications Network, www.comnetwork.org).
20. There is No Reward without Risk, but in this Instance That’s OK
In foundation grantmaking, as in many things in life, there is little reward without risk. Little progress can be made without taking chances on new ideas, novel approaches, and experimental programs. Luckily, though, private foundations like VNA are uniquely positioned to take risk. We don’t rely on contributions from individuals, government tax revenues or any other sources to which we are beholden. Therefore, after careful research, we can make a grant to a program that offers a promising new approach to an entrenched problem, even if it is wholly unproven. And whether that program succeeds or fails, we learn something. Thankfully we’ve had far more successes than failures, but every barrier our grantees have encountered, every wrong horse we’ve bet on, has informed our grantmaking and often resulted in sea changes in our thinking. In our opinion if a foundation is not experiencing some disappointments along with successes, it’s not doing its job. So, as we look back on our first twenty years and forward to our next twenty, you can be sure that some informed risk-taking is always in the picture.