How Texas Health Resources Foundation reconciles donor and health system goals to fund community partnerships

In 2018, THR Foundation received a request from system leaders to raise funds for a general community grantmaking fund. But there was a unique challenge: appointed Leadership Council members—not donors—would choose the grant recipients. THR Foundation was concerned that donors might not want others determining where their donations would ultimately be allocated.

THR Foundation chose to assess this hypothesis and provide an evidence-based recommendation to the health system. The foundation worked with a consultant to conduct 75 interviews with donors and other community leaders.

The assessment was valuable for two reasons:

1. It tested a hypothesis before expending unnecessary time and effort on fundraising. The assessment found that donors were not interested in a general community health fund. However, they would give to specific community health initiatives aligned with their personal philanthropic goals.
   
   
2. It built important relationships for the future. Through interviews, the philanthropy team met other foundations and community nonprofits that went on to become funders and programmatic partners.

The assessment enabled THR Foundation to recommend a research-driven strategy that satisfied both donors and the health system. THR Foundation advised the system to deploy a two-pronged approach to putting dollars into community health programs:

1. System-funded leadership councils are collections of stakeholders—including former board members, community leaders, and supported by community health improvement staff—organized around targeted ZIP codes within THR’s market. The councils identify local needs and related funding opportunities within these ZIP codes. Councils issue grants to external organizations aligned with THR’s goals. Those grants are funded by the health system, not donors.
   
   
2. Trajectory-changing projects are donor-funded initiatives that pilot specific, high-impact interventions. Unlike the leadership councils, where funds are awarded in a decentralized fashion, trajectory-changing projects occur when system goals, community health improvement needs, and donors’ interests align. These projects allow the health system to leverage its capabilities to improve population health in partnership with other community organizations.

Once THR Foundation determined how donors wanted to impact community health improvement, it was able to help identify and scope trajectory-changing projects. In addition to direct fundraising activities, there are three ways the foundation contributes to the design of these initiatives:

1. Identifying priorities: THR Foundation’s initial market assessment tested donor interest in various community health needs. The foundation identified areas in which health system goals overlapped with donor interest. One shared priority that emerged was housing insecurity.
   
   
2. Choosing programmatic partners: During its market assessment, THR Foundation built relationships with community organizations focused on addressing social determinants of health. These relationships are helpful for when the health system is recruiting partners for its community health improvement programs. For example, the foundation helped find two partner organizations for a pilot program focused on stable housing.
   
   
3. Scoping partnership roles: As the primary funder of their collaborative work, THR Foundation creates written agreements with its external partners. These agreements specify each partner’s programmatic role, how monies will be used, and data-sharing requirements that support ongoing donor stewardship.