Dan Palotta’s recently published book Uncharitable provides our society with one of the most compelling arguments for us to reconsider this entire “nonprofit” sector.

Mr. Palotta’s argument is  important as one contemplates creating innovation districts for teaching and learning environments.   The Ohio education bureaucracy by its nature, isolates itself from the nonprofit organizations, most of which do a superb job at providing quality child-care, quality after-school programming, quality mentoring programs and quality college counseling and psychological supports. Over and over again I hear how public school principals make it extremely difficult to link with these organizations offering services to the schools.  Union rules and regulations are such that these nonprofits cannot serve unless the schools have mentors who, must be paid.  In difficult economic times the nonprofits find it harder and harder to find the private dollars necessary to pay for these added budget items.  The schools do nothing to help.  In fairness, many of them cannot because they too are cash strapped. Meanwhile, the nonprofit workers at the schools earn a fraction of what teachers earn and oftentimes have no health insurance or retirement benefits. The whole system lacks any rationality.  It is done because that’s the way it worked forty and fifty years ago.  So the question to consider, ” is there not a way to reallocate the huge sums of state and federal monies that currently go to bloated administrative educational bureaucracies as outlined in the Brookings report I reference in a previous post?”

As a first step, Ohio must shift more K-12 dollars to classrooms. Ohio ranks 47th in the nation in the share of elementary and secondary education spending that goes to instruction and ninth in the share that goes to administration. More pointedly, Ohio’s share of spending on school district administration (rather than school administration such as principals) is 49 percent higher than the national average. It appears from projections in other states and from actual experience in Ohio that school district consolidation, or at the very least more aggressive shared services agreements between existing districts, could free up money for classrooms.

I think there is and here is where I find inspiration. The  Boys and Girls Clubs of Lorain County opened in city of Oberlin in March of 1999. The Club has provided programming in neighboring Elyria since 2004 beginning at Eastgate Elementary School and later expanded its programming to Wilkes Villa a crime ridden public housing project in Elyria, the Prospect School, and the East Recreation Center.  Elyria is a city that  typifies the economic depression in the “rust belt.”  The crime statistics and more importantly the social and economic strife make this one burgeoning mid-west town a case study of how we need to change the way we have always done things!   This area of Elyria has an unusually high number of children in single-family homes, large number of children with one or both parents incarcerated, one of the highest rates of households where grandparents are taking care of the children.  A study conducted by Dr.  Mark Singer at the Mandel School for Applied Social Sciences at Case Western Reserve University for the Nord Family Foundation in 2000 found that,  Elyria is one of three blighted urban cities in NE Ohio that has one of the highest rates of child-on-child (and mainly sibling violence) in NE Ohio due primarily to children in homes where parents are not at home because of work or other issues.

In 2005, the Nordson Corporation donated an old and unused assembly and distribution plant on the south side of town to the Boys and Girls clubs.  The Nordson Community Center  evolved with financial contributions from local foundations, including the Cleveland Cavaliers Foundation, the Community Foundation of Lorain County, the Stocker Foundation and the Nord Family Foundation.  An unused factory has become a thriving center for young people and their families. The Clubs have a simple goal which is  to assist youth members in developing skills and qualities to become responsible citizens and leaders.  The  primary programming focus addresses five (5) core program areas including character and leadership development, education and career development, health and life skills, the arts, and social recreation. A membership fee of just $5 per year allows youth to engage in hundreds of hours of safe, after-school activities.  This is part of what schools used to offer before the madness of testing morphed into the punitive system of assessment it now is.

The Nordson Community Center  is half complete and now offers a venue for classes, dramatic performances, celebrations, community meetings, health fairs, and much more.  The Nordson Center which used to be a dirty and decaying monument to the flight of manufacturing, now looks like this.

Energized from our community conversations about the medically uninsured (Blog post and the need to create medical homes), I introduced the B&G staff, as well as directors from the Lorain County Urban League to the Harlem Children s Zone model.  This innovative model, introduced by Geoffrey Canada, embraces the work of nonprofit and other social service organizations and incorporates them into the entire education of the child.  Drawing from this idea, our idea was to fill the extra space at the Nordson Community Center with medical check-up rooms.  Staffed with volunteers from the medical professions at the local hospitals rooms at the club could be used to address the physical and mental health issues faced by the youngsters and eventually their families.

The Boys and Girls Clubs staff met with the director and physicians at the nearby Elyria Metropolitan Hosptial (a charity hospital that looses about $8 million a year in uncompensated care because the poor use their emergency room as a portal to the health care system).  They have picked up the idea and already have a number of health care professionals ready to serve in the center.  At this writing the assistant superintendent of the Elyria Schools is endorsing the concept of expanding for-credit educational options to young people who attend the Clubs.  This could include online academic credit.  Additionally, the Lorain City Schools is also exploring the idea of linking physical and mental health programming in its schools as they plan for the construction of a new campus.

As the philanthropic community engages in serious discussion about integrating technology to the educational sector, it must give equal consideration to how the school systems can better integrate the hand-on and interpersonal work of the social and medical sector which are critically important to supporting families in severe economic crisis.  That is a very exciting charge for philanthropy.

The challenge for the educational sector will be how to make more effective use of the “nonprofit” sector which serves to enhance not compete with public education.  I discussed this in a post I wrote in 2008,     To do so, this sector will have to re-think its perception of the “nonprofit” sector as a group of “do-gooders” and more as business partners.  That too is an exciting challenge.

Realizing this dream however will require concerted effort on the State’s legislatures to reconsider they way they allocate federal funds through agencies such as mental health, drug and alcohol, juvenile justice and the like.  This is a major challenge for the State and Federal legislators to consider as philanthropy and nonprofits figure out ways to deliver services more efficiently and at lower cost.  Check out the attached video and listen carefully to Vivek Kundra.

“One of the biggest problems in the federal government is that process has trumped outcome. … the biggest reason is that everyone is focused on compliance and no one is thinking about innovation…”

The goals expressed in this video are already emerging with tremendous impact for nonprofit organizations. Check out ReadWriteWeb and see what the public sector can do with this tool!!

The Context – According to results from the 2008 Ohio Family Health Survey, there are an estimated 29,326 uninsured adults, age 18 to 64, in Lorain County.  This number represents 15.9% of adults in Lorain County, a statistically significant increase of 4.9% (9,160 persons) over 2004 figures.  Further, there are 2,723 uninsured children, under the age of 18.  This, however, represents 1% fewer uninsured children over 2004 figures.

The improvement in the rate among children is attributable in large part to the State Children’s Health Insurance Program (SCHIP) which provided insurance for children in families with incomes up to 250% of the federal poverty level.  In 2008, eligibility was increased from 200% of the federal poverty level.

Some of the characteristics of the adult uninsured population are as follows:

• Males were more likely to be uninsured than females.
• Younger adults have higher estimated uninsured rates than older adults.  In Lorain County, 34.1% of adults ages 18 to 24 were uninsured versus 8.4% of adults ages 45 to 64.
• Married couples have much higher health insurance rates than others.  In Lorain County, 32.4% of unmarried adults ages 18 to 64 were uninsured versus 4.8% of married adults.
• Adults ages 18 to 64 who are less educated are also less likely to have health insurance.  In Lorain County, those with a four-year college degree had an uninsured rate of 8.1% versus 47.6% for those with less than a high school diploma or equivalent.
• Differences in employment status are also related to insurance status.  In Lorain County, 7.8% of full-time workers were uninsured, compared to 19.9% of part-time workers and 29.4% of unemployed adults.
• In Lorain County, adults in households with income of at least twice the federal poverty level (FPL) had an uninsured rate of 8.5%. Those below poverty (less than 100% FPL) had an uninsured rate of 34.6%, and almost half (48.6%) of those with incomes between 101% and 150% FPL were uninsured.

The two primary hospital systems located in Lorain County are Community Health Partners Regional Medical Center and EMH Regional Healthcare System. Both systems do their share to provide care to those without coverage and/or the ability to pay.  In 2007, EMH provided approximately $17 million in charity care.  This was an increase of 15% over 2006, a 54% increase since 2004, and more than double 2001.  The same year, CHP provided $4.8 million in traditional charity care, and an additional $11.7 million in unpaid costs for Medicaid.

The Response – In 2008, The Nord Family Foundation contributed $129,000 to the Community Foundation of Greater Lorain County, to initiate HealthCare Lorain County.  These funds leveraged local grants allowing the group to contract with the Altarum Institute and the Public Services Institute of Lorain County Community College to facilitate a year-long community engagement and planning process aimed at improving access to health care for the uninsured in Lorain County.   The two contractors, guided by Robert Woods Johnson’s Communities in Charge, initiative  diagrammed stakeholders’ perspectives of the current and desired Lorain County health system, completed a local environmental scan, outlined key problems, and mapped provider resources.

Contributions from local funders included

• Community Foundation $33,000
• Stocker Foundation $25,000
• CareSource Foundation $20,000
• United Way of Lorain Co. $5,000

Participants – Approximately forty (40) community leaders, referred to as the Working Group, participated on this initiative at some level and are committed to addressing/improving the health care situation in Lorain County.  This Working Group was comprised of individuals from all aspects of the health care field (hospitals, health departments, mental health board, medical society, etc.), as well as state and local government, law enforcement, social services, local funders, faith-based organizations, and business representatives.   A Steering Committee of ten (10) members acted as a sort of Executive Committee and met when the Working Group did not – vetting data and information and taking suggestions back to the larger Working Group.  Between August 2007 and December 2009, the Working Group and the Steering Committee each met five times, under the guidance/facilitation of the consultants.

Goal – HealthCare Lorain County focused its efforts around providing access to Medical Homes for the uninsured.  In a medical home model, primary care clinicians and allied professionals provide conventional diagnostic and therapeutic services, as well as coordination of care for patients that require services not available in primary care settings. The goal is to provide a patient with a broad spectrum of care, both preventive and curative, over a period of time and to coordinate all of the care the patient receives.  This “Medical Home” decision was reached by the Steering Committee in June 2008 and presented to the Working Group in late July 2008 after much data analysis regarding the statistics of the uninsured in Lorain County, and the current rates/usage stats of the two main hospital systems.   Over the next several months the group reviewed examples of other communities’ successful solutions to the same problem Lorain County is facing and ways in which those communities adopted medical home models or something similar.  December 2009, the Committee recommitted to the long-term goal.

Status -

Charity Hospitals

Currently, Community Health Partners has started a very small Medical Home pilot program with the assistance of the Lorain County Free Clinic – both of whom served on the Steering Committee.  The two main hospitals, CHP and EMH, along with the Steering Committee Chair and two of the larger foundations funders, met in November 2009 to discuss how the two hospitals are prepared to commit to/expand on a full Medical Home program for the Lorain County community.  The most viable option for the two appeared to be the Toledo CareNet model which serves a triaging center to make sure the medically uninsured and under-insured have a human being ushering them to an appropriate care.  CareNet’s strength is in providing a continuum of care for the medically indigent requiring chronic care.  At this writing, the hospitals are reluctant to make a financial commitment to what could amount to a $300,000 operating budget for CareNet to function in Lorain County.  The foundations are continuing to meet with the hospital directors to determine why this is the case.

Public Health Departments –

In 2008, The Public Services Institute (PSI) of Lorain County Community College was contracted by the Lorain City public health department to initiate a strategic plan.  The plan was published in July 2008 with little discussion from the Health Care Lorain County group. The plan calls for a need for the three entities to “collaborate,” but fails address Health Care Lorain County’s call to explore consolidation of the three separate health districts into one.  PSI had engaged in low-level negotiations with the health departments to push the idea of merger forward in 2009.   In January 2010, Nord Family Foundation inquired about the PSI’s efforts and received the following response from the Elyria Public Health Director,

We have been unable for many reasons to meet with Lorain City. We have of course had financial reductions in grants and have laid  two positions and eliminated the well child program. We just received an 100,000 cut in the general fund from Elyria — and so are anticipating  other major changes within this year — because so much of our budget depends on grants and those grants are on a fed fiscal year, we have until June to complete whatever we  decided to do about consolidation of some of our remaining programs, etc. This has been — due to our early and constant involvement withH!N! — a very difficult and challenging year. The Board has worked and supported us — but we all know we need to come up with a new business plan that will fit our budget. Unfortunately at a time when our services are really needed on a lot of fronts, we are at risk! But the Board is still interested in some kind of collaboration with Lorain city. There has been no enthusiasm or cordiality on their part re. to invitations — but they are also under stress.

PSI’s message to Nord Family Foundation is,

You will notice the strategic priority regarding collaboration.  Honestly, unless someone funds a neutral convener and facilitator to take these two entities to the next level, I doubt much will happen until either Kathy (Elyria director)  and/or Terry (Lorain director) retire.  Both individuals have to be close to this point so the time is now.

As these conversations continue, the Nord Family Foundation awarded $297,000 in grants to unrelated health-delivery organization in Lorain County between 2008-2009.  The recipient organizations are: Community Health Partners Regional Foundation; Family Planning Services of Lorain County; The Lorain County Free Clinic; The Lorain County General Health District and the Lorain County Health and Dentistry.

Progress is being made in that the foundations continue to engage in conversations with the hospitals, the federally qualified health centers and the free clinic.  An ad hoc committee on the medically uninsured continues to meet regularly with focus on sustaining the Lorain County drug repository.  The Nord Family Foundation hosts those monthly meetings.

After more than a year of meetings, the following challenges remain:

1. There is a need to continue exploring this very complex issue of providing quality health-care to medically uninsured and underinsured people in the county.
2. There must be a new technology infrastructure put in place to facilitate data sharing.
3. There is a desire to provide every citizen a sense of a medical home.  People desire a relationship with a personal health care provider rather than an impersonal institution.
4. The community needs to explore open-source charts so every patient can have an online chart that will follow him or her to their port to the health care system. The Cleveland Clinic’s remarkable on-line health record called My Chart is a great example of what an electronic health portfolio for medically underinsured and uninsured could look like.
5. There is a need to examine how health dollars currently flow into the county.  There are tremendous inefficiencies and possible duplication of effort among  three distinct health departments (Elyria, Lorain City and Lorain County Health) which draw most of their funding from federal and state programs.  These departments which were established initially to address infectious disease in the earlier decades of the 20th Century, are not equipped to handle comprehensive chronic care that the majority of the population needs.  Competition from for-profit clinics such as Walgreens Take Care Clinic raises questions about the place of these health departments in a 21st century health care model.
6. The economic pressure necessitates collaboration between the two charitable hospitals and the Cleveland Clinic.
7. All eyes are on the negotiations with the impending federal health care legislation in Congress.

Lessons Learned -

The challenge for the Nord Family Foundation (or any foundation) deciding to take on a convening effort of this magnitude trustees must determine

• How visible a role you want the foundation to take
• have flexibility built into the expectations you have for the outcome
• know the level of risk you will tolerate (the outcome could result in stakeholders walking away from the table)
• determine how much staff time and money you are willing to put into the effort
• look for innovation from players outside the local cohort
• be willing to stick with it – conversations of this magnitude can take years but n the long run, the Medical Home is likely to result in savings to patients, employers, and health plans.  Increasing the emphasis on primary care could produce large dividends throughout our health care system

Compounding the problem is the fact that Innovation by its nature implies risk-taking.  Government entities (and some philanthropic institutions) tend to be risk averse.

I have struggled with the question how can philanthropy play a role in galvanizing the community around the idea of implementing zones where we can do something about the many glaring inefficiencies we see in our local governments.  I continue to be intrigued by Innovation Zones.  Some municipalities have introduced Innovation Zones but these are typically involve tax incentives between public and private entities to attract new businesses into towns.  The Innovation Zone I propose of are not to attract new business, but change the ineffective ‘business as usual approach to public management.  These Innovation Zones  engage the public, private, university and nonprofit sector in a zone (virtual and real) to demonstrate new collaborations that will result in cost savings and produce greater efficiencies in service delivery.  I hope that soon philanthropy will help to develop just one as a demonstration site that can be replicated in many other communities across the country.

I am going to attempt to answer for myself the following questions.  Anyone reading this blog is welcome to comment and perhaps provide answer I cannot see at this point.

• What is an innovation zone mean?
• How does one create and foster innovation zones?
• What is the goal of an innovation Zone?

Innovation is an approach to a problem.  Foundations and the nonprofits they serve, have a huge problem on their hands – an economic recession unlike any in recent memory. Philanthropic dollars no matter how large constitute a mere fraction of what it actually costs for non profit organizations to do business. Government monies in one form or another constitute the bulk of operations for schools, state agencies and the non-profits we work with each day.

The economic meltdown of 2008-2009 had a catastrophic effect on State budgets.  The Ohio 2009-2010 budget shows unprecedented cuts in social services and in education. A local school superintendent told his school board last night, “What hit Wall Street a few years ago, is only now beginning to hit us.  We are in a crisis.”  Even though the market seems to be making modest recovery, the government and nonprofit sectors are in a crisis that demands new and creative approaches to the way things have always been done.  The Cleveland Plain Dealer reported on a recent survey by the Business Volunteers Unlimited (BVU) that  revealed

… of 103 local nonprofits, conducted by Business Volunteers Unlimited and the Nonprofit Finance Fund, found that 36 percent reported ending the most recent fiscal year with an operating deficit, and 32 percent predicted a deficit for the current year. The survey represents a tiny slice of the thousands of nonprofits registered in Cuyahoga County.

To stay afloat, 34 percent of the nonprofits expect to dip into reserve funds this year. Thirty-one percent said they’ll freeze hires and salaries and 28 percent intend to reduce or eliminate programs.

In reaction to the budget crisis, nonprofits as well as government agencies now approach foundations with requests for funding that will serve as “stop-gap” funding to replace lost government dollars.  There is a presumption this money will be a temporary fix until things get better.  It is becoming quite evident that things will not get back to normal as state and local governments scramble to find new revenue sources through taxes.

The economist Jeffrey W. Sachs has an article in the October 2009 issue of Scientific American addressing The Crisis of Public Management.  The rider to the title states, “Nothing less than an overhaul of the systems that implement federal policies will suffice.”  Sachs cites a litany of government “failures” including the lack of coordinated intelligence prior to the 9/11 attacks, the Hurricane Katrina debacle, the U.S. occupation of Iraq as well as, “Government regulatory agencies (that) completely dropped the ball while overseeing the surge of dangerous financial instruments that underpinned the reckless lending that eventually burst in the Great Crash of 2008.  Mr. Sachs suggests,

“we need a better scientific understanding of these pervasive system failures.  Other nations’ governments more successfully manage infrastructure investments, health systems and environmental resources, apparently with greater flexibility, less corruption, lower costs and better outcomes…

…today’s challenges cut across specialties and institutional divisions.  In health care and energy for example, the private sector holds the key technologies, but only the public sector can finance R&D, regulate sustainable practices, and ensure access for the poor to resources and services.”

Although I agree with Mr. Sachs,  I worry that he overestimates the virtue of the government designated to oversee the R&D and regulatory abilities.  Cleveland has been witness to an unfolding drama of government corruption which involves sordid greed mongering among elected officials and business people.  I would hope that his definition of the public sector would go beyond elected officials. The inspiration is there, but the challenge for those of us in philanthropy and the non profit sector is how to make efficiencies happen in the communities where we live.

In my experience I often hear of cases where politics gets in the way of creative solutions to budgetary problems.  Recently, I spoke with two mayors who said that the county could save more than $1 million dollars a year in tax dollars by rationalizing a 911 dispatch service to route emergency calls directly to  the police and emergency departments in each city, rather than routed through a county managed dispatching agency.  The county administration is reluctant to give up budgetary control of the centralized system.   Giving up control would mean downsizing jobs often involving friends or political supporters.  Budgetary transparency is not the norm in this county.

I would argue that the greatest success with public officials is secured when one can demonstrate success. The best models have a solid financial model with demonstrable buy-in from a community that understands what the model is trying to achieve.

Unfortunately, nonprofits and government agencies have never had the funds or the idea to invest monies into developing such models and prototypes.  Government certainly does not have the funds to conduct this type of R&D modeling.  Philanthropy can be the only source for funding prototypes that will simulate new ways of doing business.   Most nonprofit and agency directors complain about the budgetary constraints and negative effects on their services.  In the next breath however, they can also provide suggestions on how the process could be improved .  Few have ever had the time or opportunity to participate in modeling solutions in virtual or real worlds.  In a web 1.0 world problems are addressed by in-gatherings of the interested and concerned.  Consultants are called to help map solutions that are translated into paper reports that rarely effect significant change to the problems at hand.  Even fewer result in any meaningful legislative change.

For years now, businesses have made effective use of web-based tools to prototype and/or simulate changes in product design and/or management that yield great greater value for the company and increase the bottom line.  The auto industry moved from using clay to prototype the automobile to three-dimensional virtual environments, the financial industry moved from pen and paper to spread sheets, and think of the innovation that has taken place in increasing knowledge and understanding in physics, biology, chemistry and astronomy by use of virtual simulation environments.  It is only the social sciences that have left this magnificent tool untapped and with the result being a woefully inefficient and overly expensive public system. In his book Serious Play, How the World’s Best Companies Simulate to Innovate author Michael Schrage, of the MIT Media Lab says, “The conventional interpretation – in science, academia, and businesses alike – is that we build ‘virtual worlds’ to better understand the problem to be solved of the opportunity to be exploited.  This is accurate without being true.  It fails to recognize where the bulk of the value may actually be realized.  The real reason we need to build and seriously play with prototypes is to get a better understanding of ourselves and our priorities.”

The current budgetary crisis places increase obligation on both the public and philanthropic sector to make better use of  the myriad of modeling tools that can positively apply to the public sector.  Simulating new ways of delivering public services and provide local, State and the Federal government with new models for finding efficiencies in service delivery and cost-savings to the tax payer.

Better and more effective use of web-based technologies and even gaming programs make that prototyping not only possible but quite feasible.  Regulating the number of “players” can allow an entity to not only guarantee transparency, but create several prototyping “teams” to come up with a variety of solutions to the same problems.  Philanthropy can serve an important role by providing some of the early-stage funding to trip-start these games for the public.  Philanthropy can also ask questions that are often difficult for government officials to ask and hard for invested parties to answer honestly. Question like: In this day and age do we really need 14 separate school districts, each with its own superintendent, curriculum director and top-heavy administration to deliver effective education in this community of 280,000 people?  Do we really need to have three separate fire departments in a geographic radius of five square miles?

Philanthropy can not only provide early financing, it can help find the partners.  To begin, you need a place to build the virtual world.  Typcially a university-based system will be a good start.  For example the New Media Consortium would provide an instant web of any number of computer gamers who would jump all over the opportunity to create a project of this scope.  In Cleveland, OneCommunity and its Knight Center provides a perfect platform to convene the public to initiate engagement in the modeling process.  Philanthropy can easily convene any number of constituents from a variety of sectors.

Innovation zones are an area where philanthropy and the public sector can explore new ways of doing business. Communities can begin to ask questions they were unable or unwilling to ask before.  The right tools will enable the community to model various alternatives and develop budgets that will demonstrate the feasibility of alternative ways of doing business.  Ultimately an innovation zone should have as its goal new models of doing public management that produce cost savings and greater efficiencies.

One of the most exciting models of this approach to better government can be found in Cleveland with the Fund for Our Economic Future and Advance Northeast Ohio’s introduction of Efficient Government.  A brief description from their website explains the idea:

The Fund for Our Economic Future, a collaborative effort to strengthen regional economic competitiveness in Northeast Ohio, has announced a new competitive awards program, EfficientGovNow.

Under the program, local governments in the region are encouraged to submit government collaboration and efficiency proposals to the Fund, which will provide a total of $300,000 to as many as three projects. Project proposals will be posted online for public review, and the residents of Northeast Ohio will ultimately select which of the collaboration projects will receive funding.

The name EfficientGovNow was chosen because it explicitly tells elected officials and the public the purpose of the program.

“The Fund wants to support government collaboration efforts that will result in more efficient government now,” said Brad Whitehead, president, Fund for Our Economic Future. “The EfficientGovNow program isn’t for studies or planning. The public is eager to see greater government collaboration and this program is designed to encourage such efforts.”

Throughout the region, numerous government entities have increased governmental collaboration and efficiency. Projects like shared fire halls or combined city-county buildings, shared school superintendents, shared emergency dispatch services, and other such collaborations are gaining momentum. The Fund sees this program as a means to accelerate more collaboration, added Whitehead.

Efficient Government project demonstrates not only a wiliness on the part of the public to meet the challenge to find more effective ways of doing business but, by a creative use of the public radio, created a competition among cities and invited the public to judge the merits of each city’s proposal to create a more efficient system

An Innovation Zone takes Efficient Governments use of both competition and fun a step further. If it makes use of virtual environments readily available, a citizens from communities across NE Ohio can develop a prototype of their proposal in a simulated virtual environment and not only study, but test the budgetary theories in that environment.  The first level of an Innovation Zones in a virtual environment can test civic-based prototyping for new ways of addressing the civic needs in community.  If it works, those citizens can petition their legislators  to establish a real-life Innovation Zone having demonstrated how the model can work.  A virtual prototype may serve to convince the most risk-adverse legislator to approve the application.

In Serious Play – How the World’s Best Companies Simulate to Innovate, Michael Schrage writes:

Innovation requires improvisation.  It means innovation is not about rigorously following the “rule of the game” but about rigorously challenging and revising them.” Schrage says that his book, “is a journey from ethnography to ethology, from describing cultures of prototyping and simulations to the behaviors of people who build and use models together.

Written more than ten-years ago, the book holds relevance to how technological developments can re-form the way humans behave when given the change to apply them to their tasks.  Two chapters trace the way the invention of the spreadsheet transformed the way people not only conducted business but spawned ways of trading money, stocks and mortgages which were unimaginable prior to the invention of this rather simple application.

The story of the financial innovations and financial engineering that transformed the business landscape of the 1980’s is written in the cells of spreadsheet software.  Every major deal was touched by this technology. From Michael Milken’s high-yield “junk-bond” financing  to Kohlberg Kravis Robert’s leveraged buyouts to the global explosion of “synthetic securities,” spreadsheets functioning as the computational catalysts accelerating the intensifying the dynamics of deal making, Venture capitalist, investment bankers and mutual-fund managers enthusiastically embraced them for their ease and power.

Spreadsheet software enabled organizations to ask themselves questions they had never been able to ask before.  And the same spreadsheets could be used to help answer those questions.

In the ten-years since this book was written there has been an explosion of many types of technological tools that – if put into the appropriate ‘teams” of workers challenged with  prototyping applications of these tools to the government – there is high probability that new value can be brought to the challenges that plague our state and city administrations. The same could be said for schools and school districts.

The Orton Family Foundation has developed a fascinating program called CommunityViz™ which allows many players to simulate community land-use issues.  With modest adaptations, CommunityViz could likely have many other applications that could simulate alternative public management systems.  Other games such as SimCity are commercial applications of gaming options for community involvement with more exciting graphic interface.

An innovation district could start as a virtual world, as a means of testing various options for planning.  Teams could compete for to prove the greatest cost-saving.  Once devised, the foundations, and collaborating government officials could petition to legislature to declare a government “innovation zone” that would impose a moratorium on the “old way” of distributing state and federal funds to nonprofit and government agencies, and allowing for better distribution of funds.

Let’s use the example of the 911 emergency call number referenced above.  Suppose the cities of Lorain and Elyria, along with the County Administrator could simulate a more efficient use of 911.  The system could be simulated and an attached budget sheet could test the hypothesis that $1 million could be saved each year.  A team would include parties from the police departments, EMT’s as well as dispatchers and so called friends who are involved in the project.  The mayors and several citizens would be appointed to sit on a panel to judge the modeling strategies.  In a simulated environment a team could test the model over a five and ten year period.   As in the case of spreadsheets, the modeling could allow city managers to ask themselves questions they had never been able to ask before and the games could provide answers to those questions.

In the midst of a terrible budgetary crisis in public education, foundations have asked the question, “Why in a county of 280,000 people do we need 14 separate school districts each with its own superintendent, curriculum director and host of highly-paid administrators?”  “What does this antiquated managerial system cost the taxpayer?” and finally, “With communication technology the way it is, can there not be a more efficient way to manage schools across the county?’ The reaction is general discomfort at best because everyone asks the same questions but few are brave enough to ask it openly.  Fewer still have any expectation that “the public school system” would change.   In an innovative zone, one could simulate the 14 districts and empower a couple of civic teams to model new ways of dealing with the issue and see what savings could result to the State educational budget.  The simulation could factor in successful charter and non-profit schools and factor in their costs and outcomes into the model.  The team that wins the prize could be rewarded with a civic engineer award with a dollar amount established by one or a group of foundations who have an interest in finding more efficient use of public dollars.

Once the “game” is proven, the legislature could provide an official designation of Innovation Zone which would enable the community to have voice in allocating the state and federal dollars.  Philanthropy could have a better sense of where it’s dollars could yield higher impact in the equation.

I can submit one final example.  Lorain Count has two tertiary-care charity hospitals and three separate public health systems: one for the City of Lorain, one for the City of Elyria and yet another for the County areas not in the Lorain or Elyria city limits.  These administrations were established at the turn of the century when the cities were more densely populated and when the primary public health challenge was prevention and management of infectious diseases.  Today, most primary health care clinics and an ever growing pharmacopoeia can treat infectious diseases.

These expensive administrative institutions serve as distribution depots to Federal and State funds that try to deal with what amounts to chronic diseases.  They were never set up for that problem and as a result are not the most efficient means of addressing that public health challenge.  In a previous blog post, I discussed a grant in which our foundation convened more than 35 citizens who were engaged in some level or another in health care delivery in the county.  Participants included physicians from the charity hospitals, directors of the Drug and Alcohol and Addition Boards, the board of Mental Health, the free clinic as well as the local public health agencies.  Each of these people would happily take part in modeling a new way of doing business. They realize that the way things are now will only exacerbate a dismal state of health care in the county.

Innovation zones are really a means for a public entity to provide the platform for greater citizen engagements.  If you listen to Michael Schrage’s comment on Innovation and shift the mental framework from his discussion of business to government, you can imagine how innovation can shift the way citizens (customers) engage with their public institutions.

Philanthropy can play an important role in stimulating this level of civic engagement.  I welcome thoughts or examples from colleagues.

I was a member of the education task force for the Ohio Grantmakers Forum which produced a set of recommendations for changing education in the State of Ohio for the Governor and legislature.  Beyond Tinkering was the report and I have written about the effort in previous posts.  The full document can be found at.  www.ohiograntmakers.org

One of the most satisfying results of the effort was gathering information from colleagues from other foundations to push the idea of innovation districts.  We used legislation out of Colorado as the inspiration.  The call for creating innovation districts in Ohio is the first recommendation in the report.  When the report was published, I did not think the Governor or the legislature would seriously consider the idea of innovation districts. It had certainly hoped it would and my colleagues can attest to the fact that I pushed for it every meeting we had.   It appears however that both the Ohio House and Senate are intrigued by the idea and have written it into the education budget.  It has to go to conference and perhaps will actually become a reality.  Should that happen, the state has opened up an exciting opportunity for transforming education and establishing national models.

Among the many excellent recommendations in the report, several have particular relevance to legislators who are genuinely interested in transforming education in the state. The idea of creating innovation districts has all the potential  to develop budget-neutral programs that could serve as models for all districts in the state. In a time of budgetary constraint, it is my guess that if they are developed carefully, and with strong leadership from the top offices in the state, innovation districts could result in cost-savings over time.

I underscore the call to create innovation districts rather than schools.  There are many school-based programs spearheaded by exceptionally creative teachers.  Unfortunately, these programs are restricted too often to one classroom.  In some cases, we see school buildings implementing innovative use of technology to support learning, but it is once again,  more often-than-not these innovations lack any alignment with the other buildings in the same district. In my travels I have heard disturbing news that successful schools are often scorned by peers in their districts.  I had the great pleasure to explore the  Macomb Academy in Michigan.  The leadership there has implemented a highly successful approach to learning with emphasis on Sciences based on the approaches advocated by the Natural Learning Institute. Despite the demonsrable success, Macomb teachers and leaders are resented by peers in their district because they have developed their own method of teaching and assessment that diverges from the norm.

I bring up this case because  a. it is not the first time I have heard cases of professional jealousy of this type crippling innovation in schools and b. because I think it illustrates a reason why we need to stop creating innovation schools as isolated entities within districts that may or may not be on board.  The emphasis must be on the district as a whole.  An innovation district would focus efforts on an entire community, and put benchmarks in place that could measure success.  Foundations could be called upon to help support these districts and direct funding to the support positive outcomes to the benchmarks put into place.

An innovation district would focus efforts on an entire community, and put benchmarks in place that could measure success.  Foundations could be called upon to help support these districts and direct funding to the support positive outcomes to the benchmarks put into place.

The language in the OGF Byond Tinkering report is very clear.  It calls for, “A bold plan for accelerating the pace of innovation – for restructuring the traditional industrial model of teaching and learning and for addressing the lowest-performing schools in our state.”  That includes a recommendation to create innovation districts. I purposely put emphasis on districts and not innovation schools.  Further in the report, is the call to “Develop a statewide P-16 education technology plan.” “Which includes improving teacher capacity in using technology.”  What better way to set this off than a district whose mission and focus would be to develop a plan that will train teachers on appropriate use of technology to meet the student learning objectives.

These recommendations are the primary ingredients for developing districts which – if properly carried out – could serve as a model for public schools across the country. The leadership would have to have the political will to take on the political battles which will be waged by interest groups.  It would prove the political leadership is finally willing to move Beyond Tinkering and transform learning opportunities.  Set the bar high and challenge these districts to carry out the plans in a budget-neutral environment and it is my guess most administrators and teachers would meet that challenge.   Ideally there would be five or more districts set up and given a five to ten-year exoneration from current collective bargaining and technological rules that could thwart the overall effort. For example, teachers in the district would not be able to “opt out” of professional development programs that would be essential to creating the districts.  If teachers do not want to participate fully in the learning opportunity they can be ushered to other districts or find employment elsewhere. That is where extreme leadership is required from multiple stakeholders in the state including union leadership, superintendents the ODE, the Oho Federation of Teachers and the Ohio School Board.  Getting them to agree means providing a coherent vision and establishing certain benchmarks to measure quality improvement.

The objective would be to create districts focused on excellence in learning. We are speaking of a new understanding of learning from pre-conceived ideas.  That means educating the stakeholders to the remarkable opportunities that new technology provides.  I had the privilege of attending a presentation by Helen Parke, Director of the Cisco Learning Institute.  During the Sunday evening keynote, Ms. Park presented a vision of education technology to a group of K-6 math teachers from across the state of Ohio.  This was a vision of Web 3.0 solutions to problems.  The conference continued for two days with the task of finding solutions to the challenge of improving the quality of math teaching in schools across the country.  Teachers were treated to presentation from education “experts” from universities across the country. As the weekeind went on however, teachers were challenged with coming up with solutions to the problem – To improve Math scores in schools across the state.  Unfortunately, the so-called solutions called for more funding to provide “math coaches” in buildings across the districts.  It was as if the presentaion from Ciso never happened.  Teachers were unable to make the connection between 3.0 software and its potential to solve their problems.  In short, we had 1.0 solutions to problems in a world where 3.0 can provide easy answers.  The experience convinced me that a better job needs to be done to invite teachers to experience and understand the technology.  Short of that, they will never understand the potential these technologies hold.  Professional development needs a complete 360 evaluation and (I would guess) a complete overhaul.

In such these innovation districts, a district adults would learn as well as  the students.. Teachers would be respected as the professionals they are, and encouraged to work with administrators and technologists to find ways in which technology can be used to find solutions to issues like student-centered learining, new ways of assessment and rethinking the way we establish standards.  Teachers would be encouraged th think of new ways to help children understand the content.

In these districts, goal would be to use technology to support student engagement and understanding of the content. Technology cannot and should not be expected to replace  learning that takes place between and among human beings.  It is not to create innovation for the sake of innovation, but to establish a culture of learning that will likely change the current model of one-teacher in a room in front of twenty students each of whom is expected to pass a testing pattern based on a pre-established set of standards.  Technology presents students and teachers with new ways to gather, assemble and demonstrate knowledge that exposes the shortcomings in the current system of assessment.  A challenge for the district would be to allow teachers in shared learning communities, to develop meaningful systems of assessment that make use of the tools available.  The result could be an incarnation of the “student-centered” learning module that has gotten a lot of lip service with few demonstrable models.

A major challenge to the district leadership would be to demonstrate reasonable cost savings as a resulting from use of social software. (For example why would five districts each need a “curriculum director” when one could possibly suffice. Could each of these districts demonstrate effective use of open-source tools to reduce the cost to the district (approximately $800 per student for textbooks used only one-year).

A district-wide initiative across the state would require an entities that supports the multi-district application.  I suggest that a good model can be found in a November 2008 article in the Harvard Business Review by authors James Cash, Jr., Michael J. Earl, and Robert Morrison.  Teaming Up to Crack Innovation Enterprise Integration is written for the business growth with focus on CEO’s, Chief Information Officers (CIO’s) and IT organizations.  The model easily adapts to a State education bureaucracy and includes two elements that would be critical to the success of the Innovation districts.  Their thesis is relatively straightforward.  Here is how they summarize the concept:

• IT has long been a catalyst of business innovation and essential to cross-functional integration efforts, but few large companies have systematically leveraged technology for these purposes.
• Close study of 24 U.S. and European businesses reveals a model for systematically doing that that through the formation of two IT-intensive groups for coordinating these two processes that are critical to organic growth
• A distributive innovation group (DIG) combines a company’s own innovative efforts with the best of external technology to create new business variations.  The enterprise innovation group (EIG) folds yesterday’s new variations into the operating model of the enterprise.
• The two groups help better identity, coordinate, and prioritize the most-promising projects and spread technology tools, and best practices.

An effective DIG and EIG could be set up within an office within the Ohio Department of Education but that is likely to be too insular and protective.  My suggestion is that  an outside agency such as the Cisco Learning Initiative or the OneCommunity in Cleveland could be a better locus for the activity.  I say that only because a good innovation district would want to gather ideas from both public and non-public schools.  Foundations could provide a service by funding the costs of the DIG and EIG officers for the course of the five-year period.   Paying salary and benefits for a year is well within ambit of  funding levels tolerated by foundations, even in this challenging economic environment.  Additionally, outside funding could guarantee that the data gathered is open to all who may want to benefit from it.    So, if we imaging these two offices set up to serve the five-districts their scope of work could be defined pretty much by what is presented by the HBS authors.   This is what they would recommend including my insertions between parentheses:

A distributed innovation group (DIG) … doesn’t “do” innovation but rather fosters and challenges  it.  Innovation is an inherently distributed activity, encompassing innovators across and outside the corporation ( ‘districts’).  The DIG serves as the center of expertise for innovation techniques, scouts for new developments outside the company ( ‘district’) and provides experst for internal innovation initiatives.  And it deploys technologies and methods that facilitated collaboration and innovation.

An enterprise integration group (EIG) is dedicated to the horizontal integration of the corporation (‘districts)’ and among the buildings w/in the district).  It picks from among competing integration projects and provides resources that enable them to succeed.  It develops the architecture and management practices that make business (educational) integration easier over time..  It may also manage of portfolio of integration activities and initiatives;  serve as the corporation’s ( ‘district‘) center of expertise in process improvement,  large project management,  and program and portfolio (curricular) management; and provide staff and possibly leaders for mager business (school) integration initiatives.

The money for this undertaking could be secured from private  sources but in the longer term, funds are likely to be found with more efficient use of funds that currently feed the Educational Service Centers across the state.  Another foundation or group of foundations can and/or should coordinate with the ODE and hire a group like the RAND Education corporation to conduct a complete evaluation of the efficacy of professional development in the state and the role of the Education Service Centers in light of this new initiative.   I would imagine their is opportunity for a vast overhaul of the administrative function of the ESC’(s) across the state.

Technology should not be focused only on the curricular components of the project.  Innovative approaches to addressing the social service supports need to be integrated into the process.  Social services as well as primary health and mental health programs must be brought to the schools in new ways.  Achieving this goals will require new ways of working the the multiple state and nonprofit agencies that provide support to families in some of the more impoverished districts.  Why can’t mental health and primary health screening programs be place right in school buildings.  School buildings can be a logical catchment for families who will bring their children to schools.  It is essential that innovation districts consider new ways in which social support services can be ushered into the schools. It is common knowledge that too many teachers are expected to teach children who do not have access to essential primary health care or mental health services. A local physician our foundation has supported conducted a study in a Lorain City elementary school and found that more than 25% of the children suffered from chronic asthma which accounted for about 40% of the absences from school. Children that suffer from undiagnosed chronic illness cannot be expected to learn. If a child is not feeling well, no increase in mentoring, after-school programs or mandatory extended days will enhance learning. Currently State programs for help these youngsters are funneled through a variety of public entities and/or nonprofit organizations but few of these entities (if any) have a presence in the school buildings. State regulations and sometimes collective bargaining rules keep these services from being performed in the building.

I would propose that a Ohio Innovation district(s) would lift all restrictions that keep essential social services out of schools thereby creating a place where schools can be a center for families rather than just students. The Harlem Childrens Zone serves as an interesting model. Getting there would be a process – probably six-months to a year, where health officials (public and private providers), school board members, teacher and administrators would form a task force to articulate a plan of how these services would be made available for each school. The plans would be posted on an open site and other districts could have input. The plans would be compared and funneled to the DIG. A goal for each plan would be to demonstrate where the plan could result in cost savings to the entire community served by this new Innovation district.

A third and final goal would be to create a place where leaders from higher education meet regularly with leaders and teachers from K-12 to ensure that the two areas are seamless. Almost every educator I speak with agrees that in the United States, there is virtually no formal communication between K-12 and “higher-Ed.” The technology available to citizens of this country is making that disjuncture a serious threat to the goal we have to create and educational system that will set the stage for young people to succeed in college and beyond.

Take a look at two Youtube video’s by Dr. Richard Miller from Rutgers University. He provides a vision for what university/college teaching will look like in the not too distant future. Although geared to an audience in higher education, his vision casts shadows on the K-12 environment.  He talks about transforming pedagogy and even learning spaces. If this vision is even remotely true, the question facing K-12 teachers across Ohio are preparing children for this future?

It is time for some state or group of state to introduce the idea of innovation districts to create  a space where innovation can combine with tried and true best practices and create new approaches to learning that can be brought to scale and save money.

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.

Your decisions will be informed by written analysis provided by competent program officers who have conducted all the “due diligence” on the organizations making sure the administration is solid, that the board is contributing to the operational expenses and that the financials are in order.

The meeting begins and you are informed that due to the economic collapse, the money you have to give out is reduced from $1 million this quarter, to a mere $350,000. You know that some of these organizations and the great programs they deliver will receive much less funding from you than in prior years. Other organizations will not likely survive because your past grants gave a credibility to them that enabled them to leverage funds from other foundations and some governments.

Included on the list are: The Second Harvest Food Bank (read their intro page)

Also, there  are several requests to support alternatives to failing public schools like those described in my favorite HBO series The Wire.

Given the crisis in education in public schools and knowing that each year thousands of  young people are lost, do you consider the request from  schools like those of the  Cristo-Rey network that are transforming the lives of children and families in inner city neighborhoods.   These schools like other faith-based receive no State support and will not survive without private individuals and  foundation support.  The total requested from four of these schools is $125,000.

In the Health and Social Services areas, there is  a request from  Providence House that provides a shelter for homeless women and their infants. They need a new roof on the building which costs $150,000.

Then there is the Youth Arts Program for schools.  Without the support of the foundation they will have to cut their artist in residency programs in schools.  Children in seven targeted  public schools will NOT get any exposure to art curriculum unless they get at least $50,000.

There is the Free Clinic, serving the needs of the ever-expanding number of medically uninsured and underinsured.   They have asked for $50,000 to assist with a pharmacy respository that will provide desparately needed medicines to those in need, especially the alarming number of uninsured patients with clinical mental illness.

Their counterpart, the Federally Funded Community Health Center lost out on a $700,000 federal grant they hoped to secure and must now ask for $250,000 to help them get through a cash flow challenge.

There are many other worthy organizations on the list.

So, how do you make your decisions?

Direct all money to the Second Harvest Food Bank that will provide another six months of food to hungry families? What about that great faith-based schools which over the past ten years accepted children from failing public schools and in one year provides remediation that gets them to grade-level reading and math. Ninety-eight percent of their children go to college whereas their friends who remain in the public schools drop out or fail to graduate and never get to college.

Do you direct all money to the free clincs to help the unisured.  What happens next year when they ask again but at increased levels?

Trustees at the foundation I work with will be faced with very similar situations when we meet. This will not be the first time difficult decisions are to be made, but the current economic climate has made it even more difficult.

Family foundations function under a  set of rules established by the Federal government and the Internal Revenue Service.  The States Attorney General has the duty to make sure the charitable institutions are registered and that they are complying with the federal regulations.  The State Attorney General has the power to revoke the charitable status of an organization.  If you are interested in the federal rules and regulations on foundations and nonprofits Marion Freemont-Smith’s book, Governing Nonprofit Organizations: Federal and State Law and Regulation,is by far the most comprehensive.

Briefly, the  government allows families of wealth to establish foundations as charitable entities .  Instead of going to the government as taxes, this money is invested in with managers and typically include a mixed portfolio that inclues equities (stocks) and fixed income (bonds).  Whereas taxes would collect the dollars and direct them to general funds for immediate needs, foundation dollars are invested with the hope that they would earn between 10 and 17% interest on the principal.  Rather than congressional representatives appropriating laws that will spend tax dollars, family foundations are overseen by  citizens who serve as stewards of these funds.  They are charged with allocating those funds, just as congressional representatives approve laws that allocate funds for many projects, including bridges to nowhere

The IRS is very specific about how these foundation funds must be directed.  For the most part only agencies that IRS determines to be charitable entieis are eligible recipients of foundation dollars.  There are exceptions for individuals but in all cases, the funds must be used for charitable purposed or to benefit the community at large.

As stewards the trustees must abide by the government rule that requires of minimum of 5% of the interest earnings on the endowment must be “paid-out” for the benefit of the community.  So, a family foundation with $100 million dollars must pay out an  minimum of $5 million year on a rolling average of three years.   Ninety-nine and 44/100% of family foundations I know take their job VERY seriously.  Distributing $5 million responsibly to worthy institutions is a complicated endeavor.  Doing it well requires time, research analysis.  There are a few stories of foolish and/or ignorant foundation trustees that misappropriated funds for their own enrichment.  The press loved those stories which resulted in an expensive and public witch hunt against foundations and people of wealth headed by a federal bureaucrat named Dean Zerby serving as  Sancho Panza to the quixotic and self-aggrandizing  Sen. Chuck Grassley.  Fortunately most legislators have realized the value philanthropy plays in this country and the punitive legislative responses by Sen. Grassley have subsided for the moment.

One useful way to understand how philanthropic decisions can be made by trustees of family foundations or by individuals for that matter is the Philanthropy Toolbox which I believe was developed out the Center on Philanthropy at University of Indiana.   The toolbox is really a spectrum of philanthropy that categorizes types of philanthropic giving.  I used the following slide show to demonstrate the types of giving.

Philanthropy Toolbox

The categories serve as headers and we “plot” all grant requests under each of the categories to get a sense of where the family is directing its giving.   This exercise allows the trustees to see where they have concentrated their giving over periods of time.  Of the organizations I described above, think of where you would place them among the categories within the toolbox.  The try to determine which request and category on the spectrum would give one organization priority over another.  Now you have entered the world of a family foundation trustee.

All the requests that come to the trustees for consideration are organizations that are doing great work and having positive impact on the lives of people they serve.   Decisions as to where to allocate funds and why can be personal and vary from one individual to another.  What makes foundations exciting places to work is that each person shares his or or reason for making the decisions they do.  the others listen to their points . Some agree and some don’t.  Debate is likely to ensue.  At the end of the meetings decisions are arrived not by secret ballot but by consensus.  On other occasions, I have described board meetings to be similar to deliberations by congressional delegations either federal or state.  Trustees are usually people of varying backgrounds and even level of wealth.  They range on the political spectrum and have deeply held passions.  Representatives from one generation often have points of view and interests that differ from their parents; so in many ways their portraits reflect the diversity of opinion, character and even race that one sees among citizens serving in elected office.  The image of foundation trustees as a homogeneous club of bow-ties and boiled wool is simply not true.  It is a miniature version of any civic organization gathered to enhance the common good.

The economic crisis is placing pressure on State, Federal and local governments budgets that have not been seen since the early 20th Century.  Scarce resources may place pressure on family foundations in the cross-hairs of government and question whether they and their endowments should continue to exist.  This is a challenging question that was discussed recently at a conference at the National Center for Family Philanthropy.  One of the sessions addressed the role of family philanthropy in a democratic society.  It is worth listening to the panel moderated by my colleague Lance Lindblom, Director of the Nathan Cummings Foundation.

If you were to be part of the decisionmaking on the board, you would be reminded that the Federal government requires a minimum payout of 5%.  You and board could make a decision to pay well beyond the 5% minimum to meet the needs of the community in times of economic distress.  Of course one would need to balance generosity with prudence.  Anyone who creates a foundation must be an optimist by nature.  Doing so assumes that a carefully managed endowment will grow and will remain as an asset to draw upon to help those in need and, at times, support innovative and creative programs that challenge the status quo.  The two brothers Eric and Evan Nord who established the Nord Family Foundation were men of profound optimism and faith in the community.  They were known to say on many occasions, when the times are difficult the foundation has a responsibility to make sure it does not cut back on grantmaking, but be extra careful about directing funds that will have the greatest impact on the community.  Most importantly, the funding should challenge the larger community to give what they can – personal giving – that will help their neighbors.  With that in mind, I anticipate some of our grantmaking in the future will be challenge grants that will require others to give of themselves in either money or time.

Your decision to choose one group over the other is neither right nor wrong. Just the fact you bothered to read this far into the blog reflects your own interest in philanthropy and giving. Your thoughts of giving to benefit the lives of others honors not only those you consider, but yourself.  I leave you with a quote by Thomas Jefferson

The good opinion of mankind, like the lever of Archimedes, with the given fulcrum, moves the world.

]]> http://www.thecivicfabric.org/2009/01/17/family-philanthropy-how-to-respond-in-the-economic-downturn/feed/ 0 http://www.thecivicfabric.org/2008/12/15/foundations-as-convenors-for-civic-discussion-another-case-study/ http://www.thecivicfabric.org/2008/12/15/foundations-as-convenors-for-civic-discussion-another-case-study/#comments Tue, 16 Dec 2008 03:30:55 +0000 John http://www.thecivicfabric.org/?p=165 It is becoming common for foundations  to serve an important function in the communities they operate.  That function is convening “stakeholders” or “community leaders” to discuss issues and in particular  – thorny issues.  They can do this for several reasons.  As funders of nonprofits, they have an interest in collaborating with colleagues who may need an audience to advocate with government officials and other stakeholders for the populations they serve.  The nonprofits typically are recipents of government funds and, as such, are players in a larger network of fiscal exchange that include private and “public” dollars.  (I define public dollars as those raised through taxes).  City and/or state agencies distribute these tax dollars to nonprofit collaborators tying them to the cohort involved.

The “thorniness” arise when discussion opens to critique the way in which the various iterations of public dollars flow and exchange among the entities.  Too often critique is mistaken for criticism and agency directors can revert to defensive postures.   This is particularly true when entrenched entities and the ways  they doing business are suddenly open to public scrutiny.

Business leaders  have an interest in the communities served by nonprofits by dint of living in the same community but also having a direct or indirect financial investment in that community.  The private sector may sneer at the way government entities function.  We suggest that it is healthier for the community to bring that critique to a common ground rather than lob salvos at an agency that might raise and individuals ire.

Foundations play a unique role in this civic environment.  If they call the meeting most people will come.  There is the power of money and the high probability that good food will be part of the deal  inevitably an incentive for people to attend the meetings.  If the meetings are choreographed carefully ahead of time it is very likely that the intellectual discussion will provide enough nourishment to sustain the conversations.

I propose that family foundation’s might have the advantage over community foundations and corporate foundations in this arena since they are inurred from “interests.” Community Foundations must raise money from the community and therefore must be careful not appear endorsing a position that could alienate a (funding) constituency.  Similarly corporations must be somewhat risk averse to issues that could result in a public relations (PR) controversy.  Of course there are exceptions to my broad comments.  Community foundations can and have taken a lead role in conferences that are meant to be conciliatory. Case in point – the Cincinnati Community Foundation’s initiative to address racial tensions in that city a few years ago was a national model and the Pittsburg Foundation’s efforts (in collaboration with the Heniz Endowment) to address thorny issues in the public schools.  The Columbus Medical Association and Foundation is a national model for convening stakeholders around the crisis of health care in that city.  The Cincinnati Health Foundation is another standard for how to engage a community around this critical issue.  With far fewer resources than our colleagues in Columbus or Cincinnati, we explored their methods as we embarked on our own response.

At the February 2008 Board meeting The Nord Family Foundation made a grant of $100,000  to the Community Foundation of Lorain County to initiate a community engagement and planning process to improve access to health care for the uninsured and under insured. (A great snapshot of the Lorain County Health statistics are found at the Public Service Institute) The initiative was a response to several critical factors.  The two charity hospitals Community Health Partners of Lorain and the Elyria Memorial Hospital are reporting approximately $20 million and $12 million in uncompensated care each year.  In addition to the two charity hospitals, the Lorain County Health and Dentistry is a beacon of hope for the scores of  medically uninsured and under insured in Lorain County.  LCHD had applied several times to receive funds from the Federal government to receive support as a Federally Qualified Health Care Center (FQHC).  Unfortunately it is considered a FQHC look alike because it has all of the services but does not get the Federal Funds.  The requests were turned down several times because demand exceeds supply of federal funds.  Equally disturbing was the increased pressure from the charitable group Lorain Free Clinic (headed by a remarkably talented and passionate executive director Paul Baumgartner)  to meet the increased demands of serving the rising number of medically indigent people in a county with staggering job loss and poverty.

Adding to the complexity is the aggressive move of the Cleveland Clinic Family Health satellite offices in Lorain and Elyria which is perceived as skimming the full-pay insured patients from the other two hospitals and FQHC.

So, when LCHD received a turn down of a $700,000 federal grant we sensed the community needed help.  A convening was in order!

We knew the task was enormous, but the urgency of the situation demanded a response.  Funds were used to support the work of the Altarum Institute of Ann Arbor, Michigan, in partnership with the local Public  Services Institute of Lorain County Community College. The overall project is currently referred to as Health Care Lorain County.

Upon approval of the grant, a Steering Committee was formed to provide community leadership for what became known as Health Care Lorain County. This ten-member committee has been chaired by the Executive Director of the Lorain County United Way and includes high-level representatives from the two main hospital systems, a local health departments, the Lorain County Medical Society, a local business leader, two nonprofit healthcare providers, a Lorain County Commissioner, and the President & CEO of the Community Foundation of Lorain County. This committee came together for a strategic planning retreat facilitated by staff of the Altarum Institute.

In preparation for the retreat, the Public Services Institute (PSI) conducted a basic environmental scan using existing data sources, to help define the prevalence and nature of the problem and to identify unanswered questions to inform future data needs. PSI and later United Way of Lorain County and Community Foundation staff also conducted one-on-one interviews with all members of the Working Group (key stakeholders, including members of the Steering Committee) to garner their expertise on the issue and input into the planning process. This compiled information was then presented at the retreat, to assist the Steering Committee in determining a shared understanding of the problem to be addressed, and to begin identifying project objectives and benchmarks for success. The Steering Committee developed into a highly dedicated group of community leaders with expertise and interest in the topic at hand and a commitment to serve the health care needs of the community. Meetings continued throughout the year, and included large stake-holder meetings  to continue data analysis, fine-tune the project direction, and determine the best steps for action.

After more than a year of meetings, the following conclusions were made:

1. There is a need to continue exploring this very complex issue of providing quality health-care to medically uninsured and under insured people in the county.
2. There must be a new technology infrastructure put in place to facilitate data sharing.
3. There is a desire to provide every citizen a sense of a medical home.  People desire a relationship with a personal health care provider rather than an impersonal institution.
4. The community needs to explore open-source charts so every patient can have an online chart that will follow him or her to their port to the health care system. The Cleveland Clinic’s remarkable on-line health record called My Chart is a great example of what an electronic health portfolio for medically under insured and uninsured could look like.
5. There is a need to examine how health dollars currently flow into the county.  There are tremendous inefficiencies and possible duplication of effort among  three distinct health departments (Elyria, Lorain City and Lorain County Health) which draw most of their funding from federal and state programs.  These departments which were established initially to address infectious disease in the earlier decades of the 20th Century, are not equipped to handle comprehensive chronic care that the majority of the population needs.  Competition from for-profit clinics such as Walgreens raise questions about the place of these health departments in a 21st century health care model.
6. The economic pressure necessiate collaboration between the two charitable hospitals and the Cleveland Clinic.

I am pleased to report that the undertaking has the active engagement of Senator Sherrod Brown and House Representatives, the Honorable Marcie Kaptur and Honorable Betty Sutton. The project has taken on a life of its own and stakeholders who would have otherwise had no incentive to come to the table have and continue to do so.  Their is consensus among the stakeholders that the large number of medically uninsured and under insured is a case of tragedy of the commons.  The response requires a willingness of leaders to listen, learn and possibly give up power in the years ahead.  That is a threatening prospect, but and genuine possibility.  It is a conversation that would not have taken place were it not for the foundation’s willingness and financial commitment to step in and assume a leadership role.

We do not know at this point where the effort will end up.  We do know that others have agreed to chip in to pay the costs to continue the facilitation.  It is our sincere belief that this effort will have positive impact on the access to health care that every family in this country deserves.  If nothing else in a age of disease resistant microbes, increased mental illness and poverty access quality health care and drugs is a public health issue that should concern all citizens.

So the challenge for any foundation deciding to take on a major effort in convening, you must determine{

• what role you want to  take
• have flexibility built into the expectations you have for the outcome
• know the level of risk you  will tolerate (the outcome could result in stakeholders walking away from the table) and
• be honest about much staff time and money you are willing to put into the effort
• look for innovation outside the conversations so to better inform the conversations
• be willing to stick with it – conversations of this magnitude can take year

We are making good progress with our effort. I admit to frustration about the ponderous pace the effort can take. It is my sincere hope that our stakeholders will embrace innovation in thought to explore interactive maps such as those developed by the Cincinnati Health Foundation, as well as virtual environments like those featured below that become places to test their theories.

Doing so will encourage even wider and broader horizions of possiblities.

Should the project work well, there can be nothing more rewarding than knowing you have created a space where citizens can leave their official interests at the door and collaborate as colleagues challenged with solving an enormous social problem.

The article certainly resonated with this superintendent, but it addresses the issues I have found in many schools across the country. My conversations with teachers, superintendents and nonprofit leaders all agree that in urban, suburban and rural schools, undiagnosed mental and emotional maladies are not adequately addressed. In the absence of integrated approach to mental – or even family health, the Carnegie Task Force on Education stresses,

“School systems are not responsible for meeting every need of their students. But when the need directly affects learning, the school must meet the challenge.” The writers are careful to make distinctions between external factors and individual disorders.

External factors are things such as neighborhood, family, school and/or peer factors such as extreme deprivation, community disorganization, high levels of mobility, drugs, violence, poor quality or abusive caretaking, poor quality schools, negative encounters with peers, inappropriate peer models, immigration status, etc.”

Individual disorders often are not diagnosed or screened and are attributed to developmental and motivational differences (e.g. medical problems, low birthweight/neurodevelopmental delay, psychophysiological problems, difficult temperament, adjustment problems etc.)”

Too often, discussion about improving the quality of challenged schools addresses the external factors but I think districts might need help with the latter. There needs to be a closer collaboration between the central offices of the departments of education and the public and mental health agencies. Philanthropy can have an important role facilitating those conversations.

A related article by the Children’s Defense Fund titled, “Cradle to Prison Pipeline: an American Crisis.”  addresses the social consequences of public health officials and school leaders lacking creative solutions to the challenge of external and internal health problems in schools.

I encourage everyone in this blog and perhaps the community to read it.

“Suppose that during the next decade, a quarter of all the children born in New York, North Carolina, Texas, Colorado, Ohio, and Pennsylvania were infected by a virulent new strain of polio or tuberculosis sometime during their youth. Clearly, our response to a health crisis affecting that many children would be to mobilize the nation’s vast public health resources. Medical laboratories would operate around the clock to develop new vaccines.

Unfortunately, an infection akin to this hypothetical tragedy is actually coursing through African American and Latino communities across the nation. I’m not referring to a virus such as HIV/AIDS or a hazardous bacterium. I’m talking about the criminalization of poor children and children from minority races who enter what the Children’s Defense Fund (CDF) identified as America’s Cradle to Prison Pipeline. Together, African Americans and Latinos comprise a segment of the U.S. population equal to that of the six states I mentioned earlier. Like the victims of a crippling or wasting disease, once drawn into the prison pipeline, massive numbers of young people lose their opportunity to live happy, productive lives, not because of festering microbes but because of years spent behind bars.”

I am finding that county and state bureaucracies function like large companies. Their ability to innovate and address new challenges are as formidable as those mentioned discussed by Clayton Christensen in the Innovators Dilemma and more recently in his book co-authored by Michael Horn and Curtis Johnson “Disrupting Class.” Philanthropy must look for pockets of innovation and bring it to scale. One of the best models is The Harlem Children’s Zone spearheaded by the visionary leader Jeffrey Canada. Philanthropy has a critical role in providing dollars to support innovative programs, but it can capitalize on its money, power and social recognition, but convening conversations with leadership that will help citizens not only ask the right questions about problems they face, but nudge state bureaucracies and political leaders to make bold moves to create new environments in schools where the child and his/her family is the focus for health and success. Why not have primary health care offices along with mental health services located directly in poor schools? Families that might be eligible for Medicaid benefits could sign up and, perhaps at some point families will be able to figure out health insurance. At this point, these would be confounding proposals for huge bureaucracies. Be interesting to see Mr. Christensen and Mr. Horn research why state mental and public health institutions are failing to meet the needs of children and families in schools. In my experience, much of the problem can be traced to a lack of innovative thinking in these large bureaucracies. Healthy families and healthy children are likely to help improve successful outcomes in schools.

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