If you have a brain and work in healthcare, you know chances are good that David Houle and Jonathan Fleece’s prediction that “one third of hospitals will close by 2020” is on the money.  Until a recent marriage and move took me to St. Louis, my job was to sell a Texas hospital system’s plans for the future to major donors; and throughout my five-year tenure, the looming and pervasive changes in healthcare weighed heavily on me.

In my situation, there was no real danger of the system disappearing.  After all, the odds aren’t too bad.  Two out of three hospitals will make it, and I was associated with a system with a strong survival instinct.  Over the last fifteen years, it had merged and morphed, adapting to become one of the largest healthcare systems in Texas.  Chances are, all or most of the hospitals in that system will make it to 2020.

The problem with healthcare financing and fundraising is the “morphing.”  Typically, major gift fundraising (think higher education, for example) is based on a very deliberate schedule of strategic planning that is funded and implemented in five- to seven-year blocks.  The speed of adaptation required in healthcare does not make that time-honored, planning/implementation model possible.  Plans are conceived and abandoned at a dizzying pace.  In this environment, when a major donor makes a gift to healthcare, he or she is really placing a bet on the leadership’s instincts and vision, and any honest hospital administrator should be disclosing that.

Imagine a sky full of planes flying through a storm.  You could be in the most advanced plane on the planet; but if the cockpit is populated with inexperienced and/or slow-to-respond pilots, your chances aren’t very good.  So odds are, there will be some well-equipped, high-visibility hospitals that don’t survive healthcare reform—and it will be because of the pilots not because of the planes.

The most honest thing a healthcare leader can do is to own the uncertainty and tell potential donors:  “We know our hospitals are going to see dramatic changes in the next five years.  We are not entirely sure where we need to make those changes, but we know it will cost money. We’re not sure how much money, but it probably will be a lot.  I’m asking you to trust my experience and instincts and to give me the financial freedom to make the necessary decisions to weather this storm.  You booked a ticket on and took off in a 747 but you may land in a Cessna. Buckle your seatbelts.  It’s going to be a bumpy ride, but we’ll make it and we’ll be stronger.”

That’s not an easy fundraising message to deliver, but it’s an honest one; and I believe honesty can take you a long way with donors.  I don’t think it follows that they will stop supporting healthcare because it is so risky.  Wise community leaders know they are up in the air in the middle of a storm.  Jumping out of the plane is not an option.  You can’t not have healthcare.

So here’s my philanthropic advice to America’s healthcare supporters:  find leaders who are experienced adaptors, who aren’t trigger-happy but who know how to make a decision quickly, and who will tell you the truth about the situation.  There’s been far too little truth in healthcare; and maybe that’s the most important place for reform to begin.

Kristine Christlieb Canavan was formerly with Texas Health Resources, Arlington, TX.

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