Featured by Grantmakers In Health and Trust-Based Philanthropy
There is a common misconception about trust-based philanthropy as extending “unconditional trust.” While the approach centers on building trusted relationships with grantees, this does not mean funders should abandon all expectations for mutual accountability and evaluation and learning. Quite the contrary, trust-based philanthropy is about building funder-grantee relationships grounded in power-sharing, transparency and mutual accountability to achieve the greatest impact.
As bi3 has moved from traditional grantmaking to trust-based philanthropy, our commitment to evaluation remains steadfast. Now, however, we recognize that impact can be captured in many various ways. Outcome metrics are indicators of change but do not fully capture the impact of grants. Learning, adaptation and growth are equally important to creating change.
Too often, funders equate accountability with evaluation and measurement; holding grantees accountable for achieving target outcomes to prove our return on investment. However, this approach to accountability often perpetuates top-down power dynamics that reduce grantees’ willingness or desire to be fully open and transparent with funders.
Trust-based philanthropy challenges us to focus on cultivating mutual accountability, establishing communication and relationships that allow for the grantee and funder to hold themselves accountable to one another. bi3 has shifted from ‘holding the grantee accountable’ to partnering with grantees to achieve a shared goal of improving health and well-being for all people.
bi3 partners with grantees by offering support beyond the check. This support includes: providing transparency around decisions and responsiveness to grantees’ needs while serving as thought partners. We continue to work to simplify our application and reporting processes and provide flexibility within grant budgets to support learning and changing needs. We recognize our grantees as experts. bi3 asks for feedback from our grantees and takes action to address it. When grantees feel valued and respected, they are more likely to engage in transparent conversations that reveal successes, challenges and opportunities.
“Often when we receive a grant, there is already built-in structure and measures that don’t always fit the work we are trying to do. The team at bi3 really trusted our expertise to do things differently, and we’ve been able to do so much in ways we couldn’t have if they hadn’t listened to that expertise. We are able to build an authentic community through bi3’s support, flexibility and response to need. I consider it a gift to be able to work with them.”
– Dr. Meredith Shockley-Smith, Cradle Cincinnati
There is no one-size-fits-all approach to measuring outcomes and impact. bi3 is intentional about ensuring evaluation mirrors the size and scope of the grant and the nature of the work itself. For example, when we award smaller, unrestricted grants, we ask our grantees to share how the dollars helped them fulfill their mission but do not require defined metrics. In 2020, bi3 awarded capacity building grants for the first time to help organizations with the unique demands created by the pandemic. We asked grantees to identify and track up to three output measures (e.g. number of people served, number of appointments, number of staff trained, etc.) and share key successes and lessons learned. bi3 analyzed the results for themes to help inform our future work and aggregated data and insights to share with our Board to ignite their interest in supporting future capacity building efforts.
“I appreciated this whole process: deciding together on meaningful metrics; communicating along the way and getting feedback; and being pointed to other resources.”
– Capacity Building Grantee
In order to transform health and achieve health equity, health-focused organizations need time and resources to think creatively and pilot new solutions to address community health issues. Therefore, bi3 often awards large ($300,000 to multi-million), multi-year grants that benefit from co-created work plans and simple outcomes charts to help guide the work along the way.
Previously, bi3 defined grant outcomes during the proposal phase, then “locked in” and monitored the outcomes for progress towards achievement. Today, we work with each grantee to leverage their strengths and knowledge to co-design an evaluation that fits the project aims. We engage in open conversation and ask thought-provoking questions to ensure we focus time and energy in the right places. Examples of these questions include:
- What does success look like for your organization?
- What do you hope to learn through this project?
- Are there key metrics (e.g. county’s infant mortality rate) or indicators (e.g. extreme preterm birth weight) that we, funder and grantee, want to keep our eye on to measure progress toward goals?
- What outputs (e.g. number of people served) and outcomes (measurable improvements in health) will help both funder and grantee learn and track progress?
bi3 has moved away from multiple, burdensome reporting requirements to regular, transparent conversations with limited written reports. From the beginning of each initiative, we want to be thought partners and problem-solvers. We aim to do all we can as a funder to lift grantees up and support their success. Through these dialogues, bi3 can offer feedback and resources, ask questions, and connect grantees and community partners. We seek to add value to the discussion and continuously focus on learning.
bi3 hosts learning sessions with grantees to build trust. Conversations allow us to better understand successes and challenges. Providing the time and space to reflect through the life of the grant helps partners not only look at the day-to-day management of a project but also think about the community context. The approach allows flexibility so partners can engage in continuous quality improvement and learning, enabling them to respond to opportunities as they arise, leading to stronger, more comprehensive solutions.
Topics of a learning session may include:
- Recent successes of the project
- Completed activities and upcoming milestones
- Updates to and changes in outputs and outcomes
- Key challenges or barriers that are impacting the project (e.g. operations, partner relationships)
- Learnings and how they are being used to improve the project
- Contextual, structural or policy factors that may influence the project and outcomes
- Budget needs or challenges (e.g. opportunities to shift some of the funding between budget line items as needed)
- What additional support and resources bi3 might provide
bi3 staff summarizes these conversations, and any supporting documents, in our grants management system to record progress and lessons and share them with our Board or other stakeholders.
An emphasis on learning improves grant outcomes and impact and makes bi3 a better funder. Learning alongside our grantees influences bi3’s approach by strengthening our work with other partners and informing our strategies.
For example, in 2020, our maternal health grantees shared the challenges stemming from the loss of Medicaid coverage at 60 days postpartum. The loss of coverage made it extremely difficult to engage women in clinical care that supports their physical and mental health and the health of future pregnancies. As a result of these conversations, bi3 identified an advocacy partner, Groundwork Ohio, and provided the resources to engage in a targeted advocacy campaign to extend postpartum coverage to one year. The advocacy of Groundwork and others ultimately led to the inclusion of an extension in the state budget. As of April 1, 2022, women are eligible for one full year of postpartum coverage, a critical step to improved maternal and infant health for all Ohioans.
Our partnerships focused on infant mortality taught bi3 what it takes to move a bold idea forward:
- Leveraging the unique strengths of our partners
- Elevating strong, diverse leaders and champions
- Building cross-sector collaboration
- Capturing lessons learned
bi3 often works with grantees to share the results of a project with our stakeholders and the broader community. We do this through Learning Series papers, blogs, media interviews and conference presentations.
As an example, our blog on integrating behavioral health into primary care (built from a Learning Series paper) was one of the top 5 Health Affairs blogs in 2020.
bi3 also actively engages with other funders to explore potential funding opportunities for our grantee partners.
bi3 defines impact through a wide lens: improvements in individual outcomes; capturing lessons learned; forming new partnerships; changing how the problem or population of focus is understood; and driving new approaches and ways of thinking. There is not just one path to success. We don’t want grantees to be so focused on achieving pre-defined outcomes, which may become outdated over the course of the project, that they miss new opportunities to achieve even more significant impact. We also recognize we need to take the long view on impact. The issues we are trying to address cannot be solved in a three-year timeframe. We need to look for milestones along the way and recognize we may not see the ultimate impact we seek for five, ten or more years.
For instance, in 2012, bi3 funded a three-year initiative to reduce infant mortality by 10% in Hamilton County, Ohio. The project did not come close to achieving this goal within the grant period. However, it built the foundation for future success by breaking down silos between sectors, building trust in the community, creating a new model of care, lifting-up community voices, sharing lessons learned and forging new partnerships. Over time, this work led to Hamilton County’s lowest infant mortality rate on record in 2020.
bi3 continues to focus on its own learning and our accountability to our grantee partners. In spring 2022, we sponsored a series of focus groups with current and former grantees to gather feedback on how they experience bi3’s trust-based approach and where we can improve. The findings will help inform bi3’s processes and activities moving forward. We will also share the resulting recommendations with the broader field of philanthropy to support our shared journey to a more equitable and trust-based community.
When funders and grantees have a trusting relationship, it creates open communication and breeds mutual respect. A shared commitment to transparent conversations and learning leads to greater impact for our communities.
- Ridzi, F. (2012). Managing Expectations When Measuring Philanthropic Impact: A Framework Based on Experience. The Foundation Review, 4(4). https://doi.org/10.4087/FOUNDATIONREVIEW-D-12-00007.1
- Trust-Based Philanthropy Resources: https://www.trustbasedphilanthropy.org/resources
- Webinar: A Trust-Based Framework for Learning and Evaluation in Philanthropy: https://www.trustbasedphilanthropy.org/resources-articles/2022-1-25-cei-tbp-learning-evaluation