AHP Connect Articles

AHP Connect Member Profile - Steven A. Rum

Steven A. Rum, MPA
Vice President for Development & Alumni Relations
Johns Hopkins Medicine
Baltimore, MD

AHP Member since 1995

Note: Steven A. Rum is one of the authors of “Ethical Issues and Recommendations in Grateful Patient Fundraising and Philanthropy,” a set of guidelines for health care development professionals, physicians and institutions facing ethical dilemmas in grateful patient fundraising.

“Ethical Issues and Recommendations in Grateful Patient Fundraising and Philanthropy” is a great set of ethical guidelines for not only development professionals, but also physicians and anybody working in grateful patient fundraising. How do you suggest health care development professionals begin to implement these guidelines?

I think the first step is to formulate a task force – an ad hoc committee if you will – of institutional leaders composed of faculty, compliance, development professionals and any other administrative leaders to address this issue… and by opening with this guidance document that we, through AHP and Johns Hopkins, took two years to develop. And upon review of the document, it is evident that we have to apply more specificity to what exactly will apply in our hospital.

So institutions should take these more general guidelines and make them more specific for their purposes.

Yes, with other leaders involved. It can’t be only development leaders. They can drive it, but it has to be a constellation of leaders.

For the Summit on the Ethics of Grateful Patient Fundraising, you convened experts from tons of fields, including bioethics, clinical practice, development, law, patient advocacy, all these different fields. Why was it important to have so many fields represented for a summit on such a specific topic?

They’re all affected by it. The president of the hospital – does he make a decision to renovate for new concierge suites in a certain area of the hospital? Does he make a decision to hire concierge staff? What’s legally within our bounds under the privacy laws with wealth screening? What should physicians do when asked by a donor/patient for their personal cell phone in case of emergency?

The physicians are of course, vital in this process. They have to be comfortable in the aspects of this relationship as it pertains to philanthropy. Of course, we needed development officers, patient advocates and ethicists to completely engage in this vital subject.

At the end of the day, [having all of these people at the table] makes for a much more credible research initiative versus just one cohort of development professionals convening and saying: “Here’s what we think.”

I mean, when you have that breadth, that depth of disciplines, particularly with the departments that we had [such as] bioethics, it lends a tremendous validity as to what we wanted to ultimately keep as an outcome for [“Ethical Issues and Recommendations in Grateful Patient Fundraising and Philanthropy”].

With all of those different voices at the table, there were several areas in the recommendations where you did not reach a consensus. How did you decide to continue with those recommendations in the cases in which a consensus wasn’t clearly apparent?

We just agreed to disagree. We couldn’t come to a conclusion about certain areas, and that was a part of the beauty of this thing. The ethics side of fundraising, the vulnerability of patients, the discomfort of doctors and the financial decisions that administrators have to make with respect to these audiences – it’s a tough subject. And even when we had a day and a half to talk about it, that wasn’t enough time. But we couldn’t exhaust the day on one topic. So at the end of a certain amount of time, we just said the consensus is that we just couldn’t come to a conclusion on this outcome, and we moved forward.

When you’re talking about ethics, there are so many different opinions and ways the discussion can go. I’m sure those conversations were so interesting.

Oh, it was terrific. It was just a fascinating day and a half. We had the dean from the School of Medicine at Boston University. We had a patient advocate. There was very little in the way of medical literature or even fundraising literature that systematically addresses a multitude of issues surrounding the ethics of grateful patient fundraising. Quite frankly, it just hasn’t been approached before. We all know the ethical gray area that we have to be sensitive to, but there are just no guidelines out there. That’s why we did it.

Can you talk about research and how it can benefit the development profession?

I think research lends credibility to our profession. Our profession is the great unknown. No one really understands what we do. They think we just go to fancy restaurants and play golf and then people write us checks. I’m being overly simplistic here, but the reality is, we have to constantly prove the credibility of this profession and that doesn’t just come from what we’ve achieved or raised. It’s also the result of study of critical areas of our work and publishing it for the greater whole of the profession. There was even discussion at the summit – is development a true, credible profession? And that’s not included in the ethics piece because it’s not an ethical issue, but some of the physicians were saying: what are the parameters, what credentials do you have to be considered a development professional? There’s no academic rigor other than earning a college degree. Some very good points were made. If you want to be an accountant, you have to pass the CPA exam. What are the true grid lines of the development profession?

The very basic answer is, well, there aren’t any. People get into this profession and we’re good at it because we build relationships. We’re hopefully experts in the social sciences, but we don’t have a lot of research to back what we do. It’s a soft science.

I did a study on coaching in 2011 – the best way to teach physicians how to understand grateful patient fundraising was one-on-one coaching. That landmark initiative helped us to say to administrators and physicians, “See, this has been proven as the most effective way to change behavior among our physicians.” And then with these new ethical recommendations, it’s the same thing. What’s the real question we’re asking ourselves here, and what is it that we can publish to give validity to the development profession? People really don’t know what we do. We’re trying to change that through research.

With physicians who are apprehensive about being involved in grateful patient fundraising, how have you helped educate them on that process?

I think it’s all about understanding the role of the development officer, the role of the institution and the role of the physician, and how those three intersect with the patient when the timing is appropriate.

It’s really a combination of the head and the heart. The head says there are certain analytics that show there is great reason to suspect that people give to health care, and great reason to suspect that people give to things they’ve had personal experiences with. And we have the data that shows if people have positive experiences, whether they’re going through a museum or going through a hospital and seeing their doctors, they’re going to be more interested in giving.

The heart is that there’s a high, emotional impact for people who give. The physicians need to understand what their role is and understand that their grateful patient is just that – grateful. There is benefaction there. There is altruism there. They want to – not because they’re forced to. They understand what they have to do in terms of articulating their vision, and then they talk to a development officer who says, “My role in this intervention is to facilitate this gift-giving – to be the one to solicit, to be the one to steward, to be the one to develop a proposal in conjunction with the physician.”

It’s clarity in role-playing, and we try to ensure the physician is comfortable doing what they want to do, and never put them in a position where they’re uncomfortable. And that’s part of a good development officer’s role throughout our practices.

If a physician just isn’t comfortable, it’s optional. They don’t have to participate if they don’t want to.

Exactly.

But I always say this: If a physician has a grateful patient and he says, “Oh, I’m just not comfortable talking about philanthropy…” Well, we have a responsibility as an institution to internalize the strategy that will have intervention with this individual. And it won’t be that direct physician, but maybe it’ll be the president/CEO or a department head or a volunteer. That’s part of the educating of faculty because if they’re seeing grateful patients and they say, “Well, I just don’t want to participate at all in development,” the development officers can’t just see an opportunity’s lost. It’s up to the development people to take it to the next level.

There are real opportunities here. Let’s try to make the doctor more comfortable, not to participate, but because he’s handing off these relationships not at the clinical level, but the philanthropic level.

How can these guidelines help fundraisers gain credibility not just with their physicians, but also with their C-suite?

This has been published in JAMA (The Journal of the American Medical Association); this has been published in Academic Medicine (published by the Association of American Medical Colleges). It’s a real issue. If we’re raising $10 billion a year around the country, from the community hospitals to academic medicine, the development person says if we can incorporate our own set of guidelines, we’ll have more physicians get involved. We’ll have greater clarity in terms of the purpose of the role of each of the cohorts: the physicians, the administrative leaders, the volunteers, etc. We’ve taken the time to address this very sensitive ethical issue and we have our own set of guidelines and we’ve taken time to publish them – internally, it doesn’t have to be much more than that – but we have a set of ground rules by which we’ll all participate.

What have you learned in your time since founding the Johns Hopkins Medicine Philanthropy Institute?

The 120-some odd students who’ve come through in the last five years – what I’ve learned is there is an absolute demand for professional development. And they don’t always get it at conferences. Conferences are good when there’s a quick shot of information from a presentation. It’s great for networking and socialization. But behavior doesn’t change. They might pick up a couple of good ideas from conferences, but their own professional growth and behavior really doesn’t change unless they’re sufficiently challenged in a very small setting.

What I’ve learned, taking 36 students over the course of 3.5 days, building their own model of what they need to work on, it’s not only the Johns Hopkins way. It’s their own institution’s way coupled with their own professional growth and development. It’s been a real journey for personalization and improving what skills would enable me to be a better development professional. That’s the most rewarding.

The second piece is the ability for us to do research and to take a portion of their fees and say you’re making an investment in the future for other development professionals because we’re going to conduct some research that will benefit us all.

You’ve worked with some big donors. What’s different about working with big donors?

The most important piece is they want to make an impact, they want to make a difference, there’s true pleasure in their giving and true gratitude for what they’re doing. Whether the $10,000 gift is going to renovate an ICU or $100 million is going to change the landscape of medical school education – the bottom line is there’s a deep sense of making an impact and investing in an institution they believe in that will make that impact, and just having pure pleasure in seeing that gift in action. There’s nothing different. It’s just the scale that’s different.

Do you think this is an exhaustive list of ethical recommendations or will it be expanded on in the future?

I don’t know if it’s going to be expanded, but I would hope that there would be more specifics. It’s very broad, but that’s all we could accomplish in a day and a half at the summit. I do think the AHP and AAMC should really coalesce development leaders and physicians to get even more specific.

The reality is there’s always this divide of how do we treat patients, so they also become donors, and what is our responsibility to nondonors?

All of these issues – appointment-setting, concierge service – need to be at the forefront of thinking, by institution, and those specific guidelines are the ones that I’d be curious about. If that happens, then we’ll have a mass of data that we can take a look at. So you know what the benchmark is: Of the 100 hospitals we’ve polled, 70 have guidelines that say the following with respect to this topic. I think that’d be very powerful information.

All we’ve done in the summit is provide the baseline, the groundwork for others to do more work, and I hope the institutions will do more work and convene a group of leaders and get into the specifics of how to address each one of these issues.