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The science of medical philanthropy: a guide for physicians

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The science of medical philanthropy: a guide for physicians

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Content Running head: SCIENCE OF MEDICAL PHILANTHROPY 1 THE SCIENCE OF MEDICAL PHILANTHROPY: A GUIDE FOR PHYSICIANS by Sarah A. Andrews, MBA _____________________________________________________________________________ A Dissertation Presented to the FACULTY OF THE USC ROSSIER SCHOOL OF EDUCATION UNIVERSITY OF SOUTHERN CALIFORNIA In Fulfillment of the Requirements for the Degree DOCTOR OF EDUCATION May 2018 Copyright 2018 Sarah A. Andrews, MBA SCIENCE OF MEDICAL PHILANTHROPY 2 Acknowledgements I would like to thank my dissertation committee, Kimberly Hirabayashi, PhD, Rebecca J. Lundeen, EdD, and especially my chair, Kenneth A. Yates, EdD, whose support, guidance and encouragement were unwavering and essential to my educational journey. My heartfelt thanks to my professors, especially Stuart Gothold, EdD, Julie R. Posselt, PhD, and Nooshin Valizadeh, EdD, for the invaluable lessons you shared, both in life and in the classroom. To my classmates, especially Susan, Jacques, Joshua, Matthew, and Patrick, you have inspired me beyond measure and I will be forever grateful for your colleagueship and friendship. And finally, to my family, especially my husband, Philip, thank you for your constant encouragement, love, and support. SCIENCE OF MEDICAL PHILANTHROPY 3 Table of Contents List of Tables 6 Abstract 7 Chapter One: Introduction 8 Statement of the Problem 8 Mission and Organizational Problem 8 Organizational Goal 10 Evidence for the Problem of Practice 11 Importance of the Problem 12 Instructional Needs Assessment 14 An Innovation Approach 14 Nature of the Innovation 14 Learning Goals for the Innovation 15 Prioritization of Learning Goals 15 Curriculum Description and Purpose 16 Curriculum Goals, Outcomes, and Capstone Assessment 17 Definition of Terms 18 Potential Designer Biases 19 Organization of the Design Blueprint 20 Chapter Two: Review of the Literature 21 The Curriculum 21 General Theoretical Approaches 21 The Practice of Grateful Patient Fundraising in Academic Medicine 22 Grateful Patient Fundraising: Limitations and Opportunities 22 Ethical Challenges to Grateful Patient Fundraising 23 Physician Attributes that Promote Philanthropic Engagement 25 Content 26 Prior Attempts 28 Analysis of Prior Attempts 29 Approaches to the Curriculum Design 30 Theoretical Foundations to the Curriculum Design 30 Chapter Three: The Learners and Learning Context 33 Learner Profile 33 Ability 33 Cognitive Characteristics 33 Physiological Characteristics 33 Self-Efficacy 34 Affective Characteristics 34 Social Characteristics 35 SCIENCE OF MEDICAL PHILANTHROPY 4 Prior Knowledge 36 General World Knowledge 36 Specific Prior Knowledge 36 Description of the Learning Environment 37 Facilitator Characteristics 37 Existing Curricula/Programs 38 Available Equipment and Technology 38 Classroom Facilities and Learning Climate 39 Chapter Four: The Curriculum 40 Overall Curriculum Goals, Outcomes, and Summative Assessment 40 Curriculum Goal 40 Curriculum Outcomes 41 Summative Assessment 41 Cognitive Task Analysis 42 General Instructional Methods Approach 43 Description of Specific Learning Activities 43 Overview of Units 44 Unit 1: Grateful Patient Fundraising Overview 44 Unit 2: Accommodating Patient Privacy in Grateful Patient Fundraising 45 Unit 3: Applying Institutional Policies for Fundraising 45 Unit 4: Stewarding Grateful Patient Philanthropy 46 Unit 5: Examining Ethics in Grateful Patient Fundraising 47 Unit 6: Appraising Patients’ Motivations for Giving 48 Delivery Media Selection 49 Authenticity 49 Immediate Feedback 50 Sensory Requirements 50 Instructional Media Options 50 Delivery Costs 51 Chapter Five: Implementation and Evaluation Plan 55 Implementation of the Course 55 Implementation of the Evaluation Plan 57 Curriculum Purpose, Need, and Expectations 57 Evaluation Framework 57 Level 4: Results and Leading Indicators 58 Level 3: Behavior 60 Critical Behaviors 60 Required Drivers 61 Organizational Support 64 SCIENCE OF MEDICAL PHILANTHROPY 5 Level 2: Learning 64 Learning Goals 64 Components of Learning Evaluation 65 Level 1: Reaction 66 Evaluation Tools 67 Immediately Following the Program Implementation 67 Delayed for a Period After Program Implementation 68 Conclusion to the Curriculum Design 68 References 70 Appendix A: Physician GPFR Pre-Test 74 Appendix B: Capstone Online Assessment 76 Appendix C: Physician GPFR Checklist 78 Appendix D: Blended Evaluation Survey 79 Supplementary Materials 81 SCIENCE OF MEDICAL PHILANTHROPY 6 List of Tables Table 1: Instructional media options 51 Table 2: Delivery costs for media options 53 Table 3: Indicators, metrics, and methods for external and internal outcomes 59 Table 4: Critical behaviors, metrics, methods, and timing for evaluation 61 Table 5: Required drivers to support critical behaviors 63 Table 6: Evaluation of the components of learning for the program 66 Table 7: Components to measure reactions to the program 67 SCIENCE OF MEDICAL PHILANTHROPY 7 Abstract As grateful patient programs have increased in both number and scope, academic medical centers are increasingly thinking about ways to engage physicians in fund development. Numerous studies reveal that physicians do not receive sufficient training to know how to engage in patient philanthropy and specifically how to navigate the intersection of patient care and development. The purpose of this curriculum is to train physicians to become effective philanthropic partners by increasing their self-efficacy and motivation to participate in grateful patient fundraising. Applying theories of adult learning and individual constructivism as the theoretical foundations for this curriculum, the training is designed as a six-module, blended course spanning four and a half hours. Upon successful completion, physicians will know how to partner in the cultivation and solicitation of grateful patient gifts; understand the donor cycle and pivotal points of engagement for physicians; understand patient privacy as it relates to grateful patient fundraising; employ ethical behavior in healthcare fundraising; and articulate complex medical and scientific concepts to donors. The summative evaluation utilizes two measures: a capstone assessment and direct observation of learners to assess on-the-job application of skills. Philanthropic success pivots on institutions’ ability to pair engaged and prepared physicians with the opportunity that grateful patient philanthropy presents. A comprehensive instructional blueprint could serve as a model of excellence to equip healthcare institutions with resources to train and develop their physicians, thus increasing the production of patient philanthropy to support research, patient care, training and education, and the health of our communities. SCIENCE OF MEDICAL PHILANTHROPY 8 CHAPTER ONE: INTRODUCTION Statement of the Problem Mission and Organizational Problem University Medical Center (UMC; a pseudonym) is a nonprofit academic health system situated in a large metropolitan area in the Western United States. With 886 licensed beds and 14,500 employees, including more than 2,150 physicians and 3,300 nurses, UMC is devoted to providing excellent clinical services with compassion. This aim is founded in the ethical and cultural precepts of its faith tradition, which inspires devotion to the art and science of healing and to the care the medical center gives its patients and staff. UMC is committed to delivering quality healthcare; advancing biomedical research; training physicians, scientists, and other healthcare professionals; and improving the health of its community (UMC, 2018). UMC is distinctive in that it has consistently been named one of America’s Best Hospitals by U. S. News & World Report, has received the National Research Corporation’s Consumer Choice Award twenty years in a row for providing the highest quality medical care in the city where it resides, and has the longest running Magnet designation for nursing excellence in the state (UMC, 2018). Over the course of its 115-year history, UMC has evolved from a community hospital whose primary mission centered around patient care and training the next generation of physicians to become one of the largest nonprofit academic medical centers (AMCs) in the United States. Despite pioneering early advances in heart and other medical specialties, it has only been within the last twenty years or so that UMC has begun in earnest to emphasize its academic research mission. Today, more than 200 principal investigators are engaged in more than 1,650 research studies, garnering more than $125 million in extramural research funding SCIENCE OF MEDICAL PHILANTHROPY 9 (UMC, 2018). In fiscal year 2017 (ending September 30), UMC ranked tenth among independent medical centers nationwide receiving funding from the National Institutes of Health (NIH) (U.S. Department of Health and Human Services [HHS], 2017). Despite its high achievements in these areas, UMC has benchmarked its philanthropic giving against local institutions of similar size and mission and has determined that UMC lags behind peer institutions in its ability to attract and sustain philanthropic support. As the institution’s research mission has grown, so too have the revenue needs to support this burgeoning enterprise. The operating budget of the NIH, which funds 37% of biomedical research conducted at academic medical centers, has contracted from a high of $40 million in 2003 to $34 billion in 2017, and threats to future funding under the current administration loom large (Grenzebach, Glier & Associates, 2017). Fortunately, academic medical centers evaded NIH budget cuts with the recent passage of an appropriations bill that increases funding to the NIH by $3 billion to a total of $37 billion for fiscal year 2018. While this news is encouraging, uncertainty remains for fiscal year 2019 and beyond. Philanthropic revenue represents a valuable stream of flexible, discretionary revenue to support the research enterprise. Thus, a primary goal for UMC is to continue to grow the amount of philanthropic revenue raised to support the institution’s research programs, as well as patient care, training, and education. As the outlook for healthcare financing has come under duress due to declining reimbursement rates and a highly competitive landscape for research grant funding, many institutions have begun to pay greater emphasis to their development programs (Barr, 2005; Chervenak, McCullough, Fraley, & Golding, 2010; DeMaria, 2006; Haderlein, 2006; Shapiro & Larson, 1987). Philanthropic contributions to academic medical centers increased 16.2% in 2013 to roughly $4.8 billion (Association of American Medical Colleges [AAMC], 2014). Support SCIENCE OF MEDICAL PHILANTHROPY 10 from individual donors is the fastest growing donor segment in healthcare philanthropy. A survey of medical schools and teaching hospitals found that 81.4 percent of individual donations were contributed by unaffiliated individuals (neither medical school alumni nor staff); many of these gifts were likely made by patients and their families whose lives had been touched by the beneficiary institution (AAMC, 2016). Further underscoring this upward trend, grateful patient gifts comprised 21% of philanthropic contributions from individuals to healthcare institutions in 2011; in 2004, this share was only seven percent of gifts from individual donors (Association of Healthcare Philanthropy, 2011). As grateful patient fundraising programs have increased in both number and scope, medical institutions are increasingly thinking about ways to engage physicians in the fund development process. Physicians play an important role in the identification and cultivation of grateful patients because of the close relationships they enjoy with their patients who may also be potential donors (Elj, 2007; Noce & Looney, 2009; Walter, Griffith, & Jagsi, 2015). An accumulation of industry knowledge demonstrates that physician participation in philanthropy programs can increase the size as well as the frequency of gifts from grateful patient donors (Prokopetz & Lehmann, 2014; Rum & Wright, 2012; Stewart, Wolfe, Flynn, Carrese, & Wright, 2011). However, it has been observed that numerous UMC physicians are not engaged with the development office which could be a reason why philanthropy to UMC is lagging relative to peer institutions. Organizational goal. By 2026, UMC aspires to rank among the top ten independent hospitals nationwide receiving philanthropic support. To accomplish this goal, the health system’s development office will need to engage a greater share of its physicians to increase the flow of grateful patient referrals, which ultimately could translate to more philanthropy. As such, SCIENCE OF MEDICAL PHILANTHROPY 11 UMC established that by 2021 at least 50% of full-time faculty will be partnering actively with UMC development officers to raise philanthropy in support of the institution’s mission. This goal was established following an assessment of physician engagement, the outcome of which provided a blueprint to deepen physician engagement over the next three years (2018-2021). Essential to the achievement of this organizational goal is UMC’s ability to equip faculty physicians with the requisite knowledge and skills to participate meaningfully in the development program at UMC. Yet the industry whose sole purpose is to nurture medical philanthropy has its shortcomings. Among the most significant: There is little consensus among development practitioners on the most effective ways to train physicians. Some institutions have pursued external consultancies to develop their physicians’ fundraising prowess while others have undertaken randomized controlled trials to elucidate the most effective methodologies for engaging physicians (Rum & Wright, 2012). However, the literature neither describes how well integrated these training programs are within academic medicine nor does it offer a detailed description of the content included within these programs (Walter et. al, 2015). Absent a clear instructional blueprint, institutions often delegate this responsibility to gift officers who may or may not have an appreciation for the educational needs of their physician colleagues and choose to forge a more isolated path, prioritizing near-term gift opportunities to achieve individual incentives even at the expense of initiatives that could increase the production of patient philanthropy over the long term. Evidence for the Problem of Practice UMC analyzed the total number of physicians engaged with the development staff and compared that to the total number of physicians under employ and found that approximately 20% of UMC faculty are engaged in the fundraising program, which is quite low respective to the SCIENCE OF MEDICAL PHILANTHROPY 12 institution’s goal. This low rate of physician engagement affects UMC’s financial performance. In the 2016 fiscal year (ending June 30), philanthropic revenue totaled $65 million which is $38 million less than what was raised in fiscal year 2014 (UMC, 2016, 2014) and UMC’s academic enterprise ran a deficit of more than $144 million (Anonymous, personal communication, September, 23, 2016). As UMC continues to expand the breadth and depth of its academic enterprise, philanthropy will be needed to sustain this growth. Importance of the Problem Philanthropy is an important revenue stream to support the missions of academic medical centers. The board of directors, executive administration, chief development officer, gift officers, and faculty all have a vested interest in an environment that is conducive to attracting philanthropic support and, thus, institutional progress. Those institutions that can successfully engage physicians in the institution’s fundraising program will be better positioned to achieve their institutional goals. Much of healthcare philanthropy emanates from the gratitude patients feel towards their caregivers, including physicians, nurses, and other caregivers, for the excellent care they received (DeMaria, 2006; Eisler, 2006; Elj, 2007; Roach & Jacobs, 2013). A philanthropic gift is often a way in which a patient can express his or her gratitude. Physicians and other caregivers who are on the frontlines of clinical care delivery are uniquely positioned to create an exceptional patient experience, thus laying the essential foundation of gratitude that can transform into philanthropy. In this way, physicians are critical partners with development officers to identify, cultivate, and steward grateful patient donors. If physicians are not engaged in the fundraising program, development officers are far more limited both in their access to potential patient donors and ability to understand grateful patients’ motivations and aspirations. SCIENCE OF MEDICAL PHILANTHROPY 13 Consequently, physicians represent the stakeholder group that is best positioned to help achieve the organizational goal of increasing philanthropic revenue to UMC so that it is on par with the top ten independent academic medical centers. However, numerous physicians at UMC have voiced their concerns about healthcare philanthropy. For those who are willing to engage, many have expressed a lack of understanding how to do it, and/or feel uncomfortable engaging in conversations with patients about philanthropy. The literature documents ethical tensions and physicians’ concerns over the solicitation of their patients and the subsequent impact on the physician-patient relationship (DeMaria, 2006; Prokopetz & Lehmann, 2014; Walter et al., 2015; Weiss Roberts, 2006; Wright et al., 2013). The vulnerability of sick patients also plays into physician concerns and the fears that some physicians may take advantage of patients in compromised situations (Roach & Jacobs, 2013). Others fear patients may feel undue pressure to give if their physician is directly involved in the solicitation (Prokopetz & Lehmann, 2014). Medical philanthropy is generally not something that is taught in undergraduate or graduate medical education, thus the responsibility falls to healthcare institutions to train and develop their physicians in this regard. The high need for physician engagement in healthcare philanthropy coupled with physicians’ low self-efficacy and/or motivation to participate in grateful patient fundraising underscores the need to design a curriculum that is personalized to the unique needs of this learner population. Academic medical centers are competing for market share amid scarce resources. Philanthropy represents a comparatively newer source of revenue that will be vital to institutions’ ability to maintain a competitive edge. Therefore, an institution’s ability to engage physicians in a program to drive philanthropic revenue is essential to success. Academic medical SCIENCE OF MEDICAL PHILANTHROPY 14 centers need to pay critical attention to training and developing physicians to engage meaningfully in the development program. A failure to do so will potentially result in a significant loss of revenue and a corresponding impact to the institution’s profile. Instructional Needs Assessment An Innovation Approach A need was identified to provide consistent and comprehensive continuing education for UMC faculty on grateful patient fundraising by using the innovation model (Smith & Ragan, 2005). The innovation model examines changes within an organization and environment to determine if instruction is needed to equip learners with the skills and/or dispositions required to realize organizational goals. Previous attempts have been made by development officers as well as external consultancies to train UMC faculty and clinical staff on GPFR in a uniform manner, but the outcomes have been uneven. A high rate of staff turnover in the development office coupled with a large influx of new faculty over the last five years has elevated the need to adopt a formal curriculum that aligns more closely with the institution’s philosophy and goals. Smith and Ragan (2005) recommend that the innovation be examined using a three-phase approach: the nature of the innovation, the learning goals for the innovation, and the prioritization of the goals. Nature of the innovation. This curriculum is designed to optimize contributions from faculty physicians to UMC’s development program. This curriculum focuses on faculty physician-scientists as a specific subset of the learner population at UMC. This distinction is important because UMC operates as what is known in healthcare as an open system, meaning physicians who practice at the hospital are not all employees of the medical center. In this setting, UMC faculty work alongside physicians affiliated with the health system’s medical foundation and physicians in private practice who enjoy privileges at the medical center. SCIENCE OF MEDICAL PHILANTHROPY 15 As UMC has developed a stronger academic focus as part of its broader mission, the composition of physicians (the learner population) has shifted significantly. Today, UMC is actively recruiting physician-scientists and biomedical researchers who are actively engaged in conducting research, including basic, translational, and clinical research. These faculty come to UMC from a variety of backgrounds and with a unique set of abilities, as well as needs. The focus of this curriculum will be designed to address the specific needs of these UMC faculty. Increasing engagement among the faculty has the potential to significantly advance the institution’s mission: to conduct groundbreaking basic discovery, to deliver innovative education to train the next generation of physicians and scientists, to translate scientific discovery to impact patient care, and to test novel first-in-patient therapeutic interventions. Learning goals for the innovation. Broadly speaking, the learning goals for this curriculum are to help physicians acquire the knowledge, skills, and attitudes that will enable them to become effective partners with development officers to engage in grateful patient fundraising. This encompasses the development of practical skills to understand how to identify, cultivate, solicit, and steward grateful patient donors as well as an attitudinal belief system that supports a strong culture of philanthropy. Finally, physicians will gain an understanding of the ethical values that inform grateful patient fundraising. By delivering instruction to equip faculty with the knowledge and skills to participate in grateful patient fundraising, the medical center will strengthen the culture of philanthropy within the health system and with that, the expectation of meaningful engagement among faculty. Prioritization of learning goals. As health systems like UMC enter an era of declining reimbursement rates, auxiliary revenue streams are becoming ever more important to the institutional mission. Philanthropy is one such revenue source that holds the potential to SCIENCE OF MEDICAL PHILANTHROPY 16 significantly advance institutional priorities within academic medical centers. The UMC board of directors and executive administration appreciate how philanthropy serves the institution and are committed to devoting the necessary resources to support the delivery of this instruction, as well as ensuring ongoing support from development staff in support of this institutional goal. Declining reimbursement rates often beget reductions in institutional operating expenditures. Whereas some UMC faculty may be apprehensive about fundraising, curtailed institutional support for their research programs has a way of encouraging their engagement in fund development. The promise of philanthropy to support their research goals can be a powerful motivator. For these reasons, the timing of this innovation is now. Data to inform the instructional design will be obtained by conducting short surveys with faculty and staff, and analyses of current training materials at UMC and in the healthcare field at- large. In addition, data will also be gathered through expert interviews and through observation of faculty trainings currently in practice at UMC. These data will provide important baseline indicators of content, instructional techniques, and outcomes, as well as an industry perspective on best practices for physician engagement in grateful patient fundraising. Curriculum Description and Purpose The purpose of this curriculum is to train UMC physicians to become effective partners with development officers to engage in grateful patient fundraising. The curriculum is designed to cover content related to the fundamental components of grateful patient fundraising specifically as it relates to physician involvement. The design blueprint will include a set of modules that includes the following topics: SCIENCE OF MEDICAL PHILANTHROPY 17 ● Guidelines for physician engagement in GPFR ● Health Insurance Portability and Accountability Act of 1996 (HIPAA) and fundraising ● Ethics and the physician-patient relationship ● Communicating a vision for philanthropy ● Pivotal points of engagement for physicians: ○ Identifying donor prospects ○ Donor cultivation and the role of the physician ○ Stewardship of philanthropic resources Curriculum Goal, Outcomes, and Capstone Assessment Effective coaching practices delivered in the healthcare setting have been shown to increase physician commitment to their institution’s development program (Rum & Wright, 2012). To address the learning needs of UMC physicians, the proposed curriculum is designed to increase physicians’ sense of self-efficacy and motivation to participate in the fundraising program. Upon completion of the curriculum, physicians will be able to: 1. Engage meaningfully in the cultivation and solicitation of gifts from grateful patients; 2. Understand the donor cycle and pivotal points of engagement for physicians; 3. Understand patient privacy as it relates to grateful patient fundraising; 4. Have an appreciation for fundraising ethics as it relates to the healthcare setting; and 5. Communicate articulately to lay audiences on complex medical and scientific concepts. A capstone assessment will be delivered to assess physicians’ mastery of the learning objectives. The capstone assessment will build upon earlier intermediate assessments that will be SCIENCE OF MEDICAL PHILANTHROPY 18 administered during each module within the curriculum. The capstone assessment will employ two measures to assess learner achievement, including a post-training online questionnaire coupled with indirect observation by role model experts. Gift officers will observe on-the-job performance of learners using a checklist developed to assess physicians’ mastery of grateful patient philanthropy practices. To supplement these measures, trailing indicators of learner achievement will be measured to assess the longer-term impact of the curriculum, including the include number of grateful patient referrals by physician and the dollar amount of gifts closed from qualified physician referrals. Definition of Terms This section includes a list of terms and definitions that are pertinent to healthcare philanthropy and used frequently within this design blueprint: a. Academic Medical Center (AMC): The term “academic medical center” (also known as an “academic health center”) refers to a medical school and its hospital (typically university-based), plus any affiliated community-based hospitals and/or practices. b. Faculty: In the setting of an academic medical center, “faculty” refers to physicians who serve as staff (employees) of the medical center. Typically, faculty will have responsibility for some combination of teaching, research, and/or patient care. c. Development officer: The term “development officer” (also known as “fundraiser” or “gift/advancement officer”) broadly refers to those individuals having responsibility for raising philanthropy within an academic medical center, university, or other qualified charitable organization. SCIENCE OF MEDICAL PHILANTHROPY 19 d. Grateful patient: The term “grateful patient” refers to patients who make philanthropic gifts to their healthcare institution emanating from their gratitude for the care they received. Programs intended to cultivate gifts from grateful patients are often referred to as “grateful patient fundraising (GPFR) programs.” e. Health Insurance Portability and Accountability Act of 1996 (HIPAA): The HIPAA Privacy Rule establishes national standards to protect individuals’ medical records and other individually identifiable health information, known as protected health information (PHI). f. Medical philanthropy: The term “medical philanthropy,” used interchangeably with “healthcare philanthropy,” refers to philanthropic gifts designated to healthcare institutions by donors, including individuals, foundations, corporations and other sources of charitable support. Potential Designer Biases As an employee of the UMC development office, the author has direct accountability for staffing physicians and encouraging their involvement in fundraising on behalf of the institution. Over the duration of her time as an employee, the author has developed a perspective of the positive impact of faculty engagement in the development program that could introduce bias into the curricular design. To avoid confirmation bias, the author will ensure safeguards are in place to suspend personal beliefs and judgments that may stem from her direct experience in this setting. The author will demonstrate rigor as well as restraint in the development of the design blueprint, prioritizing the utilization of primary and secondary data gathered through the exercise of this doctoral thesis over and above any anecdotal data drawn from personal experience. SCIENCE OF MEDICAL PHILANTHROPY 20 Organization of the Design Blueprint The purpose of the design blueprint is to develop an evidence-based curriculum to teach UMC physicians how to engage meaningfully in grateful patient fundraising. Chapter One provides an overview of the problem of practice, evidence supporting the need to engage a broader segment of physicians in the fund development program, and a rationale for this learning innovation. Chapter Two summarizes a review of the literature related to physician attitudes and perspectives towards grateful patient fundraising, a review of prior attempts to deliver curricula with similar learning objectives, and an analysis of the efficacy of these curricula. Chapter Three provides an overview of the characteristics of this learner population and the learning environment at UMC. The curriculum design, including an expanded overview of the curriculum goal, outcomes, and summative capstone assessment, is discussed in Chapter Four, along with a cognitive task analysis and a description of specific learning activities by each module included in the curriculum. The latter part of Chapter Four offers an overview of delivery media and implementation and assessment methods for the proposed curriculum. SCIENCE OF MEDICAL PHILANTHROPY 21 CHAPTER TWO: REVIEW OF THE LITERATURE The Curriculum Chapter Two is organized into three distinct sections beginning with the general theoretical approach informing the design of this instructional blueprint followed by a review of the literature that summarizes current perspectives on grateful patient fundraising and previous attempts to deliver curricula designed to engage physicians in the craft of grateful patient fundraising. This chapter concludes with a review of the theoretical approach to the curriculum design. While the first and third sections do not constitute a comprehensive review of available literature, the discussion of the theoretical approaches will provide important insight to the author’s own educational philosophy which informs the basis for the recommendations and conclusions drawn herein. General Theoretical Approaches The general theoretical basis for this instructional design is grounded in the philosophy of constructivism. Constructivism adheres to the belief that knowledge is not transmitted, rather it is constructed (Smith & Ragan, 2005). Contemporary theorists have further diversified this educational philosophy into two sects: individual constructivists and social constructivists. The author endorses the specific tenets of individual constructivism which assume that (1) “knowledge is constructed from experience, (2) learning results from personal interpretation of knowledge, and (3) learning is an active process in which meaning is developed on the basis of experience” (Smith & Ragan, 2015, p. 19). Many who espouse a constructivist approach also share a worldview of contextualism as integral to their philosophies. Contextualism assumes that “learning should be situated in realistic settings and assessment should be integrated into the task, not administered as a separate SCIENCE OF MEDICAL PHILANTHROPY 22 activity” (Smith & Ragan, 2005, p. 20). The notion of authentic assessment is of particular importance to the assumptions underlying this instructional design blueprint. Assessing higher order knowledge in the context in which it used calls for assessment to be integrated with learning activities in a seamless fashion (Smith & Ragan, 2005). The Practice of Grateful Patient Fundraising in Academic Medicine Grateful patient fundraising: limitations and opportunities. Individuals who encounter an exceptional patient experience when facing a serious health condition often exude feelings of immense gratitude for the care they received. This gratitude frequently prompts acts of benevolence toward healthcare institutions by patients and families who seek to express their appreciation. One such way gratitude is shown is through philanthropic giving, referred to as grateful patient philanthropy, which increasingly has become an important source of financial support for AMCs. Yet despite the importance of philanthropy to academic medical centers, there is virtually no prior empirical research to examine grateful patient philanthropy. In large part, the development literature contains anecdotal data attesting to the fruitfulness of physician- development collaboration in regards to the practice of GPFR, but there is scant empirical literature describing the manner by which these collaborations can be developed and optimized. A lack of published or accepted practices regarding physician engagement in GPFR may inhibit institutional success. A 2012 study marked the first randomized controlled trial in GPFR with the aim of evaluating the most effective approaches to engaging academic physicians (Rum & Wright, 2012). While this study offered insight to the effectiveness of various methodologies for engagement, it provided only a cursory review of the training content that physicians need to increase their efficacy and motivations for engaging in patient philanthropy. This design blueprint aims to fill this gap in knowledge. SCIENCE OF MEDICAL PHILANTHROPY 23 Realizing the potential of GPFR requires the engagement of physicians as trusted partners in the process, from identifying potential donor prospects to cultivating donors’ interest and philanthropic inclination. Yet the research shows that many physicians have limited experience to draw upon when responding to philanthropic inquiries from patients, while others feel uneasy about engaging in patient philanthropy because of unclear guidelines and norms (Rum & Wright, 2012; Stewart et al., 2011; Walter et al., 2015; Wright et al., 2013). Ethical challenges to grateful patient fundraising. Physician training is ingrained with a profound respect for the sanctity of the physician-patient relationship (American Medical Association [AMA], 2016). This guiding principle is a beacon driving the practice of medicine, so it is not surprising that physicians who perceive GPFR to conflict with their moral code to diminish its value to their institution. Physicians’ ethical concerns over the solicitation of their patients, and the subsequent impact on the physician-patient relationship, is well documented in the literature (DeMaria, 2006; Prokopetz & Lemann, 2014; Walter et al., 2015; Wright et al., 2013). This may present as concerns over differences in the level of care provided, e.g. physicians delivering superior care to patients who are donors. In fact, this can go both ways; some patients may harbor expectations of preferential treatment because of their giving (Prokopetz & Lehmann, 2014). The vulnerability of sick patients also plays into physician concerns and the fears that certain physicians may take advantage of patients in compromised situations (Roach & Jacobs, 2013). Still other physicians believe patients may feel undue pressure to give if their physician is directly involved in the solicitation (Prokopetz & Lehmann, 2014). The frequency of these concerns has incited some scholars to call for a more explicit articulation of ethical guidelines governing GPFR by professional societies, beyond what is perceived as the vague and overly simplistic standards that exist currently (Walter et al., 2015). SCIENCE OF MEDICAL PHILANTHROPY 24 The AMA (2016c) acknowledges that while gifts frequently are offered as an expression of gratitude and can enhance the physician-patient relationship, other gifts may be a patient’s attempt to secure preferential treatment. In an effort to help navigate appropriate gift acceptance, the AMA (2016b, 2016c) published general guidelines that are important for physicians and healthcare institutions to uphold when engaging in GPFR. Among these guidelines include being sensitive to a gift’s value relative to the patient’s means, and declining gifts that are disproportionately large or those that may present an emotional or financial hardship to the patient’s family. The AMA (2016c) cautions physicians never to allow a gift or offer of a gift to influence the patient’s medical care. Despite the chorus of concerns, numerous institutions believe that GPFR is a consensual relationship, the fulfillment of patients’ altruism inspired by the care delivered – quite the opposite of exploitation (Roach & Jacobs, 2013). However, ongoing concerns over patient privacy and trust persist among certain factions within healthcare, as well as confidence in physicians’ ability to navigate these ethical hazards, prompting some physician leaders to propose that medical centers voluntarily limit the full scope of patient information available to development programs under the new HIPAA Privacy Rule (Prokopetz & Lehmann, 2014). This sentiment is juxtaposed against a growing call for more forwardness in fundraising as a necessary antidote to the sea change affecting the financing of healthcare institutions in light of declining revenues and reimbursement rates (Haderlein, 2006; Shinkman, 2001). In fact, today many institutions are viewing philanthropy more holistically by investing in the creation of a culture of philanthropy that instills a development mindset across the entire institution. In the rush to escalate the production of GPFR, it is critical to recognize that medical philanthropy differs in important respects, namely the nature of the physician-patient relationship SCIENCE OF MEDICAL PHILANTHROPY 25 (DeMaria, 2006). If the physician’s duty is to place therapeutic obligations above all else (Weiss Roberts, 2006), how do we achieve a shared understanding of the role of philanthropy in academic medicine as we resolve to safeguard the sanctity of the physician-patient relationship? What is clear is the development industry’s duty to forge a middle path, a means by which to perpetuate the charitable mission of healthcare institutions while also providing physicians the proper guidance to navigate the ethical considerations raised by the practice of GPFR. To be successful, grateful patient fundraising requires the successful integration of multiple components, including institutional support, policies, and training to ensure physicians and development staff approach this work with the utmost integrity and skill. Physician attributes that promote philanthropic engagement. Contemporary research offers critical insight to the attitudinal beliefs that contribute to high-performing programs in medical philanthropy. Several studies sought to better understand the approaches and attitudes that are important to optimize GPFR. A 2008 qualitative study explores the perspectives of exceptional clinicians in AMCs with the objective of identifying those characteristics that are most pertinent to defining clinical excellence (Christmas, Kravet, Durso, & Wright, 2008). The authors found that multiple characteristics and aptitudes were at the core of clinical excellence: communication and interpersonal skills, professionalism and humanism, diagnostic acumen, skillful negotiation of the health system, knowledge, a scholarly approach to clinical practice, and a passion for medicine. While this study is not specific to physician involvement in GPFR, it does elucidate some of the qualities and habits of mind that exceptional physicians embody. Many of the same factors that define clinician experts, such as connecting with and inspiring others, mirror the essential qualities of those that are successful at philanthropic fundraising (Christmas et al., 2008; Ohman, Douglas, Dean, & Ginsburg, 2016; Stewart et al., 2011). SCIENCE OF MEDICAL PHILANTHROPY 26 Another qualitative study engaged physicians who have been successful in securing philanthropy to characterize the factors that translated into their success (Stewart et al., 2011). A purposive sample of physicians participated in semi-structured interviews, the results of which were categorized into themes that related to success in GPFR: excellence in patient care, connecting meaningfully with patients, institutional support (including support from and collaboration with the development office), listening for patient cues and articulation of the vision, and ability to recognize potential donors. These findings suggest that training physicians to feel comfortable discussing philanthropy and preparing them to respond to patient inquiries is an essential component of their success. Respondents overwhelmingly conveyed a sense that the provision of exceptional patient care and meaningful connections with patients served as the foundation for philanthropic gifts (Stewart et al., 2011). These approaches used by successful physicians may offer beneficial guidance to physicians with less experience in GPFR. A review of the development literature indicates a key to success is to pair engaged and prepared faculty with the opportunity that GPFR presents to AMCs. The challenge for AMCs is to educate an increasingly larger share of faculty to engage meaningfully in GPFR to realize its full potential. Meaningful physician engagement demands that academic medical centers are well-positioned to impart the requisite knowledge and practices so physicians can build their fundraising expertise over time. Content While the development literature presents some guidelines for what physicians generally need to know to be effective in GPFR (Rum & Wright, 2012), the literature does not describe their prevalence or the curricular content necessary to teach physicians to capitalize on philanthropic opportunities as they present (Walter et al., 2015). Some of the common themes SCIENCE OF MEDICAL PHILANTHROPY 27 described as being essential to GPFR include delivering exceptional care to all patients, cultivating close relationships with patients, listening for cues and clues from patients that may express philanthropic potential, being able to express a succinct vision for the role of philanthropy, and finally understanding ethical considerations as it relates to engaging grateful patients in philanthropic conversations (Rum & Wright, 2012). Despite its importance to the ethical practice of GPFR, physicians may struggle to understand the nuances of the application of patient privacy rules as it applies to GPFR. The Privacy Rule, a key provision of the Health Insurance Portability and Accountability Act of 1996, established for the first time a set of national standards for the protection of certain health information. The Privacy Rule assures that individuals’ health information is properly protected while allowing access to appropriate health information that is necessary to deliver healthcare. The Privacy Rule also permits the use of patient demographic data, health status data, and dates of health service for fundraising purposes. While these guidelines may offer some clarity and assistance to physicians regarding their role in GPFR, there remains significant room for interpretation which begs the need for employers to contextualize these guidelines within the culture and norms of the institution where physicians practice. A recent survey of oncologists at National Cancer Institute (NCI)-designated cancer centers on topics related to their exposure to development and participation in philanthropy illustrates this point (Walter et al., 2015). While 71% of respondents had been exposed to development staff, only one-third reported that these meetings included practical guidance on navigating ethical aspects of GPFR and adherence to HIPAA regulations. Walter et al. reported that most respondents shared that their interface with development emphasized primarily the importance of physician involvement in GPFR, specifically how to identify grateful patient SCIENCE OF MEDICAL PHILANTHROPY 28 prospects, thus illustrating the limited nature of their training. Physicians whose lack of preparation and skills related to the intersection of patient privacy and GPFR may contribute to their uneasiness and reticence to engage patients in this way. Prior Attempts There is no consensus on the optimal method by which to educate physicians in GPFR and enlist their ongoing participation. Prior methods at some institutions include workshops and engaging outside consultants as trainers. The topic of physician engagement in GPFR at departmental and divisional meetings is another common practice to increase awareness and commitment to GPFR. Additionally, numerous institutions have developed their own proprietary educational training programs to train physicians how to engage in grateful patient fundraising. For example, one such academic medical center developed a curriculum designed to be covered in a single, one-hour coaching session with an agenda covering a range of topics, including: (a) factors that motivate people to give, (b) ethical considerations, (c) cues that may indicate philanthropic intent, (d) assessment of philanthropic potential and interest, (e) strategies to overcome barriers to fundraising, (f) stewardship, and (g) action plan development (Rum & Wright, 2012). While the topical areas of this curriculum align with what the research tells us physicians need to know and be able to do, it hardly seems plausible that this scope of instructional content can be conveyed adequately in 60 minutes. Further, absent the integration of authentic learner assessments, training curriculums such as this one deny instructional designers the opportunity to answer a critical question: Does it work? While a range of instructional methods are used in practice, there remains little published data in the way of content, nor any formal evaluation data that conveys the effectiveness of specific training programs. There is clear need to develop a comprehensive curriculum for SCIENCE OF MEDICAL PHILANTHROPY 29 physicians who engage in grateful patient fundraising that is grounded in learning theory and incorporates evidence-based approaches to learning and assessment. Analysis of prior attempts. A survey of prior attempts to deliver instruction on GPFR reveals a lack of published data evaluating the effectiveness of these programs relative to their intended learning objectives. External consultancies catering to the healthcare industry have developed proprietary instructional programs to teach physicians best practices related to GPFR. Advancement Resources is but one among a plethora of consultancies that markets professional development training programs to healthcare philanthropy organizations. This company offers a curriculum that encompasses four modules, each delivered in two and a half to four hours, from how to make philanthropic referrals to articulating philanthropic opportunities to donors (Advancement Resources, 2017). The company’s website markets its curricula as research- based, which to the outside observer appears to be merely an ad hoc compilation of ethnographic interviews with physicians and grateful patients; the company’s published literature lacks any empirical data to substantiate its research claims. A lack of clearly articulated research methods invites concerns regarding their findings which form the basis of their instruction. Occupying another place along this spectrum is WealthEngine which bills itself as the premier authority on best practices related to GPFR. The company website offers a no-cost, downloadable brochure that offers practical advice to establish a grateful patient program in six steps. While the simplicity of this model may have merit in certain situations, it is doubtful that such a program is capable of equipping institutions to perform at the level of sophistication that is required of AMCs today. More likely, this brochure serves as lead generator which is used as a point of entry to market a broader array of services and products catering to healthcare philanthropy organizations. SCIENCE OF MEDICAL PHILANTHROPY 30 A lack of published evaluation data suggests that none of these programs have been exposed to the rigor of systematic evaluation to measure their effectiveness at achieving intended learning objectives. At best, testimonials from past participants are offered as a means of conveying learner satisfaction but do little to reveal if actual learner behavior, attitudes, and practices have changed as a result of the intervention. A lack of detail regarding course content denies the author the opportunity to assess the effectiveness and comprehensiveness of the GPFR training programs that are readily available. Approaches to the Curriculum Design Theoretical Foundations to the Curriculum Design Adult learners require differentiated instructional strategies that flow from the ways adults learn, distinct from traditional pedagogy designed for children. Instructional strategies drawn from Malcolm Knowles’ (1970) theories of adult learning and Andragogy, defined as the art and science of adult learning, offer a foundation for this curriculum design. Knowles’ philosophy is rooted in the evolving motivations of the learner which unfold throughout the maturation process: “As an individual matures, his need and capacity to be self-directing, to utilize his experience in learning, to identify his own readiness to learn, and to organize his learning around life problems, increases steadily from infancy to pre-adolescence, and then increasingly rapidly during adolescence (Knowles, 1973, p. 43). Knowles’ (1973) andragogical theory is based on four assumptions: 1. Changes in self-concept: As a person grows and matures, one’s self-concept moves from that of total dependency (in the case of infants) to one of increasing self- directedness. SCIENCE OF MEDICAL PHILANTHROPY 31 2. The role of experience: As an individual matures, a person accumulates experience that causes him or her to become an increasingly rich resource for learning, and at the same time broadening one’s base from which to relate new learnings. 3. Readiness to learn: As an individual matures, a person’s readiness to learn is decreasingly the product of his or her biological development and academic pressure and is increasingly the product of the developmental tasks required for the performance of evolving social roles, including vocations. 4. Orientation to learning: As an individual matures, adults tend to have a problem- centered orientation to learning, where the emphasis is on immediacy of application, whereas children are conditioned to be more subject-oriented, where the emphasis is on delayed application. The andragogical approach is grounded in a process model which is distinguished by its orientation towards procedures to help adult learners acquire information and skills. The instructor is concerned with involving the learners in a process of learning centered around these elements: ● establishing a climate conducive to learning; ● creating a mechanism for mutual planning; ● diagnosing the needs for learning; ● formulating instructional content that will satisfy these needs; ● designing a pattern of learning experiences; ● conducting these learning experiences with suitable techniques and materials; and ● evaluating the learning outcomes and re-diagnosing learning needs. SCIENCE OF MEDICAL PHILANTHROPY 32 This theoretical approach is vital to the design of this instructional blueprint because physicians are experienced learners and require an instructional approach that aligns with their level of intellectual sophistication and orientation to learning. Knowles (1973) observes that much professional education is totally out of phase with adult students' readiness to learn. In the case of physicians, Knowles would argue that they need to have had sufficient exposure to patients and the hospital environment before they can be ready to learn about medical philanthropy. For this reason, the author supports the delivery of this curriculum not as a component of undergraduate or graduate medical education, but as a central facet of physician continuing medical education as the individual transitions from the role of student/trainee to independent practitioner. SCIENCE OF MEDICAL PHILANTHROPY 33 CHAPTER THREE: THE LEARNERS AND LEARNING CONTEXT Learner Profile Ability For the UMC Medical Philanthropy Program, two perspectives of ability will be addressed: cognitive and physiological characteristics. Cognitive characteristics. Physician participants in the Medical Philanthropy Program have proficient reading skills, knowledge comprehension, and communication skills. They are highly self-directed in their work, capable of collaborative learning in small groups of adult learners, demonstrate active listening skills, able to follow directions in auditory and written formats, and proactively ask clarifying questions when more specificity is needed. Participants are technologically savvy, comfortable engaging in online learning modules, utilizing electronic health records, and completing online surveys and other assessments. Physicians may have varied levels of prior experience with GPFR, including interaction with development officers. Learners have varied experiences in delivering presentations to donors and prospects on their programs of research. Learners will have been trained on HIPAA as it relates to patient privacy, but perhaps received more limited training on the application of HIPAA to patient fundraising. The participants are adults who have reached Piaget’s Formal Operational stage of cognitive development. In this stage, adults can reason abstractly and think in hypothetical terms (e.g., philanthropy will enhance my research program). All learners are college-educated with one (MD) or more graduate degrees (MS, MPH, PhD, for example). Physiological characteristics. Learners can see and hear and have well-developed motor skills. They have the mental dexterity and ability to process and learn new information. Learners are adults over 30 years of age. SCIENCE OF MEDICAL PHILANTHROPY 34 Self-Efficacy This aspect of motivation is address by describing the affective and the social characteristics. Affective characteristics. Learners may have varied levels of interest in GPFR, but most all will have an appreciation for how philanthropy can enhance the academic enterprise. Many will be eager to engage with development officers in patient fundraising while others may feel indifferent, frustrated, or annoyed about completing the training, likely due to a previous negative experience they had with development staff. Some will be familiar with the content. Because learner participation in the Medical Philanthropy Program will be voluntary, learners should feel motivated to persist through the program. Learners who are newer to grateful patient fundraising may experience anxiety, resistance, or enthusiasm. Case studies from physician experts interspersed throughout the curriculum will help allay anxieties and enhance the attitudinal beliefs of less experienced participants in the Medical Philanthropy Program. Motivation levels will also fluctuate between learners. Motivation levels are predicted to be high for participants who appreciate the value of philanthropy or who have successfully participated in GPFR in the past. Motivation levels may be low in participants who view GPFR as ethically inappropriate or as an unnecessary distraction from their clinical, teaching, and/or research responsibilities. If incentives are offered (i.e., participants are extrinsically motivated to learn), motivation levels may rise. The promise of a dedicated development officer who can provide personalized one-on-one support may motivate learners to actively engage in the program. Anxiety levels may be high for physicians who lack experience in GPFR, have had a negative experience with the development office, or have competing needs or higher-level priorities. Anxiety levels could also be elevated among early-career physicians who may be SCIENCE OF MEDICAL PHILANTHROPY 35 learning alongside mid-career and senior physicians. Likewise, senior physicians could have anxiety if their abilities are perceived to be lower than those physicians who are earlier in their careers. High levels of anxiety could reduce motivation levels. An important affective characteristic that must be considered is self-efficacy or the learner’s confidence in their ability to accomplish certain tasks. Self-efficacy plays a major role in motivation and influences the learner’s decision to engage in the task. If the learner has low self-efficacy for a task, he or she may decide not to attempt the task altogether. Therefore, the curriculum will begin with an initial online survey designed to assess the learner’s self-efficacy and modulate the delivery of the curricular content to the ability of each learner. Learners will be asked to report their (a) prior experience and/or involvement in GPFR, (b) confidence level with GPFR, and (c) ethical perceptions of GPFR. Participants will report responses using a Likert- scale instrument. A similar post-training survey will be conducted as part of the capstone assessment at the conclusion of the Medical Philanthropy Program. Social characteristics. Learners will have varied levels of connection to their peers. Some participants will have numerous years of experience working at UMC, while others may be earlier in their tenures. Some learners may work in similar or related disciplines as their peers, whereas others may have had no prior interface with fellow learners. Those with strong relationships will be more heavily influenced by their peers’ attitude and level of engagement. For example, if a learner with low motivation observes their peers positively engaging in the training, he or she is more likely to become an engaged learner. Similarly, if a learner’s peer group does not value the training program and/or withdraws from the training due to a lack of motivation to engage in GPFR, the learner may also adopt this attitude. Alternatively, if an extrinsic incentive exists (i.e., a financial bonus associated with meeting or exceeding a GPFR- SCIENCE OF MEDICAL PHILANTHROPY 36 related metric in their annual performance appraisal), the learner may feel competitive and be externally motivated to outperform his or her peers. If learners feel a sense of accountability to the medical center to actively participate in the fundraising program, the Medical Philanthropy Program is more likely to yield positive results. If participation in the Medical Philanthropy Program feels like an unspoken mandate by the dean or department chair, the learner may feel disenfranchised and display poor performance. Physicians who feel recognized in a positive way by medical center administration for engaging in the training may feel compelled to exert more effort to (a) master the content covered in the training and (b) actively engage in GPFR going forward. Prior Knowledge To be successful in the program, learners must have general and specific prior knowledge before engaging with the material. General world knowledge. Participants will be highly sophisticated learners having completed a minimum of twelve years of postsecondary education, including college, medical school, internship, residency, fellowship and/or post-doctoral training. Learners will have practiced medicine for a minimum of four years, though many may have practiced for twenty years or more. These physicians will have a sophisticated understanding of their medical discipline, but some learners may have more limited practice due to the fact they are earlier in their careers. Specific prior knowledge. Examining learners’ prior knowledge is critical to ensuring that the content taught in the Medical Philanthropy Program is appropriate for the audience. For example, understanding philanthropy, and more specifically what a charitable gift is, is important background knowledge that the learner must possess before being able to participate in the SCIENCE OF MEDICAL PHILANTHROPY 37 training. A lack of understanding of these general concepts will likely result in a learner’s failure to fully grasp the training content. An assessment of learners’ baseline knowledge will be conducted through an online survey delivered at the outset of the curriculum to assess how well each participant understands what philanthropy is, what a charitable gift is, etc. (see Appendix A). The curriculum will be designed such that participants who are not clear on these basic concepts will receive more in-depth, pre-training to learn the basics of charitable giving in a healthcare environment. As learners progress through the training curriculum, assessments will be delivered during each unit to ensure the program sessions are tailored accordingly and to ensure learners are grasping the instructional material. Learners will participate in a post-training survey covering similar topics. Description of the Learning Environment Facilitator Characteristics Because peer-to-peer learning is important, the program will be co-led by a development professional and a physician who has demonstrated him/herself to be a successful fundraiser. The development instructor for the Medical Philanthropy Program has prior experience teaching physicians about GPFR and has more than twenty years of experience in the development industry. The development instructor also has a strong personal belief in the value of GPFR to academic medicine. The development and physician instructors view their roles in the Medical Philanthropy Program as (a) disseminating key information about GPFR and facilitating small group and class conversations, (b) increasing participants’ levels of self-efficacy in being able to engage in GPFR and modeling these practices for the larger UMC physician community, and (c) providing specialized expertise in evidence-based practice as it relates to GPFR. Because GPFR is very much a relational practice, the development instructor and physician instructor will be SCIENCE OF MEDICAL PHILANTHROPY 38 available to meet individually with participants to address any questions or concerns and offer one-on-one coaching to engage more deeply in topics covered in the training. This will ensure the content is customized to meet the unique needs and aspirations of individual learners. Existing Curricula/Programs The department of Organizational Development and Learning (ODL) at UMC offers a variety of consulting services to address issues that affect the productivity and success of UMC departments and units. In addition to delivering individualized consulting services, ODL offers a range of leadership development programs designed to help individuals in management roles increase and improve their technical and interpersonal leadership skills. Only one of these offerings catering to the development of healthcare leaders, including physicians, offers an introduction, albeit a limited one, to GPFR. The Medical Philanthropy Program will be integrated with physician continuing medical education and other UMC leadership development programs to ensure the delivery of training content is compatible and does not duplicate content. Available Equipment and Technology Four of the six modules that comprise the Medical Philanthropy Program will be will be delivered in an online format that is accessible via UMC’s internal training portal. Learners will be required to use their UMC-issued username and password to access the training. An unlimited number of participants may be enrolled in the online trainings at any given time. In-person seminars will be held monthly at UMC’s conference center, a state-of-the-art facility equipped with the most advanced technology, including Internet, SMART boards ®, teleconferencing, and video projection capability. To maintain an intimate learning environment, seminars will be limited to 40 participants per session. Needs assessment data reveal that participants prefer active learning and applying their prior knowledge to the training content. SCIENCE OF MEDICAL PHILANTHROPY 39 Classroom Facilities and Learning Climate The department of Organizational Development and Learning, which serves as the umbrella for all professional development at UMC, embraces a philosophy of experiential and small group learning; this program will mirror that format. The curriculum will be delivered in an online format coupled with small group, in-person seminars. Supplemental individual coaching will be also be available to learners via the instructors and UMC development officers. Online instruction will be delivered in an asynchronous environment to allow learners to access the training content on their own schedule. The classroom seminars will be offered monthly to afford maximum flexibility for learners. The classroom environment will resemble a seminar format with tables and chairs arranged in rectangle so participants are facing one another. This format conveys respect for the learners and enables a participatory environment. The instructors will occupy seats at the table alongside the learners, conveying equal footing with the learners and respect for the knowledge and experience they bring to the learning environment. The Medical Philanthropy Program will be marketed to faculty physicians at UMC according to a predefined, sequential rollout determined by the development office. During initial implementation of the curriculum, emphasis will be given to physicians practicing in high potential service lines, defined as those having strategic priority to UMC and those with higher capacity (giving potential) patient bases. SCIENCE OF MEDICAL PHILANTHROPY 40 CHAPTER FOUR: THE CURRICULUM Overall Curriculum Goal, Outcomes, and Summative Assessment Curriculum Goal There are three overarching goals for this curriculum which collectively are oriented towards training UMC faculty to engage fully in healthcare philanthropy. First, this curriculum is designed to increase faculty’s motivation to engage in grateful patient fundraising (GPFR). Faculty can feel unmotivated to engage in GPFR if they do not perceive how philanthropy can benefit the institution, including their individual practice and/or program. Knowledge imparted via this curriculum will ensure greater transparency around institutional policies and practices related to GPFR. Secondly, the curriculum is designed to increase faculty’s confidence (self-efficacy) about medical philanthropy, including the legal and ethical aspects of engaging in grateful patient fundraising. If faculty feel uncertain about the legalities of GPFR, they may be reticent to engage in GPFR. This curriculum is designed to teach faculty about federal and state privacy laws as it relates to GPFR, and offer practical guidance to navigate GPFR. Equally as important are ethical considerations. This curriculum will support open and honest dialogue about the physician-patient relationship and hopefully resolve any dissonance faculty may feel or perceive as it relates to GPFR. Finally, this curriculum is designed to enhance faculty’s level of skill (declarative and procedural knowledge) to engage in GPFR. Declarative knowledge refers to the factual knowledge faculty must possess to engage meaningfully in GPFR, and procedural knowledge refers to the application of this knowledge (Smith & Ragan, 2005). SCIENCE OF MEDICAL PHILANTHROPY 41 Curriculum Outcomes Upon completion of the curriculum, physicians should be able to: 1. Engage meaningfully in the cultivation and solicitation of gifts from grateful patients; 2. Understand the donor cycle and pivotal points of engagement for physicians; 3. Understand patient privacy as it relates to grateful patient fundraising; 4. Have an appreciation for fundraising ethics as it relates to the healthcare setting; and 5. Communicate articulately to lay audiences on complex medical and scientific concepts. Summative Assessment A capstone assessment will be administered to assess physicians’ mastery of the learning objectives. The capstone assessment will utilize two measures, including an online assessment which will be administered following completion of the modules in the training and observation of learners during on-the-job application of skills learned. The questionnaire will effectively function as a post-test and include questions that assess participants’ mastery of concepts covered within the curriculum. Because the post-test questionnaire utilizes similar prompts from the unit-based assessments, it will chart the evolution of a faculty member’s knowledge as a result of his or her participation. Gift officers will also observe on-the-job performance of learners using a checklist developed to assess physicians’ mastery of grateful patient philanthropy practices. This instrument will be administered following learners’ completion of the curriculum during one-on- one coaching sessions between faculty and the assigned gift officer. The checklist will primarily assess learners’ declarative and procedural knowledge related to GPFR. SCIENCE OF MEDICAL PHILANTHROPY 42 To supplement these measures, trailing indicators of learner achievement will be measured to assess the longer-term impact of the curriculum, including the include number of grateful patient referrals by physician and the dollar amount of gifts closed from qualified physician referrals. Cognitive Task Analysis (Information Processing Analysis) The approach to conducting the cognitive task analysis (CTA) was first to interview two subject matter experts. Going forward, these individuals will be referred to as SME-A and SME- B or collectively as SMEs. The SME-A is a senior faculty member at UMC, and SME-B is an experienced fundraiser in medical philanthropy. The SMEs were selected based on their past successes in closing gifts from grateful patients and, equally as important, the author’s perception of the level of thoughtfulness each SME would bring to this conversation. In addition to SME interviews, the CTA was informed by a review of the literature, specifically existing grateful patient philanthropy curricula and scholars’ earlier findings on the essential components of knowledge physicians must have to be successful in GPFR. For physicians to be successful in grateful patient fundraising, the SMEs highlight the knowledge and skills that learners must master to realize future success in grateful patient fundraising. This knowledge and skills can be summarized in the following six tasks: 1. Accommodating Patient Privacy in Grateful Patient Fundraising 2. Examining Ethical Perspectives of Grateful Patient Fundraising 3. Applying Institutional Policies on Fundraising 4. Appraising Grateful Patients’ Motivations for Giving 5. Identifying Patient Prospects and Opening a Philanthropic Conversation 6. Stewarding Grateful Patient Donors SCIENCE OF MEDICAL PHILANTHROPY 43 General Instructional Methods Approach The overarching instructional methods for this course are informed by Knowles’ andragogical teacher approach to adult learning which is distinguished by its emphasis on the process of learning, as opposed to outcomes (Knowles, 1973). Merrill’s (2002) first principles for instructional design provide a useful categorical structure which encapsulates this theoretical approach. This instructional approach is summarized in the following five principles: (a) solving problems a learner will encounter in their practice (b) activating learners’ prior knowledge, (c) connecting this to new knowledge, (d) application of new knowledge, and finally, (e) integration of this new knowledge into one’s practice. Instruction that is conducive to effective adult learning is premised on a belief in and respect for learner’s prior experience and ability. By activating their prior knowledge, learners will be encouraged to construct their own meanings of the instruction using personal experience as a resource to create their own associations with the content. This generative strategy of instruction has been shown to support better learning especially for highly knowledgeable learners, such as physicians, because it allows for greater autonomy to relate the information to their own cognitive structure (Smith & Ragan, 2005). Description of Specific Learning Activities Gagne’s (1985) categorical system offers a paradigm to describe the types of learning outcomes embedded within this curriculum and the specific learning strategies that will be employed to facilitate achievement of these respective outcomes. Gagne’s five domains include: (a) declarative knowledge, (b) intellectual skills, (c) cognitive strategies, (d) attitudes, and (e) psychomotor skills. This curriculum is primarily concerned with the acquisition of declarative knowledge; intellectual skills, particularly principles, procedures and problem-solving; and attitudes. SCIENCE OF MEDICAL PHILANTHROPY 44 This curriculum places emphasis on generative learning strategies which tap the experience of learners and involves them in analyzing their experience. For example, this curriculum will utilize strategies including discussion, simulation, field experience, and other generative learning activities as the basis for instruction. Overview of the Units Unit 1: Grateful Patient Fundraising Overview (CTA Steps 1-6) Terminal learning objectives. At the conclusion of this thirty-minute, online module, learners will have an awareness of and appreciation for healthcare philanthropy and GPFR as it relates to UMC, and how this curriculum can offer critical knowledge to guide learners’ involvement in GPFR. Prerequisite analysis (enabling objectives). To achieve their terminal objectives, learners must be able to: ● Understand the concept of charitable giving ● Appreciate the role of philanthropy in academic medicine and at UMC, in particular ● Know how physicians can support UMC’s strategic priorities through participation in GPFR Learning activities. A physician expert will engage learners in an overview of the role and importance of medical philanthropy at UMC. Using case studies, the expert will introduce how learners can participate in the practice of medical philanthropy. Assessment. Learners will be assessed by an online questionnaire (direct report) that surveys how physician participants attend to GPFR. SCIENCE OF MEDICAL PHILANTHROPY 45 Unit 2: Accommodating Patient Privacy in Grateful Patient Fundraising (CTA Step 1) Terminal learning objectives. At the completion of this thirty-minute, online module, learners will be able to define, describe, and apply appropriate ways to utilize permissible PHI under HIPAA for fundraising purposes. Prerequisite analysis (enabling objectives). To achieve their terminal objectives, learners must be able to: ● Know what HIPAA means and its purpose ● Know what PHI means ● Negotiate usage of PHI for fundraising activities Learning activities. Learners will recall their prior knowledge of the Health Insurance Portability and Accountability Act of 1996 and review its application to medical philanthropy. Learners will recall the attributes of PHI to qualify whether its application in specific situations (related to medical philanthropy) is permissible under the Patient Privacy Act. Assessment. Learners will be assessed by a series of short, online, multiple choice style quizzes that include a series of brief case studies/situations that cover which PHI is permissible and not permissible under HIPAA. Unit 3: Applying Institutional Policies for Fundraising (CTA Step 3) Terminal learning objectives. At the completion of this 30-minute, online module, learners will be able to describe and apply institutional policies as it pertains to grateful patient fundraising. Prerequisite analysis (enabling objectives). To achieve their terminal objectives, learners must be able to: ● Know the institutional policies SCIENCE OF MEDICAL PHILANTHROPY 46 ● Know the settings in which these policies apply ● Know the consequences of not following institutional policies ● Know how to apply the institutional policies in practice Learning activities. Learners will recall their prior knowledge of institutional policies related to fundraising, and review how these policies are applied at UMC. Assessment. Learners will complete an online questionnaire to assess their knowledge of UMC’s institutional policies on fundraising. Unit 4: Stewarding Grateful Patient Philanthropy (CTA Step 6) Terminal learning objectives. At the completion of this thirty-minute, online seminar, learners will be able to describe how to develop meaningful relationships with grateful patients and be good stewards of their generosity. Prerequisite analysis (enabling objectives). To achieve their terminal objectives, learners must be able to: ● Know the importance of stewardship in medical philanthropy ● Define appropriate actions for physician involvement in the stewardship plan ● Apply the principles of financial management of philanthropic funds Learning activities. Learners will review the sequencing and clustering of steps involved in donor stewardship. Learners will be introduced to a range of practice scenarios and, with the support of the job aid and prior knowledge, practice applying the stewardship steps for each scenario. Assessment. Learners will be assessed by a series of short, multiple choice quizzes that include a series of brief case studies/situations that cover how appropriate stewardship principles are recognized and applied by the physician at various points in the stewardship cycle. SCIENCE OF MEDICAL PHILANTHROPY 47 Unit 5: Examining Ethics in Grateful Patient Fundraising (CTA Step 2) Terminal learning objectives. At the completion of this 75-minute, in-person seminar, learners will demonstrate an attitude that values and shows respect for the physician-patient relationship, irrespective of the patient’s donative intent, and demonstrate sensitivity to the disparities in human circumstance when a patient and his or her family are facing serious illness or disease. Prerequisite analysis (enabling objectives). To achieve their terminal objectives, learners must be able to: ● Know how to ensure the clinical needs of the patient come first; philanthropy is always subordinate to patient care ● Know why it is essential to maintain a singular, high standard for patient care ● Apply ethical behavior in a clinical setting where philanthropy is involved Learning activities. In small groups, learners will engage in role-play scenario to examine and discuss ethical behavior. Following the role-play, small group debrief takes place followed by large group feedback and reflection. Assessment. Learners will complete a brief online questionnaire depicting scenarios where ethical philanthropic conduct is examined to assess their disposition. The instructors will facilitate a group dialogue where learners will share their rationale for their perspectives. Additionally, gift officers will indirectly observe how physicians are conducting themselves in practice and document their performance using a rubric that assesses the behavioral component of attitudinal learning. SCIENCE OF MEDICAL PHILANTHROPY 48 Unit 6: Appraising Patients’ Motivations for Giving (CTA Steps 4 and 5) Terminal learning objectives. At the completion of this 75-minute, in-person seminar, learners will know how to identify and describe common motivations for patient philanthropy, assess patients for philanthropic potential, and understand how to respond to patients’ expressions of gratitude. Prerequisite analysis (enabling objectives). To achieve their terminal objectives, learners must be able to: ● Differentiate among a range of motivations that inspire grateful patients to offer philanthropic support ● Discern which patient characteristics and/or attributes are highly correlated with philanthropic giving ● Identify patient cues and clues that signal philanthropic interest ● Know what to say to a grateful patient on the topic of philanthropy Learning activities. Learners will discuss the value of the patient experience as it relates to philanthropic intent and then, using case studies, draw connections between the patient experience and donative intent. Learners will also examine case studies to learn how physicians can employ strategies to nurture charitable giving. Learners develop mnemonics to recall common donor attributes that collectively signify high potential prospects. Assessment. Using a real-time online response device, learners will observe a series of examples (video or narrative profiles) to categorize examples and nonexamples of patients who demonstrate donative intent. Learners will be asked to provide a rationale for their response. SCIENCE OF MEDICAL PHILANTHROPY 49 Delivery Media Selection Numerous studies have shown that instructional design, not media, is the single most important driver of a learner’s ability to acquire knowledge and skills (Clark, Yates, Early, & Moulton, 2010). Fortuitously, this offers a range of media to be considered and evaluated to ensure the optimal selection for this, or any, training. A fully articulated scope of instructional methods is an essential foundation to evaluate effectively the unique benefits and weaknesses of specific media alternatives. Clark et al. (2010) developed a rubric proposing three key considerations, including authenticity, immediate feedback, and special sensory requirements, as a means by which to negotiate the selection of appropriate media delivery systems. Authenticity Authenticity refers to the media delivery platform’s ability to approximate the environment and/or conditions in which the application of knowledge will take place (Clark et al., 2010). Training physicians to engage in grateful patient fundraising training lends itself to authenticity in both online and in-person instructional settings. Today, sophisticated technology is available to simulate with high fidelity the settings in which physicians would apply his or her learning, thus reducing (though perhaps not eliminating) the need for live, in-person instruction. Immediate Feedback Immediate feedback refers to the delivery of corrective feedback by an expert which enables learners to apply newly acquired knowledge and skills. Multiple media delivery options can deliver the promise of immediate feedback, however asynchronous online platforms must be sophisticated enough to offer individualized corrective feedback in real time that is unique to learners’ experience with the learning activities. While these capabilities exist today, the technology will only continue to improve as cognitive technology (artificial intelligence) gains a SCIENCE OF MEDICAL PHILANTHROPY 50 stronger foothold in business training software to facilitate the delivery of instruction where experiential learning is essential to the learning outcomes, such as this one. These intelligent platforms utilize deep learning algorithms to simulate any number of instructional capabilities, including reasoning, problem-solving, perception, and knowledge representation. Sensory Requirements Certain trainings may have sensory requirements that extend beyond the visual and aural senses that electronic media cannot provide, such as taste, touch or feel, thus necessitating live, in-person instruction (Clark et al., 2010). Since GPFR lacks any special sensory requirements, the training lends itself to be delivered either online, in-person, or a blend of the two options. Instructional Media Options A range of delivery media options could be implemented to deliver this course. For example, this training could be delivered in a traditional classroom where the instructor and learners participate live and in-person at a site like UMC. Likewise, the training could be offered as an online course, either synchronous and asynchronous, or some blend thereof. Table 1 illustrates the instructional media options and how each option rates against Clark et al.’s (2010) media selection criteria. SCIENCE OF MEDICAL PHILANTHROPY 51 Table 1 Instructional Media Options Can the delivery system provide? Synchronous (Live) Instructor onsite Synchronous (Live) Instructor on Online Platform Mix of Synchronous Instructor with Asynchronous Computer-based Tutorial on Online Platform Asynchronous Computer-based Tutorial on Online Platform Authenticity Yes Yes Yes Yes Immediate feedback Yes Yes Yes Yes, if software design has this capability. Special sensory requirements N/A N/A N/A N/A While this course will be developed initially for UMC physicians, it is plausible that in the future the course could expand its reach to numerous other sites within the UMC health system but also other academic medical centers across the U.S. With future expansion in mind, it is advantageous to select a media delivery system that could eventually accommodate a broader geographic reach. Options here would include: (1) synchronous online learning, (2) a mixture of synchronous online learning and asynchronous pre-recorded learning, or (3) pre-recorded asynchronous learning. The delivery costs for each of these options will reveal which option is most feasible and cost-effective to garner the greatest possible participation. Delivery Costs For this training, projected expenditures vary by the delivery method. Live, in person training costs include: cost of instructional materials, costs of travel to and from UMC, and SCIENCE OF MEDICAL PHILANTHROPY 52 conference service fees, including room reservation fees, audio/visual technology support, and catering. For the online synchronous and asynchronous training sessions, the costs are comparable, although there are direct costs for instructor compensation for live, synchronous delivery. The costs for a computer-based delivery include access to an online conferencing platform, such as Adobe Connect, maintenance of the platform, and a phone bridge for live sessions. Participants requirements include time and access to a computer with Internet connection, and a camera and microphone if delivered synchronously. Table 2 outlines the relative cost per delivery model calculated on a per student basis. SCIENCE OF MEDICAL PHILANTHROPY 53 Table 2 Delivery Costs for Media Options Live Instructor onsite Synchronous (Live) Instructor on Online Platform Mix of Live Instructor with Computer-based Tutorial on Online Platform Asynchronous Computer-based Tutorial on Online Platform Number and location of learners Only physicians located at UMC (limited to 40 per session) All physicians on the platform (approximately 2,000) All physicians on the platform (approximately 2,000) with live session limited to 40 participants All physicians on the platform (unlimited) Total costs ($-$$$$) $$$$ $$ $$ $ Stakeholder Desirability Low Desirability; costly, scheduling challenges could mean lower participation rates; harder to engage physicians located across the health system Low Desirability; costly, scheduling challenges could mean limited access to large number of physicians High Desirability; increase value of training for experiential learning components and access to physician experts; but could be difficult to coordinate scheduling High Desirability; cost effective to design, deliver, and control for consistency and reproducibility; flexible access could mean higher physician participation rate Cost per Learner Approximately $500 per student, based on enrollment of 40 students There are marginal, variable costs. There are marginal, variable costs. There are negligible costs. Based on the cost analysis, the most efficient and least expensive option that allows for maximum reach is the mix of live instructor with asynchronous computer-based tutorial. Because asynchronous, online platforms are not quite sophisticated enough to deliver the immediate SCIENCE OF MEDICAL PHILANTHROPY 54 corrective feedback necessary to train physicians in grateful patient fundraising, during the pilot phase it will be most advantageous to deliver much of the declarative and procedural knowledge content using an asynchronous online platform, while leaving the live, in-person instructional time for the experiential aspects of the course content. This blended media delivery platform will allow learners flexible, convenient access for a portion of the units, thus mitigating any challenges that may arise with scheduling live, in-person sessions. SCIENCE OF MEDICAL PHILANTHROPY 55 CHAPTER FIVE: IMPLEMENTATION AND EVALUATION PLAN Implementation of the Course Implementation of the course will be conducted in stages to ensure the highest chance of success that UMC stakeholders will perceive the intended benefits of the innovation and move to fully integrate the course into UMC’s approach to philanthropy and continuing medical education for physicians. Stakeholder groups include development leadership, academic leadership, physicians, and gift officers. Smith and Ragan (2005) describe a well-established, developmental process that guides the adoption of an innovation. The awareness stage (stage 1) will begin with the learner population, the physicians themselves. The goal here is to raise awareness for the innovation by interviewing physicians about their involvement in grateful patient fundraising by using a mode of appreciative inquiry, a change management process that emphasizes and builds on strengths as opposed to weaknesses. By focusing on their positive engagement in UMC’s philanthropic mission and ways physicians could enhance their contributions in this regard, the learner population’s interest (stage 2) in the curriculum is likely to increase. Because it will be essential to have the buy-in of the learner population for this innovation to succeed, outreach to development and academic leadership will occur only after sufficient groundwork has been laid with physician stakeholders. Next, a subset of the learner population will be invited to conduct a high-level, preliminary review and evaluation (stage 3) of the instructional design. At this early juncture, the learner population will gain familiarity with the course design to gauge the merit of this innovation and the degree to which the investment of time and effort will benefit them. Learner SCIENCE OF MEDICAL PHILANTHROPY 56 feedback will be gathered via questionnaires and small group discussions and incorporated as appropriate. The course designer and a physician advocate(s) will deliver a presentation to development and academic leadership outlining the need for the innovation and how this course is designed to address this gap. These stakeholder groups will evaluate the costs and benefits of the innovation. Assessment of leadership buy-in and interest will be evaluated via small group and one-on-one discussions with any concerns being addressed prior to proceeding with the adoption process. Permission from leadership stakeholders to pilot the innovation to demonstrate its value is the objective at this stage of the adoption process (stage 4). During this trial phase, a small group of learners (approximately 10-12 physicians) will participate in a pilot of the curriculum to ensure the content is comprehensive, clear, and delivered at a level commensurate with the abilities of this advanced learner population. A post- trial evaluation will reveal modifications necessary to the instructional materials and/or content, instructor roles, and assessments. Changes will be incorporated as appropriate. This cycle of trial and evaluation will be repeated with expanding cohorts of learners over the course of approximately one year until adoption of the innovation is achieved (stage 5). Stage 6, integration, is achieved when the innovation becomes routine. In this case, the mechanism for delivery of the curriculum (including, but not limited to, administrative and instructional leadership; instructional resources, such as technology and support; and integration into UMC’s organizational and leadership development programming for physicians) has been well-established. SCIENCE OF MEDICAL PHILANTHROPY 57 Implementation of the Evaluation Plan Curriculum Purpose, Need, and Expectations The goal for this curriculum is to help physicians acquire the knowledge, skills, and attitudes that will enable them to become effective partners with development officers to engage in grateful patient fundraising. This encompasses the development of practical skills to understand how to identify, cultivate, solicit, and steward grateful patient donors as well as an attitudinal belief system that supports a strong culture of philanthropy. The high need for physician engagement in healthcare philanthropy coupled with physicians’ low self-efficacy and/or motivation to participate in grateful patient fundraising underscores the need to design a curriculum that is personalized to the unique needs of this learner population. By 2026, UMC aspires to rank among the top 10 independent hospitals nationwide receiving philanthropic support. Essential to the achievement of this organizational goal is UMC’s ability to equip faculty physicians with the requisite knowledge and skills to be able to participate meaningfully in the development program at UMC. To accomplish this goal, the health system’s development office will need to engage a greater share of its physicians to increase the flow and quality of grateful patient referrals, which ultimately could translate to more philanthropy. As such, UMC established that by 2021 at least 50% of full-time faculty physicians will be partnering actively with UMC development officers to raise philanthropy in support of the institution’s mission. Evaluation Framework The evaluation framework that serves as the basis for the implementation and evaluation plan is the New World Kirkpatrick Model (Kirkpatrick & Kirkpatrick, 2016), which draws from the original Kirkpatrick Four Level Model of Evaluation (Kirkpatrick & Kirkpatrick, 2006). The SCIENCE OF MEDICAL PHILANTHROPY 58 new Kirkpatrick model proposes that four levels of evaluation are planned in reverse order starting with: Level 4 (Results), Level 3 (Behavior), Level 2 (Learning), and Level 1 (Reaction), and then implemented sequentially beginning with Level 1. By working backwards from the organization’s key goal, intermediary indicators of achievement can be identified for various stages of implementation that can chart progress towards the ultimate goal, as well as allow for mid-course corrections. This approach to the design of the implementation and evaluation plan ensures proper alignment between immediate milestones, or indicators, and the organization’s overarching goal and also captures requisite stakeholder buy-in to ensure success (Kirkpatrick and Kirkpatrick, 2016). Level 4: Results and Leading Indicators Level 4 in the Kirkpatrick model measures the results of the targeted outcomes by using leading indicators to ensure that critical behaviors are on track to achieve the desired results. Table 3 below shows the proposed Level 4: Results and Leading Indicators in the form of indicators, metrics, and methods for both external and internal outcomes for UMC. If the internal outcomes are met as a result of the training and the institutional support for physicians’ engagement in grateful patient fundraising, then the external outcomes should also be realized. SCIENCE OF MEDICAL PHILANTHROPY 59 Table 3 Indicators, Metrics, and Methods for External and Internal Outcomes Outcome Metric(s) Method(s) External Outcomes 1. Increase public perception of UMC as top-ranked academic medical center. 1.a. Frequency of UMC in press coverage by national news outlets. 1.a. Track frequency of UMC mentions in the national news. 1.b. The rating scheme for tone of UMC mentions in press coverage. 1.b. Rate UMC mentions for tone (e.g. positive/negative; approving/ disapproving), and then compare quarterly. 2. Enhance UMC investment in biomedical research 2.a. The total amount of research expenditures at UMC. 2.a. Compare annual expenditure levels for biomedical research, current year relative to prior five fiscal years. 2.b. The total amount of NIH funding received by UMC investigators. 2.b. Compare total NIH grant funding, current year relative to prior five fiscal years. 2.c. The number of UMC faculty research papers published in high- impact scientific journals. 2.c. Track frequency and placement of UMC faculty research papers published. 3. Increase the perception of UMC as a destination for the delivery of the best patient care in the world. 3.a. The number of patient acquisitions from outside of the immediate UMC metropolitan area. 3.a. Evaluate new patient acquisition data by zip code/country of origin (if international), quarterly. 4. Improved rankings by external agencies and/or accreditors. 4.a.U.S. News & World Report (USNWR) survey of Best Hospitals 4.a. Track UMC rank in USNWR annual survey of Best Hospitals, compare current year rankings relative to prior five years. 4.b. Philanthropy surveys, including Association of Academic Medical Centers, Chronicle of Philanthropy, Association for Healthcare Philanthropy 4.b. Track UMC rank on annual philanthropic surveys, compare current year relative to prior five years. 4.c. Number of external awards and/or honors bestowed on UMC and UMC faculty. 4.c. Track annually the honors and/or awards received, compare current year relative to prior five fiscal years. Outcome Metric(s) Method(s) Internal Outcomes 5. Increase the number of UMC physicians engaged in GPFR. 5. The number of physicians actively partnering with the development office. 5. Track physician engagement (in- person meetings, phone, email consultations) in UMC development database and report on a monthly, quarterly, and annual basis. 6. Increase the number of donor prospects referred to development by UMC physicians. 6. Number of donor prospects referred by physicians. 6. Track physician referrals in UMC development database and report on a monthly, quarterly, and annual basis. Disaggregate data by source of physician referral. SCIENCE OF MEDICAL PHILANTHROPY 60 7. Increase the total amount of philanthropy raised at UMC. 7. Total amount of philanthropy raised annually. 7. Track gifts closed and report weekly, monthly, quarterly and annually. Disaggregate data by source of physician referral. 8. Increased UMC physician confidence/satisfaction in GPFR. 8.a. Physician survey results on key questions. 8.a. Compare annual survey results. 8.b. Positive/negative feedback from key stakeholders. 8.b. Development leadership will conduct internal rounds quarterly with academic leadership and physicians to gather feedback. Level 3: Behavior Critical behaviors. Level 3 evaluation in the Kirkpatrick model enables organizations to implement continuous performance improvement by monitoring how much participants have integrated what they have learned into their on-the-job performance. Level 3 consists of critical behaviors, required drivers, and on-the-job learning (Kirkpatrick & Kirkpatrick, 2016). Critical behaviors are the key behaviors that individuals must be able to perform consistently in order for the organization to realize its intended goal. Required drivers are ways organizations can monitor, encourage, reinforce, and reward the continued use of the critical behaviors. For successful engagement in grateful patient fundraising, there are three critical behaviors a learner must master. The first critical behavior is that physicians must deliver an exceptional patient experience; this is the foundation upon which grateful patient philanthropy is premised. The second critical behavior UMC physicians must master is the ability to identify high-potential grateful patient prospects and follow the correct procedure to refer these prospects to a UMC development officer to qualify and, if appropriate, collaborate on the development of a cultivation strategy that will hopefully lead to the solicitation of a major gift. The third critical behavior is that physicians must be able to convey a compelling vision for role of philanthropy in the fulfillment of UMC’s mission, programmatic goals, and objectives. The specific metrics, methods, and timing for each outcome behavior appear in Table 4. SCIENCE OF MEDICAL PHILANTHROPY 61 Table 4 Critical Behaviors, Metrics, Methods, and Timing for Evaluation Critical Behavior Metric(s) Method(s) Timing 1. Deliver an exceptional patient experience. 1. Patient satisfaction 1.a. Patient satisfaction survey 1.a. Survey delivered within 3 days following each clinic visit. Scores aggregated and disseminated monthly to physician, Clinical Operations, Department Chair. 1.b. Observation by development officer 1.b. Anecdotal data captured from direct and indirect observation of patient satisfaction levels by development officers. 1.c. Patient self-report 1.c. Anecdotal data captured from patients’ self-report of satisfaction level to development officers. 2. Identify and refer high- potential grateful patient prospects to a development officer. 2. Number of patient prospect referrals to development. 2. Development officers will input each unique patient prospect referral received in UMC development database. 2. Patient prospect referrals tracked on an ongoing basis in UMC development database; Development generates reports monthly, quarterly and annually for distribution to development officers and leadership, physician and department chair. 3. Convey a compelling vision for the role of philanthropy in the fulfillment of UMC’s mission, programmatic goals and objectives. 3. Convey a vision and effectively translate complex scientific ideas to lay audiences. 3. Development officer will review major gift proposals, presentations, and monitor dialogue in donor meetings for appropriate usage of language for donor audiences. 3. Ongoing basis, development officer to report back to physician and department chair monthly during first year of engagement. As needed thereafter, so long as previously successful. Required drivers. Physicians who exhibit potential though may be newer to grateful patient fundraising will require the ongoing support of a dedicated development officer and the SCIENCE OF MEDICAL PHILANTHROPY 62 institution to reinforce what they have learned during the course and to encourage them to apply what they have learned about how to engage meaningfully in this process. Reinforcement is used to remind participants of what they learned and provide refresher training as needed. Personalized coaching and mentoring is an effective vehicle to deliver encouragement to learners. Rewards can be in the form of incentives for the correct application of critical behaviors and the achievement of performance benchmarks. Finally, monitoring ensures accountability through direct observation and evaluation of physician performance in the context of their day- to-day jobs. Table 5 shows a set of recommended drivers to support the adoption of critical behaviors among UMC physicians. SCIENCE OF MEDICAL PHILANTHROPY 63 Table 5 Required Drivers to Support Critical Behaviors Method(s) Timing Critical Behaviors Supported Reinforcing Job Aid including cues and clues to assess philanthropic intent and identify grateful patient prospects Ongoing 2 Job Aid including suggested responses to patients’ expressions of gratitude Ongoing 1, 2 Job Aid including suggested phrases for opening a philanthropic conversation with a patient Ongoing 1, 2 One-on-one meetings with a dedicated development officer to reinforce GPFR policies and procedures after completion of training. Monthly 1, 2, 3 Faculty department meetings for Q&A, group discussion, and for additional training. Semi-annually 1, 2, 3 Encouraging Collaboration and peer modeling during faculty department meetings. Semi-annually 1, 2, 3 Feedback and coaching from development officer. Monthly 1, 2, 3 Rewarding Incentive compensation when physician meets annual performance objective for patient satisfaction, and/or patient prospect referrals to development. Annually 1, 2 Public acknowledgement, such as email from dean of faculty and chief development officer or article in UMC e-newsletter, when faculty performance hits a benchmark or an individual faculty member has been involved in a noteworthy gift from a grateful patient. Ongoing on a weekly or as needed basis 1, 2, 3 Monitoring Observation by development officer of physicians’ adoption of critical behaviors on the job ongoing 1, 2, 3 Achievement of key performance indicators for patient satisfaction, referrals of patient prospects, fundraising results monthly, quarterly, annually 1, 2 One-on-one meeting with development officer to check-in and review progress monthly 1, 2, 3 SCIENCE OF MEDICAL PHILANTHROPY 64 Organizational support. Adoption of this innovation will require institutional support at multiple levels of an academic medical center like UMC. First, this is premised on an institutional commitment to a strong culture of philanthropy that begins with the board of directors and executive leadership and permeates throughout all levels of the institution. Next, it is critical for academic leadership and department chairs to encourage physician participation by permitting release time for physicians to engage in educational activities and by modeling their own engagement in the philanthropy program. Full integration of the innovation will also be facilitated by the chief development officer, department chairs, and human resources supporting the integration of performance metrics for physician engagement in grateful patient fundraising into annual performance appraisals and incentive compensation plans for physicians. Financial support for development staff training and technology, including a development database to store vital data and a dashboard to monitor performance metrics, is key. Finally, having an adequate number of highly skilled development officers to provide ongoing support and coaching is critical to supporting physician learners to successfully implement, apply, and transfer their new knowledge, skills, and attitudes. Under-resourcing development officer support for physicians could jeopardize the goodwill created via this new framework for physician engagement in philanthropy and threaten to undermine the program’s success. Level 2: Learning Learning goals. Upon completion of the curriculum, physicians will be able to: 1. Engage meaningfully in the cultivation and solicitation of gifts from grateful patients; 2. Understand the donor cycle and pivotal points of engagement for physicians; 3. Understand patient privacy as it relates to grateful patient fundraising; 4. Have an appreciation for fundraising ethics as it relates to the healthcare setting; and SCIENCE OF MEDICAL PHILANTHROPY 65 5. Communicate articulately to lay audiences on complex medical and scientific concepts. Components of learning evaluation. The learning goals listed in the previous section, will be achieved with a curriculum that equips physicians with the knowledge, skills, and attitudes that will enable them to become effective partners with development officers to engage in grateful patient fundraising. The learners will study a broad range of topics pertaining to the acquisition of practical knowledge related to grateful patient fundraising, as well as engage in discussions on ethics and privacy, issues that are frequently cited by physicians as barriers to engagement. The program is blended, consisting of four e-learning modules and two in-person seminars. The total time for completion is 270 minutes (4.5 hours). The demonstration of declarative knowledge is a necessary precondition of being able to successfully apply newly acquired knowledge to solve problems. Research shows that learning is increased when learners acquire component skills, practice integrating them, and know when to apply what they have learned (Rueda, 2011). Therefore, it is important to evaluate learning for both declarative and procedural knowledge during the instructional process. The success of the implementation plan will be contingent on helping physicians to understand the critical role they play in UMC’s philanthropic program. Knowledge of grateful patient fundraising practices and knowing when and how to implement them will be key, but first must come a baseline understanding of the need and rationale for doing so. Thus, the first priority will be to address attitudinal component of engagement. It is important that learners value the training as a prerequisite to using their newly learned knowledge and skills on the job. However, they must also be confident that they can succeed in applying their knowledge and skills and be committed to using them on the job. Research shows that rationales that include a SCIENCE OF MEDICAL PHILANTHROPY 66 discussion of the importance and utility value of the work can help learners develop positive values (Rueda, 2011). Table 6 Evaluation of the Components of Learning for the Program lists the evaluation methods and timing for these components of learning. Table 6 Evaluation of the Components of Learning for the Program Method(s) or Activity(ies) Timing Declarative Knowledge “I know it.” Knowledge checks using multiple choice during and after Small group discussion and share out with everyone during Pre- and post-tests before and after the curriculum; post-test following each unit Procedural Skills “I can do it right now.” Role-play and real life scenarios where procedural knowledge is demonstrated during and after Observation using rubric and checklist during and after Attitude “I believe this is worthwhile.” Discussion about value and rationale during and after Discussion of issues and concerns during and after Observation during curriculum and on-the-job performance during and after Confidence “I think I can do it on the job.” Small group discussion about concerns, confidence during and after Mentorship and coaching after Survey questionnaires on confidence, knowledge, skills before and after Commitment “I will do it on the job.” Observation after Dashboard metrics after Performance appraisals after Level 1: Reaction It is important to determine how the participants react to the curriculum. With Level 1 the organization can evaluate the participants’ reaction to the training, such as satisfaction, engagement, and relevance (Kirkpatrick & Kirkpatrick, 2016). Table 7 Components to Measure Reactions to the Program lists methods and timing to evaluate the reactions of the participants to the curriculum along this scale. SCIENCE OF MEDICAL PHILANTHROPY 67 Table 7 Components to Measure Reactions to the Program Method(s) or Tool(s) Timing Engagement Attendance and completion rates for each unit and course as a whole at beginning and end of each module to monitor for attendance as well as ensure 100% completion of each module Active listening and participation in group discussions and practice exercises observation during in-person seminars Completion of online quizzes/practice scenarios during asynchronous modules Participation in one-on-one coaching sessions after training curriculum Relevance Pulse check via online questionnaires and discussion during asynchronous modules and discussion before/during/after in-person seminars Anonymous survey at end of each module and at the conclusion of the curriculum as a whole Customer Satisfaction Observation of participant satisfaction during in-person seminars Anonymous survey at end of each module and at the conclusion of the curriculum as a whole Evaluation Tools Immediately following the program implementation. At the conclusion of the curriculum, participants will complete a survey (see Appendix B for the survey questions). The survey will indicate relevance of the instructional materials to the practice of grateful patient fundraising, learner satisfaction, commitment, beliefs, and confidence in applying what has been learned. For Levels 1 and 2, development officers will fill out a checklist during one-on-one coaching sessions and via observation of on-the-job practice that rates the performance of physicians in several areas and then will provide feedback (see Appendix C for the checklist). During in-person seminars, the instructors will conduct pulse checks by asking the participants if the content is relevant to their work and using real-life case studies offered by the learners themselves to address areas of common concern. Level 2 will include checks for understanding SCIENCE OF MEDICAL PHILANTHROPY 68 what is being presented. Level 2 will also use small group discussions and share-outs during the in-person seminars to gauge participant understanding of the instructional content being delivered. Delayed for a period after the program implementation. Approximately 90 days after learners complete the curriculum, the development office will administer a survey (see Appendix D for survey questions) containing open and scaled items using the blended evaluation approach to measure, from the physician’s perspective, satisfaction and relevance of the training to physician engagement in grateful patient fundraising (Level 1); knowledge, skills, and a belief in the value of the practice of grateful patient fundraising (Level 2); application of the instructional content to the physician’s ability to identify, refer, and engage grateful patient prospects in philanthropic conversations (Level 3); and the extent to which physicians are engaging in the practice of grateful patient fundraising in their jobs (Level 4). Conclusion to the Curriculum Design Amid a competitive landscape for resources, philanthropy represents a valuable stream of auxiliary revenue to support the mission of academic medicine. A primary goal for UMC is to continue to grow the amount of philanthropic revenue raised to support the institution’s research programs, as well as patient care, training, and education. Physicians and other caregivers who are on the frontlines of clinical care delivery are uniquely positioned to create an exceptional patient experience, thus laying the essential foundation of gratitude that can transform into grateful patient philanthropy. Philanthropic success pivots on institutions’ ability to pair engaged and prepared physicians with the opportunity that grateful patient philanthropy presents. While a range of instructional methods are used in practice, there remains little published data in the way of content, nor any formal evaluation data that conveys the effectiveness of SCIENCE OF MEDICAL PHILANTHROPY 69 specific physician philanthropy training programs. Utilizing evidence-based approaches to learning and assessment, this curriculum is designed to optimize physician contributions to UMC’s philanthropic program by imparting the knowledge and skills to engage meaningfully in grateful patient fundraising, as well as an attitudinal belief system that supports a strong culture of philanthropy. It is believed that this comprehensive instructional blueprint could serve as a national model of excellence to equip healthcare institutions with the necessary resources to train and develop their physicians, thus increasing the production of patient philanthropy to support research, patient care, training and education, and the health of our communities. 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Success in grateful patient philanthropy: Insights from experienced physicians. American Journal of Medicine, 124(12), 1180–1185. United States Department of Health and Human Services. (2017). National Institutes of Health Research Portfolio Online Reporting Tools (RePORT). Retrieved from https://report.nih.gov/award/index.cfm Walter, J. K., Griffith, K. A., & Jagsi, R. (2015). Oncologists’ experiences and attitudes about their role in philanthropy and soliciting donations from grateful patients. Journal of Clinical Oncology, 33(32), 3796–3801. Weiss Roberts, L. (2006). Ethical philanthropy in academic psychiatry. American Journal of Psychiatry, 163(5), 772. Wright, S. M., Wolfe, L., Stewart, R., Flynn, J. A., Paisner, R., Rum, S., … Carrese, J. (2013). Ethical concerns related to grateful patient philanthropy: The physician’s perspective. Journal of General Internal Medicine, 28(5), 645–651. SCIENCE OF MEDICAL PHILANTHROPY 74 Appendix A Physician GPFR Pre-Test 1. What is your primary role at UMC? I am a physician. I am a research scientist. I am a physician-scientist. (If physician-scientist is selected, the following question appears next): 2. Clinical responsibilities occupy what percentage of your time: 20% or less 21% to 40% 41% to 60% 61% to 80% It varies. 3. I recognize the value of healthcare philanthropy to UMC and would like to help increase the flow of philanthropy to my institution. Strongly Agree Agree Disagree Strongly Disagree 4. I have prior direct experience in grateful patient fundraising. I have substantial experience. I have some experience. I have very little experience. I have no experience at all. 5. I would rank my ability and confidence level related to grateful patient fundraising as: Very confident Somewhat confident Somewhat unconfident Not confident at all SCIENCE OF MEDICAL PHILANTHROPY 75 6. What information, resources or support do you need to engage in grateful patient fundraising? [free text box] 7. I have had prior experience working with a gift officer in the development office. I have had substantial experience. I have had some experience. I have very little experience. I have no experience at all. 8. My experience partnering with a gift officer has been beneficial to helping me understand how healthcare philanthropy works and how I can engage my patients and stakeholders in philanthropic conversations. Strongly Agree Agree Disagree Strongly Disagree SCIENCE OF MEDICAL PHILANTHROPY 76 Appendix B Capstone Online Assessment For each of the questions below, select the response that best relates to how you feel about the statement. _________________________ Strongly Disagree Strongly Agree _________________________ 1. This training held my interest. 1 2 3 4 5 2 After completing this training program, I feel more confident about engaging in grateful patient fundraising. 1 2 3 4 5 3. I will recommend this training program to my physician colleagues. 1 2 3 4 5 4. I believe it will be worthwhile for me to open philanthropic conversations with patients who express their gratitude to me. 1 2 3 4 5 5. The instructional content and feedback has given me the confidence to apply what I learned in my job. 1 2 3 4 5 6. I am committed to applying what I learned during the training program in my job. 1 2 3 4 5 SCIENCE OF MEDICAL PHILANTHROPY 77 7. I found the discussion and feedback during the in-person seminars valuable for helping me to understand the physician’s role in medical philanthropy and address concerns I had about my role. 1 2 3 4 5 8. I was satisfied with the training program on grateful patient fundraising. 1 2 3 4 5 SCIENCE OF MEDICAL PHILANTHROPY 78 Appendix C Physician GPFR Checklist This is a checklist that development officers will use when observing physicians during one-on- one coaching sessions and during philanthropic meetings with patient prospects and donors to rate the physician’s skills in GPFR and ability to engage meaningfully in the process. Rating Scale 1 = Physician understands the principle and demonstrates effective use of targeted behavior. 2 = Physician understands the principle but demonstrates only moderately effective or inconsistent use of targeted behavior. 3 = Physicians does not demonstrate an understanding of the principle and displays ineffective use of the targeted behavior. Feedback comments may include specific observations that will support the physician to be more effective in the future. Target Behavior Rating Comments Physician connected with the patient by listening intently and receiving the patient’s feedback and/or gratitude. Physician respected the patient’s situation and did not impose or initiate any questions/statements that took advantage of the patient’s situation. Physician correctly applied the referral procedure when a patient indicated philanthropic intent and/or interest. Physician worked collaboratively with development officer to address the patient’s inquiry. Physician was able to convey a meaningful vision for the role of philanthropy in furthering UMC’s priorities. SCIENCE OF MEDICAL PHILANTHROPY 79 Appendix D Blended Evaluation Survey For each of the questions below, select the response that best relates to how you feel about the statement. _________________________ Strongly Disagree Strongly Agree _________________________ 1. I have had the opportunity to use what I learned during the training program on the job. 1 2 3 4 5 comments (optional): 2. Reflecting back on my participation in the training program, I believe that it was a good use of my time. 1 2 3 4 5 comments (optional): 3. Since completing the training program, I have successfully applied what I learned on the job. 1 2 3 4 5 comments (optional): 4. I have received adequate support from my development officer to successfully apply what I have learned on the job. 1 2 3 4 5 comments (optional): SCIENCE OF MEDICAL PHILANTHROPY 80 5. I am seeing positive results from my participation in the training program, including an increased level of philanthropic engagement on my behalf. 1 2 3 4 5 comments (optional): 6. This training program has positively impacted my interactions with patients, especially as it relates to helping them fulfill their altruism. 1 2 3 4 5 comments (optional): Please provide feedback on the following questions: 7. Describe any challenges you are facing implementing what you learned and what type of support could help you overcome these challenges. 8. Reflecting on this training program, what suggestions do you have for how it could be improved? SCIENCE OF MEDICAL PHILANTHROPY 81 Supplementary Materials Scope and Sequence Table 82 Unit 1 Lesson Plan and Instructor’s Guide: Grateful Patient Fundraising Overview 83 Unit 2 Lesson Plan and Instructor’s Guide: Accommodating Patient Privacy in Grateful Patient Fundraising 97 Unit 3 Lesson Plan and Instructor’s Guide: Applying Institutional Policies for Fundraising 114 Unit 4 Lesson Plan and Instructor’s Guide: Stewarding Grateful Patient Philanthropy 132 Unit 5 Lesson Plan and Instructor’s Guide: Examining Ethics in Grateful Patient Fundraising 150 Unit 6 Lesson Plan and Instructor’s Guide: Appraising Patients’ Motivations for Giving 162 SCIENCE OF MEDICAL PHILANTHROPY 82 Scope and Sequence Table I=Introduce R=Reinforce M=Mastery Unit 1 (online): Grateful Patient Fundraising Overview Unit 2 (online): Accommodating Patient Privacy in Grateful Patient Fundraising Unit 3 (online): Applying Institutional Policies for Fundraising Unit 4 (online): Stewarding Grateful Patient Philanthropy Unit 5 (in-person): Examining Ethics in Grateful Patient Fundraising Unit 6 (in-person): Appraising Grateful Patients’ Motivations for Giving Engage meaningfully in the cultivation and solicitation of gifts from grateful patients I I I R M M Understand the donor cycle and pivotal points of engagement for faculty physicians I I R R R M Understand patient privacy as it relates to grateful patient fundraising I I R R M M Have an appreciation for fundraising ethics as it relates to the healthcare setting I I R R M M Communicate articulately to lay audiences on complex medical and scientific concepts I I I R R M SCIENCE OF MEDICAL PHILANTHROPY 83 Unit 1 Lesson Plan and Instructor’s Guide: Grateful Patient Fundraising Overview Unit # Unit Title Unit Length Format 1 Grateful Patient Fundraising Overview 30 minutes Asynchronous online 2 Accommodating Patient Privacy in Grateful Patient Fundraising 30 minutes Asynchronous online 3 Applying Institutional Policies for Fundraising 30 minutes Asynchronous online 4 Stewarding Grateful Patient Philanthropy 30 minutes Asynchronous online 5 Examining Ethics in Grateful Patient Fundraising 75 minutes In-person seminar 6 Appraising Patients’ Motivations for Giving 75 minutes In-person seminar Duration: 30 minutes (online) Lesson Materials Presentation tools: pre-recorded narrated slides embedded with videos and images; resource section that includes links to published articles (e.g. white paper produced from Grateful Patient Fundraising (GPFR) Ethics Summit on June 28-29, 2017 in Baltimore, Maryland [currently in press]), pdf handouts (e.g. Permissible PHI for Fundraising, AAMC HIPAA Advisory, GPFR Ethics Job Aid, Stewardship Job Aid) and online sources (e.g. HIPAA for Professionals: An Overview) for more information. Learner Characteristic Accommodations Learners are physicians who may be motivated to fundraise, but may lack the confidence and/or skills. As adult learners, the practicality and usefulness of the training must be emphasized throughout. Developer’s Notes To informally assess their prior knowledge, near the beginning of the module, introduce a questionnaire that evaluates learners’ (1) prior experience in fundraising; (2) familiarity with key terms; (3) knowledge of HIPAA as it relates to healthcare fundraising, and (4) questions to assess their attitudinal perspective on grateful patient fundraising. This unit is an asynchronous online course. Instructional Activities Instructional Sequence Time (mins) Description of the Learning Activity Instructor Action/Decision (Supplantive) Learner Action/ Decision (Generative) Introduction 10 Provide motivation by drawing the learner’s attention to the importance of healthcare philanthropy to academic medicine, UMC and their research. Provide the overall purpose of the course: to teach a physician who already has knowledge of academic medicine how to engage meaningfully in grateful patient fundraising. Introduce the course, purpose, and goal using a video featuring a physician expert talking from his/her perspective about a grateful patient and the impact of their philanthropy. Show images of a physician working with the grateful patient and development officer as they advanced Learners answer a questionnaire that ranks their views on and prior experience with GPFR, how motivated they are to engage in GPFR, what SCIENCE OF MEDICAL PHILANTHROPY 84 through the donor cycle. In the physician’s voice, illustrate the impact philanthropy has had on their program and UMC at-large. Using a multiple choice and likert scale questionnaire, ask the learners to rank their views on GPFR, how motivated they are to engage in GPFR, what they would like to get out of the course, and what knowledge would facilitate the application of GPFR to their jobs. they would like to get out of the course, and what knowledge would facilitate the application of GPFR to their jobs. Course Goal 5 Introduce the course goal and outcomes. Present the course goal and outcomes. Learners connect and match the goal and outcomes to their personal views, expected outcomes and job application. Purpose for the Course 5 Stimulate motivation by describing the opportunity being provided to the physician and the risk that will be avoided if the course is mastered. Benefit: develop the knowledge and skills to become productive partners in grateful patient fundraising and contribute to the fulfillment of UMC’s mission. Risk: Miss opportunities to cultivate philanthropic opportunities to support programmatic priorities. Ask the learners to reflect on questions such as: “What is the value for me in this course” and “Can I do it?” and “Will I need and use what I will learn in my job?” Learners will reflect on answers to questions such as: “What is the value for me in this course” and “Can I do it?” and “Will I need and use what I will learn in my job?” SCIENCE OF MEDICAL PHILANTHROPY 85 Course Overview 10 Show all the units in the course to provide a mental model and assist the learners to organize their learning. Show that the sequence is grounded in the GPFR literature showing the essential components of physician engagement in GPFR. Provide a description of the activities, presentations from physician experts, and artifacts that will be used in each unit, including: ● Video simulation ● Role-play exercises ● Job Aids ● Small group discussion ● Expert testimony and case studies ● Research literature Use a visual model to show the units in the course and how each relates to understanding how to engage in GPFR. Drawing on the GPFR literature, describe the reasoning for the selection and sequencing of the units. Describe how the units are structured (blend of online and in-person), the overarching design of the units, and some of the activities that each unit provides. Learners follow the model and reflect on how each unit applies to their expected outcomes and reasons for taking the course. Total Time 30 Approximate time: 10 seconds Voiceover narration: ●  The Science of Medical Philanthropy: A Guide for Physicians ●  Unit 1: Grateful Patient Fundraising Overview SCIENCE OF MEDICAL PHILANTHROPY 86 Approximate time: 3 minutes The Overview opens with a brief video providing an overview of UMC’s culture of philanthropy. An example of a similar video is provided above. Directional arrows appear in the lower right hand corner to allow learners to advance through the slides. Voiceover narration provides directions on how to use. SCIENCE OF MEDICAL PHILANTHROPY 87 Approximate time: 4 minutes The video dissolves to the next screen where a video launches. The instructor (a physician expert) appears with a welcome message. Instructor narration includes the following key points: ●  Welcome, thank you for joining me today. ●  My name is ______ and I’ll serve as your guide as together we explore The Science of Medical Philanthropy. ●  Philanthropy is a pillar of our institution, of who we are and how we serve our patients and our community. ●  Like you just heard, nurturing our philanthropic culture takes all of us. ●  Philanthropy is not simply something we do because it sounds nice, it is essential. ●  [Instructor provides an overview of healthcare financing in contemporary society] ●  [Instructor discusses how research is funded in academic medicine and the growing pressure to sustain this (decreased funding, greater competition)] ●  Philanthropy plays an essential role in sustaining the mission of UMC. ●  Healthcare philanthropy is led by an important constituency: our patients. ●  Physicians play an important role in securing the foundation for philanthropy at UMC: by providing exceptional patient experiences. ●  Patients often view philanthropy as the fulfillment of their gratitude for the care received. ●  By receiving patients’ gratitude in a respectful and caring way, physicians play an important role in cultivating philanthropic potential. ●  [The instructor then shares a personal anecdote about a particular grateful patient who has supported his/her programmatic priorities with philanthropy.] ●  This is a story that each one of us can take part in. ●  This course will teach you the fundamentals - the art and the science - of engaging in grateful patient fundraising. Before we begin, I’d like to ask you to share your experiences with grateful patient fundraising by completing a brief survey. This feedback will help personalize the course content to your needs. SCIENCE OF MEDICAL PHILANTHROPY 88 Approximate time: 4 minutes Voiceover narration provides instructions to learners how to complete the quiz: ●  One question per slide for a total of 10 questions ●  After learners answer the question (no incorrect answers) and the quiz automatically advances to the next question. At conclusion of the quiz, voiceover narration resumes: ●  Thank you, let’s review the course goal and objectives SCIENCE OF MEDICAL PHILANTHROPY 89 Approximate time: 4 minutes The instructor shares the goals and objectives for this curriculum. Voiceover narration: ●  The goal of this curriculum is to train UMC physicians to become effective partners with development officers to engage in grateful patient fundraising. ●  The curriculum is designed to cover content related to the fundamental components of grateful patient fundraising specifically as it relates to physician involvement. The learning objectives for the course are to: - Engage meaningfully in the cultivation and solicitation of gifts from grateful patient donors - Understand the donor cycle and pivotal points of engagement for faculty physicians; - Understand patient privacy as it relates to grateful patient fundraising; - Have an appreciation for fundraising ethics as it relates to the healthcare setting; and - Communicate articulately to lay audiences on complex medical and scientific concepts. Instructor asks learners to reflect on why they are there: ○  What is the value to you in completing this course? ○  Do you need this information to be successful in your practice? ○  How will you use what you learn in your practice? Instructor encourages learners to engage fully in this course. Having an understanding of the important role of philanthropy at UMC and the meaning it brings to your patients will serve you well in your career. It certainly has mine. However, closing a gift is only a preliminary step in grateful patient fundraising. Much of the most important work follows. While we know this to be true, you also know it is yet one more responsibility to add to your already full plate. But let me be clear: if you cannot commit to appropriate donor cultivation and stewardship, you should not be fundraising. It is that simple. SCIENCE OF MEDICAL PHILANTHROPY 90 Approximate time: 3 minutes Video continues. Instructor narration: As we get started, it will be important for you to know how to navigate UMC’s development office. ●  A high-level organizational chart shown here provides the names and titles of key leaders in our development office and the areas they oversee. ●  UMC has assigned a dedicated gift officer(s) to staff specific service line(s). ●  If you do not know which gift officer is assigned to your area, contact your department administrator or the development office directly. ●  Either can put you in touch with your designated gift officer who will serve as your partner to identify, engage and cultivate prospective grateful patient prospects. ●  Additionally, gifts officers can also provide guidance to help you navigate UMC policies as it relates to GPFR. SCIENCE OF MEDICAL PHILANTHROPY 91 Approximate time: 4 minutes A graphic depicting the sequence and flow of the curriculum will be shown. Voiceover narration: ●  The curriculum consists of six units, including this course overview. Unit 1: Grateful Patient Fundraising Overview Unit 2: Accommodating Patient Privacy in Grateful Patient Fundraising Unit 3: Applying Institutional Policies for Fundraising Unit 4: Stewarding Grateful Patient Philanthropy Unit 5: Examining Ethics in Grateful Patient Fundraising Unit 6: Appraising Patients’ Motivations for Giving ●  The content and sequence of the units is grounded in research literature describing the essential components of physician engagement in grateful patient fundraising. ●  Collectively, these units will equip you with information you need to become a confident and capable philanthropic partner. SCIENCE OF MEDICAL PHILANTHROPY 92 Approximate time: 4 minutes A graphic depicting the overarching design of the units will be shown. Voiceover narration: ●  This curriculum is offered in a blended format, with units offered both online and in-person. ●  Units 5 and 6 are seminars which will be held sequentially (total time: 2.5 hours) in one day. Attendance in-person is required. ●  The remaining units are offered online and may be completed at your own pace. ●  Once you have completed a unit, you may register for the next unit offered in the curriculum. ●  Registration for the Seminar (units 5 and 6) require satisfactory completion of units 1, 2, 3 and 4. SCIENCE OF MEDICAL PHILANTHROPY 93 Approximate time: 4 minutes A graphic depicting a representation of the types of activities conducted will be shown. Voiceover narration: ●  The online coursework are intended to offer you the flexibility of accessing the training content when it is convenient for you. ●  These units will provide you essential knowledge, including federal privacy laws, UMC policies and procedures, and more to help you be successful. ●  The seminar offers an opportunity for discussion and collaborative practice, and equally important, a chance to learn from others in the room. We’ll also have development officers present to help provide guidance and the invaluable perspective they bring to our mutual work. ●  Each workshop will have a resource section with links to articles, job aids, and other information that will assist you as you progress through the curriculum. You can download resources as you need them, or you can visit the dedicated Medical Philanthropy resource library on the UMC Intranet. A link will be included in an email that will be sent at the conclusion of today’s session. ●  The resource library offers the “Ask A Question” feature where you can request information regarding a specific situation, and how you would like to be contacted, either by phone, text or email. You will receive an answer within 24 hours. ●  At any time, you may contact our program coordinator, [NAME], in the Development office for more immediate response. SCIENCE OF MEDICAL PHILANTHROPY 94 Approximate time: 2 minutes Video The instructor closes unit 1 with a summary and next steps: ●  As we draw this introductory session to a close, I wanted to thank you again for embarking on this training. ●  Today’s session provided you with an understanding of the goals and objectives for this curriculum, the sequence and flow of the six units, including the format, and some of the activities each unit provides. ●  Each workshop is designed with you in mind. If you have any feedback, we’d certainly like to hear from you. ●  Thank you again for joining me today. See you next time. SCIENCE OF MEDICAL PHILANTHROPY 95 SCIENCE OF MEDICAL PHILANTHROPY 96 SCIENCE OF MEDICAL PHILANTHROPY 97 Unit 2 Lesson Plan and Instructor’s Guide: Accommodating Patient Privacy in Grateful Patient Fundraising Unit # Unit Title Unit Length Format 1 Grateful Patient Fundraising Overview 30 minutes Asynchronous online 2 Accommodating Patient Privacy in Grateful Patient Fundraising 30 minutes Asynchronous online 3 Applying Institutional Policies for Fundraising 30 minutes Asynchronous online 4 Stewarding Grateful Patient Philanthropy 30 minutes Asynchronous online 5 Examining Ethics in Grateful Patient Fundraising 75 minutes In-person seminar 6 Appraising Patients’ Motivations for Giving 75 minutes In-person seminar Unit Duration: 30 minutes (online) Introduction: This is the second unit in the six-unit course on how to train physicians to participate in grateful patient fundraising (GPFR). Physicians may be reticent to engage in GPFR if they feel uncertain about the legalities of GPFR as it relates to patient privacy. This unit is designed to teach you about federal and state privacy laws as it relates to GPFR, and offer practical guidance to navigate the practice of GPFR. Learning Objective(s) Terminal Objective: Given a fundraising scenario involving a patient and a physician, learners will be able to define, describe and apply appropriate ways to utilize permissible protected health information (PHI) under HIPAA for fundraising purposes. Enabling Objective(s): ● Given the scenario between a physician and a patient, learners will be able to apply HIPAA and know how to negotiate usage of PHI for fundraising activities. ● Given the term “protected health information,” learners will be able to define and know what patient information is covered under PHI. ● Given the dialogue between the patient and physician, learners will be able to know what HIPAA means, its purpose and how the rules apply to the use of PHI for fundraising purposes Lesson Materials Access to computer with Internet for learning platform Handout: HIPAA Privacy Rule Summary Handout: AAMC Advisory on the Use of PHI in Fundraising Communications Handout: Permissible PHI for GPFR Handout: HIPAA Administrative Simplification Regulation Text, March 26, 2013 Link to: HIPAA Breach Notification Rule Link to: HIPAA for Professionals: An Overview Video: Patient/Physician scenario Online questionnaires/assessment Pre-recorded narrated presentation slides SCIENCE OF MEDICAL PHILANTHROPY 98 Learner Characteristic Accommodations Learners will take the course online. Developer’s Notes This is an asynchronous online course. The presentation, practice, and feedback actions are all online. Corrective feedback will need to be integrated into the design of the instructional software. Where the slides indicate ‘video,’ full motion video should be used for the instructional segments and scenarios. Instructional Activities Instructional Sequence Time (mins) Description of the Learning Activity Instructor Action/Decision (Supplantive) Learner Action/ Decision (Generative) Gain Attention 3 Short video of a pre-filmed scenario in which a physician says to a gift officer “You are going to do what with my patient? You are going to get me fired!” followed by audio narration stating: “Have you ever encountered a situation like this?” The instructor provides a brief overview of HIPAA and PHI which leads into a series of three brief scenarios and possible responses “Is the sharing of this kind of information permissible under HIPAA or not?” Instructor pre-records all audio. Asking a guiding question or presenting a scenario establishes a framework or lens that focuses attention to a problem/misinformation that needs to be solved. It activates thinking and allows a learner to consider ways in which the question relates to previous personal experiences. Moreover, using relatable examples, the learners can engage with the content without anxiety or immediate need for scaffolding. Learner listens to narrated images. Learner thinks about the questions being asked, attaching personal experience to the proposed problem. Learners engage in the “Is this permissible?” by choosing a yes or no. Each step will lead to additional information designed to engage and instruct the learner. Learning Objectives 2 Lesson objectives are presented in writing and repeated orally. (see above for specific objectives addressed) Instructor states the objectives aloud through pre-recorded audio narration, relating the guiding question to the learning objectives and purpose of the lessons. Learner listens to and reads objectives. Reasons for Learning - Benefits - Risks 2 Benefits: being able to identify and apply permissible PHI to the practice of GPFR facilitates successful fundraising. Risks Avoided: misusing PHI and a violation of HIPAA that places the institution, physician and gift officer at risk; being overly conservative which could result in few or no philanthropic gifts. Instructor states the reasons for learning the material and the risks avoided. Key points will be stated aloud and others will be bullet points on screen. Learner listens and reads the reasons for learning. Visual cues will be used and reference back to the initial motivational scenario. For example, if you SCIENCE OF MEDICAL PHILANTHROPY 99 chose ‘yes’…you may put yourself at risk for…etc. This is meant to draw connections between major “do’s” and “don’ts” of patient privacy and GPFR. Overview - Prior Knowledge - New Knowledge - Learning Strategies (What you already know...what you are going to learn...and how you are going to learn it.) 3 Previous lessons on PHI as it relates to the clinical setting will be tied to new knowledge as it applies to healthcare philanthropy using hypothetical scenarios in which physicians will define and describe that knowledge to negotiate appropriate usage of PHI in GPFR. Presentation of key problem-solving learning strategies through visual cues and auditory narration highlighting key strategies. Instructor delivers an overview of the unit with guiding question(s). Learner listens and watches presentation of overview with guiding question(s). Prerequisite Knowledge 4 This section is taught annually as part of UMC’s mandatory annual compliance training but a brief review of the declarative knowledge, principles and cognitive strategies will be provided to activate prior knowledge and prepare learners for new learning material. Topics include: a) Rules governing patient privacy as determined by HIPAA b) List of PHI permissible under HIPAA for fundraising purposes Instructor presents using visual and audio tools (video with narration) to review prerequisite knowledge. Instructor—through audio and video—revisits the same meeting scenario between the physician and gift officer at the beginning of the lesson. This will pick up with a gift officer saying “HIPAA allows a discrete set of PHI for use in GPFR” and then listing each one. The physician responds, “okay, so what next?” Learner reads and watches short presentation of prerequisite and prior knowledge to prepare for learning material. Learner engages in brief quiz to review prerequisite knowledge. SCIENCE OF MEDICAL PHILANTHROPY 100 Learning Guidance - Lecture - Demo. 8 This lesson will demonstrate (1) how to recognize a situation where PHI is being used and (2) knowledge of principles to discern how this information can be applied in healthcare setting. Specifically, the lecture and demonstration will include: (a) Recognize situations where HIPAA applies. (b) Determine whether HIPAA is applied correctly in the context of patient fundraising. Instructor—through audio and video—elaborates on the application of PHI by continuing the same meeting scenario. The gift officer will continue by describing how to apply the use of PHI for GPFR by showing examples and non- examples (to illustrate the “do’s” and “don’t’s”). The demonstration will consist of an instructor’s recorded audio over a scripted video of a physician and a gift officer engaging in a strategy conversation about developing a pool of patient prospects to demonstrate how to apply PHI while the instructor will ‘pause’ the video and provide essential learning principles including the rules of patient privacy, contextual considerations, and appropriate application of the rules in GPFR. Narration will discuss when to use it, why to use, and how to use it, thus following the steps for the principle lessons. Learner watches the demonstration lecture, responds to guiding questions, and can pause the video at any time. Practice and Feedback Practice occurs at each step outlined above. Practice scenarios will allow physicians to (1) practice stating the rules of patient privacy as it relates to GPFR (2) appropriately recognize situations where the rules of patient privacy apply (3) practice application of patient privacy rules in the context of GPFR and (4) determine if patient privacy rules have been applied correctly. Practice with feedback is untimed and ungraded. Instructor corrective feedback is provided asynchronously. Practice will be done through short multiple choice style quizzes. Learners will have two attempts to answer correctly. After two incorrect attempts, the correct answer will be revealed through a 15- second narrative video that allows learners to connect new learning with correct answer. Learners select, define, and respond to questions with increasing difficulty and complexity. Since mastery of the content is the goal, learners will have multiple opportunities to succeed and demonstrate proficiency before the final assessment. SCIENCE OF MEDICAL PHILANTHROPY 101 Authentic Assessment 5 Principle Application: Scenario-based questions asking physician to apply the principles to a new context related to each enabling objective and the terminal objective. Instructor provides assessment questions, mastery criteria, and corrective feedback as needed. See the Assessment Plan for the criterion level toward mastery. Learners will be asked to respond to a variety of questions related to PHI and its application to GPFR. Retention and Transfer 1 Connections made to how patient privacy fits within the larger schema of GPFR. Instructor will challenge learners to recall a real- life GPFR situation and reflect on whether the principles of patient privacy were applied correctly. Learner recalls real-life situation where principle was applied. Big Ideas 1 Review and re-motivate: Review the take-aways from this unit and the application of procedures. Connect the importance of the learning principle to the goals of the unit and course. Instructor asks the learners to reflect on how this principle will be applied in the context of their jobs. Learner downloads any supporting materials and handouts from the resource section, and reviews learning strategies needed to be successful. Advance Organizer for the Next Unit 1 Connections made to application of this principle in concert with other rules governing GPFR which will be covered in the next unit of the course. Instructor previews next unit by drawing connections between current unit and its application to course goal. Learner listens and watches overview of next unit. Total Time 30 Approximate time: 10 seconds SCIENCE OF MEDICAL PHILANTHROPY 102 Approximate time: 3 minutes Unit #2 opens with a brief video depicting a scenario where a gift officer is laying out a strategy with a physician to cultivate a potential patient prospect. The physician says to a gift officer “You are going to do what with my patient? You are going to get me fired!” followed by audio narration stating: “Have you ever encountered a situation similar to this?” Directional arrows appear in the lower right hand corner to allow learners to advance through the slides. Voiceover narration provides directions on how to use. SCIENCE OF MEDICAL PHILANTHROPY 103 Approximate time: 3 minutes The opening video dissolves to the next screen where a video launches. The instructor appears with a welcome message. Instructor narration includes the following key points: ●  Welcome, thank you for joining me today. ●  My name is ______ and I’ll serve as your guide as together we continue the course, The Science of Medical Philanthropy. ●  Today’s workshop focuses on patient privacy as it relates to GPFR. ●  As clinicians, I know you understand the importance of respecting patients’ privacy. ●  However, you may not be aware how privacy rules govern the use of PHI for fundraising purposes ●  At the end of this workshop, you should: ○  Know what HIPAA means, its purpose and how privacy rules apply to the use of PHI for fundraising purposes. ○  Understand the specific PHI that is permissible for fundraising activities. ○  Be able to correctly apply privacy rules and use PHI appropriately (legally and ethically) for GPFR SCIENCE OF MEDICAL PHILANTHROPY 104 Approximate time: 3 minutes The instructor provides a brief overview of HIPAA and PHI. Narration: ●  Health Insurance Portability and Accountability Act of 1996 (HIPAA) ●  HIPAA aims to protect the confidentiality and security of healthcare information. ●  The Privacy Rule component of the law established national standards to protect individuals’ medical records and other personal health information (PHI), and sets limits and conditions on the uses and disclosures that may be made of such information without patient authorization, including uses for fundraising. ●  The Privacy Rule originally allowed for utilization of the following: ●  Patient demographics ●  Health insurance status ●  Dates of service, and ●  Specialist physician ONLY with signed consent from the patient SCIENCE OF MEDICAL PHILANTHROPY 105 Approximate time: 4 minutes Video and narration: ●  Updated HIPAA regulations were released in 2013 to clarify the rules fundraisers must follow to comply with the statute. ●  Hospitals are now able to have expanded access to more patient information for fundraising purposes. ●  It is important for anyone engaged in GPFR to revisit these modifications to ensure proper adherence. Let’s explore in detail what these changes and the implications for the use of PHI for fundraising purposes. The instructor—through audio and video—revisits the same meeting scenario between the physician and gift officer at the beginning of the lesson. This will pick up with a gift officer saying “In 2013, HIPAA clarified and expanded how PHI without a patient’s authorization could be used for fundraising:” Guidelines as of March 26, 2013: ●  Patients do not need to sign a consent form; they are automatically ‘opted in’ ●  Department information (general, not the specific clinical care area) ●  Physician(s) name(s) ●  General treatment outcome information (favorable or not) ●  Patient demographic information, health insurance status, and dates of service are still permissible PHI requiring written patient authorization prior to fundraising use includes: ●  Diagnosis ●  Nature of services ●  Treatment SCIENCE OF MEDICAL PHILANTHROPY 106 Approximate time: 3 minutes The original scenario continues with the physician responding, “What do you mean when you say patients are opted in? What if they don’t want to be solicited?” The gift officer explains: ●  Prior to using allowed PHI for fundraising purposes, a Notice of Privacy Practices must state that the patient may be contacted for fundraising efforts and that the patient has the right to opt out of receiving any fundraising communications. ●  This Notice must be provided to the patient in advance of receiving care. ●  Patients have the right to opt out of receiving fundraising communications. ●  UMC may not send fundraising communications to or otherwise contact individuals who have opted out of receiving such communications. The physician responds, “I see, this is becoming much clearer now.” SCIENCE OF MEDICAL PHILANTHROPY 107 Approximate time: 2 minutes Instructor narration: ●  Misusing PHI could mean a violation of patient privacy rules and place you and UMC at-risk for financial penalties, not to mention the damage to patient trust. ●  Likewise, a lack of clarity on how to appropriately use PHI for fundraising purposes could limit UMC’s philanthropic potential. ●  The purpose of this workshop is to provide you with a clear roadmap to follow when you engage in GPFR. ●  Let’s practice with a few scenarios... SCIENCE OF MEDICAL PHILANTHROPY 108 Approximate time: 3 minutes A series of three brief scenarios (approx 30 sec. videos) are presented. 1.  A physician forwards an email exchange with a patient to their gift officer. The email has specific information in it regarding the patient’s diagnosis and treatment plan. The physician’s email to the gift officer says “better act quickly.” 2.  During a meeting, the gift officer presents a physician with a list of his/her patients that have been screened for major gift capacity (aka wealth screening). 3.  A physician asks their gift officer to come to the clinic so s/he can introduce them to a new patient. The physician invites the gift officer into the exam room while s/ he is finishing a conversation about the patient’s treatment plan. The physician continues, “I invited my gift officer in to talk with you about a prostate cancer clinical trial. This trial is a great option for patients with your diagnosis, but we need philanthropy to launch the study. Sarah can tell you more about it.” The physician leaves the room. ●  After each scenario, the learner is asked to answer the question “Is the sharing of this kind of information permissible under HIPAA or not?” Answer options include, “yes,” “no,” “maybe,” and “I don’t know.” ●  Learners will have up to two tries to answer correctly and justify their response. When the correct answer is selected, a brief rationale is given for the correct answer. If the learner answers incorrectly twice, the correct answer will automatically appear after the second incorrect attempt with a brief rationale. SCIENCE OF MEDICAL PHILANTHROPY 109 Approximate time: 4 minutes The physician asks, “So what does this look like in practice? What can we do and not do?” The gift officer continues by saying, “Here are some general guidelines…” Do...: ●  Be proactive in partnering with your gift officer to identify possible prospects by assessing the patient’s inclination and capacity ●  Take advantage of personalizing annual appeals (solicitations by mail) based on permissible PHI, specifically the department in which the individual is receiving care. Do not...: ●  Send a solicitation to a patient that indicates you are privy to more than the general department of service or treating physician. ●  Compile a mailing list based on information more specific than general department of service (e.g. Oncology) or treating physician. SCIENCE OF MEDICAL PHILANTHROPY 110 Approximate time: 2 minutes Narration: Let’s check your understanding of the application of these principles. A series of three questions are asked. Can you... 1.  Mail a fundraising communication about breast cancer to a mailing list of patients of physicians who treat breast cancer? (answer=YES) 2.  Mail a fundraising communication about breast cancer to a mailing list of all patients seen in the Oncology Department? (answer=YES) 3.  Mail a fundraising communication about breast cancer to a mailing list of all patients diagnosed with breast cancer? (answer=NO) (because you don’t ‘know’ that) ●  Answer options include, “yes” or “no.” ●  If the incorrect answer is selected, a brief rationale is given for why you cannot do that, and follows with a rationale for the correct answer. SCIENCE OF MEDICAL PHILANTHROPY 111 Approximate time: 3 minutes Video The instructor closes unit 2 with a summary and next steps: ●  As we draw this workshop on patient privacy to a close, I want to thank you for your attention. ●  Today’s session provided you with an understanding of HIPAA, its purpose and how privacy rules apply to the use of PHI for fundraising purposes; PHI that is permissible for fundraising activities; and finally how to correctly apply privacy rules and use PHI appropriately for GPFR. ●  During the next workshop, we will focus on institutional policies governing GPFR at UMC. Knowledge of these policies and how to apply them correctly will ensure your continued success as a physician partner in our development efforts. ●  If you have any feedback on today’s workshop, we’d certainly like to hear from you. ●  And be sure to visit the resource library for additional information which you’ll find at the end of this module or on the UMC Intranet. ●  Thank you again for joining me today. See you next time. SCIENCE OF MEDICAL PHILANTHROPY 112 SCIENCE OF MEDICAL PHILANTHROPY 113 SCIENCE OF MEDICAL PHILANTHROPY 114 Unit 3 Lesson Plan and Instructor’s Guide: Applying Institutional Policies for Fundraising Unit # Unit Title Unit Length Format 1 Grateful Patient Fundraising Overview 30 minutes Asynchronous online 2 Accommodating Patient Privacy in Grateful Patient Fundraising 30 minutes Asynchronous online 3 Applying Institutional Policies for Fundraising 30 minutes Asynchronous online 4 Stewarding Grateful Patient Philanthropy 30 minutes Asynchronous online 5 Examining Ethics in Grateful Patient Fundraising 75 minutes In-person seminar 6 Appraising Patients’ Motivations for Giving 75 minutes In-person seminar Unit Duration: 30 minutes (online) Introduction: This is the third unit in the six-unit course on how to train physicians to participate in grateful patient fundraising. To be successful partners in GPFR, physicians must first know and be able to apply institutional policies governing philanthropic conduct, including policies related to gift acceptance and the management of philanthropic funds. This unit is designed to teach you the institutional policies and procedures that are applicable to GPFR at UMC. Learning Objective(s) Terminal Objective: Given a GPFR scenario, learners will be able to recognize, describe, and apply institutional procedures as it pertains to grateful patient fundraising. Enabling Objective(s): ● Given a GPFR scenario, the physician will know the institutional policies and the settings in which these policies apply. ● Given dialogue between the instructor and learners, physicians will know the consequences of not following institutional policies. ● Given a list of institutional policies, the physician will be able to define each policy and give an example of how each policy is applied in practice. Lesson Materials Access to computer with Internet for learning platform Handout: UMC Gift Acceptance Policy Handout: UMC Federal and non-Federal Indirect Rates Online questionnaires/assessment Pre-recorded narrated presentation slides SCIENCE OF MEDICAL PHILANTHROPY 115 Learner Characteristic Accommodations Learners will take the course online. Developer’s Notes This is an asynchronous online course. The presentation, practice, and feedback actions are all online. Corrective feedback will need to be integrated into the design of the instructional software. Where the slides indicate ‘video,’ full motion video should be used for the instructional segments and scenarios. Instructional Activities Instructional Sequence Time (mins) Description of the Learning Activity Instructor Action/Decision (Supplantive) Learner Action/ Decision (Generative) Gain Attention 2 Instructor gains attention by asking guiding questions about what a physician would do in various situations such as (1) when a patient hands them a check for a philanthropic gift, (2) submitting a major gift proposal to a patient and (3) utilizing philanthropy for a purpose other than the donor intended. Instructor pre- records all audio. Each guiding question is accompanied by a 15-second narrated video that depicts a setting in which this may occur. Each video pauses before the physician’s response is revealed. Learner listens to narrated video. Learner thinks about the questions being asked, reflecting on their own personal experience to compare how they may have reacted previously to each proposed scenario. Learning Objectives 3 Instructor presents in writing and repeats orally the UMC policies and procedures to be learned related to gift acceptance, including: - UMC indirect rate on charitable gifts - Supervision and coordination of charitable gifts - Procedures for financial management of charitable gifts Instructor reads aloud through pre- recorded audio narration the high- level categories of UMC policies and procedures to be reviewed and their applicability to physician engagement in GPFR, emphasizing how these streamline workflows and reduce errors/problems with philanthropic gifts. Instructor draws connection between the policies and procedures to the purpose of the lesson. Learner listens to and reads policies and procedures to be discussed. SCIENCE OF MEDICAL PHILANTHROPY 116 Reasons for Learning - Benefits - Risks 3 Benefits: correct application of UMC policies and procedures ensures physician remains in good standing and facilitates donor stewardship. Risks Avoided: reduces risk of non- compliance with UMC policies as well as federal laws (IRS) governing charitable giving. Instructor states the reasons for learning the material and the risks avoided. Key points will be stated aloud and others will be bullet points on screen. Learner listens and reads the reasons for learning. Visual cues will be used and reference back to the initial scenario. For example, if the learner takes a specific action…you may put yourself at risk for…etc. This is meant to draw connections between major “do’s” and “don’ts” of gift acceptance. Overview - Prior Knowledge - New Knowledge - Learning Strategies (What you already know...what you are going to learn...and how you are going to learn it.) 3 Previous trainings on UMC corporate integrity are tied to new knowledge using analogies and hypothetical scenarios in which physicians will apply that knowledge to recognize, describe and apply institutional procedures related to gift acceptance and management of philanthropic funds. Presentation of procedural learning strategies through video demonstration and auditory narration. Instructor describes and explains prior knowledge connection to new knowledge as well as learning strategies employed including: ● the order of instructional activities ● related tasks including UMC policies and procedures handouts, video demonstration practice, and assessment Instructor also “chunks” main ideas/tasks to guide new knowledge. This does not detail the Learner listens and watches presentation of overview with video demonstration downloads supporting materials and handouts, and reviews learning strategies needed to be successful. SCIENCE OF MEDICAL PHILANTHROPY 117 procedures but rather provides a summary overview of the procedures to be learned. Prerequisite Knowledge 3 A review of the information will be provided to activate prior knowledge and prepare learners for new learning material. Topics include: 1) Structure and mission of UMC Development office 2) What is a charitable gift? 3) What is an indirect rate? Instructor presents using visual and audio tools (video with narration) to review prerequisite knowledge and how that knowledge is applicable to knowledge of gift acceptance procedures. This will be done through a short quiz with multiple choice questions for each category of prerequisite knowledge required for this module. Learner reads and watches short presentation of prerequisite and prior knowledge to prepare for learning material. Learner engages in quick check on learning quiz to review prerequisite knowledge. Learning Guidance - Lecture - Demo. 8 This lesson will demonstrate (1) how to identify situations where institutional policies apply, (2) knowledge of the order of steps to implement the policy, and (3) knowledge how to complete the steps correctly. Specifically, the lecture and demonstration will include: (a) UMC indirect rate on charitable gifts (b) Supervision and coordination of charitable gifts Instructor— through pre- recorded audio and video— elaborates on the application of institutional policies and procedures. The instructor will describe specific situations where the policies apply and how to apply the procedures by showing examples and non-examples (to illustrate the “do’s” and “don’t’s”). The demonstration will consist of the instructor’s recorded audio intermingled with scripted videos Learner watches the demonstration lecture, reads any captions or keywords that break up the scripted scenario, and can pause the video at any time. SCIENCE OF MEDICAL PHILANTHROPY 118 depicting simulated real-life scenarios involving various stakeholders relevant to each situation (physicians, patients, gift officers, and/or academic leadership etc.). Instructor will pause the video and provide essential learning principles, including characteristics of situations requiring the procedure, the order of steps in the procedure, and correct completion of the procedure. Narration will discuss when to use a specific procedure, why to use it, and how to use it correctly, thus following the steps for the procedural lessons. Practice and Feedback Practice occurs at each step outlined above. Practice scenarios will allow physicians to (1) appropriately recognize situations where the gift acceptance rules apply, (2) recall and apply the steps in the procedure, (3) make decisions about additional steps required (sub-procedures), and (4) determine if gift acceptance procedures have been applied correctly. Practice with feedback is untimed and ungraded. Instructor corrective feedback is provided asynchronously. Practice will be done through a short “fill in the blank” and multiple choice quiz. Learners will have two attempts to answer correctly. After two incorrect attempts, the correct answer will be revealed through a 15- Learners select, define, and respond to various questions with increasing difficulty and complexity. Since mastery of the content is the goal, learners will have multiple opportunities to succeed and demonstrate proficiency before the final assessment. SCIENCE OF MEDICAL PHILANTHROPY 119 second narrative video that allows learners to connect new learning with correct answer. Authentic Assessment 5 Classification and Application: Scenario-based questions asking physician to apply a UMC policy/procedure to a new context related to each enabling objective and the terminal objective. Instructor delivers assessment questions, mastery criteria, and (asynchronous) corrective feedback as needed. See the Assessment Plan for the criterion level toward mastery. Learners will be asked to respond to a variety of questions related to gift acceptance policies and procedures. Retention and Transfer 1 Summarize key institutional policies and major steps in procedures. Through pre- recorded audio narration and images, instructor will group and review situations where the different procedures are commonly applied, including contexts where variations of the procedure will apply. Instructor will convey the desire to achieve institutional alignment and the goal of delivering the best possible donor experience as the overarching intent behind these procedures as whole. Learner recalls real-life situations where procedures are applied. Big Ideas 1 Review and re-motivate: Review the take-aways from this unit, emphasizing the utility of these policies and procedures to promote efficiency and reduce error. Connect the importance of the procedural knowledge to the goals of the unit and training. Instructor asks the learners to reflect on how these procedures will be applied in the context of their jobs. Learner downloads any supporting materials and handouts from the resource section, and reviews learning strategies needed to be successful. SCIENCE OF MEDICAL PHILANTHROPY 120 Advance Organizer for the Next Unit 1 Connections made to application of these policies and procedures in concert with effective stewardship of philanthropic gifts and relationships —the next unit in the course. Instructor “previews” next unit by drawing connections between successful GPFR and stewardship. Learners reflect on connecting the ideas and strategies to the practice of GPFR. Total Time 30 Approximate time: 10 seconds 121 SCIENCE OF MEDICAL PHILANTHROPY Approximate time: 2 minutes A video launches and the instructor appears with a welcome message. Instructor narration includes the following key points: ●  Welcome, thank you for joining me today. ●  My name is ______ and I’ll serve as your guide as together we continue the course, The Science of Medical Philanthropy. ●  Today’s workshop focuses on UMC institutional policies as it relates to gift acceptance and GPFR. ●  The primary rationale for having policies and procedures related to gift acceptance is to ensure alignment within our institution. ●  Not to limit your efforts or encumber initiatives you’d like to pursue with philanthropic support. ●  These policies are intended to streamline your workflow and eliminate any potential problems or errors with the receipt of philanthropic gifts. 122 SCIENCE OF MEDICAL PHILANTHROPY Approximate time: 3 minutes Video continues. Instructor narration: Let me ask you a question. Think about your answer or perhaps a time that this situation occurred in your practice. 1. What do you do when a patient hands you a check in clinic? Very brief scenario (15 seconds) is depicted. Video pauses before physician’s action is revealed. How about this one: 2. What do you do before presenting a donor with a proposal to fund a priority initiative? Very brief scenario (15 seconds) is depicted. Video pauses before physician’s action is revealed. Or this one: 3. How does UMC’s indirect rate apply to philanthropy? Very brief scenario (15 seconds) is depicted. Video pauses before physician’s action is revealed. 123 SCIENCE OF MEDICAL PHILANTHROPY Approximate time: 3 minutes Video continues. Instructor narration: ●  These are just a few examples of some of the procedures you’ll need to know as you engage in GPFR. ●  We’ll explore these more deeply in just a minute. For now, let’s review the course goal and objectives ●  The goal of this workshop is to equip you with the knowledge to understand UMC policies as it relates to gift acceptance. ●  Specifically, we will review: ○  UMC’s indirect rate on charitable gifts ○  Supervision and coordination of charitable gifts ○  Procedures for financial management of charitable gifts ●  At the end of this workshop, you should: ○  Be familiar with these institutional policies and the settings in which these policies apply. ○  Know the consequences of not following institutional policies. ○  Be able to apply these policies in practice. ●  Abiding by these policies ensures good donor stewardship, and also reduces the risk of non-compliance with UMC policies as well as federal laws governing charitable giving. 124 SCIENCE OF MEDICAL PHILANTHROPY Approximate time: 4 minutes Video continues. Instructor narration: Before we go further, let’s take a moment and review some of the key terms we’ll be using today: Q: What is a charitable gift (choose all that apply)? a.  Money given in exchange for preferential access to UMC physicians. b.  Money given to a qualified charitable organization like UMC to support a worthy cause. c.  Goods or services donated to support a program or initiative at a qualified charitable organization. Answer: B and C Explanation: 1.  A charitable gift applies to any gift or grant from a private entity. a.  A charitable gift (also known as a donation) is any gift made to a qualified charitable organization which does not confer full or partial ownership of a deliverable, financial benefit, or control to the donor in return for the donation. b.  A gift could be a donation of money (cash, check and/or stock) or it could be the donation of goods or services - called an ‘in-kind’ donation. i.  In the latter case, the goods or services are donated at no-cost to the charity and it is incumbent on the donor to place a $ value on the goods or services for the purposes of their charitable deduction on their income tax return. c.  A gift could be from an individual; a family foundation, community foundation or other private foundation; a corporation; or any other private organization, such as a faith-based organization or a voluntary health organization, such as the American Heart Association or the Crohn’s and Colitis Foundation of America. i.  Philanthropy does not count grants from public funding agencies, such as the NIH, Department of Defense, or state or local public agencies. 125 SCIENCE OF MEDICAL PHILANTHROPY Approximate time: 4 minutes Video continues. Instructor narration: Let’s try another question: Q: What is an indirect cost rate (also known as an administrative overhead rate) (choose all that apply)? a.  The rate at which we spend money to cover administrative salaries and related costs. b.  Expenses incurred by UMC as a normal cost of doing business. c.  A percentage rate charged to cover costs that are not directly attributable to a particular project, facility, or product. Answer: B and C Explanation: 1.  UMC’s indirect cost rate, sometimes referred to as “the dean’s tax,” is applied to all philanthropic gifts to cover our academic infrastructure. a.  Indirect costs are costs used by multiple activities, and which cannot therefore be assigned to specific project, grant or initiative. b.  This includes the costs of maintaining laboratory space, utilities, and other indirect costs associated with our academic enterprise - costs that are borne by the institution on behalf of the faculty. c.  Many of you are familiar with the NIH indirect rate which we negotiate to cover indirect costs related to research. d.  Following this same rationale, an indirect rate is also applied to philanthropy. 126 SCIENCE OF MEDICAL PHILANTHROPY Approximate time: 4 minutes Video continues. Instructor narration: Now that we’ve covered a few of the basics, let’s discuss the supervision and coordination of gifts at UMC. Instructor introduces scenario depicting a physician responding to a grateful patient’s interest in making a donation. The physician drafts an overview of a project s/he’d like funded and presents it to the donor by email…. (Instructor pauses scenario to offer instruction.) First, a few guiding principles excerpted from UMC’s gift acceptance policy: ●  Acceptance and documentation of gifts… ○  No gifts shall be solicited by… ○  Gifts solicited outside of.... Let’s do a quick review before we move on: Q1: Gifts solicited by a physician without being coordinated through development could be ______ (answer: B) a.  For the physician’s sole, discretionary use. b.  Returned by UMC to the donor. c.  Redirected to the general fund. Brief explanation of why each answer is correct or incorrect. Q2: ________ coordinates the development and submission of proposals to donors. (answer: A) a.  Development b.  Academic Affairs c.  Physicians Brief explanation of why each answer is correct or incorrect. 127 SCIENCE OF MEDICAL PHILANTHROPY Approximate time: 4 minutes Video continues. Instructor narration: Let’s watch another scenario now: Instructor introduces scenario depicting a physician asking his/her assistant to send a letter to all of his patients asking for donations. Per the physician’s letter, patient donations are sent to his/her office. The physician keeps the checks in his desk for 6 weeks until s/he has time to handle them. The physician hands the bundle of checks to his/her assistant and instructs him/her to draft a memo to the Finance department with directions on which account to deposit the checks to…. (Instructor pauses scenario to offer instruction.) Okay, here are a few procedures to keep in mind: ●  The Development office is responsible for receiving and processing all charitable gifts. ●  This ensures that all gifts are processed and receipted (IRS rule) within three business days. ●  Should a physician receive a donor gift directly, please contact the development office immediately to pick up the check. ○  Do not send checks, cash, or credit card information by email or inter-office mail. ○  Do not store donations in your desk or other unlocked area. ○  Do not send donations to the finance department for deposit into your account. These will be rejected. Let’s do a quick review before we move on: Q1: True or false? (answer:) a.  The Finance department receives all revenue at UMC and deposits it into the appropriate account. (answer=FALSE) b.  The Finance department takes direction from Development when it is appropriate to move gift revenue to designated accounts. (answer=TRUE) c.  The Internal Revenue Service requires all donors making gifts of $250 and above to receive a gift receipt. (answer=TRUE) Brief explanation of why each answer is true or false. 128 SCIENCE OF MEDICAL PHILANTHROPY Approximate time: 4 minutes Video continues. Instructor narration: ●  Indirect cost rate: 20% ●  Non-negotiable ●  Charged at the time of disbursement from the account ●  Principal investigators must cost-share if a donor caps indirect cost rate at a percentage less than 20% Let’s do a quick review before we move on: Q1: True or false? (answer:) a.  Having the Finance department process charitable donations is one way to avoid the indirect cost rate being applied to gift revenue. (answer=FALSE) b.  UMC will waive the indirect costs on a private grant if the foundation’s policy is to not cover any indirect costs. (answer=FALSE) c.  Indirect costs are levied at the time gift revenue is booked and transferred to the PI’s account. (answer=FALSE) Brief explanation of why each answer is true or false. 129 SCIENCE OF MEDICAL PHILANTHROPY Approximate time: 2 minutes Video. The instructor closes unit 3 with a summary and next steps: ●  As we draw this workshop on gift acceptance policies and procedures to a close, I want to thank you for your attention. ●  Today’s session provided you with an understanding of UMC’s indirect rate on charitable gifts; supervision and coordination of charitable gifts; and finally, how to apply procedures to manage charitable gifts. ●  During the next workshop, we will focus on the topic of stewardship of philanthropic resources. ●  If you have any feedback on today’s workshop, we’d certainly like to hear from you. ●  And be sure to visit the resource page at the end of this module or on the Intranet for additional information. ●  Thank you again for joining me today. See you next time. 130 SCIENCE OF MEDICAL PHILANTHROPY 131 SCIENCE OF MEDICAL PHILANTHROPY SCIENCE OF MEDICAL PHILANTHROPY 132 Unit 4 Lesson Plan and Instructor’s Guide: Stewarding Grateful Patient Philanthropy Unit # Unit Title Unit Length Format 1 Grateful Patient Fundraising Overview 30 minutes Asynchronous online 2 Accommodating Patient Privacy in Grateful Patient Fundraising 30 minutes Asynchronous online 3 Applying Institutional Policies for Fundraising 30 minutes Asynchronous online 4 Stewarding Grateful Patient Philanthropy 30 minutes Asynchronous online 5 Examining Ethics in Grateful Patient Fundraising 75 minutes In-person seminar 6 Appraising Patients’ Motivations for Giving 75 minutes In-person seminar Unit Duration: 30 minutes Introduction: This is the fourth unit in the six-unit course on how to train physicians to participate in grateful patient fundraising. This unit integrates prior knowledge learned on institutional policies governing gift coordination and acceptance, while introducing new principles of financial stewardship and its role in enhancing grateful patients’ ties to your institution, potentially leading to repeat giving and larger gifts. Learning Objective(s) Terminal Objective: Given scenarios depicting interactions between a grateful patient, gift officer and a physician, learners will be able to describe how to develop meaningful relationships with grateful patients and be good stewards of their generosity. Enabling Objective(s): ● Given dialogue with a physician expert, learners will know the importance of stewardship in medical philanthropy ● Given a scenario role modeled by a development officer and physician expert, learners will be able to identify appropriate actions for physician involvement in the stewardship plan ● Given observation of a scenario between a grateful patient and physician, learners will be able to apply the stewardship steps in a manner appropriate to the situation ● Given dialogue with a physician expert, learners will be able to recognize and apply UMC procedures for financial management of charitable gifts Lesson Materials Handout: Stewardship Job Aid Handout: Stewardship Baseline vs. Picklist Job Aid Video: GPFR stewardship scenario Assessments and rubrics Presentation slides Learner Characteristic Accommodations Learners will participate in this course online. SCIENCE OF MEDICAL PHILANTHROPY 133 Developer’s Notes This is an asynchronous online unit. The presentation, practice, and feedback actions are all online. Corrective feedback will need to be integrated into the design of the instructional software. Where the slides indicate ‘video,’ full motion video should be used for the instructional segments and scenarios. Instructional Activities Instructional Sequence Time (mins) Description of the Learning Activity Instructor Action/Decision (Supplantive) Learner Action/ Decision (Generative) Gain Attention 2 Instructor gains attention by showing a brief video depicting a gift officer conversing with a physician, Dr. Jones, who last year received a six-figure gift from grateful patient. The gift officer is meeting with the physician because his content for the stewardship report to the donor is past-due. The gift officer reminds the physician of the gift designation (pancreas cancer research) and explains the rationale for the donor report noting the capacity for a larger gift. The gift officer asks, “how was the gift used?” The video shows the physician stammering while he recalls in his mind a conversation that took place with a colleague last year, “Hey, I just got a windfall. Remember that conference in Greece we wanted to go to. Consider it done.” The narrator poses several guiding questions: Is this an appropriate use of donor funds? What guidance would you offer Dr. Jones? Have you ever witnessed a questionable use of philanthropy?” Instructor pre- records all audio and video. Learner listens to narrated video. Learner thinks about the questions being asked, reflecting on their own personal experience to compare how they may have reacted previously to each proposed scenario. Learning Objectives 3 Instructor presents in writing and repeats orally the UMC Advancement policies and procedures to be learned related to stewardship and the management of philanthropic funds, including: - General stewardship guidelines - Advancement policies regarding donor reporting and stewardship - Procedures for financial management of charitable gifts - The role of principal investigator on philanthropic accounts Instructor reads aloud through pre- recorded audio narration the high- level categories of Development policies and procedures to be reviewed and their applicability to stewardship of grateful patients, emphasizing how these work in the physician’s favor to deepen relationships and encourage repeat Learner listens to and reads policies and procedures to be discussed. SCIENCE OF MEDICAL PHILANTHROPY 134 giving. Instructor draws connection between the policies and procedures to the purpose of the lesson. Reasons for Learning - Benefits - Risks 3 Benefits: correct application of UMC Development policies and procedures ensures physician remains in good standing and facilitates good donor stewardship, which could lead to repeat giving. Risks Avoided: reduces risk of non- compliance with UMC policies as well as federal laws (IRS) governing charitable giving. Instructor states the reasons for learning the material and the risks avoided. Key points will be stated aloud and others will be bullet points on screen. Learner listens and reads the reasons for learning. Visual cues will be used and reference back to the initial scenario. For example, if the learner takes a specific action…you may put yourself at risk for…etc. This is meant to draw connections between major “do’s” and “don’ts” of the management of philanthropic gifts. Overview - Prior Knowledge - New Knowledge - Learning Strategies (What you already know...what you are going to learn...and how you are going to learn it.) 3 Previous trainings on UMC gift acceptance policies are tied to new knowledge using analogies and hypothetical scenarios in which physicians will apply that knowledge to recognize, describe and apply institutional procedures related to donor stewardship and management of philanthropic funds. Presentation of procedural learning strategies through video demonstration and auditory narration. Instructor describes and explains prior knowledge connection to new knowledge as well as learning strategies employed including: ● the order of instructional activities ● related tasks including UMC policies and procedures handouts, Learner listens and watches presentation of overview with video demonstration, downloads any supporting materials and handouts, and reviews learning strategies needed to be successful. SCIENCE OF MEDICAL PHILANTHROPY 135 video demonstration practice, and assessment Instructor also “chunks” main ideas/tasks to guide new knowledge. This does not detail the procedures but rather provides a summary overview of the procedures to be learned. Prerequisite Knowledge 3 A review of the information will be provided to activate prior knowledge and prepare learners for new learning material. Topics include: 1) UMC indirect rate on charitable gifts 2) Supervision and coordination of charitable gifts Instructor presents using visual and audio tools (video with narration) to review prerequisite knowledge and how that knowledge is applicable to knowledge of stewardship procedures. This will be done through a short quiz with multiple choice questions for each category of prerequisite knowledge required for this module. Learner reads and watches short presentation of prerequisite and prior knowledge to prepare for learning material. Learner engages in quick check on learning quiz to review prerequisite knowledge. Learning Guidance - Lecture - Demo. 8 Demonstrate (1) what the steps are for identifying, and applying financial management procedures related to the management of philanthropic gifts, (2) classifying and applying appropriate stewardship actions to convey appreciation and the impact of grateful patient gifts, and (3) how to implement these steps in a stewardship plan for a grateful patient donor. Given a scenario involving the donation of a gift from a grateful patient, a brief video will show how appropriate stewardship principles are recognized and applied by the physician and/or gift officer at various points during the ensuing year following receipt of the gift. Learner watches the demonstration lecture, reads any captions or keywords that break up the scripted scenario, and can pause the video at any time. SCIENCE OF MEDICAL PHILANTHROPY 136 Role play scenario will pause periodically for instructor narration to emphasize and explain the timing and rationale for each stewardship action taking place. Practice and Feedback Practice occurs at each step outlined above. Practice scenarios will allow physicians to (1) appropriately recognize situations where financial stewardship of philanthropic funds applies, (2) recall and apply the steps in the procedure, (3) make decisions about additional steps required (sub- procedures), and (4) determine if financial and stewardship procedures have been applied correctly. Practice with feedback is untimed and ungraded. Instructor corrective feedback is provided asynchronously. Practice will be done through a short “fill in the blank” and multiple choice quiz. Learners will have two attempts to answer correctly. After two incorrect attempts, the correct answer will be revealed through a 15- second narrative video that allows learners to connect new learning with correct answer. Learners select, define, and respond to various questions and prompts with increasing difficulty and complexity. Since mastery of the content is the goal, learners will have multiple opportunities to succeed and demonstrate proficiency before the final assessment. Authentic Assessment 5 Classification and Application: Scenario-based questions asking physician to apply a UMC policy/procedure to a new context related to each enabling objective and the terminal objective. Instructor delivers assessment questions, mastery criteria, and (asynchronous) corrective feedback as needed. See the Assessment Plan for the criterion level toward mastery. Learners will be asked to respond to a variety of questions related to financial management of philanthropic funds and stewardship policies and procedures. Retention and Transfer 1 Summarize key institutional policies and major steps in stewardship and management of philanthropic funds. Through pre- recorded audio narration and images, Instructor will group and review situations Learner recalls real-life situations where procedures are applied. SCIENCE OF MEDICAL PHILANTHROPY 137 where the different procedures are commonly applied, including contexts where variations of the procedure will apply. Instructor will convey the desire to achieve institutional alignment and the goal of delivering the best possible donor experience as the overarching intent behind these procedures as a whole. Big Ideas 1 Review and re-motivate: Review the take-aways from this unit, emphasizing the utility of these policies and procedures to promote positive donor experiences and reduce potential for financial error. Connect the importance of the procedural knowledge to the goals of the unit and training. Instructor asks the learners to reflect on how these procedures will be applied in the context of their jobs. Learner downloads any supporting materials and handouts from the resource section, and reviews learning strategies needed to be successful. Advance Organizer for the Next Unit 1 Connections made to application of these principles in concert with other rules governing GPFR, and how this applies to ethical conduct and GPFR which will be covered in the next unit. Instructor previews next unit by drawing connections between current unit and its application to course goal. Learner listens and watches overview of next unit. Total Time 30 Approximate time: 10 seconds 138 SCIENCE OF MEDICAL PHILANTHROPY Approximate time: 2 minutes A video launches and the instructor appears with a welcome message. Instructor narration includes the following key points: ●  Welcome, thank you for joining me today. ●  My name is ______ and I’ll serve as your guide as together we continue the course, The Science of Medical Philanthropy. ●  Today’s workshop is the fourth workshop in our series, and focuses on donor stewardship and the management of philanthropic funds. ●  This unit builds on prior discussions we’ve had on institutional policies governing gift acceptance, while introducing new information related to financial stewardship and its role in enhancing grateful patients’ ties to UMC, potentially leading to repeat giving and also larger gifts. ●  To get started, let’s explore a scenario... 139 SCIENCE OF MEDICAL PHILANTHROPY Approximate time: 3 minutes Video continues. A brief video depicts a gift officer conversing with a physician, Dr. Jones, who last year received a six-figure gift from grateful patient. The gift officer is meeting with the physician because his content for the annual progress report to the donor is past-due. The gift officer reminds the physician of the gift designation (pancreas cancer research) and explains the rationale for the donor report noting the capacity for a larger gift. The gift officer asks, “how was the gift used?” The video shows the physician stammering while he recalls in his mind a conversation that took place with a colleague last year, “Hey, I just got a windfall. Remember that conference in Greece we wanted to go to. Consider it done.” The video pauses and the narrator poses several guiding questions: ●  Did usage of the funds comply with the donor’s intent? ●  What guidance would you offer Dr. Jones in this situation? ●  Have you ever witnessed a questionable use of philanthropy?” 140 SCIENCE OF MEDICAL PHILANTHROPY Approximate time: 3 minutes Video continues. Instructor narration: ●  Outlandish? An impossibility? Trust me, situations like these have happened. ●  Our goal today is to equip you with the knowledge and tools to avoid finding yourself in a situation that may violate the tenets of proper donor stewardship and UMC policy. ●  Now, let’s review the course goal and objectives. ●  The goal of this workshop is to inform you how to develop meaningful relationships with grateful patients by being good stewards of their generosity. ●  Specifically, we will review: ○  General stewardship guidelines ○  Advancement policies regarding donor reporting and stewardship ○  Procedures for financial management of charitable gifts ○  The role of the principal investigator on philanthropic accounts ●  Abiding by these policies ensures good donor stewardship, thereby deepening the donor’s relationship with UMC and the opportunity for renewed -- even greater -- giving. 141 SCIENCE OF MEDICAL PHILANTHROPY Approximate time: 4 minutes Video continues. Instructor narration: ●  Closing a gift is only a preliminary step in grateful patient fundraising. Much of the most important work follows. ●  Let’s begin by reviewing some general stewardship guidelines. ●  It may be common knowledge to most of you that demonstrating the impact of donors’ giving is a fundamental aspect of GPFR. ●  While we know this to be true, you also know it is yet one more responsibility to add to your already full plate. ●  But let me be clear: if you cannot commit to proper donor stewardship, you should not be fundraising. It is that simple. ●  Early in my career…(instructor shares personal anecdote to illustrate the do’s and don’t’s of donor stewardship) ●  So, poor donor stewardship is like treating your patients poorly - something you would never do. ●  By doing so, you could be bringing potential harm to UMC’s brand profile, damage patient/donor relationships, introduce compliance issues or even be paid a visit by the dean - not the kind of visit you’d like. 142 SCIENCE OF MEDICAL PHILANTHROPY Approximate time: 9 minutes Video continues. Instructor narration: ●  You might be thinking, “so what does good donor stewardship look like?” ●  Watch this... (video of physician/donor scenario launches) In the scenario, the physician is shown receiving a gift from a grateful patient and the exchange that occurs between them. Video pauses. Instructor narration: ●  This scenario highlights of donor stewardship: 1.  Thanking the donor - the physician does this in person and follows-up with a personal thank you letter. 2.  Physician acknowledges and confirms donor intent, how the donor would like their gift to be used (in this case, an endowed fellowship). 3.  Physician commits to ongoing engagement of the donor in the project, in this case, inviting them to lunch to meet the fellow the donor is supporting. 143 SCIENCE OF MEDICAL PHILANTHROPY The video resumes. It is approximately 6 months later and the physician receives a phone call from the donor requesting help with a referral to another specialty. Video pauses. Instructor narration: ●  This segment illustrates a key point. ●  Each one of you has a personal preference for how accessible you are to your patients. Some give their cell phones freely, while others don’t. ●  I am not suggesting you give your cell phone to every donor or potential donor. ●  I am telling you that good donor stewardship means making certain that you are available, expeditious, and trustworthy. ●  Everyone in your office - your research coordinator, your assistant, your scheduler - everyone needs to have an awareness of who the donors are and deliver an exceptional experience, just as they would with a patient. They represent you to your patients, and to donors as well. 144 SCIENCE OF MEDICAL PHILANTHROPY The video resumes. It approaching one year anniversary of the donor’s gift. The scenario shows an exchange between the gift officer and physician regarding the preparation of an annual stewardship report and a preliminary strategy about soliciting the donor’s next gift. Instructor narration: ●  Our primary objective is to strive for a high return on philanthropic dollars (RPD) ●  RPD is achieved principally when: ○  The principal investigator (PI) honors donor intent when expending philanthropic dollars ○  The PI directs philanthropy to the highest and best use. ●  Remember, our goal is to demonstrate impact to our donors. ●  UMC is not serving our donors well when their resources are frittered away on pet projects that have little to no impact. ●  Our policy at UMC is to provide donors with a personalized narrative report on the impact of their gift. This is standard for all gifts of $250,000 or above, and by the donor’s request for gifts less than that. ●  Trust me, you don’t want to find yourself in a position a year later with nothing to say to that donor. ●  Let’s take a look…(video resumes). 145 SCIENCE OF MEDICAL PHILANTHROPY The scenario continues by the physician and gift officer presenting the donor with a portfolio containing a stewardship report. Highlights are shared by UMC and the donor expresses satisfaction with the program. The physician introduces his vision for expanding the program in the coming year. The donor asks what would be needed to accomplish that. The gift officer shares details.. ●  Stewardship can flow naturally into cultivation for the donor’s next gift. ●  (Instructor shares a personal anecdote to reinforce the simulation in the video.) 146 SCIENCE OF MEDICAL PHILANTHROPY Approximate time: 4 minutes Video continues. Instructor narration: So now that we’ve discussed donor stewardship, let’s do a quick review of UMC’s financial management policies, an important aspect of stewardship of philanthropic resources. Q1: UMC’s indirect cost rate on philanthropy is ____ percent. (answer=C) A.  10% B.  15% C.  20% D.  Indirect cost rate doesn’t apply to philanthropy. Q2. Indirect costs are charged as funds are _________ the account? (answer=B) A.  Deposited to B.  Disbursed from Q3. Gifts of $250,000 or more can be commingled with other philanthropic gifts. (answer=FALSE) A.  True B.  False Q4. The Finance department is equipped to process donor gifts. (answer=FALSE) A.  True B.  False 147 SCIENCE OF MEDICAL PHILANTHROPY Approximate time: 2 minutes Video. The instructor closes unit 4 with a summary: ●  As we draw this workshop on stewardship and financial management to a close, I want to thank you for your attention. ●  Today’s session provided you with an understanding of UMC’s general stewardship guidelines, development policies regarding donor reporting and stewardship, procedures for financial management of charitable gifts, and finally the role of the principal investigator on philanthropic accounts ●  This workshop completes the online portion of this curriculum. ●  The final two workshops in this series, The Science of Medical Philanthropy, are in-person seminars. ●  At the conclusion of this workshop, you will receive a link to a survey requesting your feedback on this workshop. ●  I hope you’ll take a few minutes to let us know how the content, instruction and format suited you. Your feedback will help us continue to refine workshops for future participants, so thank you in advance for your candor and thoughtfulness. ●  As a reminder, the Resources section lives on the UMC Intranet. We will continue to update this website with information you can use to be successful in your practice of GPFR. ●  A final reminder to register for seminar, the final workshop of this series. This two-part seminar is held monthly. Seats are limited so be sure to sign up soon on the UMC Intranet. ●  On behalf of <name of UMC faculty leader> and <name of chief development officer>, thank you again your participation in The Science of Medical Philanthropy. See you soon! 148 SCIENCE OF MEDICAL PHILANTHROPY 149 SCIENCE OF MEDICAL PHILANTHROPY SCIENCE OF MEDICAL PHILANTHROPY 150 Unit 5 Lesson Plan and Instructor’s Guide: Examining Ethics in Grateful Patient Fundraising Unit # Unit Title Unit Length Format 1 Grateful Patient Fundraising Overview 30 minutes Asynchronous online 2 Accommodating Patient Privacy in Grateful Patient Fundraising 30 minutes Asynchronous online 3 Applying Institutional Policies for Fundraising 30 minutes Asynchronous online 4 Stewarding Grateful Patient Philanthropy 30 minutes Asynchronous online 5 Examining Ethics in Grateful Patient Fundraising 75 minutes In-person seminar 6 Appraising Patients’ Motivations for Giving 75 minutes In-person seminar Unit Duration: 75 minutes (in-person) Introduction: This is the fifth unit in the six-unit course on how to train physicians to participate in grateful patient fundraising (GPFR). Industry knowledge indicates that many physicians lack adequate guidance to navigate ethical hazards of GPFR. Many physicians struggle with ethical concerns over the solicitation of their patients and the subsequent impact on the physician-patient relationship. This course is intended to allow physicians to explore their own personal beliefs on the ethics of GPFR and provide the tools to support learners to develop an understanding of how they can incorporate GPFR into their practice in an ethical and responsible way. Learning Objective(s) Terminal Objective: Given reflective dialogue with experts and peers, learners will demonstrate an attitude that values and shows respect for the physician-patient relationship, irrespective of the patient’s donative intent, and demonstrate sensitivity to the disparities in human circumstance when a patient and their family is facing serious illness or disease. Enabling Objective(s): ● Given a GPFR scenario, learners will be able to apply ethical behavior in a clinical setting where philanthropy is involved ● Given dialogue between the learner and physician expert, learners will know how to ensure the clinical needs of the patient come first and that philanthropy is always subordinate to patient care ● Given dialogue between the learner and physician expert, learners will know why it is essential to maintain a singular, high standard for patient care Lesson Materials Handout: AMA Principles of Medical Ethics Handout: AMA Code of Medical Ethics: Gifts from Patients Handout: GPFR Ethics Job Aid Handout: White paper produced from Grateful Patient Fundraising (GPFR) Ethics Summit on June 28-29, 2017 in Baltimore, Maryland (currently in press) Video: GPFR scenario Discussion prompts (see Facilitator’s Guide) Presentation slides SCIENCE OF MEDICAL PHILANTHROPY 151 Learner Characteristic Accommodations Learners will participate in this seminar in-person. Facilitator’s Notes This is in-person seminar features live instruction. The presentation, practice, and feedback actions will be performed real-time during the seminar. Instructional Activities Instructional Sequence Time (mins) Description of the Learning Activity Instructor Action/Decision (Supplantive) Learner Action/ Decision (Generative) Gain Attention 3 Short video of a pre-filmed GPFR scenario involving a physician and a patient in a clinical setting. The scenario depicts a gravely ill patient suggesting a large charitable gift in exchange for access to an off-label drug. The video pauses before the physician responds. The audio narration (narrated by physician expert) states: “Have you ever encountered a situation like this? How about observing a physician colleague being overly aggressive with wealthy patients to encourage giving? How do you respond? What actions should you take?” Instructor pre- records all audio and films any necessary video. Asking a guiding question or presenting a scenario establishes a framework or lens that focuses attention to a problem that needs to be solved. It activates thinking and allows a learner to consider ways in which the question relates to previous personal experiences. Learner listens and watches video. Learner thinks about the questions being asked, attaching personal experience to the proposed problem. Learners engage in the “What would you do?” by thinking about possible next step. Each step will lead to additional steps designed to provoke deeper thought on attitudinal beliefs towards GPFR. Learning Objectives 3 Lesson objectives are presented in writing and repeated orally. (See above for specific objectives addressed) Instructor states the objectives aloud through audio/video narration, relating the guiding question to the learning objectives and purpose of the lessons. Learner listens to and reads objectives. Reasons for Learning - Benefits - Risks 5 Benefits: being able to identify and navigate a range of ethical situations and dilemmas that may surface in the practice of GPFR Instructor states the reasons for learning the material and the risk avoided. Key Learner listens and reads the reasons for learning. Learners SCIENCE OF MEDICAL PHILANTHROPY 152 Risks Avoided: perception of unethical conduct towards patients and their families points will be stated aloud while others will be bullet points on screen reflect on guiding questions that link back to introductory video and highlight the benefits and risks of lesson. For example, if you chose, A…you may put yourself/your patient or institution at risk for…etc. Overview - Prior Knowledge - New Knowledge - Learning Strategies (What you already know...what you are going to learn...and how you are going to learn it.) 5 Previous lessons and knowledge on medical ethics and patient privacy tied to new knowledge using analogies and hypothetical scenarios in which physicians will apply that knowledge to identifying and engaging problem schema to solve ethical dilemmas related to GPFR. Presentation of problem solving learning strategies by reviewing declarative knowledge and principles highlighting key strategies. Instructor describes and explains prior knowledge connection to new knowledge as well as learning strategies, including: ● Reviewing declarative knowledge related to GPFR ● Reviewing general problem- solving strategies and modifications appropriate to these situations ● Reviewing types and source of principles related to these situations Learner listens and watches presentation of overview and reviews learning strategies needed to be successful. Prerequisite Knowledge 4 Building off the overview, this section reviews critical knowledge and principles to activate prior knowledge and prepares learners for new learning material. Instructor will compare new knowledge with old knowledge through analogies connecting a learner’s own experience with not knowing how Learner listens to short presentation of prerequisite and prior knowledge to prepare for learning material. SCIENCE OF MEDICAL PHILANTHROPY 153 to do something to, through modeling and practice, being able to solve a problem that was once very complex and is now relatively simple and automatic. Learning Guidance - Lecture - Demo. 10 Demonstrate (1) how to identify and decompose ethical problems related to GPFR and (2) knowledge of principles and strategies to resolve these problems. Specifically, the lecture and demonstration will include: (a) Recognize situations where ethics may be compromised. (b) Determine how to act ethically in the context of patient fundraising. Instructor begins with simplified versions of ethical dilemmas, advancing to ones of increasing complexity. Instructor provides model think- alouds and asks guiding questions with helpful hints to help learners decompose scenarios and apply problem- solving strategies. Learners listen to the demonstration lecture. Practice and Feedback 30 Practice scenarios are provided in which physicians must appropriately identify, apply schema, and respond to scenarios related to ethics and GPFR. Small groups of learners will be provided unique situations to explore. Learners will reconvene for share-out and discussion following the practice scenarios. Instructors provide scenarios with discussion prompts with increasing difficulty and complexity to engage learners in reflective dialogue. Timely feedback (inquiry- driven, not corrective) is provided to deepen conversation. Learners define and respond to various scenarios and prompts with increasing difficulty and complexity. Authentic Assessment Scenario-based questions asking physicians to apply a problem-solving strategy to a new context related to the terminal objective. Instructors assess learners’ mastery of knowledge by observing practice and feedback discussions (see above). Instructors evaluate learning with a rubric designed to assess mastery of content. Learners engage in dialogue on key principles and problem- solving strategies related to ethics and GPFR. Retention and Transfer 8 Review the take-aways from this unit: restate key attributes of ethical dilemmas in GPFR and summarize effective strategies for problem- Instructor asks learners to think about similar scenarios they Learners reflect on analogous scenarios and SCIENCE OF MEDICAL PHILANTHROPY 154 solving. have encountered in practice and explicitly states how these problem-solving strategies could apply. application of learning strategies to resolve these problems. Big Ideas 3 Re-motivate: Review the importance and breadth of new knowledge to the goals of the unit and the practice of GPFR. Instructor reiterates main ideas. Learners listen to and reflect on main ideas. Advance Organizer for the Next Unit 4 Connections made to understanding motivations for giving and responding to donative intent—the next unit in the course. Instructor previews next unit by drawing connections between ethics and successful physician engagement in GPFR. Learners reflect on connecting the ideas and strategies to the practice of GPFR. Total Time 75 SCIENCE OF MEDICAL PHILANTHROPY 155 Unit 5 Facilitator’s Guide: Examining Ethics in Grateful Patient Fundraising Agenda 8:00am – 8:20am Welcome and Introduction to Unit #5 8:20am – 8:30am Demonstration: Best Practices for Identifying and Resolving Ethical Problems Related to GPFR What is the role of philanthropy in the patient-physician relationship? 8:30am – 9:00am Examining Ethical Scenarios: Small Group Roundtable Discussions 9:00am – 9:10am Large Group Sharing, Reflection, and Discussion 9:10am – 9:15am Wrap-up and Next Steps Introductions/Overview/Ground Rules/Assess Prior Knowledge (Due to time limitations, after instructor introductions, participants will introduce themselves to each other at their respective tables. If participants are late to the workshop, the instructor should start the introductions on time and let latecomers introduce themselves when they arrive) 8:00 - 8:20 20 minutes Facilitation Goals for this Section ● Introduce unit content with brief video. ● Develop rapport among learners. Have people start to meet one another. ● Conduct a quick survey to find out what ethical encounters participants have experienced. ● Reawaken their commitment to medical ethics and human caring. ● Show them how this workshop fits with other units in the curriculum. SCIENCE OF MEDICAL PHILANTHROPY 156 Slide Slide Slide Slide Video Slide: embedded video ● Begin workshop with video depicting a patient/physician scenario that examines ethical conduct ● Scenario transitions to reflection prompts to stimulate participants’ thinking on ethical conduct and GPFR o Did the physician act appropriately? o How would you have responded in this situation? Introductions Slide: name, department/center/institute 1. Introduce yourself 2. Ask the group to introduce themselves with their name and department/center/institute Agenda and Ground Rules Slide: Show the Agenda slide and review it with the group. Slide: Refer to the prepared Ground Rules handout in the Participant’s Guide and ask the participants to follow along ● Turn communications to “silent” ● Participate fully. ● Ask questions! ● Note locations of exits and restrooms. Objectives and Overview Show slides in this order with each event below: 1. Image of a physician in distress and patient (in clinic) 2. Text of the unit objectives 3. Image of a physician, gift officer and patient in dialogue (in neutral setting) 4. Table of Curriculum and Units Numbers below refer to slide number above. 1) In small groups, ask participants to exchange their perspectives on/attitudes towards the ethics of GPFR, supported by experiences, either observed or experienced directly (pulse-check; SCIENCE OF MEDICAL PHILANTHROPY 157 very brief share out within groups). 2) Ask the participants to reflect on the learning objectives on their agenda or on the slide. a) Summarize the research literature on the ethics of GPFR, the gaps in physician education and how this workshop aims to equip physicians with a mindset and skills that uphold the sanctity of the physician-patient relationship while also providing the tools to engage ethically in GPFR. b) Develop a shared understanding of the role of philanthropy in academic medicine and at UMC. c) Given a range of patient situations, you will have the skills to be able to … d) Ask for understanding and questions about the objectives. 3) Describe how ethical conduct is essential to the practice of GPFR. Review the benefits of successfully identifying and navigating problems related to the ethics of GPFR (citing the literature where appropriate): a) Providing sacred spaces for patients and their families who are facing serious illness; b) Avoiding the perception of inappropriate behavior (e.g. quid pro quo), preferential treatment, or behavior that violates the medical code of ethics; and c) Building trusting relationships with patients and their families that lays a foundation for transformational philanthropy for your institution. 4) Describe where this unit fits within the overarching curriculum. Overview: Tell the participants what they already know about the sanctity of the physician-patient relationship from their experience as a clinician in academic medicine. Ask them to share their own beliefs and experiences and how this influences their practice. Tell the participants that philanthropy is the fulfillment of a patient’s altruism stemming from the gratitude they feel for the care they have received. Describe that, in this module, they will explore the ethics of GPFR, best practices for conducting themselves in an ethical manner when engaging in GPFR (demonstration), and then they will be given the opportunity to practice negotiating situations that involve ethics and GPFR and receive feedback from both their peers and the instructors. SCIENCE OF MEDICAL PHILANTHROPY 158 Slide Slide Assess Prior Knowledge - What do you already know or feel about ethics and the physician-patient relationship? Use the Poll Everyone technology to assess prior knowledge of: ● Know the code of medical ethics ● Know there is one standard of patient care ● Know what patient-physician trust means, especially with vulnerable patients ● Know what patient privacy means ● Know how PHI can be used for GPFR ● An altruistic grateful patient = a patient who is driven by interest and passion for the hospital, program, physician, or research agenda. ● A transactional grateful patient = a patient who wants something (quid pro quo) in return for a donation. Assess and teach, if necessary, prerequisite skills: ● Engage in active listening (LiSA) ● Apply non-verbal (body language) strategies ● Read non-verbal cues (body language) ● Ask open-ended questions Ask participants to demonstrate these skills to each other. Demonstration: Best Practices for Identifying and Resolving Ethical Problems Related to GPFR 8:20 - 8:30 10 minutes Introduce a video that provides overview of best practices as it relates to ethics and grateful patient fundraising. Each best practice will be narrated by a physician expert who draws on his/her own experience and perspectives to reinforce the best practice. Scenarios include: ● Philanthropy in academic medicine: Is there a place for this? ● Upholding physician-patient trust: Therapeutic obligations first. SCIENCE OF MEDICAL PHILANTHROPY 159 Slide ● Role of patient privacy in grateful patient fundraising ● Handling the transactional donor ● To solicit or not to solicit: The physician’s role Describe how the content of the video was drawn from the research literature and a recent white paper produced by the GPFR Ethics Summit held at Johns Hopkins University in June 2017. Play the video. Scenario Examination and Small Group Discussion 8:30 - 9:00 30 minutes Set up the small group discussion (eight participants per table) by describing how we learn more when we experience it and when we share our experiences with others. Ask them to refer to the handouts. Using the scenario that participants selected from the menu provided on the handout, ask three participants to assume a role - the physician, the patient or the development executive/administrator (will vary by scenario). Each UMC role player (e.g. not the patient) with have a dedicated shadow person who focuses on and documents their attitudes and decisions/actions to the situation/actors involved using a rubric. The remaining three participants will be observers and focus on the dynamics at play on a macro level (e.g. influence of institutional culture) using a second rubric to evaluate the strategies employed. The scenario is acted out for approximately 5-10 minutes, followed by a 20 to 25-minute small group debrief/discussion. The following discussion prompts can be used as guides: ● What ethical issues did this scenario present? ● For <role>, was there a clear “right” path? ● How would you have acted/responded in this situation? ● Explore the factors that are likely influencing this patient's motivations to give. ● Offer an example (or suggestion) of a strategy that was/could be used to ensure sacred space for patients dealing with terminal illness and/or those facing sensitive clinical conversations from those related to philanthropy. SCIENCE OF MEDICAL PHILANTHROPY 160 Large Group Sharing, Reflection and Discussion 9:00 - 9:10 10 minutes Ask participants to share with the larger group key takeaways from their review and discussion of the ethical dilemma presented in the physician- patient scenario and how they might resolve such a situation in practice. 1. Discussion prompts: a. Has examination of these scenarios helped to clarify your own understanding/beliefs/perspectives on GPFR? b. Did your perspective on the ethics of GPFR change and if so, how? c. How will you integrate this knowledge into your clinical practice? d. Is there anything you learned today that would be difficult to do? Wrap-Up and Next Steps 9:10 - 9:15 5 minutes 1. Thank everyone for their participation in the first half of this seminar. 2. Tell the participants that the second part of this seminar will continue after a 15-minute break. SCIENCE OF MEDICAL PHILANTHROPY 161 Unit 5 Job Aid: Navigating Potential Ethical Hazards • Physician should clearly communicate primary relationship with patient is clinical. • Physician should not allow philanthropy to impact care provided to the donor or to other patients who are not donors. • Physicians should be cautious when prospective donors are vulnerable as a result of their illness or that of a family member. • Delegate solicitations to development officers to avoid compromising the physician- patient relationship • Physician and institutional leadership must be prepared to decline a gift if situation violates ethical principles. (Wright et al, 2012; AMA Council on Judicial and Ethical Affairs; Capozzi, 2004; Spence, 2005, Graufberg, 2007) SCIENCE OF MEDICAL PHILANTHROPY 162 Unit 6 Lesson Plan and Instructor’s Guide: Appraising Patients’ Motivations for Giving Unit # Unit Title Unit Length Format 1 Grateful Patient Fundraising Overview 30 minutes Asynchronous online 2 Accommodating Patient Privacy in Grateful Patient Fundraising 30 minutes Asynchronous online 3 Applying Institutional Policies for Fundraising 30 minutes Asynchronous online 4 Stewarding Grateful Patient Philanthropy 30 minutes Asynchronous online 5 Examining Ethics in Grateful Patient Fundraising 75 minutes In-person seminar 6 Appraising Patients’ Motivations for Giving 75 minutes In-person seminar Unit Duration: 75 minutes (in-person) Introduction: This is the sixth and final unit in the six-unit course on how to train physicians to participate in grateful patient fundraising. Many physicians have expressed a lack of understanding how to do it, and/or feel uncomfortable engaging in conversations related to philanthropy. Most have limited experience to draw upon when responding to philanthropic inquiries from patients. Physicians who lack preparation and skills may be reticent to engage patients in this way. This module is intended to teach you how to appraise grateful patients’ motivations for giving and how to open and/or respond to philanthropic conversations and inquiries. Learning Objective(s) Terminal Objective: Given a situation between a physician and grateful patient, learners will know how to identify and describe common motivations for patient philanthropy, assess patients for philanthropic potential, and understand how to respond to patients’ expressions of gratitude. Enabling Objective(s): ● Given dialogue with a physician expert, learners will be able to differentiate among a range of motivations that inspire grateful patients to offer philanthropic support. ● Given dialogue with a development officer expert, learners will be able to discern which patient characteristics and/or attributes are highly correlated with philanthropic giving. ● Given observation of a scenario between a grateful patient and physician, learners will be able to identify patient cues and clues that signal philanthropic interest. ● Given expert modeling and role play scenarios, learners will know what to say to a grateful patient on the topic of philanthropy. Lesson Materials Handout: Cues and Clues Job Aid Handout: Opening a Conversation Job Aid Video: GPFR scenario Assessments and rubrics Presentation slides SCIENCE OF MEDICAL PHILANTHROPY 163 Learner Characteristic Accommodations Learners will participate in this seminar in-person. Facilitator’s Notes This in-person seminar features live instruction. The presentation, practice, and feedback actions will be performed real-time during the seminar. Instructional Activities Instructional Sequence Time (mins) Description of the Learning Activity Instructor Action/Decision (Supplantive) Learner Action/ Decision (Generative) Gain Attention 3 Short video of a pre-filmed GPFR scenario involving a physician and a patient in a clinical setting. The scenario depicts a patient who is expressing appreciation to the doctor and the entire care team for the wonderful experience she has had. “When I first received my diagnosis, I was in despair. But you have been wonderful, walking me through each step of my treatment, answering my questions. I have never felt so cared for - thank you. Today, I feel great and I owe that to you. How could I ever repay you for the gift of life you have given me?” The video pauses before the physician responds. The audio narration (narrated by physician expert) states: “Have you ever encountered a situation like this? How did you respond? With a simple ‘thank you’ or did you answer differently? Instructor pre- records all audio and films any necessary video. Asking a guiding question or presenting a scenario establishes a framework or lens that focuses attention to a problem that needs to be solved. It activates thinking and allows a learner to consider ways in which the question relates to previous personal experiences. Learner listens and watches video. Learner thinks about the questions being asked, attaching personal experience to the proposed problem. Learners engage in the “What did you (would you) respond?” by thinking about possible next step. Each step will lead to additional steps designed to provoke deeper thought on the practice of GPFR. Learning Objectives 3 Lesson objectives are presented in writing and repeated orally. (See above for specific objectives addressed.) Instructor states the objectives aloud through audio/video narration, relating the guiding question to the learning objectives and purpose of the lessons. Learner listens to and reads objectives. Reasons for Learning - Benefits - Risks 3 Benefits: being able to know how to receive and respond to patients’ expressions of gratitude that could lead to potential philanthropic support for UMC priorities; knowing how to raise respectfully the topic of philanthropic priorities with qualified patients; Instructor states the reasons for learning the material and the risk avoided. Key points will be stated aloud while Learner listens and reads the reasons for learning. Learners reflect on guiding SCIENCE OF MEDICAL PHILANTHROPY 164 leveraging appreciation to garner financial resources to support UMC priorities Risks Avoided: missed opportunities for charitable support; leaving “money on the table” others will be bullet points on screen questions that link back to introductory video and highlight the benefits and risks of lesson. For example, if you chose, A…you may be on a path to cultivate a major gift from this patient; if you chose B (did nothing), you risk missing out on a potential gift…etc. Overview - Prior Knowledge - New Knowledge - Learning Strategies (What you already know...what you are going to learn...and how you are going to learn it.) 3 Previous lessons and knowledge on ethics and patient privacy tied to new knowledge using analogies and hypothetical scenarios in which physicians will apply that knowledge to identifying and engaging problem schema to solve problems related to how to initiate and/or respond to philanthropic conversations with grateful patients. Presentation of problem solving learning strategies by reviewing declarative knowledge and principles highlighting key strategies. Instructor describes and explains prior knowledge connection to new knowledge as well as learning strategies including: ● Reviewing declarative knowledge related to GPFR ● Reviewing general problem- solving strategies and modifications appropriate to these situations ● Reviewing types and source of principles related to these situations Learner listens and watches presentation of overview and reviews learning strategies needed to be successful. Prerequisite Knowledge 3 Building off the overview, this section reviews critical knowledge and principles to activate prior knowledge and prepare learners for new learning material. Instructor will compare new knowledge with old knowledge through analogies Learner listens to short presentation of prerequisite and prior SCIENCE OF MEDICAL PHILANTHROPY 165 connecting a learner’s own experience with not knowing how to do something to, through modeling and practice, being able to solve a problem that was once very complex and is now relatively simple and automatic. knowledge to prepare for learning material. Learning Guidance - Lecture - Demo. 15 This lesson will demonstrate (1) how to recognize cues and clues that suggest patients’ philanthropic potential and (2) knowledge of problem-solving strategies to engage in philanthropic conversations. Specifically, the lecture and demonstration will include: (a) How to identify and decompose problems specific to GPFR. (b) Understanding patients’ motivation for giving (c) Know what to say/how to respond to patients when they express gratitude. (d) How to open a philanthropic conversation Instructor begins with simplified versions of GPFR scenarios, advancing to ones of increasing complexity. Instructor provides model think- alouds and asks guiding questions with helpful hints to help learners decompose scenarios and apply problem- solving strategies. Learners listen to the demonstration lecture. Practice and Feedback 35 Practice role play scenarios are provided in which physicians must appropriately identify, apply schema, and respond to scenarios related to the physician’s role in GPFR. Small groups of learners will be provided unique role play situations to explore. Learners will reconvene for share-out and discussion following the role play scenarios. Instructors provide role play scenarios with discussion prompts to engage learners in dialogue. Timely feedback (inquiry- driven, not corrective) is provided to deepen conversation. Learners will discuss the value of the patient experience as it relates to philanthropic intent and then, using role play, draw connections between the patient experience and donative intent. Learners will also participate in role plays to learn how physicians can employ strategies to SCIENCE OF MEDICAL PHILANTHROPY 166 nurture charitable giving in a range of situations. Learners develop mnemonics to recall common donor attributes, such as affluence, affinity, and access (AAA), that collectively signify high potential prospects. Authentic Assessment Scenario-based role plays (accompanied by guiding questions) asks physicians to apply a problem- solving strategy to a new context related to the terminal objective. Instructors assess learners’ mastery of knowledge by observing practice and feedback discussions (see above). Instructors evaluate learning with a rubric designed to assess mastery of content. Learners engage in role plays followed by a small group debrief to discuss application of procedural steps pertinent to the physician’s role in GPFR. Retention and Transfer 5 Review the take-aways from this unit: restate key steps and considerations as it relates to the physician’s role in GPFR and summarize effective strategies for approaching philanthropic conversations. Instructor asks learners to think about similar scenarios/patient relationships they have developed in clinic and how these relational strategies and practices might be applied. Learners reflect on analogous scenarios and application of learning strategies to address these patient situations/phil anthropic opportunities. Big Ideas 5 Re-motivate: Review the importance and breadth of new knowledge to the goals of the unit and the practice of GPFR. Summarize importance of course as it relates to practice of GPFR Instructor reiterates main ideas. Learners listen to and reflect on main ideas. Advance Organizer for the Next Unit N/A N/A N/A Total Time 75 SCIENCE OF MEDICAL PHILANTHROPY 167 Slide Unit 6 Facilitator’s Guide: Appraising Patients’ Motivations for Giving Agenda 9:30am – 9:45am Welcome and Introduction to Unit #6 9:45am – 10:00am Demonstration: Appraising Grateful Patients’ Motivations for Giving and Best Practices to Open a Philanthropic Conversation 10:00am – 10:30am Collaborative Practice: Opening the Conversation 10:30am – 10:40am Large Group Sharing, Reflection, and Discussion 10:40am – 10:45am Wrap-up and Next Steps Introductions/Overview/Ground Rules/Assess Prior Knowledge 9:30 - 9:45 15 minutes Facilitation Goals for this Section ● Welcome participants back from the break. ● Introduce part II of the seminar with brief video. ● Conduct a quick survey to find out what experience participants have had with GPFR. ● Reawaken their commitment to role of philanthropy in advancing institutional priorities, and their programs. ● Show them how this workshop fits with other units in the curriculum. Video Slide: embedded video ● Begin workshop with video depicting a patient/physician scenario where the patient expresses gratitude to the physician ● Scenario transitions to narrator (physician expert) who stimulates SCIENCE OF MEDICAL PHILANTHROPY 168 Slide Slide Slide participants’ thinking by asking: o Have you ever encountered a situation like this? o How did you respond? With a simple ‘thank you’ or did you answer differently? Agenda Slide: Show the Agenda slide and review it with the group. Reminders: ● Turn communications to “silent” ● Participate fully. ● Ask questions! Objectives and Overview Show slides in this order with each event below: 1. Image of physician and patient engaging in conversation 2. Text of the unit objectives 3. Graphic of physician role in grateful patient donor cycle 4. Table of curriculum and units Numbers below refer to slide number above. 1) In small groups, ask participants to exchange their experiences having a philanthropic conversation with a patient. How did they identify the patient as having an interest or inclination to give? What did they say? (Very brief share out by groups) 2) Ask the participants to reflect on the learning objectives on their agenda or on the slide. a) How to differentiate among a range of motivations that inspire grateful patients to offer philanthropic support. b) How to discern which patient characteristics and/or attributes are highly correlated with giving (capacity). c) How to identify patient cues and clues that signal philanthropic interest (inclination). d) Given a range of patient situations, you will have the skills to be able to respond to patients’ expressions of gratitude and/or direct philanthropic inquiries… e) Ask for understanding and questions about the objectives. 3) Review the benefits of successfully completing the workshop: a) Understanding that the foundations of patient philanthropy are delivering exceptional care and connecting SCIENCE OF MEDICAL PHILANTHROPY 169 Slide meaningfully with your patients – skills they already developed b) How to transform these trusting relationships into philanthropic relationships that benefit the patient, the institution, and the physician by developing their ability to: i) Recognize potential grateful patients ii) Discern their interest and inclination to make a gift. iii) How to cultivate and/or respond to their interest. 4) Describe where this unit fits within the overarching curriculum. Overview: Tell the participants what they already know about delivering exceptional patient experiences and building trusting relationship with their patients. Describe that, in this unit, they will be shown how to deepen these relationships by learning how to help patients fulfill their philanthropic aspirations. They will learn how to understand different motivations for giving, identifying cues and clues that signal philanthropic support, and what to say when a patient expresses gratitude or asks about philanthropy directly (demonstration). Participants will then be given an opportunity to practice “opening the conversation” with a patient prospect with other class participants and receive feedback from both their peers and the instructors. Assess Prior Knowledge - What do you already know about assessing capacity and/or interest in giving, and how to open a philanthropic conversation? Use the Poll Everyone technology to assess prior knowledge of: ● Know what a philanthropic vision means ● Know what connecting meaningfully with a patient means ● Know what trust means in the context of the physician-patient relationship ● Know what qualifies a patient prospect ● Know what interest means ● Being able to identify interest ● Know what willingness means ● Being able to identify willingness SCIENCE OF MEDICAL PHILANTHROPY 170 Slide Assess and teach, if necessary, prerequisite skills: ● Engage in active listening (LiSA) ● Apply non-verbal (body language) strategies ● Read non-verbal cues (body language) ● Ask open-ended questions Ask participants to demonstrate these skills to each other. Demonstration: Appraising Grateful Patients’ Motivations for Giving and Best Practices for Opening a Philanthropic Conversation 9:45 - 10:00 15 minutes Instructors (development expert and physician expert) provide overview of best practices as it relates to appraising patients’ motivations for giving, assessing patient interest and inclination, and opening philanthropic conversations. The live presentation is supported by brief videos that showcase a physician expert modeling the practice in a simulated real-life situation. The instructors add his/her own experiences to reinforce the best practice. Best practices include: ● Understanding patient motivations for giving ● Recognizing cues and clues that signal philanthropic potential and/or interest ● Recognizing and differentiating between patient capacity, interest, and inclination ● Responding to patients’ expressions of gratitude ● Opening a philanthropic conversation o Crafting and expressing a succinct vision for philanthropy Describe how the best practices and content of the video was drawn from the research literature examining best practices in GPFR. Introduce each best practice then show the brief video. Check for understanding before moving on to the next best practice. SCIENCE OF MEDICAL PHILANTHROPY 171 Slide Collaborative Practice and Feedback 10:00 - 10:30 30 minutes Set up the small group role play (eight participants per table) by describing how we learn more when we experience it and when we share our experiences with others. Ask them to use the handouts. Each table is provided with three unique scenarios that involve a physician and a patient. Each table divides into two groups (4 participants in each group; two groups per table). One participant assumes the role of the physician, another the patient, and the remaining two participants are observers-evaluators using a rubric. The scenario is acted out for approximately 3-5 minutes, followed by a 3- 5-minute debrief with the observers. The group then rotates roles and follows the same procedure to practice with the second and third (if time allows) scenarios. For the remainder of the time (approximately 5 minutes), each table will come back together for a small group debrief/discussion at the table. Large Group Sharing, Reflection and Discussion 10:30 - 10:40 10 minutes Ask participants to share with the larger group key takeaways from their participation and debrief of the role play scenario. 1. Discussion prompts: a. What did you learn from participants at your table that was novel in terms of how one could approach this type of conversation with a patient? b. How important is it to receive a patient’s gratitude? c. What are some of the complicating factors that could arise and how would you negotiate these? d. How will you integrate this knowledge into your clinical practice? SCIENCE OF MEDICAL PHILANTHROPY 172 e. Is there anything you learned today that would be difficult to do/uncomfortable for you to do? Wrap-Up and Next Steps 10:40 - 10:45 5 minutes 1. Ask the participants to complete online feedback survey within 24 hours (link has been sent via email). a. Importance: i. Completion of survey required to record attendance and satisfactory completion of workshop ii. Feedback will help development to provide better support in the future. b. Reconfirm that physician ID is used only to note participation and that the feedback shared via the survey is anonymous. 2. Remind participants that the Resources section lives on the UMC Intranet. We will continue to update this website with information they can use to be successful in their practice of GPFR. 3. Emphasize that development is here to serve as resource to them as they integrate these ideas into their practice. For specific questions, email or call. 4. On behalf of <name of UMC faculty leader> and <name of chief development officer>, thank everyone again their participation in The Science of Medical Philanthropy. SCIENCE OF MEDICAL PHILANTHROPY 173 Unit 6 Job Aid: Grateful Patient Cues and Clues “Tell me about your research.” “My research is focused on… If you’d like, I can have my colleague contact you to share more information. Perhaps we can get together for lunch and I can tell you more about our goals and how you could get involved.” “I want to make certain my children don’t get cancer.” “Cancer prevention is a big focus of what we do here. If you’d like, I can have my colleague contact you to share more information about our efforts here.” “Dr. XX was wonderful during my wife’s final days. I am so grateful.” “If you have an interest in honoring your wife’s memory, I would be happy to have my colleague contact you to discuss ways you can do that at UMC.” “This place saved my life. I wish I could do something to thank you.” “I am touched by your gratitude. Many of our patient families find great satisfaction in supporting our research/education mission. If you’d like, I can have my colleague contact you to share more information.” “How can I get a plaque in the Cancer Center?” “These plaques acknowledge the individuals whose philanthropy sustains our Cancer Center. I would be happy to have my colleague contact you to share more information.” “How much does it cost to get my name on the wall?” “I appreciate you asking. Can I put you in touch with my colleague? S/he can answer all of your questions.” SCIENCE OF MEDICAL PHILANTHROPY 174 Unit 6 Job Aid: Opening a Philanthropic Conversation • “Mr. X, I know you have a strong interest in precision medicine. Much of the research we are pursuing is aimed at…. If you are interested in learning more, I can have my colleague arrange a time for us to have lunch.” • “Mrs. M, you have been a strong advocate for our program. We are poised to expand our offerings so that more of our patients can participate. I’d love to get your thoughts on how you could help us grow. If you’d like, I can have my colleague arrange a meeting where I can share our plans with you.” • “Your support of Stand Up to Cancer is admirable. You may not be aware that our Cancer Center is actively engaged in research to…If you are interested in learning more, I’d love to arrange a behind-the-scenes tour of our research laboratories.” • “In addition to seeing patients, I am also engaged in research to develop new treatment options for patients with ___ cancer. I’d love to tell you more about our work.”

Abstract (if available)

Abstract As grateful patient programs have increased in both number and scope, academic medical centers are increasingly thinking about ways to engage physicians in fund development. Numerous studies reveal that physicians do not receive sufficient training to know how to engage in patient philanthropy and specifically how to navigate the intersection of patient care and development. The purpose of this curriculum is to train physicians to become effective philanthropic partners by increasing their self-efficacy and motivation to participate in grateful patient fundraising. Applying theories of adult learning and individual constructivism as the theoretical foundations for this curriculum, the training is designed as a six-module, blended course spanning four and a half hours. Upon successful completion, physicians will know how to partner in the cultivation and solicitation of grateful patient gifts

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Asset Metadata

Creator Andrews, Sarah A. (author)

Core Title The science of medical philanthropy: a guide for physicians

School Rossier School of Education

Degree Doctor of Education

Degree Program Education (Leadership)

Publication Date 04/11/2020

Defense Date 02/13/2018

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag Fundraising,grateful patient fundraising,healthcare philanthropy,medical philanthropy,OAI-PMH Harvest

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Yates, Kenneth (committee chair), Hirabayashi, Kimberly (committee member), Lundeen, Rebecca (committee member)

Creator Email saandrew@usc.edu,sarahabyandrews@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-6983

Unique identifier UC11671641

Identifier etd-AndrewsSar-6223.pdf (filename),usctheses-c89-6983 (legacy record id)

Legacy Identifier etd-AndrewsSar-6223.pdf

Dmrecord 6983

Document Type Dissertation

Rights Andrews, Sarah A.

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA