As with everything, the web has changed philanthropy. The upstarts are changing the rules, but as this Fortune article points out, traditional nonprofits like United Way are taking heed.

From the article, the innovators: Kiva allows you to loan money to entrepreneurs in developing countries, and while loans are interest free, you are able to receive email updates from the entrepreneur, when your money comes back you are able to reinvest in another project; DonorsChoose.org where teachers ask for materials in order to teach students, you are allowed to choose a project to support, allowing students to learn, and in the end they send you thank-you notes (if you have ever received a thank-you from children, you know how good that can feel); global giving connects you with grassroots charity projects around the globe; and Progreso Financiero allows you to help Hispanic immigrants build businesses.

Some of the benefits of the new approaches: lower operating costs than the standard “bricks and mortar” nonprofit; speed in providing services (loan requests on Kiva can be granted within hours); better information that allows givers to see exactly where their money goes and who it helps; allows anyone and everyone to get involved, the college kid living off ramen noodles and the investment banker downtown can contribute just the same; and customized giving allows donors to give to projects related to interests they hold near-and-dear to their hearts.

So far Kiva has attracted nearly 250,000 lenders and disbursed $22 million across 40 countries. Lenders may withdraw loans upon repayment, but 90% recirculate the funds, so the kitty keeps growing. Kiva expects to have doled out $100 million by 2010 and $1 billion within a decade, $25 at a time. “To get everyone a piece of the action, we had to set a limit on the size of the loans,” says 32-year-old president Premal Shah, who came to Kiva from his product manager position at PayPal in March 2006. “When’s the last time someone put a cap on your philanthropy?”

Capping philanthropy? The business plan is obviously working.

The key to all of it: involvement. Givers enjoy seeing and hearing about what their money has done for specific people (whether it’s one or thirty). Being involved throughout the process adds a compelling human factor: a donor can see the goodness his or her money has provided daily.

My thinking is this: hospital foundations are stagnant. While many are trying hard, hospital foundations have not traditionally been hubs for innovation (golf tournaments are a dime a dozen). It seems every nonprofit organization (locally and nationally) is looking for support. There is big competition for donations. As people become more aware of information like 30-40% of care provided in the health care system is waste, health care consumes 20% of GDP, perverse reimbursement incentives, issues arising from not providing enough free care, etc., luring donations is only going to get harder. True or not, good or bad, perception is reality.

Hospital foundations are going to have to find new ways to reach donors. One way to do this is to set up a system (similar to the above) that allows donors to see what projects in a health system need funding. Whether it is the purchase of a new MRI machine, the construction of a healing garden, or important cancer research, donors can choose the project that best fits their interests and donate accordingly.

Turbulent times require innovation everywhere, even in the hospital foundation. What is there to lose in at least trying the idea?

The folks of Health 2.0 (definitions) missed each other so much that they held an interim conference (excuse me, Health 2.0 “Unconference”) from March 3-5 to stoke conversations amongst participants.

Microsoft showed off HealthVault. American Well was explained. And a whole bunch of other stuff happened…

The rush through the summary of what happened is because I wanted to get to Scott Schreeve’s closing comments blog post. The point Mr. Schreeve makes is that while the companies of Health 2.0 are serving the needs of someone (hopefully a group of people, read the post for a worthy health care long tail explanation), we must also remember the raison d’etre of new technology: improve the health care delivered in this country.

I have always maintained that the enabling technologies were only part of the story - and the thing they should be enabling is the transition to next generation healthcare (which is going to involve some very painful reform - ie, “this is going to sting a little”). For this reason, I have focused on the concepts of value driven health care (outcomes/price), transparency, openness within healthcare (and open source!), and collective intelligence via networked collaboration (social or otherwise). These reform concepts are critical if we are to begin to correct the fundamental and foundational problems that plague our health care “system.”

What I liked most, however, were the seven words Mr. Schreeve used to describe the “next generation health system:”

Effective, Efficient, Equitable. Technology Enabled Reform. Thrive.

Looks like I have found my raison d’etre.

Quality of care (and by proxy medical errors) is probably topic number two behind insurance reform on the nation’s health care agenda.  The Institute for Healthcare Improvement’s 100,000 Lives Campaign was dramatically successful.  In fact, since reaching the 100,000 lives threshold, IHI has introduced The 5 Million Lives Campaign (“a voluntary initiative to protect patients from five million incidents of medical harm over the next two years”).

Medical errors happen (a lot).  But we don’t always hear a personalized story.  And the story is often what brings the issue into focus.  So with great interest, I’ve been following the events of multiple medical errors at the non-health care blog Nine Shift.  It’s an amazing account of a series of improbable events.  Thankfully, the story has concluded positively.  Go, here to read it (you can probably figure out what to do from there but just in case: successive posts here, here, here, here, here, here, here, here).

By the way, while we’re somewhat on topic, look into their book (”Nine Shift - Work, life and education in the 21st century”), “Nine Shift explores the uncanny parallels between today and 100 years ago, examining the changes between the two transition periods and the forces that restructure society in the new economic era. Discover each of the major nine shifts currently taking place and find out the implications of each shift for business and work, life and education.”  The book was one of my earliest introductions to the topic of universal health care.

Thank you William Draves for sharing your family’s very personal story, our thoughts and prayers are with all.

While doing some Sunday reading (finals are over!) to avoid digging my car out of the 20.4 inches of snow we received in Columbus, I came across an interesting article in the New York Times on regional theater expansion.

Expansion has been on my mind lately. Evidently it’s been on theater people’s minds, too. “In recent years many of the 75 companies that form the League of Resident Theaters have looked at their aging or unaesthetic homes and joined what amounts to a nonprofit theatrical building boom. Since 2000 they and other institutions coast to coast have initiated dozens of construction projects whose combined tab is approaching $1 billion.”

Here’s the kicker, though: “What’s less evident is what it really means to operate them once they’re built.” Operating budgets doubled or nearly doubled for the new/expanded theaters. “But donors who have put their names on the cloakroom or water fountain may be tapped out when it comes time for the boring old annual fund. And annual funds are distressingly annual.”

But it’s lurch, and when one is in a lurch, one needs to find a solution.

But the companies are stuck in an economic bind. Reasonably enough, directors want the opportunity to stretch their imaginations with the latest technology, performers want dignified work conditions, and audiences want seats whose springs don’t threaten to give them tetanus. If the theaters don’t address these issues, they will stay small. If they stay small, they have to raise their prices; if they raise their prices, they risk losing new audiences; if they lose new audiences, they don’t have a future.

Change some words and all of the sudden it’s applicable:

But the hospitals are stuck in an economic bind. Reasonably enough, boards/administrators want the opportunity to stretch their imaginations with the latest technology, providers want dignified work conditions, and patients want care whose delivery components don’t threaten to give them tetanus. If the hospitals don’t address these issues, they will stay small. If they stay small, they have to raise their prices; if they raise their prices, they risk losing new patients (and old alike!); if they lose new patients, they don’t have a future.

Raising prices is easy to do.  Raising reimbursement levels is the problem and is highly unlikely in the current environment.  So what does everyone do to compensate? Increases utilization. What does increased utilization do? Moves us from spending a lot on health care to a lot more. Expansion and growth are part of business. All I’m advocating for is a little foresight.

“Art washes away from the soul the dust of everyday life.” –Pablo Picasso

I’ve heard that art has healing power. Whether that is true for everyone, it matters not. As one Planetree (”promotes the development and implementation of innovative models of healthcare”) component says, “Artwork in patient rooms, treatment areas and on art carts add to the ambiance (of the hospital). Volunteers work with patients who would like to create their own art, while involvement from artists, musicians, poets and story tellers from the local community help to expand the boundaries of the health care facility.”

Art’s importance in the hospital setting is a design component that can help patients and families (and staff!) feel more comfortable. Anything that helps to reverse the notion that a hospital is cold and gray is a good thing. Art adds color and warmth.

But we must be careful: I’m sure we’ve all seen those tired, old pieces that have been on display in the hospital’s waiting room for too long. our own system has a solution. Seth wrote a few months ago (I’ve remembered it this long, so it must have been good) about a truly intriguing idea: an artist in residence. We will hire an artist (or a few, even, depending on our size) that comes to work everyday to create art that will be displayed throughout the hospital. If anyone wants to buy a piece of art, they can. That piece will be taken off display and replaced with another work. Rotating art will keep the atmosphere fresh, it may even turn into something of an exhibition that we normally see at museums.

The notion of good art in the hospital is growing. There’s even a conference on The Value and Importance of Art in Health Care (be careful, it’s a PDF). And you can even get a daily fix on health care and art by reading this blog, it has some good stuff. If going all the way and hiring an artist in residence is too much for your organization here are some tips on starting an art program.

Principle #8: our own system, on its journey to try innovative ideas, will hire an artist in residence (maybe even a team!) to keep the hospital full of great art. This art will help to create an atmosphere attractive to patients, staff, and the community.

our own system makes its Health Wonk Review (”a biweekly compendium of the best of the health policy blogs”) debut at Workers’ Comp Insider.

While we leave the true wonkery to the real professionals, I think the questions we ask here can add to the debate.  Have a read.

The dutiful student in me forces the usual time spent blogging to be spent studying for a final exam.  In lieu of a full-fledged post, here are some links to explore…

The Atlantic has an article exploring the subprime mess and what it means to American suburbia, “A structural change is under way in the housing market—a major shift in the way many Americans want to live and work.”  After years of trying to get away from the shadows of the skyscrapers downtown and moving to the cookie-cutter neighborhoods of suburban living, Americans are moving back downtown.  What does this mean for hospitals—both downtown and the sprawl of medical services that occurred with the population as it moved outward?

I’m big on primary care and its role on helping us get out of the mess we are in (and the larger mess we’re going to be in in a few years).  The Healthcare Economist blog has a good post on a recent study on the effect of family physicians on health improvement, “When FP supply is instrumented by age-related capitation it has markedly larger and statistically significant effects. A 10 percent increase in FP supply increases the probability of reporting very good health by 6 percent.”

Enjoy.

Last night’s winning numbers for “Win for Life,” a game of the Oregon Lottery: 8, 20, 73, 77.

But that website doesn’t have is the results for a lottery’s importance not measured in a dollar sign and zeros…

Covered widely by big media, and for good reason, the state of Oregon is offering a few of its luckiest citizens not eligible for Medicaid the opportunity to win health insurance.

Really? Are they serious?

The article reports that only a few thousand out of more than 80,000 applicants will get lucky.  It seems like a rather shameful situation to me.

Have you noticed the number of hospital expansion projects in your area? Odds are quite good that you have. If not, read here, here, here, here, here, and here. That’s a small sample.

I realize that some hospitals have finally reached a strong enough financial position and can now expand after putting off the need for years. And that our population is aging: to prepare we need more capacity.

What if the expansion is due to a medical arms race? A Health Affairs article says, “Hospitals are increasing capacity in high-end and high-volume product lines, to compete with other hospitals and freestanding outpatient facilities.”

That makes sense financially, but is not necessarily good for the patient.

What are we going to do with all the capacity when the retirees are no longer so numerous? Another Health Affairs article says, “Ultimately, a great deal of added cost to the health care system will result from recent construction activity, some of which might be attributable to costly duplicative and underused capacity.”

And this should be sobering. This article in the Journal of the American Medical Association says that when a cardiac hospital opens, heart surgery in the Medicare population within that community increases. In other words, capacity creates demand. If things stay the same (doubtful, I know…but for the argument’s sake) we won’t need to worry about excess capacity because those beds will be filled…potentially with patients who really don’t need to be there.

I’m all for hospitals growing with a purpose, it just scares me of the managerial (and cost!) problems these expansion projects could leave us with in 30 years.

Some good reading related to hospital expansion.

Most of the health care (the way we know it today) consumed in the United States is delivered locally (”Mary visits her doctor at the clinic with a cough”). Some of it is delivered regionally (”Laura is delivering her baby at the regional hospital”). A little bit is delivered nationally (”Mark is going to a specialist at Mayo”).

My thought is this: if so much of health care is based locally, why are we trying to solve its problems nationally?

Massachusetts (so far), California (it got somewhat close) and a host of other states have tried to reform health insurance at the state level–and have found reform to be expensive. If anything, this has shown us that policy reform needs to happen at the national level. That’s an important first step, but any health insurance reform aimed at covering all citizens does not address the issue of rising costs.

The needs of the people in each state are different. The needs of citizens at a local and regional level are different in those states. These needs can’t be solved with an overarching national reform effort to make us all healthier. They can be solved with local leadership, with local citizens, and with local programs.

Irving Wladawsky Berger writes at AlwaysOn in a post titled (Almost) All Innovation is Local, “But often, the best new ideas are found in those areas that you know best - right around you. Global aspirations need to be grounded in local actions.”

It’s easy to share. If we make every community in this country an innovation hub, collectively dedicated to solving the many problems of health care, the problems don’t seem so numerous. It’s comparable to the idea of cloud computing, where computing resources are used collectively to solve a particular problem quickly. If ideas work, communities can copy those ideas that other communities have tried. By developing a large menu of various ways to address issues, communities can select what will work best to address a specific problem.

Some organizations around the country are already dealing with health care issues locally by finding ways to provide access to all, promoting high-quality health care, finding ways to reduce waste and thus reduce cost, and making our communities healthier by promoting healthy behaviors. Some examples: Access Health Columbus, Healthy Memphis, Healthy Wichita.

Mr. Berger concludes, “Even the most global among us still spend most of our time and energy with our families, friends and colleagues right near our homes. We get most of our nurturing and inspiration from our local base. And, . . . it is this base that then enables us to go out and properly deal with the vast global world out there.”

While the platform for change will be built nationally, the solutions should be constructed locally.