“Small Can Be Effective.” Five Things to Know About Richmond Memorial Health Foundation

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We periodically publish quick overviews of grantmakers on our radar, looking at recent developments and key details about how they operate. Today, we’re taking a look at Richmond Memorial Health Foundation (RMHF), based in Richmond, Virginia.

The foundation’s roots go back to 1957 with the creation of the Richmond Memorial Hospital. In 1977, the hospital board of directors created the Richmond Memorial Hospital Foundation to hold reserve funds during a period of rampant inflation. The hospital’s assets were eventually merged into the foundation, which was subsequently renamed Richmond Memorial Health Foundation.

With $107 million in total assets, the foundation’s mission is fostering an equitable and healthy Richmond region. It defines “health equity” as ensuring that “everyone has a fair and just opportunity to be healthy and well as possible.” For the foundation, this requires “engaging communities and partners to reduce health disparities by removing obstacles to health such as poverty, discrimination, and their consequences.”

Here are five things to know about this grantmaker.

Its strategic framework has been evolving

In 2016, the foundation’s trustees and staff began a process of reimagining its vision, mission and values. President and CEO Mark Constantine told me that they took guidance from a paper written by former Ford Foundation Public Affairs Director Paul Ylvisaker (1921-1992), called “Small Can Be Effective.”

“We sometimes think that philanthropy needs to have $4 billion to have an impact,” Constantine said. But Ylvisaker, whom he called a “powerful force,” argued otherwise. The paper “became the compass for the foundation’s trustees.”

In November of 2019, RMHF released a strategic framework for the years 2020 through 2022. In the summer of 2021, Constantine and Senior Fellow Gladys Washington interviewed trustees to shape the next iteration of the plan. During these conversations, the pair emphasized the importance of general operating support for grantees. As it turns out, the trustees didn’t need much convincing. “When Gladys and I interviewed our trustees as we were updating that strategic framework, they unanimously and enthusiastically agreed that general operating support investments were key to advancing health and racial equity,” Constantine said. COVID played a role in this evolution, mirroring other funders’ moves at the time. But as I’ll get into below, RMHF’s embrace of general support has been particularly robust.

The updated strategic framework, “Our Commitment to Richmond,” was approved in September 2021 and will guide the foundation until June 2027. It consists of five main funding strategies to advance health and racial equity — a “fundamental shift” to multiyear general operating support; capacity-building grants; “opportunity investments” for organizations in need of time-sensitive support; foundation-directed, collaborative investments; and program-related investments and impact investing.

It has doubled down on multiyear general operating support

I want to emphasize that shift to general operating support, given funders’ persistent and frustrating resistance to the approach. RMHF’s recent history of general support started in 2016, when trustees began making general operating support grants to nine long-standing partners. When the pandemic hit, like many of their peers, the trustees repurposed all of the foundation’s grants as unrestricted.

It’s at this point that trustees at other foundations usually start pumping the brakes. I can’t help but revisit a 2022 Center for Effective Philanthropy report showing that of the mere 27% of respondents whose foundations were providing multiyear, general operating support in early 2021, when CEP collected its data, 31% were undecided about keeping the spigot open once the pandemic receded. For whatever reason, these respondents concluded that their general operating support experiment wasn’t paying off.

RMHF’s trustees? Not so much. When Constantine and Washington spoke with trustees about the importance of general operating support in summer 2021, “they understood why it was so important,” Constantine said. “They knew that nonprofits didn’t have to spend a lot of time fundraising, because, quite honestly, they know their organization better than we ever will.”

In January 2022, about four months after the new strategic framework went live, RMHF hosted a webinar for its partners describing its commitment to general operating support. Then, in June, the trustees awarded 23 two-year, general operating support grants to organizations ranging from $120,000 to $200,000 over the grant period. This summer, Constantine’s team will engage in learning conversations with each partner. The foundation will open the next multiyear general operating support grant process in 2024. At the time of this writing, RMHF classifies 92% of its investments as multiyear, general operating support.

The foundation’s evolution is a reminder that it clearly helps when trustees don’t need to be lobbied to dole out unrestricted support. It also suggests that if trustees do push back on the idea, it’s up to leaders and program officers to make the case — assuming, of course, those staff are comfortable with diluting their authority by giving up or sizing down what may have been a complex and bureaucratic, project-based grantmaking operation.

Should these individuals — or other nonprofits! — need talking points to help make the pitch for general operating support, RMHF’s site includes a video explaining how unrestricted funding provides its grantees with flexibility and infrastructure support.

Its doors are wide open for “mission-aligned” organizations

The foundation is refreshingly accessible to regional, “mission-aligned” nonprofits. It defines such an organization as one that “advances health and racial equity, embodies an understanding of the social determinants of health and impacts those most affected by inequities.”

RMHF is currently making capacity-building grants, opportunity investments, impact investing grants and collaborative investments. It is also preparing to launch an RFP focusing on community healing and community violence, and will be rolling out a strategy to support older adults and aging in the Richmond region. All of these grants — with the exception of capacity-building and opportunity investments — are general operating support. 

Constantine noted that grantees are no longer required to submit closeout reports. “Instead, our team has learning conversations with them when grants close, and our team is responsible for preparing closeout learning documents,” he said. “This practice began in full in 2021, although we began testing this approach in 2020.”

Robert Wood Johnson Foundation is a key partner

The Robert Wood Johnson Foundation has provided RMHF with significant funding since 2017. Last year, RMHF received a $1 million, general operating support grant from Robert Wood Johnson to advance health and racial equity. “The investment has been very significant for RMHF and our partners,” Constantine said, noting that RMHF disbursed $750,000 of that amount to three statewide policy organizations.

As far as the remaining $250,000 is concerned, Courtney Rice, the foundation’s chief of impact and strategy, is currently working with the Richmond-based Commonwealth Institute to provide capacity-building resources to up to 12 Black and brown-led, community-based organizations. Rice’s efforts will enable the foundation to “live into our commitment to support both policy and advocacy and civic engagement strategies that advance health and racial equity,” Constantine said.

It’s building out work in aging and mental health 

RMHF is currently collaborating with the Bob and Anna Lou Schaberg Foundation, a local family foundation, on the issue of aging. The strategy consists of four components — systems-building and coordinating services with the city of Richmond and a local agency called Senior Connections; advocating for increased wages and support for direct care professionals, many of whom are Black, brown and immigrant women; building relationships among direct service providers and statewide policy organizations to galvanize action on the policy front; and addressing issues related to housing for older adults, with a focus on home repair.

It should be noted that this information was not on the foundation’s site when I spoke with Constantine, since the board only recently approved some major investments. He anticipates the foundation will update the site in February.

Additionally, during the pandemic, trustees voted to give out an additional $1 million in grants from the foundation’s endowment to address mental health challenges facing residents and has since disbursed half that amount to regional organizations. Constantine told me that Rice and her team are now meeting with community stakeholders to determine “how to deploy the remaining resources to promote community healing and address issues like community violence.” He expects the foundation will announce the next phase in the coming months.