When Healthcare Wants the Money but Not the Leadership Responsibility
I recently read a Becker’s Hospital Review article asking 23 health system CEOs how their job descriptions have changed. Their answers reflected what anyone in healthcare leadership already knows. The CEO role has become extraordinarily complex. Artificial intelligence, workforce pressure, affordability, technology, public policy, community trust, operational transformation and financial performance all compete for attention at the highest level of the organization.
What caught my attention was what was missing. Across 23 different descriptions of the modern healthcare CEO role, there was no meaningful discussion of philanthropy, fundraising or donors.
That matters because healthcare organizations increasingly expect philanthropy to do more.
Campaign goals are getting larger. Capital needs are substantial. Margin pressure continues. Organizations are looking for philanthropic support for facilities, technology, programs, research, workforce initiatives and community health priorities. In many organizations, philanthropy is no longer viewed as a nice supplemental revenue source. It is expected to become a meaningful component of the financial strategy.
That expectation creates a basic leadership problem when philanthropy is treated as the responsibility of the chief philanthropy officer while the CEO remains largely outside the process.
Ask a university president or chancellor whether fundraising is part of the job and the answer is generally obvious. Higher education has spent decades building a leadership culture in which presidents understand that donor relationships are part of institutional leadership. They meet donors. They travel. They cultivate relationships. They articulate vision. They participate in solicitations. They accept that philanthropy requires a meaningful portion of their time.
Healthcare has not consistently developed the same expectation.
That difference places chief philanthropy officers (and their fundraising teams) in a difficult position. They are often given increasingly aggressive fundraising goals while having limited access to one of the most important philanthropic assets in the organization: the CEO.
The CPO is expected to produce transformational gifts, but may struggle to get executive time with transformational prospects. The development team can spend months building a relationship only to encounter difficulty scheduling the CEO for the meeting that matters most. Fundraisers are told that philanthropy is a priority, but donor engagement can quickly lose its place on the calendar when operational matters arise.
Operational matters will almost always arise.
That is precisely why philanthropy has to be understood as part of the CEO's job rather than an activity that happens when time permits.
This is not an argument that healthcare CEOs should become full time fundraisers. They should not. Their responsibilities are too broad, and professional fundraising teams exist for a reason. It is an argument that the organization cannot hold the CPO fully accountable for philanthropic performance while treating CEO participation as discretionary.
That model does not make sense.
Major philanthropy is relational. At significant gift levels, donors are rarely making decisions based solely on a proposal prepared by the foundation office. They are making decisions about leadership, direction, trust and confidence in the future of the institution. They want to understand where the organization is going and whether the leadership has the ability to get there.
In those conversations, the CEO matters.
The CPO can prepare the strategy, understand the donor, develop the case, manage the relationship and orchestrate the process. The CPO cannot substitute for the CEO when the donor wants to hear directly from the person ultimately responsible for the organization.
This creates one of the most frustrating dynamics in healthcare philanthropy. Fundraising teams can be evaluated on results that depend, at least in part, on executive engagement they do not control.
Boards also contribute to the problem when they establish ambitious philanthropic expectations without establishing corresponding expectations for the CEO. A campaign may be approved. A major goal may be announced. Consultants may be hired. Additional development staff may be recruited. Yet nobody has clearly discussed how much CEO time will be required to make the strategy work.
Then everyone becomes frustrated when results fall short.
Higher education learned long ago that fundraising is not simply the advancement office asking wealthy people for money. It is a leadership function that happens to be supported by a professional advancement organization.
Healthcare should think about philanthropy in much the same way.
This issue is one of the reasons I wrote Vibrant Vulnerability: Mastering Philanthropy for Today and Tomorrow’s Healthcare CEOs. The book was written around a simple premise: healthcare CEOs do not have to become fundraisers, but they do need to understand their role in philanthropy.
That role includes being accessible to important donors. It includes articulating a compelling vision. It includes understanding why donors give. It includes being willing to develop authentic relationships before there is an ask. It includes recognizing that the CEO’s presence can communicate institutional priority in a way that no brochure, campaign video or development officer can duplicate.
If healthcare systems want philanthropy to become more significant, this conversation has to move beyond the foundation office.
The question is not whether the CPO has a strong enough strategy. The harder question is whether the organization has created a leadership model in which philanthropy is understood as a shared executive responsibility.
Until that happens, healthcare will continue asking philanthropy teams to produce higher levels of revenue while withholding some of the leadership engagement required to produce it. Heck, I even wrote a book about this issue and a guide to help CEO’s.
That is not primarily a fundraising problem. It is a CEO leadership issue.
