A Love Letter to Grateful Engagement
September 7th marks National Grateful Patient Day, a time for patients to express appreciation for their caregivers and celebrate the life-saving care they have received.¹ In health care philanthropy, talking about grateful patients is a daily occurrence, as those who have had positive care experiences are often the most likely to give back to health care organizations through philanthropic gifts.
As a health care philanthropy professional, there’s no better feeling than helping a grateful patient or family member express their gratitude in a meaningful way. However, many challenges still exist in engaging patients, families and clinician allies. As someone who has helped implement grateful patient and clinician partnership strategies in over 85 hospitals across the United States, Canada and the United Kingdom, on this National Grateful Patient Day, I’d like to share my insights on these challenges, as well as celebrate our successes and express profound appreciation for my colleagues and their dedication to advancing this noble work.
In health care, patients and families make up the majority of donors, yet it wasn’t until the mid-2000s that the industry began proactively engaging them. In 2007, the Advisory Board Company dropped a study revealing that 88% of large gifts to health care came from grateful patients and families, with gratitude being the top motivator. This study gave birth to “the grateful patient program” and almost overnight, health care philanthropy organizations began implementing strategies to be more proactive about engaging patients and families as donors.
However, grateful engagement strategies have historically been dictated by the Health Insurance Portability and Accountability Act (HIPAA). Prior to 2013, health care philanthropy officers could only use a patient’s basic demographic information (name, address, phone/email, date of birth, gender), health insurance status and dates of service, leading to transactional strategies like mass letter appeals and cold call visits to patients during their inpatient hospital stay. However, the 2013 update to HIPAA rules under the Health Information Technology for Economic and Clinical Health Act (HITECH) was a game changer. The update allowed access to clinical service areas, treating physician names and patient outcomes, enabling more targeted and strategic fund development efforts. This shift also opened the door to closer collaboration with physicians, nurses and other health care allies who offer extraordinary value in identifying, cultivating and stewarding grateful patient donors.
Engaging a patient’s physician or clinician in the philanthropy process has proven to be one of the most effective strategies for successfully cultivating grateful patients and families into major gift donors—an approach I’ve worked to gain a deeper understanding of over the past decade. An article published in the Fall 2010 issue of Association for Healthcare Philanthropy Journal revealed that the average gift from a prospect identified by a philanthropy officer or wealth screen was $49,000, compared to $455,000 when identified by a physician—highlighting the significant return on investment (ROI) of physician involvement in fund development efforts.²
In the case study Build a Clinician Network to Resemble Your Donor Network: A Case Study in Achieving Exponential Growth in Service-Line Based Grateful Patient Philanthropy, Tampa General Foundation Philanthropy, successfully raised over $17 million in 2023 from grateful patients and family members. This remarkable achievement was driven by about 20 physician partners who worked closely with Tampa General philanthropy officers to identify, cultivate and steward patient and family donors.³
It is evident that physician and clinician allies play a crucial role in grateful engagement, yet involving them effectively has proven to be challenging. This is in part due to past approaches being too transactional—relying on fancy apps and large training events, but lacking the follow-up effort needed to support and sustain clinician involvement. Today, successful organizations take a more holistic approach, prioritizing relationship-building with physicians, much like cultivating a major donor. Once trust is established, philanthropy officers work closely with their clinician partners to envision a successful partnership.
Media coverage has also created challenges in grateful engagement. A 2019 New York Times article, Hospitals are Asking Their Own Patients to Donate Money, cited University of Louisville bioethics professor Mark Rothstein’s concerns about involving physicians in fund development, in which he expressed, “Getting physicians involved in philanthropy is somewhat fraught with danger.”⁴ In 2020, another New York Times piece, Patients, Can You Spare a Dime, discussed a JAMA Network study on general public attitudes toward hospitals encouraging donations. However, the study participants self-reported a history of cancer or heart disease without necessarily having recent patient experiences.⁵ Ultimately, neither article considered the significant impact of patient gratitude on philanthropic decisions, focusing instead on unwarranted concerns and outdated perspectives.
In her book, Transforming Health Care Philanthropy, Accordant CEO Betsy Chapin Taylor, FAHP, writes:
“Gratitude is action-oriented. Dr. Robert Emmons of the University of California, Davis, is one of the foremost thought leaders on the science of gratitude. He shares that gratitude is an action. It isn’t just something to be felt but something to be expressed and acted upon…expressions of gratitude go beyond a simple tit-for-tat reciprocity. Gratitude can even inspire great acts of charity for philanthropy.”⁶
The aforementioned articles overlook factors like purpose, autonomy and gratitude. Over the past decade of working with over 400 physicians, I’ve seen firsthand how understanding the science behind gratitude and learning how to help patients express their appreciation in a deeply meaningful way revitalizes physicians’ passion for their work. Autonomy also plays a huge role. In my 42 years of life, I have never been able to force anyone to do anything. Therefore, I surely cannot force a busy physician to start making grateful patient referrals to the foundation if they do not wish to do so. Although the JAMA study found that 83.2% of participants felt physician involvement in donations might strain patient relationships,⁷ most physicians I work with prefer to encourage patients to share their stories, and never discuss money. While asking patients for donations or involving physicians in the philanthropy process might seem icky and unnatural to some, those of us in the field know that grateful patients and families appreciate and value the opportunity to give when it's presented thoughtfully.
Despite the evident challenges within grateful engagement, we have also seen significant wins.
Sharp Healthcare’s Guardian Angels caregiver recognition program has received over 80,000 gifts, raising more than $10 million in honor of 5,000 Sharp Healthcare physicians, clinicians, nurses and staff. Notably, four Sharp Healthcare physicians have been recognized over 500 times, and more than 100 physicians have been honored over 100 times each. Under the leadership of CEO Bill Littlejohn, Sharp Healthcare Foundation has pioneered efforts to “pay it forward,” guiding numerous other health care philanthropy institutions in developing successful strategies to effectively engage grateful patients and families.
Additionally, over the past 10-15 years, tools for analyzing patient data have exponentially improved. Instead of merely screening for capacity, modern tools now use artificial intelligence to identify potential patient donors with both affinity and capacity for giving. For example, DonorSearch Ai employs machine learning, over 800 data points and proprietary Ai algorithms to recognize patterns, process more information and make specific recommendations on prospects who are most likely to make a gift within 12 months.⁸ It can also be used to identify physician champions with high volumes of grateful patients. These advanced tools are crucial for effective grateful patient and family engagement in health care philanthropy.
Finally, I’d be remiss not to highlight some of the most rewarding moments I’ve personally experienced and witnessed in this field throughout the years:
An oncologist in Little Rock, Arkansas, who expressed that a $10 quarterly gift from her 90-year-old cancer patient means more to her than a six-figure donation
A surgeon in Owensboro, Kentucky, who had tears in his eyes when he learned about the power of gratitude and how much it means for his patients when he acknowledges their appreciation
The head of primary care for a health system in southeast Ohio and West Virginia who nurtured a cow for three years after being gifted it by a patient who knew the physician’s daughter loved animals
A Dayton, Ohio, burn unit patient who, after 40 years and upon selling his house, handed a $25,000 check to the hospital’s foundation, sharing he had been waiting decades to make his gift
A Tampa, Florida, oncology nurse who, after seeing a patient in treatment bring in food for the nurses several weeks in a row, successfully connected him to the foundation where he gifted $2.3 million to support research for his rare type of cancer
In health care philanthropy, one might say that every day is grateful patient day. The daily task of advancing grateful patient philanthropy is filled with both challenges and triumphs. This year, on National Grateful Patient Day, let’s not only celebrate our patients but also honor our dedicated colleagues who work 365 days a year to help patients and families express their gratitude in meaningful ways and give back to our health care organizations. To my fellow colleagues and allies who make all this possible, you have my utmost admiration and respect. Thank you so much for all that you do.
2 https://www.ahp.org/docs/default-source/resource-center/healthcare-philanthropy-journal/fall2010ahpjournalfinal. pdfsfvrsn=15960673_2
6 Chapin Taylor, B. Transforming Health Care Philanthropy (2018). “Embracing the Science of Grateful Engagement.”
About the Author: Erin Stitzel, FAHP, is a Principal Consultant for Accordant and a leader in building robust clinician partnerships to advance philanthropy. You can reach her through email at Erin@AccordantHealth.com or through LinkedIn.
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