When I arrived as CEO of the Josiah Macy Jr. Foundation in 2008, my experience as a faculty member at Harvard Medical School convinced me that achieving our mission of improving health care required a new focus. Simply financing medical education was not enough. Developing innovators who could spread ideas for change needed to become a crucial part of our mission.
To figure out what to do, we had to look at what impedes innovation. We realized a large part of the problem stems from the fact that medical education doesn’t focus enough on changing systems so they better serve patients and society.
What’s more, we focus too little on the people who can bring about real change in how medical education works. Faculty members in midcareer turn out to be the best change agents. They have the knowledge and influence that can make a difference, and they maintain the zeal for patient care that propelled them into medical education in the first place.
By creating a program to invest in these faculty members, we learned important lessons for other foundations. Very few foundations spend much money on career development for the people working on the missions they seek to advance, whether in arts and culture, environmental protection, humanitarian aid, or any of the other myriad causes that grant makers tackle. Yet we have found that this might be one of the most efficient ways to change systems that prevent everyone from thriving.
Promoting Diversity and Collaboration
In 2010, we started a program to give medical and nursing faculty who have shown great promise as educators the needed time, support, and opportunity to advance change in their institutions. They also become part of a national network of change agents. Since its debut, the Macy Faculty Scholars program has funded 36 medical and nursing faculty members, who have put in place a wide range of innovations.
They have, for example, removed some of the barriers and challenges facing faculty of color; developed courses for students and residents on improving the quality of care and patient safety; and designed programs that better equip doctors, nurses, and other health professionals for collaborative practice.
Macy has invested $10 million in this program since it began; it now makes up nearly 25 percent of our annual grant-making budget. Although we sponsor only five scholars a year, the program draws an average of 80 applicants — a sign of the interest, need, and enthusiasm for this kind of training.
The scholars we have supported have been promoted in academic rank (13 of the first 15 are now full professors), and they are taking on larger roles in their institutions. They are sought after to speak nationally on ways to improve education in the health professions and to take on roles outside their institutions.
Eve Colson is a great example. She has had a transformative effect at the Yale University School of Medicine. Her scholarship has led to training in which students from various health professions learn early how to function as part of a team throughout a typical patient’s full medical experience.
Because the Macy Foundation scholarship gave her the time and support she needed to mentor students and pursue this goal, medical students, nursing students, and physician-assistant students at Yale are now working together rather than in isolation.
Alan Dow at Virginia Commonwealth University Medical School in Richmond is another example. Foundation support gave him the time and support to focus on his goal of promoting more collaboration among students of medicine, nursing, pharmacology, and social work. He established the first office of interprofessional education at VCU and then was hired to run it.
Dow now influences education across the university and across the country, and he has made interprofessional education a pillar of health-care delivery.
And Meg Zomorodi, a faculty member of the School of Nursing at the University of North Carolina at Chapel Hill, was recently named director of the university’s first Office for Interprofessional Education and Practice. Her goal was to help the university’s professional schools collaborate on ways to prepare the work force of tomorrow. Getting money from a foundation to support her work was a crucial way to get key players to pay attention. “Because they know someone else has invested in me, they are invested in me,” she said.
Keys to Success
One of the reasons our efforts have been successful is that we are very clear about what we’re trying to accomplish. While all of our scholars are given support to design and implement an educational project, we see this as a career-development program that goes beyond the completion of a project. So we try to identify people who we think are at the right point in their careers to benefit the most and who will have impact that continues beyond the period of funding.
Here are some key lessons others may benefit from as they shape similar programs:
Foundation support must be robust. We provide up to $100,000 a year for two years so scholars can spend at least 50 percent of their time at their home institutions developing an educational project and pursuing other career-development opportunities. We also offer up to $30,000 in fringe benefits and provide additional support for career development. Scholars know they have time to focus on innovation, and they are given the opportunity to participate in annual meetings, become mentored advisers, and participate in career-development programs at the Harvard Macy Institute and elsewhere.
Make a career-long commitment. We are committed to helping Macy Faculty Scholars succeed throughout their careers so their work can have greater impact.
Although our financial support ends after two years, we remain involved in their careers and track their accomplishments. The annual meeting provides an opportunity for scholars and mentors to discuss their progress and support one another. We continue to involve scholars in other work that Macy does and to support their involvement in national activities.
Be clear on the target population for the program. We went into this program with the goal of supporting both medical and nursing faculty because they are the two largest and most influential professions in health care. We also explicitly want midcareer professionals, those who are at a pivotal point in their careers and are ready to assume leadership. Faculty members in nursing are crucial because we believe the health-care system will not meet the public’s needs unless we reap maximum benefit from talent in the nursing field.
Pay attention to the elements needed for success. We spend a lot of time deciding whether candidates for the program are at the right time in their careers and in the right environments to benefit from this career growth and make an impact. Each scholar needs to have a dean, a mentor, and an institution supportive of change and new ideas.
Make sure the application process is rigorous. All candidates must be nominated by their deans, and each school can offer only one candidate. We require nominating letters from the dean, the department chair, a mentor, and at least two senior faculty members. We want these references to speak to the career-development potential of the candidates, why this award will be critical for them in their career paths, and why they are expected to be leaders.
Have a distinguished external advisory group. We have found that the commitment, insights, and reputation of an advisory group of nationally recognized educators has been essential to the success of our program. The advisory group’s members participate in the selection process, advise the scholars on their projects and careers, and advise the foundation on elements of the program.
After more than 10 years at the helm, I have just stepped down. I believe my greatest legacy as a foundation president will be the careers of the health professionals we helped to develop.
We hope that what we have learned prompts other foundations to see career development as an important part of their mission. Foundations historically have spent only a small percentage of their resources on career development as a way to advance their mission. Our experience shows that a small philanthropy can leave a big and lasting footprint by intentionally investing in the careers of promising individuals.
George Thibault retired last month as head of the Josiah Macy Foundation.