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1447 posts categorized "Philanthropy"

The Brave New World of Open Source

May 09, 2017

The following post is part of a year-long series here on PhilanTopic that addresses major themes related to the center’s work: the use of data to understand and address important issues and challenges; the benefits of foundation transparency for donors, nonprofits/NGOs, and the broader public; the emergence of private philanthropy globally; the role of storytelling in conveying the critical work of philanthropy; and what it means, and looks like, to be an effective, high-functioning foundation, nonprofit, or changemaker in the twenty-first century; As always, we welcome your thoughts and feedback.

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OpensourceAllow me to introduce myself. My name is Dave Hollander, and I'm a data scientist here at Foundation Center. The role of a data scientist is to use techniques from statistics and computer science to make sense of and draw insights from large amounts of data. I work on the Application Development team, which engineers the code in Foundation Center products you use, including Foundation Maps and the new search tool that was launched as part of the redesign of foundationcenter.org.

Like nearly every software development team, the members of the center's Application Development team share code among ourselves as we work on new projects. This allows us to work on smaller parts of a larger machine while simultaneously ensuring that all the parts fit together. The individual parts are assembled during the development phase and eventually comprise the code base that powers the final product. When finished, that code lives internally on our servers and in our code repositories, which, in order to protect the intellectual property contained within, are not visible to the outside world. The downside to keeping our code private is that it does not allow for talented programmers outside Foundation Center to review the code, suggest improvements, and/or add their own entirely new twists to it.

We plan to change that this year.

Open-source software (OSS) is a term for any piece of code that is entirely visible and freely available to the public. Anyone can pull open-source code into their computer and either use it for a personal project or change it and "contribute" those changes back to the original project. Open source is not strictly related to code, however. Wikipedia, which allows anyone to create an account for free and edit articles and entries, is also an example of an open-source project. To ensure a high-level of quality throughout, submissions to Wikipedia are evaluated by volunteer editors, and while a bad entry may sneak through on occasion, the Wikipedia community eventually will find it, review it, and amend it.

Open-source code projects work in much the same way as Wikipedia, but rather than editing text, users edit code and then submit their changes back to the project. The process can be a challenge to monitor, but today there are tools available that make it relatively easy to manage the edits of multiple users and prevent source-code conflicts. The most popular is GitHub, a free service that serves as a repository for code projects and allows any user to make copies of any other project hosted on the platform. Once a project on GitHub is copied, the user can make changes to the original code, or use the code for his or her own purposes.

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Weekend Link Roundup (May 6-7, 2017)

May 07, 2017

Macron-victory-celebrationOur weekly roundup of noteworthy items from and about the social sector. For more links to great content, follow us on Twitter at @pndblog....

Corporate Philanthropy

Forbes contributor Robert Reiss profiles five organizations that are redefining corporate philanthropy. 

Environment

The restoration of the Chesapeake Bay, one of the most important estuaries in the United States, is showing signs of success. So why, asks journalist and Bay Journal columnist Tom Horton on the Yale Environment 360 site, is the Trump administration seeking to eliminate funding for those ongoing efforts?

Lots of people in the climate change community are not happy the New York Times hired longtime Wall Street Journal op-ed writer Brett Stephens as a columnist for its opinion pages. Vox's David Roberts explains.

Inequality

Could persistent disagreements over inequality and opportunity (e.g., "self-made" vs. "takers") be the result of cognitive bias? On the New York Times' Upshot blog, Sendhil Mullainathan, a professor of economics at Harvard, looks at how our tendency to remember and celebrate the challenges we faced, not the advantages we've had, colors our perceptions of those who are less fortunate — and how we might use that bias to create better public policy.

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5 Questions for...Claudia Juech, Associate Vice President and Managing Director, Rockefeller Foundation

May 04, 2017

Since joining the staff of the Rockefeller Foundation in 2007, Claudia Juech has led the foundation's efforts to identify and assess new, large-scale opportunities for impact across the foundation's priority areas and spearheaded its horizon scanning activities, informing both strategy and programs.

Recently, PND spoke with Juech about Rockefeller's "scan and search" activities, an approach the foundation is using to bring more diverse voices into the earliest stages of its work, ensure that all early-stage decisions are based on the best available evidence, and ultimately do the most good with the resources it has.

Headshot_Claudia_JuechPhilanthropy News Digest: What were the factors that led Rockefeller to adopt the "scan and search" approach? What are its benefits over more conventional approaches to philanthropic investment? And has your background in finance shaped your thinking about what the foundation can and should do to maximize its impact?

Claudia Juech: We wanted to develop a tool that would help the foundation generate the most impact for its investment — and to do that, to truly achieve transformative change, we needed to cast a wider net. That entailed a couple of things: in addition to being guided by our in-house experts, we realized we needed to reach out and listen to a broader spectrum of voices, and to look at problem areas that we hadn't considered previously. And we wanted to find ways to put the "winds of change" at our back — to identify changes that were already happening and could help us achieve our impact goals.

In comparison to more conventional philanthropic approaches, it's very open-ended and opportunity-driven. Rather than settling on a strategy or approach beforehand — say, increasing agricultural productivity — and then doing research to confirm our assumptions, we look at problems affecting vulnerable populations and try to keep an open mind in terms of deciding which issues we want to work on and how.

We're looking at big spaces, big fields, big problems where we want to make big bets. And there are a couple of things from my experience at Deutsche Bank, where I was responsible for trend monitoring, that I've tried to apply to my work here — using futures methodologies, for example, to predict "winds of change" trends. We start by looking quickly at about a hundred options, potential big bets, and then winnow them down to those we think will generate the biggest bang for our buck. I see some similarities with venture philanthropy in the belief that not every investment will have the impact you want, and that you look across a wide range of options and try to place informed bets. We look at a broad range of options, from cybersecurity concerns for the poor, to issues of energy poverty, to urban food insecurity, to neglected tropical diseases, and we ask where we could make the most headway, and what we can bring to the table in terms of our assets and competencies. Eventually we'll move on to dedicated, rigorous research and stakeholder consultation on a short list of options.

PND: What are some of the challenges you faced in shifting to the "scan and search" approach — internally with foundation staff, as well as externally, with grantees? And are there any lessons you could share with the field?

CJ: I think the short answer is that the work is not any easier with this approach. It might provide a broader array of opportunities and in the end lead to better results, but it doesn't necessarily lead to a "silver bullet," any more than other approaches would. We've learned a couple of things, though. Internally, there have been a lot of questions about the staff's "ownership," engagement, and role in shaping these ideas. Typically, our investment ideas had been developed by, for example, someone leading the foundation's agricultural program, so when a separate "scan and search" team was tasked with casting a wider net for ideas, well, it initially created some tensions and challenges. It was a change-management process for the first two years. And in some ways I feel that tensions will always exist around mechanisms designed to ensure that outside perspectives are included in the planning process and that we don't fall into programmatic silos, which is one of the things scan and search is meant to address.

Over the years, we've developed different processes designed to bring in our colleagues and their expertise. We work closely with our in-house experts, who are our partners and advisors in the work of surfacing new ideas, and we use various facilitation methods, internal huddles, ideation meetings, and the like. In fact, some of those methods are now being used after the work has progressed to a later phase. So, we've advanced the work of the foundation not only substantively but also methodologically.

Externally, because scan and search is used in the very early stages of the initiative pipeline, the implications for grantees have not been that dramatic. We reach out to a broader universe beyond our grantees, to experts and people who can provide insights or who are directly affected by the problem. Although often the work we do ends up informing the work our grantees are doing as well.

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Most Popular PhilanTopic Posts (April 2017)

May 03, 2017

For those in the Northeast, April was rainy, cool, and dreary. Here on the blog, though, things were hopping, with lots of new readers and contributors. The sun is back out, but before you head outside, check out the posts PhilanTopic readers especially liked over the last thirty days.

What have you read/watched/heard lately that got your attention, made you think, or charged you up? Feel free to share with our readers in the comments section below. Or drop us a line at mfn@foundationcenter.org.

Statement Supporting NGOs in Hungary

Hands-upThose of you who check in with PND on a regular basis know (here, here, and here) that Viktor Orbán, the illiberal and increasingly authoritarian prime minister of Hungary, and lawmakers from the country's governing Fidesz party have launched a campaign to rid Hungary of liberal (and dissenting) voices. In addition to attacks on the press and political activists, the campaign has targeted nongovernmental organizations operating in the country with the help of foreign funding — with a particular focus on groups backed by the Open Society Foundations and its founder, Hungarian-born U.S. financier George Soros.

Last week, a group of funders led by the European Foundation Centre, the Rockefeller Brothers Fund, and the Stefan Batory Foundation issued a statement in support of Hungarian NGOs and the broader values of "transparency in the public, private, and social sectors and the reasonable regulation of civil society organizations." We are pleased to share that statement, which has been signed by a coalition of more than eighty philanthropic and civil society leaders from Europe and the United States, below.

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Statement Supporting NGOs in Hungary

As the leaders of private philanthropies in the United States and Europe, we are greatly concerned by the repeated efforts of the Hungarian government to restrict and stigmatize nongovernmental organizations operating in the public interest. This includes actions in recent years that have threatened the existence of organizations supported by Norwegian civil society grants and, more recently, steps that may force the closure of the Central European University. We are especially concerned with efforts to require entities that receive even modest international financial support to register as foreign-funded organizations and list this designation on their website and all publications, or face fines and potential closure.

We support transparency in the public, private, and social sectors and the reasonable regulation of civil society organizations, but some of the proposals currently under consideration go well beyond what is reasonable and would have the effect of discriminating against certain organizations and stigmatizing those that operate at world-class levels and are able to attract financial support from private foundations in Europe and globally. Hungarian law already requires all civil society organizations to report their sources of income and other support to the National Office for the Judiciary. We oppose public communications campaigns that undermine public trust in civil society organizations, falsely implying that such organizations in general, and those receiving foreign funding in particular, may be more prone to engaging in illegitimate activities than others. We are especially concerned that listing NGOs in a special registry of foreign-funded organizations may open the door to further, discriminatory treatment of these NGOs.

The ability to source funding from international donors is an important signal of the international quality and competitiveness of Hungarian NGOs, and it reflects Hungary’s solidarity with the European commitment to civil society. We hope the Hungarian government will honor the country’s and Europe’s commitment to the freedom of its citizens to form organizations, debate the issues of the day, and seek financial support from all legitimate sources.

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[Book Review] Just Change: How to Collaborate for Lasting Impact

May 02, 2017

How can the social sector create lasting impact? By changing the way it thinks about and approaches social change, writes Tynesia Boyea-Robinson in Just Change: How to Collaborate for Lasting Impact. Drawing on her experience in both the private and social sectors, Boyea-Robinson shares lessons she's learned and strategies she's found to be effective for changing how we think about and create change, how our organizations work, and how we collaborate.  

Book_just_change_3dIt's an approach well worth considering; as chief impact officer at Living Cities, a partnership of foundations, financial institutions, nonprofit organizations, and the federal government that's committed to improving the vitality of cities and urban neighborhoods, Boyea-Robinson is tasked with ensuring that the organization's investments lead to measurable impact. She also has witnessed, both in her own family and in her previous work at Year Up National Capital Region, the barriers that many poor urban children come up against, leading her to acknowledge that the challenge of creating change, let alone lasting change, is daunting.

Something like closing opportunity gaps, for example, is a complex problem, one that involves interconnected relationships unique to each situation, as opposed to a merely complicated problem, the solution to which involves many difficult steps but can be mastered and replicated. And yet, she writes, we can create lasting impact, even around complex problems, if we work together and focus on a problem's underlying cause instead of its symptoms, continually improve our efforts through ongoing feedback, use data to define the impact we are looking to achieve, and align our programs, policies, and funding streams with clearly articulated goals. 

Boyea-Robinson is careful to note that meaningful social change rarely is driven by a single individual, organization, or sector. And while forging cross-sectoral partnerships is just one of the six ways, as she puts it, to "change how you create change" (the others are focusing on bright spots, changing systems through individuals, defining success in terms of people not neighborhoods, engaging the community, and supporting racial equity), it really constitutes the core message of the book. By definition, participation in a cross-sectoral collaboration creates the possibility of achieving something bigger than any one individual, organization, or sector could achieve alone. At the same time, collaborations, if they are to succeed, require solid relationships and a high level of trust, not to mention partners who are willing to commit to a collective goal that transcends their own individual objectives or reputation.

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Weekend Link Roundup (April 29-30, 2017)

April 30, 2017

World_peace_in_our_handsOur weekly roundup of noteworthy items from and about the social sector. For more links to great content, follow us on Twitter at @pndblog....

Children and Youth

In a post on the Colorado Trust site, Kristin Jones, the trust's assistant director of communications, details three of the structural factors that, according to the latest data from the Annie E. Casey Foundation's KIDS COUNT initiative,  are holding back children in the state, with real consequences for their health.

Communications/Marketing

As if there isn't already enough in the world to disagree about, design shop Elevation has created a gallery showcasing its favorite 75 nonprofit logos. Let the games begin!

Environment

Barry Gold, director of the Environment program at the Walton Family Foundation, explains why fishing reforms recently enacted in Indonesia and the U.S. Gulf Coast region point the way to a more sustainable fishing industry in the twenty-first century.

Foundation Center has launched a new Web portal, FundingTheOcean.org, designed to help funders and activists track, inform, and inspire ocean conservation. 

The UN Foundation's Justine Sullivan shares seven reasons why the U.S. would be foolish to pull out of the Paris Climate Agreement.

Food Insecurity

On the Civil Eats site, Mark Winne talks to Andy Fisher, author of the new book, Big Hunger: The Unholy Alliance Between Corporate America and Anti-Hunger Groups, about poverty, the "business" of hunger, and Fisher's vision for a new anti-hunger movement.

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More Than a School

April 25, 2017

The following post is part of a year-long series here on PhilanTopic that addresses major themes related to the center’s work: the use of data to understand and address important issues and challenges; the benefits of foundation transparency for donors, nonprofits/NGOs, and the broader public; the emergence of private philanthropy globally; the role of storytelling in conveying the critical work of philanthropy; and what it means, and looks like, to be an effective, high-functioning foundation, nonprofit, or changemaker in the twenty-first century; As always, we welcome your thoughts and feedback.

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SDG_schoolsAs a unifying, universal agenda for countries around the world, the Sustainable Development Goals (SDGs) represent a unique opportunity to deliver innovative solutions and much-needed development assistance to the world's poorest countries and regions. Philanthropists the world over have answered this rallying cry and are playing a critical role in filling technical and funding gaps between what is required and what is available, while also providing important intellectual capital. While the current impact of these efforts is not to be underestimated, it is crucially important that philanthropic dollars are directed in the right way, to the right projects, at the right time. Without lasting buy-in from populations and communities targeted by these investments, impact can fade rapidly and disappear altogether over time. But to really have an impact, this funding needs to go beyond standalone projects and contribute to longer-term systems change.

Here's an example of what we're talking about. A foundation or individual donor decides to pay for the construction of a new school in an impoverished village. The odds are good that, when built, the school will have an immediate impact on the local population. But if the school is not supported by parents and local stakeholders, there's a decent chance that, within a few years, it will fall into disrepair. To achieve real, lasting impact, the school should be viewed as a community-based project that, among other things, provides local youth with a competency-based curriculum and skills training that prepares them for market-driven employment opportunities.

These are real-world challenges for philanthropic investment

It is critically important that philanthropists (and other social investment types) understand the complex development "ecosystems" of the countries in which they work. Why? Because no issue is an island, and many issues overlap in a complex web of cause and effect. Those wanting to have a long-lasting impact in a country must understand this reality, invest wisely, and work with local and national stakeholders to make sure the solutions they support truly are sustainable.

One thing we have seen time and again in the development field is philanthropy and government not working with each other. This often leads to missed opportunities for collaboration, additional funding, and innovation. Philanthropy can benefit from the public sector's knowledge of current policy and development frameworks, the specific and interrelated needs of the target population, and details about what has, and has not, worked in the past. Similarly, governments too often miss out on philanthropy's deep field knowledge, agility, and tolerance of risk. To improve this situation, we believe philanthropy and government need to locate where their interests converge, identify instances where they can collaborate, and share lessons learned.

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Saving the Affordable Care Act

April 21, 2017

Healthcare_reform_for_PhilanTopicThat was a close one. Twenty-four million Americans get to keep their health coverage — for now. Grassroots pressure undoubtedly influenced the decision of Speaker of the House Paul Ryan and the White House to pull the Obamacare repeal bill, but winning the first round of this battle is not grounds for complacency. Indeed, now more than ever, Americans need a robust political movement in support of affordable health care for all.

In the end, the American Health Care Act (AHCA), as the bill was called, failed because Republican members of the House who wanted to dismember the Affordable Care Act (ACA) could not agree among themselves how to do that. Ordinary Americans also were fortunate to have powerful stakeholders such as the American Hospital Association and American Medical Association on their side. There is no escaping the fact, however, that Republicans gained control of both chambers of Congress and the White House in the 2016 election by promising to repeal the ACA.

This makes the conspicuous lack of consumer-focused nonprofit organizations focused on health and policy all the more troubling. The situation is in stark contrast to the corporate healthcare sector, which spent $509 million in 2016 lobbying the federal government on behalf of drug makers, hospitals, providers, and insurance companies. In addition, most health nonprofits focus on a particular area of health care, such as insurance coverage or wellness or mental health, which contributes to the field's inability to build a unified movement for more affordable and accessible care.

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Support Girls of Color by Listening First

April 19, 2017

NOVO Pre Young black girls Conf Gathering 4172016_DSC7603CLast year, the NoVo Foundation announced a seven-year, $90 million commitment to support and deepen the movement for girls of color in the United States. After more than a decade of partnership with incredible organizations working with and advocating on behalf of adolescent girls across the country, we saw that the need for additional funding to support girls of color specifically could not be more urgent or clear.

Girls of color face structural barriers in nearly every aspect of their lives. Over 60 percent of girls of color are born to families living on low incomes or below the poverty line. Sexual violence is pervasive in the lives of all girls and often goes neglected, especially for girls of color. What's more, girls of color who face harm are often unfairly penalized. Black girls, for example, are six times more likely to be suspended in school than their white peers — and are disproportionately represented in the juvenile justice system. At least eight trans women have already been murdered this year, most of them women and girls of color. All these disparities combine and deepen into new disparities in adulthood: the median wealth for single black women, for example, is just $100, compared to $44,000 for single white men.

Despite this profound structural inequity, a movement for and with girls of color thrives. And we knew that the best way to deepen our own relationship with this movement was to be guided directly by the women and girls of color who'd been leading it for decades — rather than by our own assumptions. Otherwise, we'd simply be reinforcing the very structural barriers and power structures we sought to dismantle.

So, before developing a new strategy to guide our work, we spent a year traveling across the country, from the Northeast to the rural South, from the Midwest to the Southwest, to hear from girls of color as well as activists, movement leaders, and organizers of all ages. We prioritized communities that are often underresourced, less visible, and living with their own unique challenges — as well as possessing unique strengths.

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The Role of Philanthropy in Preventing Health Care Harm

April 18, 2017

Patient-safety-2Preventable harm in health care is a leading cause of death in America and must be tackled more comprehensively — as a public health crisis — than it has been to date. Philanthropy has a key role to play, and it's highlighted in a new call to action developed by the National Patient Safety Foundation.

The call to action builds on successful efforts to reduce health care-associated infections and is inspired by America's long history of coordinated public health responses to specific diseases and conditions. That history produced what arguably is the greatest advance in America in the twentieth century: an increase in the life expectancy of Americans of some thirty years.

Efforts to improve patient safety have been ongoing for several decades, but the improvement has been limited. What's needed now is a shift from reactive piecemeal interventions driven by individual organizations to a coordinated system-wide effort aimed at providing safe care delivery across all aspects of care. Philanthropy is essential to that shift, and its role should play out across several dimensions.

First, foundations and other funders are needed to help build a consensus around the importance of a coordinated national effort to eliminate preventable harm in health care. As a nation, we know how to create successful public health responses to crises. Preventing harm in health care certainly rises to that level, and because so much of that harm is preventable, failing to combat it comprehensively is nothing less than tragic.

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Weekend Link Roundup (April 15-16, 2017)

April 16, 2017

Glitter-eggs_2Our weekly roundup of noteworthy items from and about the social sector. For more links to great content, follow us on Twitter at @pndblog....

Advocacy

Our colleagues over at GrantCraft have put together an excellent suite of resources that captures the wisdom of philanthropic leaders who have participated in multi-party advocacy collaboratives. Check it out.

And Salsa Labs, a maker of integrated software for nonprofits, has released a a Nonprofit Advocacy Action kit that includes, among other thing, best practices and customizable advocacy templates. (Registration required.)

Climate Change

There's no denying that philanthropy is as industry that loves jargon — or that the use of jargon often undermines the effectiveness of our messaging and communications. With that in mind, Achieng' Otieno, a communications officer in the Rockefeller Foundation's Nairobi office, shares some tips about how to communicate the concept of "resilience" to non-experts.

Health

Here on Philantopic, the Robert Wood Johnson's Foundation John Lumpkin has some suggestions about what we can do to improve care for patients with complex needs.

Higher Education

On the Inside Philanthropy site, Mike Scutari examines the implications of a new Marts & Lundy report which finds that mega-gifts for higher education are rising while alumni giving overall is falling.

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A Multi-Pronged Approach to Impact Investing for Family Foundations

April 12, 2017

The following post is part of a year-long series here on PhilanTopic that addresses major themes related to the center’s work: the use of data to understand and address important issues and challenges; the benefits of foundation transparency for donors, nonprofits/NGOs, and the broader public; the emergence of private philanthropy globally; the role of storytelling in conveying the critical work of philanthropy; and what it means, and looks like, to be an effective, high-functioning foundation, nonprofit, or changemaker in the twenty-first century; As always, we welcome your thoughts and feedback.

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Socially-responsible-investingOne hundred percent of foundations and philanthropists have set up their portfolios for "impact." But in the words of Heron Foundation CEO Clara Miller, "they just don't know if their impact is positive or negative."

The assumption has been that foundations and philanthropists would be among the earliest adopters of investment strategies that align their portfolios, their values, and the social change they are trying to achieve. Sadly, this has not been the case.

According to the Global Impact Investing Network's 2016 Annual Impact Investor Survey, foundations in 2016 accounted for only 4 percent of an estimated $77.4 billion in impact investment assets under management. At the same time, there is much in the report to be excited about, starting with the finding that survey respondents indicated a high level of satisfaction with the performance of their impact investment portfolios. In fact, "[e]ighty-nine percent (89%) reported financial performance in line with or better than their expectations, and 99% reported impact performance in line with or better than expectations."

There are many foundation leaders who are well aware of the potential of impact investing to drive social and environmental change. Liesel Pritzker Simmons, principal of Blue Haven Initiative, captures the sentiment of a growing number of philanthropists: "Just your philanthropic dollars are not enough to solve big world problems. We have a responsibility to use everything we have to make an impact."

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[Review] The Power of Kindness: The Unexpected Benefits of Leading a Compassionate Life (Tenth Anniversary Edition)

April 11, 2017

Ours is not a particularly big-hearted species. Many of us come of age believing that success is measured in dollars and that kindness, compassion, and a willingness to turn the other cheek are behaviors best left to fools. Our generosity, meager as it often is, is reserved for kith and kin, and when extended to others often comes with a price. We would rather be feared and respected than loved and admired. And so it goes.

Book_the_power_of_kindness_2In The Power of Kindness: The Unexpected Benefits of Leading a Compassionate Life, Italian psychotherapist Piero Ferrucci rejects this ethos and instead asks his readers to reflect on what it truly means to be kind. To help us, Ferrucci explores nineteen "qualities" he deems to be the essential components of kindness, ranging from virtues such as forgiveness, empathy, and patience to honesty, a sense of belonging, and gratitude.

His reasons for doing so aren't solely altruistic. Ferrucci points to a multitude of studies which show that kindness and its related qualities are good for our health and overall sense of well-being. Not, he argues, that we should be kind simply because it's good for us, as though kindness were like "broccoli or exercise" but because, as studies show, we are hardwired to be kind. What's more, Ferrucci argues, integrating kindness more fully into our lives need not be a thankless sacrifice. Instead, we should think of it as bringing a musical instrument into tune with itself. Not necessarily easy, but so essential to our humanity that without it we are, by definition, diminished.

Much has changed in the ten years since the first edition of The Power of Kindness, translated from the Italian by Vivien Reid Ferrucci, was published. The new edition includes a preface by the Dalai Lama, a new introduction by the author, and a chapter on an additional quality, harmlessness, and its relationship to kindness. Like its predecessor, the new edition also addresses many timeless themes, offering advice calibrated to a wide range of situations and leaving ample space for readers to reflect on their own beliefs, priorities, and vulnerabilities. And yet, against the backdrop of our current contentious and deeply polarized political climate, I often found myself considering Ferrucci's advice and guidance and wondering whether the book stands the test of time.

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Beyond the Emergency Department: How We Can Improve Care for Patients With Complex Needs

April 10, 2017

Healthcare_heart_for_PhilanTopic_300As a physician, I have struggled with the question of how best to care for patients with complex needs since my early days of working in a hospital emergency department. Back then, my colleagues and I routinely encountered people in crisis who were battling medical, behavioral, and social difficulties all at once. And I realized over time that while we did our best to address their clinical problems, the issues they faced at home or in their communities were often what led them to the ED.

In recent years, my colleagues and I collectively have come to the realization that our patients — and others facing similar challenges — have, in many ways, been failed by society. Researchers have uncovered patterns of unstable, traumatic childhoods among patients with complex needs. They've also learned that many of these patients felt disrespected by the hospitals and clinicians who cared for them, which often resulted in patients skipping their medications or missing needed appointments. All too often, patients with complex needs are seen as statistics — just another person with diabetes or heart failure — when what those patients desperately want and need is to be acknowledged as individuals.

While the social implications of how we fail to fully care for these patients are deeply troubling, the economic cost is equally stark. We know that while people with complex needs represent only about 5 percent of the U.S. population, they represent about half of all healthcare spending.

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