BC Women’s Health Foundation With Genesa Greening

Many typical or traditional hospital foundations are confined to the four walls of the hospital. The BC Women’s Health Foundation, however, has taken a different path. BC Women’s Health Foundation is British Columbia’s largest non-profit organization dedicated to advancing the full spectrum of women’s health. On today’s show, Douglas Nelson interviews its CEO, Genesa Greening, about the elements of their foundation’s success and how it’s recognizing and addressing women’s unique healthcare needs.

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BC Women’s Health Foundation With Genesa Greening

Our guest is Genesa Greening. She’s the CEO of the BC Women’s Health Foundation and we’re pleased to have her on the show. Welcome, Genesa. You’ve been with the foundation for almost 3.5 years. Over that time, there has been a true renaissance or an awakening of the foundation. What were the elements of that success? Was it the plan that you had when you started on your first day?

I would like to suggest some at present, but I don’t think I could have necessarily foreseen exactly where we ended up. I did know that when I took on the role that there was a real appetite at the board level to see us transition into being a more relevant organization in the philanthropic space in the city. That there was a want to figure out how we could do a better job of supporting the hospital and the efforts of the hospital. There had been some discussions about looking more pan provincially, but probably, although this is going to sound a little pompous perhaps on my part, it did take about three weeks to figure it out. It’s only because I was fortunate that quite a bit happened in the first 2 or 3 weeks on the job, including the openness of the hospital leadership to incorporate me directly into strategic conversations about where it was going.

It started to trigger for me some real opportunities to look at things differently and to think about what we might be able to look at women’s health across the province of BC rather than having a campus-centric perspective to things. I came into it with nothing but possibility in front of me and hoping that we could come up with something innovative and interesting. It took 2 or 3 weeks to get a sense of what was possible from a blue sky perspective. It took about another four months for us to figure out what the appetite was for the risks that were likely going to be needed and the pace that we were likely going to need to engage in to get to where we are. We certainly have seen a transition that is rare in this sector and at the pace at which we’ve been able to do that.

It is an ambitious transition. Many typical or traditional hospital foundations are confined to the four walls of the hospital. That campus-centric perspective with maybe 1 or 2 outreaches into the community type of initiatives that match what the hospital is doing or the healthcare system is doing in the community. You’ve taken a different path. Maybe you could share with our readers, you’re thinking about moving from BC Women’s Hospital Foundation to BC Women’s Health Foundation.

For us in our previous iteration as a hospital foundation, we were never quite able to find our feet. We’ve been around for a couple of decades and we had a successful campaign to support the new neonatal intensive care unit on the campus that was coming to completion when I started. Otherwise, we hadn’t been able to provide the support that even some of the community hospital foundations have been able to provide to their hospitals. In looking at the why and there were a bunch of reasons as to why that was the case. We share a campus with BC Children’s Hospital, which provided a lot of confusion in the market as to what our role was compared to their role and they are the largest philanthropic organization in the Province of British Columbia.

 

They also represent something where nobody’s ever going to question the value of providing support to the work that they do. I would also argue that we rarely talked about women’s health. We talked a lot about maternal newborn health, which has an importance in the life stages of some women. It isn’t an all-encompassing approach to recognizing the value of looking at women’s healthcare in isolation of the larger system and recognizing why women have unique healthcare needs. We weren’t getting into that. As a result, people didn’t understand what our unique proposition was.

For us, it was an exercise in trying to figure out how we could do a better job of providing support to the hospital, but also looking at the women across the province because not every woman in BC is going to come to this campus or be touched even directly or indirectly by the work of BC Women’s Hospital. Yet, there is a need to elevate the conversation to share what we do and do not know when it comes to the life stages and unique healthcare needs of women. We wanted to figure out what our role was in that conversation. Ultimately, we made a decision then the board got together in January 2017 and then we spent an entire day together crackling with some of these big questions.

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The board made a decision that day that we wanted to become the BC Women’s Health Foundation and that we wanted to have a pan provincial view of the work that we did. That we wanted to be more than a hospital foundation, but then the board engaged in its necessary due diligence and spend the next better part of a year, probably closer to fifteen months. We met multiple times to flush out all of the various aspects of that. Everything from governance to brand to mandate to stakeholder’s partnership structure to see what we were going to be willing to do. If we had the iron gut to make the decisions that we needed to make. Kudos to my board of directors for taking something that was typical and turning it into something that is unheard of in this space.

We decided to no longer or be a hospital foundation. We’re still the foundation of BC Women’s Hospital, but we’re a health foundation that’s looking at the health equity needs of women across the province of BC. We also have a national and global mandate when it comes to our research and innovation work. It took a lot of heavy lifting. It took a lot of commitment. It took a view to turn something completely inside out as well as making sure our shareholders and stakeholders, like the hospital, were still comfortable with this transition. That didn’t come without its challenges. The fear that we were leaving folks behind, that we weren’t going to be able to fulfill the needs of the hospital the way that they were hoping we would be able to. Whereas what ended up happening is we’ve contributed more to the hospital in the last couple of years than we ever have in our 23-year history.

That’s the risk. I would imagine the conversation with your colleagues at the hospital while they were undoubtedly supportive of the organization growing and taking on that larger mandate, wanted to make sure that they didn’t get left behind. What were those conversations like?

Those conversations were exciting at times, difficult at other times. It was frustrating for both parties. The thing about change is until you’re through the other side of it, there’s much unknown that fears a natural emotion for everybody involved. The thing that we’ve had to make sure people understand about our foundations, we are the BC Women’s Health Foundation. Our only job is not a philanthropic investment. We have a mandate that we do provide philanthropic support. We are the go through for the hospital as well as for the Women’s Health Research Institute, which is also on this campus. We have our mandate, which includes ensuring women have equitable access to quality healthcare, when, where and how they need it.

That includes during our education and awareness and advocacy efforts, which as you can imagine when you’re attached to an organization. The hospital is leading the conversation in most regards in population health and clinical service delivery is looking to us saying, “You’re not the expert.” Fair enough. We’re not the experts, but we can curate, facilitate and communicate the information that they’re not able to a larger public. There was a lot of push and pull between the hospital and us and between us and others and making sure everybody’s staying in their lane and that we’re getting our information from the right places. We’re not entirely inside the health system.

We’re an autonomous organization with our own board governance structure that can have conversations that systems are not able to have. The rightful structure of who’s on first as it pertains to who gets to talk about what in the public space, whereas we’re not restrained that way, which is you can imagine also created some push and pull and some abrasion that we still work through every day. Our job as a foundation is to elevate the conversation in the public space to inspire transformational investment and change. This means we always want to be aligned with it but we’re not beholden to the pace of the system itself. Which some days we win, some days we don’t.

Ultimately, at the end of the day, the thing I love about BC Women’s Hospital and the research institute and those that are as attached to it is the level of commitment to women and ensuring they get trauma-informed, culturally-safe, and humility-informed care is there. Everybody recognizes that we’re all trying to lean in towards the same outcome, but we all play different roles and we haven’t historically played this role. There’s always going to be some challenges and some days we get it right and some days we don’t. The key is to keep moving and be respectful. I’m proud of the fact that we’ve been committed to doing that. We’ve seen some substantial shifts in changes in people’s perception of not your foundation but the hospital and the research institute. We see a lot more being discussed in public spaces than we ever have before. There’s been a real win-win for most folks.

I would imagine the day-to-day negotiation of what are going to be the priorities and having priorities beyond the scope of the hospital is the reality. You’re working day-to-day with those colleagues at the hospital. I would imagine that the conversation with the board is a little different because it’s a new motion. It’s a new habit for them to be thinking beyond the hospital and they’re not there every day. How have you been able to keep the board engaged in this process and aware that you’re balancing the immediate need at the hospital with this much larger national and even international mandate? 

The challenge for anybody who reports into a board of directors is quite simply they’re coming to this with a clear set of responsibilities, but they’re also coming to with a level of restriction. They don’t live this every day. They’re not in it moment-to-moment, day-to-day. As you can imagine, the pace for which we’ve had to move to get from where we were a few years ago to where we are has been breakneck, with the board only coming in at touchpoints. A large part of my biggest challenge has been making sure the board feels like they know what’s happening, that they have trust and faith in the process and that we’re not leaving them behind. They are close enough to the discussion also to fulfill their responsibility in not just providing governance but determining strategy and vision for the organization.

I have to admit, I didn’t come into this probably with an eye to that as much as I probably should have. We have spent 2019 coming back, trying to make sure that we’re all on the same page. That everybody’s aware of what’s happening and that there’s a level of trust and understanding as to what needs to happen and reminding people what they decided to do. Part of it is, and it’s the same thing even with staff internally, you have to go back and go, “This is what we said we were going to do. This is what we said mattered to us. This is what we said we ultimately wanted to accomplish. Are we aligned with that? Is that work happening? Is there anything that’s happening that’s the outside scope that we need to be thinking about?”

 

Part of what we’ve had to do over is I got a coach specifically only to work with the board in the last few months. I was recognizing the fact that the board was starting to have challenges with that for no other reason than we were having a pace problem. That’s not okay for everybody involved because it results in people feeling that the CEO is getting too far out ahead or that the organization is getting too far out. There are frustrations on my end. We wanted to make sure we had an eye to that. We’ve made some course corrections. There have been lots of times where we’ve had to have conversations that the board not only agreed to this, you’ve set this forth, we’ve been working towards this.

Where are the challenges? What are you concerned about? Where are your anxieties related to continuing to move in these directions? Not everybody agrees. The thing that is always a challenge with any board of directors is everybody’s coming to the organization for different reasons and people are coming to the organization at different times. We’ve had several members of our board who’ve been on the board for six-plus years. They’ve been in this from what would’ve been the middle of the NICU campaign, which was ambitious for them. It was also typical in its structure. It was that transactional, we need to support these things. Let’s find people who are comfortable with and excited to support those things. They provide that philanthropic support and then you shake hands, give some thanks and store those people through. It wasn’t anything that was this substantially involved.

We get to a point where we’ve been holed into national conversations around changing the trajectory of the women’s health research space. We’ve been pulled into global conversations with folks like the World Health Organization, the Bill & Melinda Gates Foundation to be a part of informing how people are choosing to both invest and also prioritize women’s health concerns. We’ve started a national coalition between the other two women’s hospital foundations and us to develop a national conversation around philanthropy and sponsorship investment from the corporate sector. We are developing our own research papers to inform what we hope will be changes in policy and practice and how women’s healthcare is delivered provincially. We are no longer just working in, we find a donor to match and meet. We facilitate that transition of dollars into the organization. We do the typical tax receipt, stewardship recognition and name it. That’s a portion of the work that we do.

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What ended up happening for us at this point is I’ve talked about this as we’ve got more coming to us than we have the capacity to manage. Part of the role of the board is figuring out what’s the highest and best use of the organization in its effort to meet its mandate. Those conversations are hard to have when the rest of the organization is working at such an incredible pace. We’re trying to figure out how do we stick to those strategic conversations at the board level and limit the amount of discourse that we have that’s more around the day-to-day, which is a transition for any organization. I’ll admit some days I am good at keeping them in the loop and some days it’s not that I choose not to or even forget. It’s just you come to that point where you lift your head up and you’re like, “I should make a phone call.” You should be like, “Great.” That’s going to be forever a challenge for us as long as we’re doing the right thing.

The thing about this work is if you’re fulfilling a real need and you’re addressing systems failures. You’re taking advantage of a movement and a moment in time. We’re not always going to have adequate bandwidth and space and time to have all of the conversations we might like to have to ensure at 100% of the time everybody feels completely briefed, in the loop, and in agreement with the work that needs to be done. You hope you do it well and I’m forever grateful that I have a board of directors that’s committed and has taken some incredible risk.

That has dug in to do the heavy lifting in a way that a lot of folks have struggled to get their boards to do. We have to high five, give gratitude where it’s deserved and hope you keep being able to maintain the trajectory that you’ve developed. We’ve found a niche that clearly has been needed because our phones are always busy. Our inboxes are always full. We’ve been able to facilitate 600% increases in revenue and 300% staff increases in the last few years. It also comes with change management challenges and HR challenges.

I want to get into some of the stuff. What you’re describing there is a revolution in the organization. You talked about the courage and the risk that the board has taken on. Can you think of a specific instance where you thought, “I haven’t given them enough information for this change or I’m pushing them too far?”

I would say that happens regularly. I would say that’s been unfortunately more the norm than the not norm. In large part too because I have fourteen board members. Part of what I’ve come to realize in the last little bit is that they meet quarterly plus they have committee meetings. I need to spend a lot more time one-on-one with each of them because of the sheer not pace, but the magnitude of the change and also the magnitude of the opportunities that have come to us. We spent a fair bit of time in Ottawa in 2019, advocating for real change in the sex and gender space when it comes to healthcare research and healthcare research funding.

Even though we only went to Ottawa 3 or 4 times and it was myself and a staffer that went. We got a $10 million cervical cancer investment and three of the items written into the mandate letter for the Federal Health Minister came directly from our advocacy efforts. It’s the recognition that what we’re saying is landing on fertile ground, but then how are we going to manage the outcome when people are like, “Great, let’s do it.” I’d be like, “I didn’t know if I was fully prepared for you to say yes this quickly.” Being able to make sure that the board feels like they’re still leading because this was their vision, this was their intention, but it’s the constant checks and balances to make sure they feel like it is in alignment within that. I’ve often been told by people that my minimum is most people’s maximum, which I could see.

There’s some truth in that. I’m already ten steps ahead in my head and I know the nine things I have to do to get to that tenth step. For me, it’s making sure the board understands the strategy from the day-to-day that I have inside my head to get us to that endpoint that they can see what it is that we’re doing and why it’s working. How it is in alignment with the direction that they’ve given the organization and the vision that they’ve ultimately set out. Spending more time one-on-one with my board has been a priority for me and these last few months. I’ve spent 1.5 to 2 hours with each of my board members over the last few months and I’m going to do that twice a year. In addition to our typical board meeting structures so that they also have an opportunity to ask questions because everybody comes to the board with different skillsets as well, not always do they necessarily understand certain components of what’s happening. Being able to make sure they feel like they have access to not only the information but to ask the questions that they might not ask at a board meeting but informs the discourse that happens at the worst board meetings.

That can either be positive or frustrating. That’s been something that I definitely miss the mark for a period. When we were working towards finishing our brand, getting the launch, getting the federal government investment we needed in our Women Deliver Conference. We went from seeing each other all of the time to seeing each other infrequently and got that out the door. I realized, “I didn’t do a good job of making sure they felt connected.” That’s 1 of the 4 top priorities for me moving forward. We’ve got board alignment, organizational stability, brand execution and revenue generation. Those are the four things that from an operational perspective we need to make sure we have an eye to. Board alignment is my top priority within those four as a member of the senior leadership team.

One of the questions that keep coming to mind as I’m listening to you describe this big change, this transformation. Revenue is increased by 600%. It is a powerful one to underline and builds a lot of credibilities and gives a lot of confidence. If revenue had remained flat, would the board be as willing to come along? 

I wouldn’t say that they wouldn’t have, the board would have always agreed to move in this direction. Simply because when they hired me and my particular skillset and approach to things for a reason, they wanted to see some substantive change and some substantive innovation. For me to have been able to prove that what we had identified was the right thing to pinpoint and the right thing to move towards. If I hadn’t been able also to prove that we could increase revenue, not even for the sake of increasing revenue, but I needed resources to be able to execute on that. That required us to raise more money so that I can hire more staff. Without that, we would never have been able to get to where we are.

The other thing too is when I started here, we were running deficits and we’ve had surpluses since I’ve started. The board has held me to make sure that we’re meeting our budgets. This is part of their mandate and responsibility, but at the same time, deficits were being run prior to my time here. The insistence that we run balanced budgets since I’ve got here is sometimes, I will admit been incenting because you’re like, “We’re growing.” At the same time, it’s held us to a level of accountability that pace needs to keep on both not just, “Are we meeting our mandate? Are people listening? Are they interested? Are they contributing to the conversation that you are inspiring?” It certainly hasn’t been without its challenges.

 

We’ve gone from being about $2.3 million organization when I started and our goal in 2020 is to try $15 million. We’ve gone from having 11 staff to around 30. At the same time, we’ve also gone from being an organization that facilitates philanthropy and all of the aspects of that to an organization that has communications mandates and has a movement that is trying to inspire. That requires all of the aspects associated with that. Even from a philanthropic perspective, to become a Charity: Water, Women’s Health is going to take us some time. It has entirely different mechanisms than hospital foundations. It’s not even the same philanthropy. We now, in some cases, have two lines of the business internally. If I hadn’t been able to prove that we could raise more money, I can’t imagine the board would have been allowed to continue to give me the latitude to do all of that work and to increase those expenses. If we hadn’t been able to balance it out with the revenue side, they would’ve given me some time. We were luckily able to start turning things around quickly.

One of the sayings that I summarize a lot of relationships between CEOs and their boards is that the problems of an organization are nothing that’s successful and fixed. Being able to deliver on the revenue covers up a lot of learning and a lot of missteps or potential missteps. What I’m interested in hearing you talk about is the conversation that you would have with a donor three years ago about what your foundation exists to do? It’s that same conversation with that same donor three years later. You’re describing a different organization and you’re describing that dual mandate of movement-based philanthropy along with the contemporary health foundation discussion. How have your conversations with donors changed over the last couple of years?

One of the benefits in some cases is being able to find a niche for any donor who’s interested in either the hospital, the research institute or the movement. We can move people to where they’re interested. I will say that some donors are like, “I give to the hospital, that’s what I do.” Yay for you for doing all these other things. Hopefully, they’re successful. My commitment is specific to this. Luckily for us, we’re able to facilitate that in a lovely way. The thing that’s been helpful is that we’ve been able to share the importance of the hospital in the larger space that I don’t think we did well before. The thing about BC Women’s Hospital is because it’s the only women’s hospital in the Province of British Columbia and it’s only 1 of 3 in the country.

It plays an essential role in informing policy and practice and clinical guidelines related to the delivery of women’s healthcare outside of this hospital. One of the things that we’ve been able to do when people are tied to philanthropically supporting BC Women’s Hospital is helping them understand that what they’re supporting here is warming how people are doing things elsewhere. The impact that they’re having far exceeds the campus here on Oak Street. I always take every opportunity to talk to every donor I possibly can about the larger issue. Most people have stories about how women have felt dismissed or received a misdiagnosis or been misunderstood by the healthcare system. Helping them understand why that happens, why the work that we’re doing is going to help bridge the gap between what the healthcare women receive now and the healthcare they should be receiving and then helping them understand how the hospital and research institute plays into that.

When you’re talking to donors one-on-one, you can have that complex conversation. When you’re talking to donors in the larger space, we’ve never had the following that a lot of other hospital foundations have. We didn’t have a successful direct mail program. We didn’t have tens of thousands of donors who were highly committed to committing to this campus outside of our major gift donors’ space. We’ve been able to maintain a group of folks that have always given to our direct mail that is tied to the maternal newborn programming. We’ve got more than enough need to fulfill there until we’ve maintained a direct mail program that’s specific to them. Otherwise, all of our broad base of direct marketing efforts has been in helping people understand why women deserve a unique approach to their healthcare, why women’s healthcare is not just their reproductive years, why women’s health needs are entirely different from those of their male counterparts, why do we know little about women’s healthcare needs and how that plays out in the doctor’s office and in the healthcare system in a way that’s inspired people.

The thing I’m most proud of in the work that we’re doing and helping people understand that including our new donors and our previous donors. We’re in the solution business, not in we’re pointing out the black hole that we’re throwing money into and hopefully, something will stick and change. For us, there is an inequity. We do not understand women’s unique physiology. We do not understand how things change in her inner life. It’s because the research has not been done. Women have not included in clinical trials when it’s not equitable inclusion. We’re not doing desegregated data by sex and gender in clinical trials. Female researchers are being underfunded. They’re more likely to research women’s health issues. Predominantly the people making decisions about who gets funded and markets funded are still predominantly male.

If we can adjust all of that, which sounds substantial but it’s not crazy to think about the fact that we want women to be included in clinical trials. We want to know the difference between men and women. We want to have diverse representation around decision-making bodies. We can do that work. That work is possible. We know that we’re going to know more. The more we know, the more important policy and practice and equipment will receive different healthcare. It’s not something that’s a void of possible change. This is something that clearly has an opportunity. That donors can inspire that change. The thing we also know is that $1 spent on research philanthropically can turn it into $2,000 of granting dollars for that particular research. Once that proof of concept goes through, we know that $1 in research is $7 in the GDP. When donors want to give to something. We have a high return on investment that we can give to them. It’s a compelling argument. It’s not throwing money at a system and hoping it eventually changes and responds.

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We find ourselves in a fun space where we’re trying to help people understand what’s happening and what they can do to fix and change that. There’s been a real appetite from big partners like Pacific Blue Cross and others that we’ve developed these pillar partnerships. They aren’t giving us money to do some of these big research projects but are looking at their own insurance delivery around sex and gender and making changes that will impact the women across the province. We’re doing some fun things. We have somewhere we can plug in any philanthropist. Whether it’s the $20 a month person or it’s the $1 million person. We’re in a position to find something that matches what they’re hoping to accomplish. There are rougher places to be from a fundraising perspective than where we find ourselves.

I want to conclude our conversation by thinking or having you finish the sentence. In a few years, I know we’ll be successful if?

I know we’ll be successful if we can create a sustained movement of people committed to better understanding women and their unique healthcare needs. This has to be more than money. This has to be a conscious social shift in recognizing that women are valued and that they are the sinew of culture. That when we have healthy women, we have healthy families and communities and if we can get to a point where that’s something anybody can say, “That makes sense,” then we will have been successful. That’s where the sustained revenue comes from. That’s where the sustained change will come from. It won’t be a matter of constantly having to yell into the ether about the inequity, but simply the positive side of that coin, which is it makes complete sense that this is something that people should invest in. For us as an organization, it’s about spending the next few years creating enough public discussion that it is happening in and of itself without us necessarily always having to be the instigators of that.

Genesa, it is a real privilege to hear you talk about this vision and to have a ringside seat as you and the organization go through this. You are rewriting the book as to what is possible for a social profit in Canada and healthcare. I wish you all the best of not this last quarter of your fiscal year, but over the next few years and beyond that. You are the story to follow in this space. I know many of our readers will be following along as well.

Those are kind words. Thank you, Doug, for having me. I appreciate it.

Important Links:

• BC Women’s Health Foundation
• Bill & Melinda Gates Foundation
• https://www.BCWomensFoundation.org

About Genesa Greening

Genesa is the heartbeat of this movement. With conviction and courage, she is committed to leading the evolution of women’s healthcare across the province. Genesa is a wild-eyed optimist bolstered by an extensive background in the global non-profit space.

With a tenacious spirit and bold conviction, Genesa is dedicated to eradicating inequity in healthcare for women in all life stages, determined to shed light on the misperception that universal healthcare means universal access. She is committed to underscoring inequity in research, by championing for greater investment in studies that are specific to women’s unique physiology.

Inspired by the perseverance of her mother and the confidence of one of her mentors, Virginia Greene, Genesa will not rest until the Foundation’s—and her personal goal—is realized: healthy women everywhere, capable of anything.