What if I need care?

This is a wide-ranging conversation with Paul McIntyre Royston, CEO of the Grand River Hospital Foundation.  We talk about that specific foundation does, what governments in Canada pay for and what they don't when it comes to health care, what the term 'health care' encompasses.

The conversation also moves into what could it mean if we were contributing to a stronger health care system for everyone?  That securing our own potential, future, maybe- health needs might be done by giving to build a stronger system today.  For everyone.  What if we, as donors, saw giving that way?  What if we had a better understanding of what motivated organizations?  Would we give more?  Give differently?  Get better outcomes?  Actually change the world?

Links that are mentioned in the conversation:
General GRHF page: https://grhf.ca/ 
Paul talks about the meaning of the lotus and it's petals, explanation and pic found here: https://grhf.ca/blogs/grand-ideas/hospital-pins
Paul talks about the foundation values, found here: https://grhf.ca/pages/ourteam
Grand River coffee tokens: https://grhf.ca/products/buy-a-coffee-for-a-healthcare-worker

Transcript

Sara (00:04):

What if I need care? Sometimes it comes out as skepticism of our retirement projections. Sure. That all looks fine as long as I don't need care. What if you do? I'm Sara McCullough, and in this episode of Sara makes sense. I'm talking to Paul McIntyre, Royston, c e o of the Grand River Hospital Foundation. We're often worried about how to fund our own care as we age. Today I want to talk to Paul about what care is available, what's funded, and what's not in Ontario. And if you're not in Ontario, keep listening because there's so much else in this conversation. Paul and I talk about the possibilities of contributing as a society to a care system that could benefit more of us and change the cost. We also get into a charitable giving conversation if you have the capacity and desire to give, but don't know how to choose where to give. Keep listening for my seven prong questions to Paul on how to open up our own giving. My guest today is Paul McIntyre, Royston, president and c e o of the Grand River Hospital Foundation, one of the local hospitals in my hometown of Kitchener Waterloo in Ontario, Canada. Paul, can you introduce yourself with a few sentences about your present responsibilities, the experience that got you here, and one thing that you're excited to do in the future? 

Paul (01:37):

Happy to do so and delighted to be here. And so I'm CEO of the Grand River Hospital Foundation, and I was brought in to sort of lead a resurgence might be good word to you. It's sort of a transformation of healthcare, fundraising and philanthropy here in Kit Waterloo. And, uh, one of the, the reasons for that is there's a dire need of new infrastructure support. And if you look at sort of where the funding was, it was, it was really struggling. And I happened to comment just before Covid and so I was already bringing in some transformation and then covid happened and, uh, talk about that after, right? But it jumps in my background. I spent a couple years at the Canadian Olympic Committee as the, the foundation, uh, in Toronto. And I got to go to the games, which was remarkable and fundraise for sport. 

Paul (02:22):

Um, previous to that, I did about seven years at the Calgary Public Library Foundation as c e o. And we had a 350 million campaign, public and private in support of libraries. In fact, building one incredible brand new, new central library, uh, adding three new ones and growing three other ones. And then before that, uh, I had worked at Hamilton on finance and Sunnybrook Hospital, uh, some sort of healthcare, and then actually with my alma mater, uh, the University of Waterloo. And actually the same faculty I have a degree in, so stumbled into fundraising. I, my degree is in mathematics, but have fallen in love with the ability of it to truly change the world. And, so that's turning the ethos with which,  which we operate. 

Sara (03:03):

Okay. So what I heard in there was that the one thing you're excited to do in the future is change the world. 

Paul (03:09):

Absolutely. 

Sara (03:10):

I love that. I love that. Okay, so I'm, I'm going to kind of back up, I think maybe all the way up to, “we're Canadian, we have free healthcare”. Why do hospitals need a foundation? Why isn't it funded? I don't, I don't get a bill now, mind you, I don't go there often. That's good. I'm very blessed to not have to go there often <laugh>. Um, but what, can you talk to me a little bit about what kinds of things I guess are, are not funded then? So if there's a foundation by logical extension, I'm going to assume that I'm initially incorrect, not everything's funded. What is your biggest need would you say, for Grand River? 

Paul (03:52):

Well, I'll start with a bit of an anecdote that I've been told actually by the CEO of the hospital, which is, uh, okay, the sort of comparison between American hospitals and Canadian hospitals or for-profit,  versus not-for-profit hospitals in a, in a large system. And it's that in a, in American hospitals, you're happy when you're full.  And Canadian hospitals, right- You're happy when you're empty. And I, and I think that's actually an important dichotomy, right? And so one of the framings, and it works a little bit different in every province, but in Ontario it's actually pretty specific and basically, and there's a little bit of nuance, but the government does not fund the equipment that goes inside the hospital. Full stop. So no beds, no IV poles, no large equipment like MRIs, X-rays, no, they do not fund that. Now, in a, in a new sort of build of, you're building up a brand new hospital, which is in the long range plans for us, uh, they fund 90% of that build, but then even 10% of the actual bricks and mortar has to be funded in what's called the local share. 

Paul (04:58):

And then also on a build like that, you're also still funding the entire fit out. So every little bit: couches, carpeting, all of that typically falls to local and it works out on a larger project somewhere between 23% and 27% of the project goal. So say you were, you know, building a billion dollar hospital, you're looking at $230- $270 million minimum from a local share 

Sara (05:22):

From local, okay. And 

Paul (05:24):

That's not all fundraising necessarily. It could be from a taxation levy, uh, that is city or a regional hospitality levies. It could be the sales of assets or other business development funding; say the hospital has a pharmacy that makes money or parking That money can count as part of the local share commitment when you're building a new build. But so right now you sort of end it with the question, so what are you fundraising for right now? We're actually in partnership with our other local hospital, St. Mary's, and we're fundraising for two new MRIs. We're quite under- serviced for MRIs in this region and we have a 10 million joint goal. And those are big numbers, right? So not only is it buying an MRI, but it's also outfitting the room that it's in. And so the province is putting in money to fund it annually, so they're paying for the staff to operate it, the electricity, whatnot. 

Paul (06:16):

And that's about eight, give or take $800,000 to year, which is great, but we can't use that money nor operate that service until we can buy it, right? And that gives you an example a little bit, but one of the things we really believe in at our foundation, it's not just, and this actually will I think get to some of your future questions that I've anticipated is, is, you know,  not everyone wants to fund an MRI, right? And so we actually have, and I’m not shy to say we have over 500 different things right now that somebody who wants to support  can choose to support. And we very much believe in, in both freedom of choice. And frankly, you know, if you don't give a wit about an MRI, but if you're passionate about, say, puppies and children, we actually have a program that brings in therapy dogs for both, uh, elderly  patients as well as children. And so that might be something that is really much more up your alley and likely, and this is completely the self-interest, you're probably gonna give more to that than you would to the MRI, so we can actually get more funding to support that and other programs throughout, well throughout the health system. 

Sara (07:30):

Okay, that is interesting. I mean, that seems like a really big number of initiatives and again, I've had, um, personally really limited contact with, with the healthcare system up to this point, but I do love the idea that there's so many options because I think sometimes, and we'll maybe get into this a little bit more later, that 10 million for an MRI: I think in some moments it feels like, “if I had, you know, if I was trying to make a decision on $300, is that really going to make a difference to you? Do you know what I mean? It feels like a bit of a tiny cheque. And I think if I was looking for somewhere to give at Christmas, maybe I would skip over that <laugh> if I didn't know to look or, or I didn't know that I could make a discernible difference. I'm certainly not saying that$ 300 towards 10 million doesn't make a discernible difference because quite frankly, if enough of us did that <laugh>, we would be done <laugh> and we'd have the 10 million. But I think sometimes it feels like such a tiny, you know, nickel into the bucket that that doesn't matter.

Paul (08:45):

You know? So, so I think you've hit one nail on the head and there there's a lot of different ones, but it, it's, it's this idea and a lot of shops and you even, they even advertise the annual giving, like make a gift every year. I I don't like that term [annual giving] because I find it puts an onus on the community to give every year, which  I don't think it's fair, right? Because I think it's giving should never feel like an obligation. In fact, the entire taxation model of it is that it can't be, it has to truly be given,  without conditions; from a perspective about getting things for your gift.  So I use, I use term impact giving because if you add it all up, it makes an incredible impact. 

Paul (09:26):

And you've already alluded to that, right? So, you know, 300 times a thousand people is $300,000 and, you know, we go to multiple avenues, not just from a donor perspective but also from a purchase perspective. So we happen to sell pins and, and other things here. I'm just pulling one up. You know, we have, we have a Christmas one and so on, and we don't make a lot of money on these, but you know, if I sell a pin for $10, you know, our profit margin is about $8 on that, and then all of that funding can get rolled in the highest priority needs. So if we can get the amount of donors to add up to be the MRI project at at 10 million, and thankfully we're actually, I think we're over 9 million already raised, which is wonderful. So yes, $300 really can't help <laugh> always be asking at $100, but hang on, wait a minute. 

Paul (10:13):

But it, it's this, it's this idea that, you know, we really want to engage you in a lot of different ways, because whether it's attending an event, we've had lots of events for the MRI, for example.  This year we had a big gala, there's ball tournament and you truly, we try to package it together just like any family would. Oh, you know, how are we going to pay for this renovation? Oh, well, you know, dad's going to give us, you know, $10,000 bucks to outfit the kitchen. Um, I'm going to go get the second job and mow lawns on the side and you're going to cobble it together. Which it seems actually quite reasonable, you know, because very rarely is someone going to say, oh, I'm going to give you $10 million to do that. It happens. But we a can never count on that. And frankly, most larger donors don't want to be holding the whole bag on something, right? They, they want to share the risk. There's not a lot in this context [very large donations], but you want to share that, you know, you, you want it to be part of something as opposed to just being the only one who does something. 

Sara (11:08):

Okay. Okay. Can you give me, you gave me I think a bit of a glimpse of, of just how maybe broad what hospitals do is, and so can you just give me a sense of, you know, when I say hospital, again, to me personally at this stage, because of my experience, it means: I've been there like once for a really minor procedure. Um, my kids have been there, fortunately, almost never, and my parents have yet to be there for anything like that. So can you just give me a sense though of, you know, I could maybe come up with like critical care and surgery, that you do, but can you give me a sense of kind of what happens in the region and when, like this hospital network you mentioned too,  St. Mary's, I can see from my office window, in fact what that means where hospitals and healthcare kind of intersect, what does that mean to the region? 

Sara (12:12):

Because what I'd like to get a little bit more towards is how this is related to really every single conversation I have with a client, no matter how old the client is, at some point they say some version of “what if I lose my health”, right? If you're younger, you might have a glimmer that maybe one day, “what if I were to be disabled?” “What if I couldn't work?” As you get older, you realize that physical bodies betray you in unexpected ways, right? And we talk about care then, but this whole idea,  this comes up across the board, right? And we often talk about it like: I can't really control it, I'm scared of it because I can't really control it. But I think it's interesting in this context to think, well if I am worried about that and there is a foundation that would, that is focused on improving the level of healthcare in my region, maybe in fact I do have some control over this in an interesting way. 

Paul (13:22):

<laugh>. Yeah. So, I that's such a brilliant question and, and I'm going to attempt to unpack it because I think it is lots of different variables. So yeah,  you'll see, I think you can see behind me here, this statement to rally every member of our communities to ensure world class healthcare right here. And,  that's a very important statement for our hospital in particular,r because it is not about our hospital, you know, it is very much about a health system because one cannot work without the other. And frankly, you know, you've alluded to a few times that you haven't use our services, which is wonderful. So thank you for not using them, but once to get that difference between the American system- [and the Canadian health system]- 

Sara (14:02):

Yes, anytime. But believe me, we are both committed to this <laugh>, 

Paul (14:06):

But it, it's this idea, right? Like but you want it there when you, when you need it. I do.  “When it matters most”.  Actually, an old hospital campaign, that was their tagline. “When it matters most.” . And because fundamentally we've, we've gotta have it even in, even in a, you know, we're a public system here, even in a privatized model, you still really need that in your community. And this idea of world class, you know, there can be some objective measures. I'm actually not concerned about objective measures. I want it to be a subjective measure. So I want everyone in our community here to feel like they're going to have that. And, you know, our care from our staff is remarkable. And if you objectively see very high rankings across the board in almost every discipline, like some good stuff.  But our infrastructure is severely lacking. 

Paul (14:54):

It's quite dated, it's old. We're definitely not trending well with the population. And, and so the hence the large ask to build new infrastructure with the province and to grow that, okay? But it is this community piece, right? So when, when I talk mm-hmm <affirmative> to the community, it's okay, you, you will use the [health] system, you know, from, from birth: almost for sure you were born in the hospital, not everybody, but almost for sure. And almost for sure you're going to use this, at the end, right? And you’ve got to assume somewhere in that 85 plus years there's going to be an interruption, but it watch of like 2 million, you know, it's, and that's our catchments actually by about 2040. It's gonna be 2 million between ourselves and our and our friends in St. Mary's, uh, in this region, okay. Footprint. Right. And you, you asked me sort of what areas and so you'll see a, yeah, a little logo down here. 

Paul (15:47):

It's the Care Never Stops campaign for Grand River Hospital. Yes. And there's eight petals. Okay? And so each one of those petals actually represents a key care area. The two largest petals are, are Grand River [Hospital] kids and the Grand River Regional Cancer Center. So those are the two, the two main petals. Uh, on top of that we have mental health, which is a huge priority for a hospital and, and kidney at the bottom. There's the continuum of care, which is both seniors and disability and, and sort of complex issues. And then you have emergency and critical care in, in our emergency departments[ which are] heavily used. And the remaining two petals are not actual care areas, but the main one inside sort of that internal part of the Lotus is patient experience- elevating how important that aspect of the journey is, aside from just medical care, it's everything around that. 

Paul (16:43):

And then the top is sort of the pedal that thrusts up above is innovation and learning because we recognize that we have an ability and need, in fact to, to continually get better and to grow. And we're in a very unique region with a lot of innovative technologies and how do we leverage that to and truly create this world-class healthcare system. And so our friends at, you hear what I didn't mention, I didn't mention, cardiac, which our friends at St. Mary's do so incredibly well. And we partner with them in so many ways. Our staff is all at, the doctors are all conjoined. We have a number of integrated departments, so we work very closely with them on that. And they also do eyes and some other, some other care areas. So it's really is about a partnership.  We also partner locally with a lot of community agencies to ensure a broad range across the health system. 

Sara (17:32):

Okay.  And again, I think it's interesting that if I'm not paying attention and I hear Grand River Hospital Foundation, I  do, I think, narrow that down to hospital, which, you know, I do love, do support all those things. But again, pulling it back to: I'm having this conversation with every single client and, and trying to build into their individual plan about “What if”, “What if I need care?”, right? “What if I need care and how are my resources going to do that?” “How am I going to set this up to do that?” And I think it's interesting to maybe pull it back a little bit and say, “Can I contribute to my community differently so that I'm, I'm in some ways building a joint safety net”, I would be maybe shifting the community so that I'm safer, right? And so is everybody else, right? 

Sara (18:34):

Like, how can we do this so that everybody else, because that's also another important piece of conversations that I have with clients. I wouldn't say that one is necessarily with a hundred percent of clients about giving, about giving back to community. And again, it's not in depth with a hundred percent of clients, but it often comes up and I think it often comes up and they want to do it, but we don't know how. Part of what I wanted today to be was really an opportunity for my listeners to hear you talk about why you do what you do so that they really understand that, that there is so much kind of passion on your side for changing the community and, and changing our experience. And I think sometimes as donors, we somehow miss that part. And I'm, I'm not sure why that happens, but I often will, will sometimes get hesitation from clients on giving. 

Sara (19:52):

And what they say is,  you know, sometimes we'll use phrases like “I think their admin costs are too high”, right? “I would give to them, but their admin costs are too high”. And I think if we get down to it, what they mean is, “I don't know that they're committed to, to changing the landscape” or “I don't know how passionate they are. I don't know.” Do you know what I mean? It's almost like they, they can't quite hear, they're kind of hearing some administrative body is asking for money because it's Christmas. And I think there's a myth, like when I talk to people who run organizations or people who work at organizations, you know, I wish they [donors] could hear kind of the pre-, this is a pre covid term, the lunchroom conversations right? About what you [the organization] want to happen about, you know, if you had a magic wand, if you, if you had a really big gift, like what would you do? And I think if we could get those two conversations happening at the same time, it would maybe give people more understanding of what's 

Paul (20:58):

Possible. So I love your question, Sara, because like there's seven and one still <laugh>. I know <laugh>, you're tricky. Um, so, I'm going to start, I'm going to start with one and it's kind of right above my head. I don't think you can read that. Yeah. Those are our foundation values and, and one of them, and the hospital always quotes this back to me. The first one at the top is enable easy because you have so many charities talking to you, you have all this need. It is so confusing, right? Like who knows what to do?  And, and so what I love is our partners at the hospital have basically, you know, they put this into the world. They've put that they have a very bold strategic vision, uh, at aiming high, which is to  fundamentally create this world-class healthcare system here. And the system side is really the key. 

Paul (21:45):

And so I, I want to start there with, with the sort of this answer and how do we enable easy for that? Well, frankly, we're an incredible supporter financially of St. Mary's, either through our donors who then designate to St. Mary's or just for projects there. We also do the same at other hospitals and we actually help many other causes. And in fact we're the fundraiser for the Ontario Health team, which is sort of a conglomeration of 40 agencies. And we actually do fundraising for them and with them and, and it's important. And we're going to do an event next year. We're inviting all the house causes because fundamentally we're realizing that we, we need to make it a little bit easier for donors and then, so there can almost be a, a one stop shop. And I'm going to, I'll get to some admin, some other stuff in a second. 

Paul (22:25):

But I think it's, I think it's really important to recognize, and, your donors should know this, that, you know, you can designate. So say you write a check and you say to a charity,  I want to support, let's do puppies and children, and you, you put that in the memos [line on your cheque] or in a note to them, they are legally obligated and can't give you a tax receipts unless they use it for what you stated. They actually can get in trouble and lose their charitable license. So if we couldn't do something with children and puppies, we could not cash that cheque.  I think that's important to note because often I think sometimes people feel they can, you're just, it's going into like some big pocket or war chest somewhere  and so on. 

Sara (23:07):

Yeah. Surely somebody’s deciding, right? Like I know, I know you said, and I responded to the puppy poster, but 

Paul (23:14):

<laugh> true. I'm glad I got you in on the puppies, but no, I'm a fundamental believer. I think what the fourth value down is transparent first. So if you go to our site, grhf.ca or careneverstops.ca you'll see what I hope is a lot of transparency. First of all: our financial statements, all of that, we have it very open because, you know, if you want to delve into that, please [do].  We like unrestricted funds because then the hospital can say, this is our next most important thing. We, we need money for that. But, and if you go to our site, you'll see there are loads of different projects in each of those care areas I talked about. Because you might have more of a passion for ‘Y” and another person might have more passion for “X”. 

Paul (23:56):

And I want to go to this admin [cost] comment a little bit too. And it's interesting, over the last five years, all I think all of the big US foundations now, we’re talking like the Carnegies, the Fords, ones that have billions, hundreds of billions of assets, have really changed their tune with respect to admin costs. Well, because they understand that you can't[not be upfront about costs] because charities were getting stripped. If you say a hundred percent of the money you give cannot go to any admin cost, we can't do that. And then, either we pull from other money, or we literally can't [do the project/use the gift]. So if you say “must go to patient care”, yes, you could make maybe some potential [admin cost allowance], but you, you, we can't do that. And so I, I used to work with a fundraiser who was a bit extreme in these regards. 

Paul (24:44):

He said, how come a grocery store can, um, spend 98 cents to make a dollar? And that's a, you know, 2% margin. A little bit off of the math if I look at it that way. But it gives you the example and that's, you know, that's profit margins in groceries and that's great. Yet we hold charities [to a different standard], you know, and CRA  starts to investigate as soon as we're over sort of 35 cents on the dollar, which is almost three to one, so we're turning 35 cents into a dollar. And that's too extreme. No, no, that's not quite the right analogy, but I bring that up because it's, you really gotta think about it. And then when I, another one I, I like to do as an analogy is, okay, so if I spend a million dollars and I raise 5 million with that, that is a, we use the term “cost for dollar raise”. 

Paul (25:30):

So that'd be a 20 cent cost per dollar. Okay? Right? Now compare that instead to spending 2.5 million to raise 10 million, right? That's a 25 cents per, per dollar raise. So it's higher, it's 5% more. But, and this is what I would put to the community, what makes a bigger impact? Is it the 4 million or is it the 7.5? And so it it's an interesting argument, right? Like it, it's, I would argue frankly on, on the$ 7.5 million, because I desperately know how much the health system needs it. And one last comment to that is to our first sort of, one of your first questions was, you know, what does the government fund, what does it not do? Why do we even exist as a foundation? And right, and this is the crux of it, and actually our CEO at the hospital says this really, really well. 

Paul (26:22):

The government gets us to ‘good’, sometimes ‘adequate’, very rarely ‘great’, because in what, in one jurisdiction can government ever produce something that's great, let, like, just to be a little bit devil’s advocate, I'm, I'm pro-government, but like, you know, they can't, it, it just, they can't. And so it's the donor dollars, it's extra funding that takes us to great, excellent in world and we can't do it without it. We can't, the system is designed to fail if you don't have that. And the more we get, the more great we can be. And so it's up to the community to come together. 

Sara (26:59):

Okay.  I mean, I may be the only one in Canada that, that missed that. And if I am, then that's fantastic news because we've solved that problem for Canada today. <laugh>, 

Paul (27:10):

I'm just, I like your full admissions here, Sara, this is great. 

Sara (27:14):

I'm also hoping that, that as people are listening to this, they are kind of, um, just able to understand  what is actually happening in their own community wherever they are, because I have listeners in a lot of different places. So I think it's just really exciting to start thinking and hopefully using pieces of this conversation and whether as a listener, you're applying it directly to, you know, healthcare funding, hospital funding, or any organization that you are considering, right? I, I think a lot of your words and a lot of your reason for doing this are really broadly applicable. So I'm hoping people kind of hear it from a “wait a minute, if somebody got into, you know, fundraising or if I've got an organization contacting me, what if they kind of have the same passion that, that Paul has for this”, right? What would that mean then if I were to donate to them, right? So I'm hoping that this conversation is both kind of specifically applicable and really broadly applicable too, as people are trying to evaluate where to give once they've decided to give, how do you make that decision? Because there is, you know, a ridiculous number of charities in Canada that do a lot of different things. And so it is, it can be an overwhelming choice for people, I think. 

Paul (28:55):

Well, it absolutely can. And you know, there's over 80,000 registered the last time I looked, right? And so, uh, and, and some overlapping and duplicating, right? That's unquestionable. Um, often because there's different sort of missions and beliefs. But one of the things that I think is really, really important is for people to align their giving with their own value, right? You know, you, you and I were talking a little bit about just sort of the health system and need. So obviously I'm going to make the case for, for the health system, but, you know, having this conversation with my own father and he's soon to be 73 next year, and, you know, talking about estates and Will, and, you know, he's been smart and planning these things, but you know, I, I don't particularly want or need his money. I think he should decide to do what he wants with that. 

Paul (29:41):

It's his money and there's some amazing [planning], you know, you can basically eliminate the tax you pay in your estate, right? We actually have a calculator on our site that allows you to do that. Just sort of figure it out. But, people don't, ah, they don't think of that, right? But like, think about that impact. If you believe in, in puppies and children <laugh>, if that's your thing, or if you know cravat wearing turtles, okay, I bet you there's a charity for that. And so don't give to me, don't give to the hospital, give to them because then you're directing the money you earned to the things that you care about the most. And I would say for everybody working in my field of philanthropy, like that's what we want because then we'll align the right donors to the passion and we'll get that funding and we won't have to necessarily just get the government support. It, it can really be really incredible and, and powerful because you are aligning the things you care about the most with your earnings, your opportunities. 

Sara (30:44):

Okay, I'm going to sidetrack a little bit and we're going to see where this goes because this wasn't in my outline at all. So you mentioned that you did a stint out west with libraries. From what I understand, the only reason that we now have publicly funded libraries is because there was enough private persistence and that's what got it started. And then governments took over, right? So I think the other place that that can become, um, either confusing or, or maybe a place to land if the decision to give feels overwhelming is sometimes people will say, “Well, if it was really necessary, the government would fund it", right? Like, like, “Stop talking to me about this, whatever, whatever thing. Because if it was really broadly necessary, the government would fund that.” And I have a really great article, which now that I've said it out loud, I'm going to have to go find somewhere in my digital filing drawer about things that we now very easily accept as public policy that only came about because there were enough people committed to funding it until it got to public policy, including seatbelt laws, right? 

Sara (32:05):

So I mean, now it seems ridiculous because there is such a clear safety value, but there was a time that that was not clear. And so I would love to have you crystal ball the idea of <laugh>. Um, so if we could really come to terms with Canada's healthcare systems, is comprehensive only for this list of things. It is not totally comprehensive and this list over here needs to be supported by community. Could you see a time where maybe it became more comprehensive? Is that possible? Do we want that? Say whatever you want to say here. 

Paul (32:54):

Once again, a seven prong question. So no, I'm going to unpack it right back to the beginning, which is, which is, you know, I know the story of the libraries really well, right? So that was Andrew Carnegie and before that, uh, there were really no public libraries. A few groups of people got together and shared books, but it wasn't really a thing. And, you know, there was a lot of issues. He was, uh, considered incredible union buffeting rampant evil capitalist at the time, very much so. Um, and yet he was building these, these libraries. And in fact, in Calgary where I, where I worked, um, the, there were women, uh, actually it was a woman named Amy Davidson who knocked door to door, uh, around Calgary and actually had to do it three times because he didn't, didn't get enough votes for city council to entertain. 

Paul (33:39):

Once again, this eludes one, the hospital paid a, a fee for a head library because if, if they had enough investment from the city, just a little bit from operating and Andrew Carnegie kicking the capitol to build the building and they ended up getting $80,000 and floor plans to build Calgary's first library. And it was in 19 and most North American cities, I think there's 2,900 in total, have a Carnegie Library. There's one around the corner for me here in, in Kitchener, but it was once a Carnegie Library. And that truly is the only reason. And so why I, why I stress that is the government, government is, it's the politics, right? Like they're only going to invest really in where the need is. And philanthropy can wag that, be that tail that wags the dog? And, and that's the power of it, right? 

Paul (34:27):

So if we can get the community invested in something that actually makes the change. So I talked about wanting to change the world, you've hit that on the head. I  really believe in building community. There's a whole bunch of different ways to do it. That's why I have fundraised libraries, sports universities. It's not about the money, it's about the change. You could grade by investing, time, energy, volunteership, all of those things in a concept and idea. And so getting to the tail end of your question, which was where, where do we prognosticate, where do we crystal ball to? It's, it's this idea of, okay, you know, the US has privatized healthcare pretty much, right? Canada has public healthcare mostly, right? <laugh>, there's so many nuances of those payments. [Nuances] I know well. 

Sara (35:15):

Let that go for today. 

Paul (35:17):

And you know, there's a, there's a real fear of, of two-tier healthcare, although there's a stronger argument you could make you, we already have a version of two tier healthcare. So let's, I'm going to throw all that out the window. I'm going to instead do a term actually that I recently was chatting with a few of my board members around, so forget privatization of healthcare. What about nonprofitization of healthcare? What, what if we looked at, okay, the government will and should do some, and they, I  described the share of building a new hospital here, right? Like they're already up to a certain point. What if we can engage with the community at all those different levels to make those things better, to create innovations, right? You look at even, you know, research that's done at universities around North America, lot of that is donor funded. 

Paul (36:03):

You know, government certainly does an incredible support. Yes. But it, it's even at the hospital, like we're, we're a large hospital and, and there's a large budget. Almost all of it is tied by government funding. You, it must be spent on ‘X’, this must be spent on ‘Y’ must be spent on said job or dollars allow them to spend on those things that the government won't let them or they just don't have room in the government budget to do. So it, it provides a flexibility and nimbleness. The governments so often lie, there's a lot of things there, but <laugh> 

Sara (36:36):

Yes, we thank you for that because I think, I think sometimes the other deep hesitation that we maybe have as donors, and I think it is very hard to articulate is, is this sense of, um, “I wanted my donation to change the world. I wanted my donation to make a difference.” And sometimes I think maybe we don't see that the organization is committed to that, or sometimes again, we almost boomerang it back on ourselves. And, and as soon as I say I wanted my donation to change the world, there's a little voice in the back of my head that's going to say, well, how is your stupid $300 going to change the world? Do you know what I mean? And so, we almost can paralyze ourselves into not contributing and, and not, you know, and so I kind of sometimes think about what if even a hundred of us changed our mind on that this year, right? And then what, 

Paul (37:44):

Well, I wanted to show you a coffee token because I, I think it really speaks to what you're talking about. I'll explain why. So just before the pandemic, we actually created these little coins. Uh, there's quarter sized made out  of copper with, uh, with an American company. They make coins. It wasn't terribly expensive and it was a going to be a thank you for donors when they visited the hospital at one of our coffee shops. And it was just basically this is a nice thank you to donors, then you know, covid hit. And we're like, um, yeah, we can't do that now <laugh>. And  so somebody on my team had the most brilliant idea. Uh, they could possibly have had, you know, lets give them to staff, but instead of just giving them to staff, we actually put it online and let our donors picture standing in line with a doctor, standing in line with a nurse for another caregiver and being able to buy him a coffee, right? And within half an hour of a tweet that one of our board members did, we'd sold $16,000 over the internet. 

Sara (38:47):

Come on. 

Paul (38:48):

And absolutely. And it, and it's not like the coffee's going to change the world, but we know, and we still see a day-to-day because we provide managers and staff with the ability to help their teams, that a coffee like that on a really rough day in the, in the emergency room or in the operating room, like, it, it changes their lives. Like if they, they know that it's come from you, right? Like, and, and it's a silly $2 coffee and you go to grabacoffee.ca, you'll see our whole coffee thing there. Like, but, but it, you know, we do meals as well and they're 10 bucks, but it, it's not, and we make $0 like there, there's no profit margin at all because we fundamentally, we want to make it feel for, for you, the community that you're doing that, right? And why I do that, why we do that is because small gestures, like we know this in our own lives, right? Like 

Sara (39:38):

I, that's what I'm saying is we know this difference 

Paul (39:41):

<laugh> and it, and it makes a difference in alot. Like we have 4,700 staff including docs at Grand River hospital and you are all having a coughing fest and all of your listeners in your community hospitals just full right now with, with rsv, with covid, with everything going on, it is brutal. And we're short staffed and no one wants to work in nursing in healthcare it feels like right now. And so, all of those things, you know, the big request we got at Christmas is just like, you know, a new microwave for the nursing lounge. Like small things that just, you know, and, and, and big things as well, like when equipment breaks and so on. Like, we're have to be there for that. But that's why I view it as, as a sort of a, a circle of, of opportunities. So I want to work with a donor to get, you know, that $300 to help buy the MRI, I want you to buy, you know, a pack of five coffees for, you know, your dad got cared in the ER and there was these five [coffee tokens], we even sell them in a vending machine now in the hospital. 

Paul (40:42):

So you can actually buy the, yeah. So you know, you're, you're there for cancer care, you can go buy and you take the coins and you give 'em to the, the staff who helps, cuz life's, life is hard. Let's make it better <laugh> frankly, like, and all those moments, those gestures and you know, we sell swag and hats and so on and, and, but it makes a difference. And yeah, just putting that all together, <laugh> I get very heated about this, apparently <laugh>, 

Sara (41:07):

I, which is, which is why you're good for this, right? Again, I I think, um, sometimes in the… again, from the donor side, I think sometimes from what can feel like endless requests, um, these things in the mail, I did something one time and now I'm on everybody's list asking for money, right? Like I just, uh, go away. The government tells me there's inflation, I must not have money left. So I think sometimes what we miss in the things that are easy to get out and you need to get them out, like as a, as a foundation, we can only put you out there so many times, you've got the same 24 hours in a day that we all have. But I, what I wanted for today was for listeners to really be able to hear is: does this matter to you? Right? Do you, do you just like the title president? 

Sara (41:58):

Do you not care what you're president of? I don't know. They [listeners] don't know. Um, <laugh> yeah, because I think, I think again, it's so easy when we're all busy with our own lives to maybe not stop and think, right? Like I, I personally love my own career and I will do a lot of things for my career because I really, really love it. But I might not pick up a mailing from the Grand River Hospital Foundation and immediately think, wow, I bet they really love their jobs. Wait a minute, they've staked their career on this. There must be something to it, right? And I, I think that that gets so easily missed. Uh, we could probably argue in a number of areas, but we're talking about giving today <laugh>. Um, so I think that what gets missed is that there is an entire team of people that have staked their careers on ‘this is important.’ 

Sara (43:00):

Giving to this hospital is important, not because it gives me a job, but because it does all these other things. And I think I really, again, when I go back to that other side of the conversation that I have with clients about, you know, and I think we've kind of covered this often, we think about how we and I, and that's the individual we, how we might cover ourselves for healthcare. Like how can I buffer that risk? Um, or how can we buffer that risk? But really today we're kind of talking about how we actually, we collectively can buffer this risk. And I think that does become community changing and therefore life changing for all of us. So when we, again, that real deep need that we find very hard to say that when I give, I, I actually want to change the world. Like I, I am bold enough to say I would love it if by in conjunction with other people could actually solve this problem, change the world and change the, the way that we're living. And, and so I think that is really huge. If we could get even partway there today. ll 

Paul (44:17):

Let me add some ideas to that because I talked about it before, this idea of having different ways to give, I've talked about the coffee, now I mentioned the pin. Why we truly do that is because we're all different, right? So I I, you know, I have a donor who bought a, bought a, the, which is a instrument related to cancer and they had cancer. And so there was a really nice alignment. We, you know, we've had another one buy a shower chair because their dad, you know, really had trouble showering while they were in the hospital and we just did that. enough to go around. So things that are really connected to, to what, and then we introduced this new product actually called a careship and they'd sort of been around, but think about it as like a scholarship for your care. 

Paul (44:58):

And I'm actually doing one after my mom, um, who passed away when she was 49 and had a really difficult journey. But the idea of a careship is it actually allows the, the hospital social workers to provide for people who are undergoing a very challenging illness journey, whether it be in cancer, kidney or, or any area and actually literally provides them with funds. And because if you think about it, you know, say you're dealing with, with a, with a cancer and you're, you know, out of a job and cancer's very expensive on a family and you know, the medical equipment, if you need help with, with medical aids, we actually have a massive unfunded drug. We, we give the hospital over a million dollars a year to, to actually pay for drugs that the government won't fund. But it's this idea of the care ship. 

Paul (45:43):

And so we have a few named careships that people can actually get, just like you would name a scholarship at a university. It's exactly the same concept because, because we believe so and  because some people like getting your name on things. Okay? But the one with my mom, this is, we're just fundraising for it now is going to have her name on it. But it, it's because it's a way to honor her as well, right? Because there's a lot of nuance in it, you know, we're going to see how big I can get it, but it'll be, you can endow it and you know, the interest payout or you can just pay it out and you know, the stories we get from this you that we already have. It's, it's all of a sudden these patients can just like worry and just focus on and, and focus on taking care of themselves and you know, we've paid for phone bill sometimes we'll pay for transit if they truly can't afford it, right? 

Paul (46:26):

It's so it's, it's finding these ways and, and that's why I love things like this and, and our ability to work with our hospital to stall. Not just, you know, we need to buy a piece of equipment X and that's critically important. Government doesn't fund it, but it, but it's also the entire process of this journey. And one of the other ones that, that I want to mention because it's, it almost will sound when I say it of bits selfish still for, for individuals. So we, before Covid we were actually still charging for, for wifi for patients and which, which was just silly. And so, um, especially in Waterloo, so we, we invested, uh, donor money in upgrading an entire and creating a just for patients high speed wifi network at no cost. Uh, we now actually we've got a bunch of donations of Chromebooks and iPads and we loan those out to patients as well at no cost. 

Paul (47:15):

And we're also introducing the ability to order things right to the bedside. So whether it even be a coffee from the Tim Hortons or you know, you say, you know, you're going in for a few days, you can actually create, and this is going to sound kind of funny, a care registry. So you know what I'd love as I could get a massage and a robe and a pizza delivered and your Uncle Joe, The Bahamas who you know, has more money than sense can <laugh> can put somebody into your, into your, into your care registry. And so you have a better time of it and it works for the hospital because you're spending less time in the bed, right? You're, you're, it, it, so it's, it's all this of this, it's this patient journey piece with all these other variables that we can add in and, and work with the community to help change and solve and evolve. 

Sara (47:59):

Okay? Okay. I do think that's really interesting because you're right, I think we, we do flip between, you know, just a moment ago you said this might sound kind of selfish and all I heard was, are you saying that if I happen to land in a bed, there is a way for me to get back out faster? Cuz you seem great Paul, but, god, I don't want to be there. Do you know what I mean? <laugh>, I'm like, that is not selfish. That is good planning <laugh>, 

Paul (48:23):

Right? And how do we get each other out faster, right? Like how, how do we use the rigor of the science but we also know that people who are feel more cared for, yes, exit faster, which saves the system money, which means there's more room for you <laugh>, 

Sara (48:38):

Right? Which is, which I don't want to use, I'll give it to somebody else, but you're right, there is this whole funny, um, you know, really good circle, right? We often talk about negative spirals, but there is this really interesting good circle of wait a minute, if we could, if we could build a system that was so good that we were hardly spending any time there. Wow, that sounds amazing, right? That sounds so relaxing <laugh>. Um, but again, as you say, it's there if I need it. Hey, 

Paul (49:07):

And truth be told, you know, we get in all hospitals to get a number of gifts in, in Wills legacy gifts. Yes. You know, when you read the language and the will that really is their intent. And you know, we, we call our own program care forward, the idea of paying it forward and we fundamentally, you know, longer term that's probably the, the main way and we'll we'll be able to do these advancements and these extras to help create world classes. This idea of people saying, you know what, I'm going to really invest, I love doing it in real public. We just had this incredible person who just shared that they was putting $500,000 in their will toward just their, their Haiti. Um, and uh, we're going to honor though, while there's still a lot, right? Because why wait, like why this let's, let's celebrate that, right? 

Paul (49:53):

Like let, like let's, let's tell that story. And so it just, it's, it's really interesting because there's, there's so many different ways to help and, and I al I believe in the personification or the per, sorry, the personalization of philanthropy cuz then you're gonna love it more. And, and I, I'd had the privilege of working with a few people who had only ever given fallen out. And then we work with them to really align their passions and they've taken a few people from a thousand to over a million dollars, like from long term and, and their lives. Like they, they get mad at me cuz now they're addicted to giving, right? Because it's so in a good man <laugh>, they're, they're so passionate about it because they see the impact they can actually make on, on both individuals and on society. And it, it's awesome. 

Sara (50:39):

It is exciting. And I think, you know, one of the clients that I worked with, I got to see kind of the beginning of her giving because a lot of her money was inherited. So initially there was kind of that, that paralyzing, that's a lot of money and it's my parents' money, right? And so, so it took her some time to get used to the money and she started giving, um, in smaller amounts. And she was very, she actually I think did a really good job of finding charities that aligned with her values. She was able to, um, find some that really specifically aligned. There were a couple of specific things that she really loved and she went and found organizations that did that. And again, this is probably a whole other topic, but just that idea of I will give if I get a tax receipt and, and that is important. 

Sara (51:32):

I have a whole thought on that, which I will write out later. But what was so interesting to me was after a couple of years and she was increasing her giving and then we had booked an appointment for her to meet with somebody to do a donor advised fund. So she was gonna do, you know, she had a pretty solid list of charities. They did have, they were in a high tax bracket. So part of this was, look, you've already agreed to give this money, let's take a lump sum, set it aside, it's gonna be given as you wish. That was all good. She actually canceled the appointment last minute and she said, you know, I thought about it and I like the interactions with the charities. I like doing the donations every year. I don't want to give that up by going to a donor advised fund. And I thought that was such a beautiful thing for so many reasons that, and I think it again, goes to a lot of what our conversation has been is if we find that personal connection to an organization that I think is where we get community change and, and that grassroots change that we're all kind of looking for right now. 

Paul (52:44):

Very well said. Yeah. 

Sara (52:45):

All right. Is there anything else, Paul, that you would like listeners to know or to think about? And I get that that's an unfair question because obviously the answer is yes, 12,000 things. Sara, thanks so much, <laugh>. 

Paul (53:00):

Yeah, you know what I, I I think it's, I think it's, it's this in nonprofits like ours, like we're, we're very deliberately partnered with, uh, with a sister organization. Like our, our purpose is to support them to, to gto to enable easy for them to make them as great as they can, right? And you know, we're sort of different than because we don't do a lot of direct charitable action where other, other causes would, right? But, but, so there's kind of those two, I use the term actually cause profit, which is a bit, a bit perhaps dangerous but sad, you seeking profit for your cause. So we are absolutely doing that because we fundamentally believe that the more we can provide the hospital truly helps achieve that sort of long-term vision, this idea of cost profit. But I, you know, it, it's why I really liked your last comment was the charity's gonna mostly want that too, right? 

Paul (53:50):

Sometimes charities are going to be feel a little bit like, wait a minute, the donor wants us to do these things and So, you know, I would say it has to be about a dialogue. You know, you, you, you try to force one vision on will work and that's what you should shop around, find the care well, you know, and, and find those causes that resonate you. And often it's, it's a founder. Often it's the CEO, just because they're like a figurehead. But, you know, I've got a great, uh, but small but mighty team of people who connect throughout our community in lots of different ways. Right. And, you know, a lot, and increasingly, especially since Covid, a lot of that interaction is happening online. Like we have a, we have a chat bot on our system. It's actually not a bot. It, it connects to people. <laugh> 

Paul (54:29):

Kind of important. Right. And, and, and, and you can literally reach anybody from my team. I can will, you know, my phone number in fact is on our website. And actually I have a link to book a meeting with me, any time because so few people actually do it. But please, you know, call me. Yeah. I will meet with you. Um, because we believe fundamentally, like, I don't care who I talk to because, you know, and I don't just want to meet with people who can give us a pile of money, I want to actually meet with anybody who is passionate enough to want to talk about what we're trying to do. And that, and I would say that goes for 99% of all charity.  

Sara (55:04):

Right. Thank you. That is a great, I think, wrap up thought for today. Thank you so much for your time today, Paul. 

Paul (55:10):

It was a blast. Thank you, Sara. 

Sara (55:16):

The information in this podcast is intended for general information and illustrative purposes only for advice relevant to your specific situation. Meet with a qualified financial planner, lawyer, or accountant before making any changes to your situation. Sara's designations and licensing include Certified Financial Planner, registered financial planner, certified divorce financial analyst, chartered divorce, financial specialist, and holding an insurance license.