Case Study #8: Mastering the Private-public Partnership
The Fisher family’s several triumphs in catalyzing medical and family care
When it comes to philanthropy supporting veterans, servicemembers, and their families, the Fisher family represents the gold standard. They were in the field before almost anyone else. Their projects have been soaringly successful. And they have managed to repeat their triumphs—first in one area, then in another, later in third and fourth sectors.
It is difficult to summarize on a few pages the size and breadth of the Fisher family’s giving to the military, but the highlight reel looks something like this: They turned a retired aircraft carrier into a floating museum of military history dedicated to those who have served (doing this in New York City, no less, where they had to overcome many regulatory obstacles). They built 58 comfort homes with private funds, to house injured servicemembers and their families during extended treatments at V.A. or Department of Defense medical facilities; these homes have so far provided more than 4.7 million days of free housing to these stressed families. At a time when the Fishers considered the “death benefits” paid by the government to families of fallen servicemembers to be insufficient, they supplemented those payments with private charitable funds. To improve the rehabilitation of combat amputees, the Fishers built a 60,000 square foot rehabilitation center that has redefined the state of the art. And most recently, the Fisher family began building a network of privately funded traumatic stress and brain injury research and treatment centers on V.A. and Department of Defense medical campuses around the country.
This work was carried out through several different giving vehicles—the Intrepid Museum Foundation, the Zachary and Elizabeth M. Fisher Armed Services Foundation, the Fisher House Foundation, and the Intrepid Fallen Heroes Fund. And the Fishers recruited hundreds of funding partners to finance these charitable activities. But the family has consistently put organizing energy as well as money into these ventures, and their contributions have evolved over time in very savvy ways to remain relevant to the needs of veterans and members of the military as circumstances have changed.
One thing remains constant through each of these engagements, a factor that is likely be the family’s major philanthropic legacy. The Fishers pioneered a unique and exemplary take on the private-public partnership. Indeed they managed to take the traditional private-public collaboration—within which the influence of philanthropy is often swamped by the demands of the government—and stand it on its head. Rather than letting large and inflexible public institutions call the tune, the Fishers managed to wield their private philanthropy as a prod to get the public sector to act in much more entrepreneurial ways.
There is constant talk in the world of philanthropy about “private-public partnerships.” In many cases, however, this devolves into government officials and bureaucracies setting the rules and then trying to get private entities to cut the check. A lot of these efforts—for instance when taken up in traditional public-school systems—have turned out to be disappointing and dysfunctional. A private-public partnership in the Fisher philanthropy, however, is a different beast. Under their model, the private partner has been the instigator, planner, agenda-maker, setter of the schedule, and energy source. The private donors have solved launch issues the government was too cumbersome to sort out, and then they’ve held their public partners to account for timely follow-through.
A Long History, Not a Flash in the Pan
Zachary Fisher initiated the family’s charitable work on behalf of members of the military. Born in 1910 to Jewish immigrants from Lithuania, he dropped out of high school at the age of 16 to work as a bricklayer, joining his brothers Martin and Larry in the family business of general contracting. Soon, they formed a new real-estate business in New York City, Fisher Brothers, through which they would eventually build or manage more than 10 million square feet of prime space in the city, and make the fortune that has allowed their decades-long philanthropy to flourish.
After the bombing of Pearl Harbor, Zachary tried to enlist in the U.S. Marine Corps but was denied because of a knee injury he had incurred while working construction. Instead, he offered his services to the U.S. Army Corps of Engineers to help construct coastal fortifications at home. His wife, Elizabeth, served in the USO, entertaining troops with the Ziegfeld Follies.
They continued their commitment to the well-being of members of our armed forces through various projects in the 1950s, 1960s, and 1970s, until they embarked on their first major philanthropic project: saving the USS Intrepid from becoming scrap metal, turning it instead into the Intrepid Sea, Air, and Space Museum, a place where children and adults in New York City could develop a richer appreciation of military service. In addition to putting up $25 million of his own money for the project, Fisher worked to pass an act of Congress to purchase the carrier, and to rewrite New York City building codes to harbor it in the then-economically depressed Hell’s Kitchen district. By 1982 the Intrepid Museum was open for business, and soon after it became an entirely self-sustaining endeavor.
After the 1983 bombing of U.S. Marine barracks in Beirut, Zachary and Elizabeth Fisher created the Intrepid Fallen Heroes Fund to support the families of slain servicemembers. Though the government provided one-time cash transfers to these families, the Fishers felt they were insufficient. So they began giving as much as $25,000 in supplemental gifts directly to families. They continued distributing these until 2005, when the government significantly increased its own contributions to the survivors of the fallen.
Focusing on What They Do Best
In 1990, Zachary and Elizabeth Fisher contacted Adm. Carlisle Trost, Chief of Naval Operations, to ask how they might expand their support for families of wounded servicemembers. Trost relayed an issue that had concerned his wife, Pauline, for some time: the lack of affordable housing for out-of-town family members visiting wounded servicemembers on their way to recovery. Many families must travel long distances from their homes to help care for loved ones recovering for days, weeks, or months in V.A. and Defense Department medical facilities. These sojourns in strange cities often presented serious financial and emotional hardships for family members.
After hearing the story of a young sailor who slept in his car while his wife received treatment at a DoD hospital, the Fishers decided to act, with Zachary famously saying, “I’m a builder, I have my own architect, we can do this.” With their own $20 million investment, the Fishers created the Fisher House Foundation. The idea of providing homes away from home where families can stay while their servicemembers medically recuperate was simple. Implementation was not as easy.
The Fishers required that no family ever be charged for its stay at a Fisher House. They also stipulated that the houses had to be within walking distance of the medical facilities they were meant to serve—which generally meant building on government-owned land. Zachary Fisher knew his limits—he was a gifted builder, not a hotel manager—so he insisted that some other entity had to actually manage the houses once they were erected.
Developing the houses would have been a multi-year bureaucratic and budgetary ordeal for the federal government, “but we could build them faster, for lower costs, and with extremely high quality, ultimately saving the government millions of dollars” says Zachary’s great-nephew Ken Fisher, chairman of the Fisher House Foundation. It was much more feasible for the Departments of Defense and Veterans Affairs to provide land, ongoing maintenance and operation, and property management, especially with the added incentive of getting the fully furnished comfort home for free. Says Fisher, “It was just a natural step to build them as gifts and proffer them to the government, which would fold them into the base and military culture so they could do what they do best, which is operate and staff them.”
Once the deal was struck, Zachary Fisher brought in architects and construction partners to build the first two Fisher Houses at Walter Reed Army Medical Center and National Naval Medical Center. On their completion in 1991, Fisher proffered the buildings to the Department of Defense, and the Fisher Houses were open for business.Fisher Houses provide more than just a place for caretakers to rest at the end of long days of recovery—they provide community
Since then, the Fishers built another 58 houses, including one abroad (for families of wounded British soldiers at Queen Elizabeth Hospital in the United Kingdom), and new houses continue to open as this is written. Each house consists of anywhere from 8 to 21 suites, with shared kitchen space, laundry facilities, dining room, library, and living room, in a 5,000 to 16,000 square-foot edifice. In 2012 alone, the houses served 19,000 different families. The nearly 5 million days of free lodging they have provided have saved families hundreds of millions of dollars in food, lodging, and transportation expenses.
Fisher Houses provide more than just a place for caretakers to rest their heads at the end of long days of recovery. One of the effects of housing these families together has been the inherent sense of community and shared experience. Worried and grieving families are brought together in a supportive and comforting environment where concerns and joys can be shared with others facing the same circumstances. The homes have proved wondrously popular.
Through this carefully structured private-public partnership, private philanthropy was able to motivate government to quickly provide a service that it was failing to provide on its own. Government was able to expand its care for servicemembers and their families with much-reduced startup costs and bureaucratic effort. And American families in distress benefited greatly.
Once established, the Fisher Houses became an entry point for other private philanthropy in the notoriously difficult-to-access worlds of the V.A. and DoD. In 2005, the Fisher Houses and DoD began administering a Hero Miles program through which seven airlines allow passengers to donate their frequent-flyer miles to provide free tickets to servicemembers receiving medical care who are ineligible for government reimbursement, plus family and close friends visiting injured servicemembers during their recovery. Since its inception, the program has provided over 30,000 tickets collectively valued at more than $45 million.
Administered similarly, the Hotels for Heroes program provides free lodging to these populations at 17 hotel chains. The Returning Heroes Home Foundation was able to form a similar private-public partnership to build the Warrior and Family Support Center, a privately funded 12,000 square-foot assistance and recreation center on the campus of the San Antonio Military Medical Center in Texas.
Far More Than Lodging
After Zachary Fisher’s death in 1999, the rest of the Fisher family continued to expand their philanthropic work in support of servicemembers, veterans, and their families. In addition to continually building new Fisher Houses to keep up with injuries from the wars in Afghanistan and Iraq, the Fishers became involved in the medical treatment process itself. As with the Fisher Houses, the family offered a jump-start by providing expertise, energy, and startup funding.
Under the leadership of Tony and Arnold Fisher (Zachary’s nephews), the Fishers’ medical work first focused on those with major amputations or extensive burns—soldiers who likely would have died in previous wars with less advanced battlefield medicine, and who now needed long-term rehabilitation and prosthetic help. After the government increased death benefits for families of fallen servicemembers in 2005, Arnold Fisher led the family to repurpose the Intrepid Fallen Heroes Fund for this new cause. By January 2007, the fund had raised $55 million from 600,000 donors and completed construction of the Center for the Intrepid. Located next to two Fisher Houses on the campus of the San Antonio Military Medical Center, this gleaming 65,000 square-foot facility treats about 140 gravely wounded patients, in a total of about 600 appointments, in any typical week. Like the Fisher Houses, once the foundation had planned, built, and equipped the center, it was proffered to the government for staffing, maintenance, and programming.
With its focus on serving those with amputations, severe burns, or functional limb loss, the Center for the Intrepid brings under one roof prosthetic fitting and fabrication, behavioral medicine, and physical and occupational therapy. Patients receive intensive treatment from teams of professionals working together to address the patient comprehensively, rather than one malady at a time. Supplemented by state-of-the-art technology and adaptive sports equipment, treatment plans allow patients to learn to walk again, to take care of themselves, to play sports, even to reacquaint themselves with their old military work and weapons systems.
Although the V.A. and DoD have many fine medical facilities and programs, the privately funded Center for the Intrepid offered several advantages. First, as with the Fisher Houses, private funding and building services allowed the center to be open and aiding badly wounded men and women years before would otherwise have been possible. Moreover, the center enabled the military medical system to bring a wide range of medical professionals under one roof to provide integrated care that would previously have required multiple visits to multiple facilities. The Intrepid Fallen Heroes Fund didn’t simply donate a new building, it demanded and facilitated the reorganization of resources within the Defense Department to better serve patients.
Building for Brain Health
After cutting the ribbon at the Center for the Intrepid, the Fisher family quickly reoriented toward a new problem: mental and brain health in the military. Post-traumatic stress and brain injuries are not new to the wars in Iraq and Afghanistan, any more than multiple amputations, severe burns, and functional limb loss are new. But as more routine medical problems are solved by improving medicine, these trickier effects of combat are now a major focus of military medical care.
Recognizing how difficult it can be to diagnose and treat brain injuries and traumatic stress, the Fishers decided to invest in that area. Although the military had excellent physicians, “the need for a center of excellence that could both conduct research and treat patients had become critical,” says Ken Fisher. Following the model they had pioneered with both Fisher Houses and the Center for the Intrepid, the Fishers decided to create a facility that could elevate care for neurological issues in the way San Antonio’s Center for the Intrepid had improved amputation therapy. Arnold Fisher set about meeting with doctors all over the country to determine what such a facility might need in terms of space, equipment, and other requirements.The Intrepid Fallen Heroes Fund catalyzed the reorganization of resources within the Defense Department to better serve patients
Initially, the military was nervous about the idea—“like anyone, they want to be able to take care of their own,” says Ken Fisher, “but we weren’t looking to take over or take away, we were looking to complement what was being done.” They warmed up to it quickly and a facility was planned for the Walter Reed National Military Medical Center campus in Bethesda, Maryland. It was dubbed the National Intrepid Center of Excellence, or NICoE (pronounced “nigh-coh”).
Officially proffered to the Department of the Navy in June 2010, NICoE is a 72,000 square-foot facility carrying out research, diagnosis, and treatment on brain injuries and stress disorders with injured servicemembers and veterans. Over the course of four weeks at NICoE, patients undergo evaluations by a team of medical professionals—sometimes more than a dozen—that diagnose problems and develop a treatment program for the patient’s entire family. After evaluation, NICoE physicians work with the patient’s home doctor to coordinate the treatment plan.
Since completing NICoE, the Intrepid Fallen Heroes Fund has embarked on a project to build as many as six more NICoE satellite centers around the country, so patients can be treated as close as possible to their homes. Explaining the rationale behind these, Ken Fisher says: “You don’t just receive treatment and walk out. It has to be ongoing—the satellite centers are meant to get patients home as quickly as possible so they can receive treatment there, while monitoring their progress.” Each of these $11 million NICoE satellite clinics will provide evaluations and treatment, and train healthcare providers. The local clinics will conduct some research, but as they open the facility in Bethesda will become the primary center for evaluations and research.
How does a philanthropic family with experience constructing and managing real estate come to instigate solutions to complex medical problems like amputations, burns, brain injury, and traumatic stress? The same way as it addressed the hardships faced by family members caring for their injured loved ones. By focusing attention on the problem, quickly building top-of-the-line facilities where those in need could be treated, all the while pressing the responsible government bureaucracies to create staff and plans to solve the problems, and then turning over the keys for professionals to run the place. Essentially, the Fishers defined the issues, then set up a dynamic where it would be too painful for the government to fail to address them, and relatively easy to accomplish good new things.
Getting Beyond the Buzzword in Private-public Partnerships
It was a great advantage for the Fishers that they had a nearly 20-year track record of working with the military before the war on terror magnified problems of the sort they wanted to solve. That earlier experience unquestionably enhanced their ability to ramp up creative private-public partnerships where private philanthropy was the driving force, not the lagging influence. Nonetheless, the sheer programmatic diversity, geographic spread, and consistent excellence of their good works is so unparalleled in the world of philanthropy that it’s clear there were also some very smart strategy decisions being made, quite apart from their advantages of experience.
In the Fisher family’s work with DoD and V.A., the private donors never simply write a check to pay the government to provide services. Nor does private philanthropy dream up and demand a project that would eventually become a burden on government resources better spent elsewhere. The Fishers avoided both of those dead ends.
Instead, their work has allowed both the philanthropists and their necessary public partners to bring their specialties and strengths to the table. And the private donors have, somewhat inexplicably, managed to avoid letting the bureaucratic blob overwhelm them. The philanthropists provided the motivating force and essential marching orders that allowed fresh solutions to emerge. And in case after case, better services resulted, more quickly and over a broader geography, than either side of the partnership could have rendered up alone.
As a family of builders, the Fishers used physical facilities and infrastructure to get their foot in the door, as the starting point for arranging new solutions to unaddressed problems. But they never let the buildings become the end point. The buildings, produced with a speed and quality which would have taken years for public agencies to reproduce, were just the carrots. The Fishers recognized that the programs erected inside the shells were the most important element.
In this work, there was no doing without the Departments of Defense and Veterans Affairs, with their essential access to the relevant populations and highly skilled medical corps. But by staying in the driver’s seat while creating new entities within public facilities, the Fishers used their valuable gifts to entice large government agencies to find creative ways to offer new services to Americans in need.