Voice over 0:00
This is Health on the Plains, a podcast about rural communities, rural life, and the many factors influencing the health and well-being of rural Kansas. Health on the Plains is a podcast from the Kansas Health Institute, a nonprofit, nonpartisan, educational organization committed to informing policy and improving health in Kansas through honest, nuanced conversations with leaders and doers from a variety of backgrounds. The Health on the Plains podcast offers unique insights into rural health challenges in Kansas and shines a light on the people and organizations working to make their communities healthier, more vibrant places to call home.

Wyatt Beckman 0:42
Welcome back to another episode of Health on the Plains. Today we are at the Sunflower Foundation here in Topeka, Kansas. We just wrapped up a great conversation with Brandon Skidmore and Elizabeth Burger, two of the leaders of this health philanthropy, and we really got to dive-in deep. To think about how they approach their work, and how they think about being a catalyst for change for health in, in Kansas. It was a really great conversation with a lot of nuance and a lot of interesting ideas, and I hope you enjoy. Well, welcome back to another episode of Health on the Plains. I’m your host, Wyatt Beckman. Today, we are at Sunflower Foundation here in Topeka, the state capitol. The Sunflower Foundation is a statewide health philanthropy established in 2000, and our two guests today are Brandon Skidmore, the President and CEO, and Elizabeth Burger, who serves as Vice President of Programs and Strategy. Before becoming President and CEO, Brandon served as Vice President of Health Systems for the foundation. Before coming to Sunflower, he racked up over a decade of government experience, holding various roles with the state health department. Prior to becoming Senior Vice President of Programs and Strategy, Elizabeth served the foundation as a Program Officer, and eventually as Vice President of Healthy Communities. Elizabeth worked in several health focused roles before joining Sunflower, including academia and with the academy, American Academy of Family Physicians. Brandon and Elizabeth, we are so excited to be here with you today. Thanks for having us.

Brandon Skidmore 2:22
Thanks for coming.

Wyatt Beckman 2:23
So we’re sitting here in this beautiful building. You’ve got some offices down below us. I’m looking over at the Powerhouse Room. We’re here at the Sunflower Nonprofit Center, and we’re at a really pretty storied location, that sometimes called “Healing Hill,” which I always have trouble saying, but I just got out. Healing Hill. So this location has, has a wonderful, rich history, and the Sunflower Foundation is coming up on 25 years. So before we dive into the work you’re doing now and what’s to come, can you tell us a little bit about this place that we’re sitting at and the Sunflower Foundation, some of your history?

Brandon Skidmore 3:06
Sure, well, welcome to the foundation, we’re thrilled to have you. So, this hill is, has a really fascinating history when you go back to its origins, which really in the early 1900s. So, we are what we would call the third chapter, of the health history of this particular property, which started really with an organization called Knights and Ladies of Security, which was an organization based in Topeka, a fraternal organization. And they formed to look at how they could provide insurance, life insurance, to everyday, working individuals, including women, which was really novel at that particular point in history. And through evolution of that organization, in the early 1900s, the organization merged with another organization here locally to become the Security Benefit Association. And with that merger came a host of new services, and that’s really a lot of the infrastructure that we still see on the Hill today, primarily with the clock tower, which was actually originally the hospital, built in the mid-1920s, and by 1930 that hospital had 250 beds, and a host of other amenities that individuals could take advantage of through the membership association. Individuals would would belong to this particular organization and come from all across the country to receive medical services here in Topeka. They would arrive by train and then be taken to the Hill, where the Hill at that time boasted everything from a hospital, to long-term care as we kind of know it today, an orphanage. It had a fully working dairy farm. It had a power plant, which is the building across from us, with the smokestack. And so it was really self-sufficient at that time. And that model continued on until, really after World War II, when, when things within the healthcare world really started to change. Insurance came on as we know it today, and by the 1950s that was, that membership model was no longer a viable model for that particular organization. Security Benefit evolved, certainly into the global company that we know today and our neighbor across the street, and this property then took on its second chapter, which was the Menninger Foundation’s purchase of this facility. And the work, the pioneering work that they’ve done in mental health and psychiatric care, really grew at that point, and really at its heyday, between the 1960s and 1990s. At that point, about 10% of the psychiatrists trained in the, in the country were actually educated here at the Menninger Foundation in the medical, Menninger Clinic. That chapter closed at the late 1990s, early 2000s when Menninger merged with Baylor School of Medicine and moved to Houston. And this property really set dormant for a couple of decades, until Sunflower Foundation had an opportunity to purchase some of this property. We, we now occupy about 13 acres of what was really the original 400 plus acres, of the original hospital and setting, from back in the early 1900s. So we are very cognizant of that history. We try and live up to the professionals who were really cutting edge in their particular areas of work in the early 1900s, and so we’re excited to be here. We’re excited to bring people to this campus and to kind of give it new life.

Elizabeth Burger 7:04
And the only thing I might add to that, too, is acknowledging that the land that this building is on, is the unceded territory of the Kaw Nation and Prairie Band Potawatomi Nation, which Prairie Band now still has, of course, their headquarters just up the road. And we as a foundation have really been honored and privileged over the last decade to have a close working relationship with the four tribes and their intertribal Health Coalition. So just want to acknowledge that as well.

Wyatt Beckman 7:40
Absolutely. Thanks for for adding that as well. And something I heard in, in some of the history, these ideas of the groups that were here were innovative, forward-thinking, and creative. And when I, when I look at the mission of the Sunflower Foundation. It says the mission is serving as a catalyst for improving the health of all Kansans. And I am thinking about that word, catalyst. So when you think about what the foundation does and what it hopes to be, here in this space, with that history, and looking towards the future, what do you mean when you say the foundation will serve as a catalyst?

Brandon Skidmore 8:29
So the, the foundation was, was was formed through a legal settlement between the State of Kansas and Blue Cross and Blue Shield of Kansas, in 2000. And, and through that settlement agreement, the foundation was formed, and that, that agreement set aside the dollars from that settlement to form the endowment that we operate from today. And so it was that inaugural board that was really tasked with figuring out what would the the focus of the foundation be. We already really knew what our service area was going to be, which is all 105 counties. And while the endowment that we work from is, is a very generous endowment, it’s still a small amount of money compared to the challenges that we’re asked to address through our mission. And so it was really the foresight of that inaugural board that said, if our mission is going to be to improve the health of Kansans, the dollars that we have to put in play might not be enough to actually achieve that. So, so what are some ways that, that we could be more focused and, and that’s really where the term catalyst came from. Maybe as a foundation, we can’t solve all of the challenges ourselves, but we can be a catalyst for getting that work going, bringing partners together. Spurring on the types of things, the innovation and best practice that collectively, we all kind of know about and work on, to put in place. So catalyst is a very important part of our mission. I have never really worked for an organization that is so dedicated and focused on its mission statement as Sunflower Foundation. And so I think, it’s to the credit of the founding board, and the founding CEO, who really recognized the value of how you word your, your mission statement, and that really goes back to how well then you can achieve it.

Elizabeth Burger 10:43
And if I may just add about being catalytic in terms of this space, I don’t know who said this. I think it might have been Brandon. But if we think about a building, a foundation as a building, and grants are the bricks, but you need mortar to hold those bricks together, and we think of this space, in a sense, in the fact that we can do convenings, and bring together people in a, in a beautiful setting that allows them to have sort of, unfettered innovation in their thoughts. That’s, that’s the mortar that holds those bricks together in a way that a group of randomly distributed, disparate grants perhaps can’t, if that makes sense.

Wyatt Beckman 11:26
That makes a lot of sense, and what a great image of how, can think about utilizing the monies that you have, and the investment that you have. Because I think, thinking that the, the shoes of a, a local champion, in a rural community, that it can be easy to look at any philanthropic organization that has sums of investment dollars to give out and go, couldn’t you just give? Couldn’t you just solve our problems? Just give us some bricks, and we’ll be happy. But you really sort of described that the thinking behind those, those grants that you give, is a lot more holistic, and you acknowledge that, you know, even though you have a, an amount, an endowment that gives you a lot of opportunities, it doesn’t address all the problems. So trying to be really intentional about what investments can be sparks and catalysts for future change. And I think that’s probably a perspective that can be easy to not see when you’re in a local community and just look up and go, “Well, there’s this really big organization that’s got lots of dollars.” So I appreciate the, the painting that picture of how you’re thinking about the work you’re doing.

Brandon Skidmore 12:51
Yeah, we always say that it’s easy to give away money. It’s really hard to invest money, when the goal is to elicit a social good. And so when we look at investing money, we’re really investing money in people, and in places, and in ideas. And that’s a lot different than just spending money. And when you’re doing work that way, it takes a lot of strategic thinking. It takes a lot of partnership building. It takes a lot of listening, to understand where the little bit of money that you might infuse into a situation can do the most good. And that’s really where we’re focused most of the time, with our energy, and with our thoughts, and how we’re planning, because we really look at the money that we put into the field as an investment, into the state, into the communities. That those are the folks that know how to take this money and actually do good things with it.

Wyatt Beckman 13:55
Absolutely and one of the, one of those areas of investment that was first on my radar when I started hearing about the Sunflower Foundation, was all the work that you all have done around trails, across the state. And, the la, the latest number I saw, supported over 200 trail projects. And when I look at the map of all those projects. There’s not very many counties that haven’t been been touched or reached by trails in the state. So when you think about in that context of, these are investments that can be catalytic, particularly for our rural communities. How? How have you seen investing in trails being something that, that catalyzes other good things for those communities where you’ve made those those grants?

Elizabeth Burger 14:46
So happy to answer that question in defensive of trails. And I do need to update the numbers. Not your fault at all. Probably need to update our map. It’s almost 230 trail projects in 85 counties. Many of which are rural, and for many of these counties, was the first public access trail they ever had. If I could take you back just a little bit to the thought process on the trails program, and you are right. Most people, if they’re in the trails world, they think Sunflower Trails, and that’s, that’s all we do. And sometimes I have to remind them, we’re not a Trail Foundation, we’re a Health Foundation. But that’s okay. That speaks to their passion. Back in 2005, if I can take you back almost 20 years, when the country was sort of coming to grips with this new epidemic of obesity, the CDC and World Health Organization had just, you know, labeled it as a true epidemic, and then also some thoughts around the built environment and how it contribute, facilitates or acts as a barrier to physical activity. Our board and founding CEO at the time were, were very, I think, prescient in their thinking of, well, if we want to encourage people to be more physically active, we need to help them have a place to do it. And but at the time, I love this because it was almost, it was almost naive in its thinking of, well, let’s just build trails to help do physical activity. That is still the case. Let me never diminish the role of trails in facilitating physical activity, but they had no idea of everything else trails would do, which I would say almost supersedes the physical activity component. That’s just a part. And so to your question about rural communities, time and time again, and we do have data to show this. What the trail does, it’s, it’s like a barn building, in a sense of, for a rural community that has very few public places or resources, and that’s just as you know, due to the low tax base, because of sparser population, they’re remote. They’re far away from resources. They just don’t have as much, a trail provides that important “third place” that we often hear about, important for civic discourse, and a resource in a place that might not have a gym, it might not have any swimming pool. If you’re in school, you can do sports, but outside of that, the trail provides this place. And to get that trail built often takes many sectors of the community, your rotary groups, your church groups, historical groups, art groups. The trail is a trail, but it also acts as, almost a empty vessel upon which a community can imprint its values, if that makes sense. This also happens in urban and metropolitan places. I don’t want to diminish that, but again, because resources can be so limited for our rural communities, that trail perhaps takes on a greater concentrated importance that we’ve seen for civic enhancement, social cohesion, and even economic potential and opportunity.

Wyatt Beckman 18:11
I had, that, those, that was wonderful background and description, and I even when I when I asked about it, I focused on, what does a trail do for a community once it’s built? But you rightly pointed to getting there. Getting the trail built brings a lot of people together as well. And there’s, there’s a lot of value in the conversations, the discourse, the planning, the, the thinking that a community does to even create a trail, and that’s part of the benefits, too. And absolutely, if you’re in a town of 1500 or so, that, the like relative magnitude felt impact of a brand new trail is going to be immense. And what a great example of, I think, the thought process of, how can we invest in things that lead to other good things?

Elizabeth Burger 19:05
Absolutely, that’s how we often see trails as catalytic. And if I can add just one more thing. We do, one of our favorite examples is a town, and I won’t name it, but it had struggled for many years to gain any traction. I know you’ve seen many towns like this. And, but, they are placed along the Flint Hills trails, and for kind of years, had not really taken up that opportunity, but then with the right people in the right position, they saw that and got some grant funding from Sunflower and many other sources, and they’ve now created a really, a culture of trails in that town. In a letter they wrote to us was “Sunflower, you may have thought you were just investing in a trail, but what you were really investing in were a town’s hopes and dreams.” So that,

Wyatt Beckman 19:56
Yeah, what a great nugget, and what a-

Elizabeth Burger 19:58
so and I realize a lot of people still think trails are kind of fluffy things. And you know what’s, how? What does it really do for your health? And that’s okay. We know that it is probably one of the most powerful tools we have for equitable community development that exists.

Wyatt Beckman 20:13
Absolutely, and what a, what a great note to receive. I can only imagine that that’s probably got to be one of the best things you can hear as a funder, trying to support this work. It, it is something that, that seems simple on the outside, but is, there’s a lot of complexity and nuance. And, another area that’s similar in that way, that kind of feels straightforward, but it’s, is really complex, and an area that that Kansas can do better at, kind of ironically, is nutrition and food access. We’re a state that grows crops. We have cattle. There’s, people are close to food in a lot of ways, and yet we know, that unfortunately, there are far too many of our fellow Kansans that struggle with food access, and nutritional security. And you all have come at that challenge in a number of ways. I’ve seen some recent work related to a new food bank out in western Kansas that you’ve been in, been a part of. But where I want to start is your Food is Medicine program. And, you know, I know the, a lot of people probably have heard the expression “an apple a day keeps the doctor away.” And I think that maybe there’s a little overlap with what Food is Medicine is, but I don’t think that’s entirely what it is. So tell me what is a Food is Medicine program? And for maybe those that have never heard of that, what does it look like? And specifically, in maybe a rural context, what’s a Food is Medicine program do?

Elizabeth Burger 21:49
Well, sure, I’m happy to take the first stab at that, and I’ll add a couple more quotes to that. Probably everyone’s heard the Hippocrates quote of “Let food be thy medicine, and let medicine be thy food.” So that’s kind of along “the apple a day.” But one I actually like better is by author and activist Wendell Berry, which is, “People are fed by a food industry, which pays no attention to health, and healed by a health industry, which pays no attention to food.” So I share this Wyatt, because, when we think about Food is Medicine, what we are doing is taking two historically, fragmented within themselves, and separate from themselves, systems, a food system, and a healthcare system. And Food is Medicine is trying to weave those two into an integrated model. Simple, right? And so I share that because it, it does go beyond just the food itself, and everything that goes around it. Now I want to stress that there’s a lot of different, sort of, working definitions and approaches to Food is Medicine. And the one that Sunflower has chosen to pursue, is we use The Aspen Institute, a national thought leader, as you probably know, in this work. And they work closely with HHS and NIH around this, and sort of, that working definition is Food is Medicine is an approach, where chronic dietary-related diseases, you use nutrition and food intuitively as a way to prevent, treat, and reverse those very diseases. Which again, seems very simplistic, but when we go back to those fragmented systems, is not. The integration into the medical model we feel is very important. Because right now, and I know Brandon can talk more about this, we live and work in a world in the United States where, sustainable payment for a lot of social services can only be found through our medical system. So that is one reason rooting Food is Medicine within the medical model is important, because we have seen in other states. There are mechanisms for payment beyond just grants, because grants will never pay for this. And the other thing I’ll say about, to your point about rural communities, we all hate our healthcare systems, but we love our providers. And this is never more true, and evidence shows in rural communities where there’s still a sense of trust in that provider. And so you could have all the PSAs in the world about eating healthy, but evidence will show when a provider is face-to-face with the patient, and talks to them about Food is Medicine, and using food as a nutritional intervention, that can have an impact far beyond that. And then the very last thing I’ll say, and then I’ll shut up and let Brandon add. About Food is Medicine in the rural community, you are so gosh darned right that this is hard, hard, hard in a rural community, which ironically, we have food deserts in farm country. Here in Kansas and in the Midwest. And I wish I could say, “oh, we’re figuring out all these magic ways around it.” We’re not, we’re slogging through, we’re figuring it out piece by piece, bit by bit. But what has been exciting about that slogging it out, is realizing, and I’m not bragging on Sunflower, I’m bragging on Kansas. There are very few places in the country right now trying to do Food is Medicine in a rural setting. And it is because of that, that The Aspen Institute has partnered with Sunflower to try to highlight this work. Again, not about Sunflower, it’s about our rural communities that are trying to figure this out. I don’t know if you have anything you want to add Brandon, or if I covered it all?

Brandon Skidmore 26:00
No, I think, I think you covered it all. I think you know that, that discussion around the two systems, that Elizabeth was alluding to, internally, we refer to our Food is Medicine program often as disruptive innovation, where we’re wanting to create innovation within existing systems. But sometimes to do that, you are disrupting how they were originally built. The charitable food system was really originally built to feed people. You have hungry people who need food. The disruptive piece about what we’re trying to do now with the charitable food system and Food is Medicine, and partnering with them, is to add that element of while feeding people, how do we keep them as healthy as possible? And then Elizabeth’s point around the healthcare sector, you know, so much, especially in today’s age, when we’re, when we’re dealing with especially chronic disease issues, you know, we’re reverting to yet another pharmaceutical. And pharmaceuticals have been game changers in the world of managing chronic disease, but there is a point where you get overload for an individual patient. Where adding another drug into the mix is sometimes as harmful, as just managing the ones that they’re already taking, with the side effects, and everything else that comes from that. So Food is Medicine is really kind of going back to what we’ve always known. Which is, healthy food is good for people, and is there a way to incorporate healthy foods into the management of chronic diseases and, or to the prevention of chronic conditions in the first place. So food plays, in our opinion, a very pivotal role in in the treatment of individuals in terms of a prevention standpoint, but also an ongoing management perspective of their particular conditions. And so, it’s taking things that we’ve always known. And really the trick is not to prove that healthy food is good for individuals. It’s really to figure out, how do you incorporate something like food, into these very sophisticated, developed systems? And doing it in a way that is accepting to the individuals that practice there, and to the patients who seek care there, but also in a sustainable way, from a reimbursement and payment perspective.

Wyatt Beckman 28:26
Absolutely, and I had never thought about it in that clear of a distinction. Of the, how healthcare system and food system, were not really built to work collaboratively, to say it one way. And so that’s, you described it as a slog in some ways. Of that probably is really hard work to try and find ways for those two systems to work together. And what I keep hearing in, in all of the comments that you’ve been sharing, even from the first, first, beginning parts of our conversation is this attention to, place and systems and context and how things work together. That there’s not, sort of, things work in isolation. Trails don’t exist in a vacuum. Food access doesn’t exist in a vacuum. And so I want to take us to another piece of that, that I, is part of your work, that also doesn’t exist in a vacuum, and that’s access to care. That’s another one of your strategic areas. And in framing that on your website, you talk about investing in innovative strategies that ensure more Kansans receive the right care, in the right place, and at the right time. And we know that access to care is really top of mind, unfortunately, in a lot of ways, in our rural communities, because they’ve seen decreasing access to care. So when the foundation thinks about that challenging, complex, nuanced issue, how are you all thinking about access to care and your role in the state for trying to chip away at that challenge?

Brandon Skidmore 30:11
Yeah, I think, you know, we fall back to where we started our conversation, which is the catalytic part of our mission. What is it that we can do to really light that spark? To think differently about the systems, or the programming, or work that happens. We try and focus a lot on looking at the existing infrastructure that we do have. There are certainly needs to expand our infrastructure. There’s no doubt about that. But I think, we, we try and start with, what is it that we actually have on the ground right now, when we’re thinking about expanding access, and then it becomes a question of, is there a way to use what we have on the ground differently, than maybe we’ve used it in the past? I think a great example of that is our Integrated Care program. We launched Integrated Care back in 2012 and Integrated Care really is about, incorporating behavioral health into a primary care space. But we’ve also looked at Integrated Care from the standpoint of integrating primary care into a mental behavioral health space as well. Really, it’s, back to your point, Wyatt, about delivering care for patients in the environment that they feel most comfortable. So if that means they feel most comfortable, for example, visiting their primary care physician, how do we develop models and incorporate ways of practicing that incorporate things like mental or behavioral health into a primary care setting? And that’s really what Integrated Care has focused on for the last 12 years. Is helping clinics or mental health centers make that that, that, that transition. Because it really is a whole practice transition when you’re talking about integration. So it’s really important that we’re, we’re looking at the infrastructure that we do have and figuring out, how do we use that backbone and maybe do something different? You know, we have 195, I think, rural health clinics in Kansas. That is an awful lot of opportunity to expand access to behavioral health. We’re really privileged to have a new partnership within the Sunflower Foundation with the Kansas Fights Addiction Grant Review Board. In that partnership, we are working to provide the grant infrastructure for the review board’s work to distribute the opioid settlement funds for Kansas. And that’s yet another opportunity for us to look at, you know, how do we use that existing infrastructure to do different and innovative work for the residents in those communities? And I think when you look at our smaller communities, there are those anchor points that can be really the impetus or locus for new and innovative changes. We have 100 local health departments across the state, what, 85 + critical access hospitals, 20+ mental health centers, 20+ community health centers. So the anchor points within the healthcare system are plenty in some cases. We just need to figure out, are there ways to manipulate them and use them in different ways than we’ve thought? And of course, there are those locations that do need, those anchor points that don’t have them right now, and that will always be front, front of mind. But I think for us, looking at access to care is thinking, first and foremost, how do we use our existing infrastructure? Maybe in a different way?

Elizabeth Burger 33:48
I’ll just really quickly add, and that’s where being a catalyst comes in, where it’s not necessarily creating something new, like, oh, the next shiny ball, and we have to, we have to own it. It’s ours. It’s to Brandon’s point, if the existing infrastructure is there, the catalytic component as we as philanthropy have the luxury to take some financial risk, right? Whereas a medical clinic does not, and if, by taking that risk, we can start to shift and move the system, until systems of payment eventually start to catch up. That’s where we feel like we can really play a catalytic role.

Wyatt Beckman 34:31
Yeah, the it, I think it’s really interesting that we’re sitting here or in a, in a foundation, I’m talking to two people that think about how to fill gaps, to distribute resources, to help address challenges, and both quick to point out there are already strengths and resources in these communities, and you’re almost starting from a place of, “what’s good here that we can build upon, or maybe activate in a different way, or innovate around?” And I think that’s a really good balance to the conversation that can sometimes be had, especially in rural communities, especially around access to care. Which is one of loss, quite frankly, in a word, and starting from the perspective of yes, there are challenges, absolutely yes, there are gaps, absolutely and, and there are anchor points. There are people here doing good things. There are strengths we can build upon, I think, long-term, that probably yields more sustainable, more context-appropriate solutions and innovations than saying there’s nothing good here. Let’s just import a bunch of resources.

Elizabeth Burger 35:51
That’s so well said, I might have to quote you on that at some point, Wyatt.

Wyatt Beckman 35:56
And it, it also connects to another thing that I’m, that I, is top of mind for me, in part because we’re sitting here and I can see the room where it took place, but just last month, I was here with you all as part of an event you were hosting, focused on building nonprofit capacity. So it had a bunch of nonprofits from across the state here, learning about being a nonprofit and how to be more effective, more sustainable, write grants, all sorts of great capacity-building information. We have this beautiful building, as I mentioned. We’ve got grants that you’re distributing as part of that, and you have these events that you’re bringing people together, that’s a lot of investments in nonprofit organizations. Why is Sunflower Foundation investing so much literal time and money into other nonprofit organizations across the state? What’s the, what’s the goal there? What’s the thinking around all of the nonprofit investment?

Brandon Skidmore 37:04
Well, I can start and then Elizabeth can jump in, definitely. You know, it really goes back to the data. You know, we know that 80+ percent of what drives health happens outside of the healthcare system. So that means it’s happening in community. It’s happening where people work, where they play, where they worship, in their own neighborhoods. And most of the work happening in those places are done by community-based organizations. So we’re really cognizant of the fact that if we’re going to move the needle on any of our big challenges, it’s going to require an eclectic mix of organizations, both on the healthcare side of the equation, but also on the community side of the equation. As Elizabeth talked about earlier, the challenge that we have in this country is that while we have a very robust, established reimbursement mechanism for healthcare, we don’t have that on the community side. So the organizations that we lean on, to make those changes within the community, to drive that, that health improvement work. They don’t really have a reimbursement mechanism that they can tap into. They’re tapping into fundraising. They’re tapping into grant writing. And so much of what drives a community-based organization, is really their dedication to the to the work and to the mission, which is very different than a for-profit organization. A for-profit organization spends a lot of time thinking about their business infrastructure, their bottom line, how their organization is structured. That’s just good business, but a lot of times nonprofits, they don’t have the space to do that, because they are, they are so focused on helping individuals, moving the needle in their community to make things better, that a lot of times what ends up suffering is their own infrastructure. So we know that if we are going to get ahead in the race, towards health improvement, that those, the health of those organizations is paramount. We know that we don’t have enough money to invest in that space. So if we’re wanting to entice other investors to come into Kansas, or those that are in Kansas, then those investors are looking for a good product, and they need that infrastructure to invest in. And so, part of our goal is to help nonprofits become the best version of themselves possible. And a lot of times when we ask them, what do you need on that side of the equation? The things that we focused on in the event that you’re referencing are the things that they, that they talked about. Their business infrastructure, their communication channels, their board development, all of the things that make sense, but a lot of times, they don’t have the time, and bandwidth, or the capacity to focus on.

Elizabeth Burger 40:20
The only thing I’ll add to that is, sort of taking a different view here. Could, you know, plus one to everything Brandon said. But you know, I’ve heard people say, “Well, why? Why invest in all these little nonprofits when probably one policy change could solve it all?” And to me, it’s not an either/or, it’s an and/both. Certainly policy and advocacy is always needed to fix some of our deep systemic issues. But we look at systems change like air traffic controllers, where it’s happening at multiple levels. And so yes, you may have your policy change up here, but that’s really only going to emanate from a lot of activity happening down here, with your community based organizations and nonprofits. And let’s say you fund 100 nonprofits, and out of one of them, that $10,000 to the right nonprofit at the right time, makes an impact and makes that change. We figure that is a good philanthropic risk to take. But I will say, we have a better than 99 to one odd chance.

Wyatt Beckman 41:35
The, and you’ve mentioned it a couple of times, this idea of risk, and I think that I, that’s a piece of this work that I think probably, I know I don’t think about as much, but probably is something that folks in the community might not think about. What it’s like to do the work of a philanthropy, and maybe the unique position that you all are, you all are in where, similar to KHI, we’re an organization that serves across the state, and there are times where our position being connected to the community, but at us being able to zoom out and look at statewide has some advantages. You all have that as well. But the piece of risk where, for an individual hospital, individual nonprofit, there are innovations, there are experiments that they wouldn’t be able to take on, because for them, the risk is not, the pro/con doesn’t come out. But for you all, as a philanthropy, you can take that risk with the upside that if we achieve our goal of sparking something great, then it will absolutely have an impact that is well worth the risk. Tell me a little bit more about how you think about risk, I just want to hear, pulling on that idea of being, being able to lean into risk in different ways in some of your work.

Elizabeth Burger 43:08
I’m going to quote one of Brandon and I’s favorite quote, which is, we often learn the most from the grants that don’t work out well. Or don’t work out the way we expected. I think we truly embrace the idea of failing forward. That being said, I mean, there is a risk to, we want to be able to, these are, these dollars are not our dollars. They belong to the people of Kansas, in a sense. And so you want to be able to show an ROI of social good and impact for the people, for our Board of Trustees to whom we report. But there, so there’s that risk, but it is, I think we truly believe that with the privilege of investing funds, you have to be willing to take that risk, and you have to be willing to fail forward, and you have to be willing to be divorced from your personal or foundation ego, to that grant, and say that didn’t work. What can we learn? How will this inform our grant-making going forward? That’s, those are my thoughts.

Brandon Skidmore 44:21
Yeah, I would agree. I think also sometimes it’s hard to do innovation with tax dollars. And so when you think about state and local grants, or state and federal grants, especially, a lot of those grants are derived from tax dollars. So what we expect a lot of times out of those types of programs are evidence-based programming. These are the things that the research and the literature say we should be doing. So let’s make sure those things are being done in the various sectors and areas that these grants can support. And that’s phenomenal work to be doing, and we need to be doing more of that. Sometimes, though, it’s hard to take that same pot of money and say, well, let’s innovate with it. Let’s go beyond what the literature base says. Let’s let’s push the envelope, because that’s really how we get into these new frontiers. That’s how we learn, and that’s how ultimately, the evidence base grows. So to fund innovation, really requires a lot more risk, because you’re going out onto the plank without knowing a lot of what’s under you. And so if we want organizations to be doing that kind of work, then we recognize, our Board recognizes, and has been very pivotal in this work, and is supporting us to do this, in that, we have to absorb that for them. They can’t incur those losses with with their own reimburse dollars, or their, or their federal grant dollars. And so, to Elizabeth’s point, we’re learning through that investment. We’re learning through Food is Medicine. We learned, as Elizabeth said, through trails. Through our initial thought, that trails was going to be around physical activity. And what we learned through that innovation was that, wow, it’s as much or more about economic incentives and development. So I think when we think about innovation, sometimes in philanthropy, it’s immediately connected to risk, and who’s going to absorb it? Are we going to push the risk on to the grantee, or are we going to assume that risk as the funder?

Wyatt Beckman 46:36
And you mentioned as one of the examples of that, the Food is Medicine program, and I was making that connection in my my head as well. The, one of the ways that you can extend, in a lot of cases is to, try to do work in a setting where there isn’t as much of an evidence base. And a lot of cases, that’s rural communities, where we have a program, or an idea that came out of a urban place that we’re not sure if it works, and someone or some group has to be willing to, to take on some risk, to hold that tension of where we have confidence that this can be a good program based on the evidence and based on our knowledge, but we don’t have certainty, but we can have enough confidence to move forward and try together, and learn as you go. And I think that’s a great example. I, I want to,

Elizabeth Burger 47:34
I’m sorry,

Wyatt Beckman 47:35
yes-

Elizabeth Burger 47:35
I just, I have, I feel like I have to say, less than 7% of philanthropic dollars nationwide go, as you know this, to rural communities, and I think it is exactly to what you said. All credit to our great research centers and, you know, and academia centers in urban settings to do the magnificent research they do. But then when it comes to trying to find the feasibility and operationalize that in rural settings. Sometimes tax dollars can’t do that because of the innovation of which you are both speaking. We also see this as an equity issue. There’s all sorts of lens at which to look at equity, and certainly location and geography is one of them, and that’s another reason we feel willing to take the risk on anything, but especially things in rural communities, like Food is Medicine.

Brandon Skidmore 48:31
And I think to add on that, because I think it’s also important that innovation doesn’t always have to be about the strategy. Innovation can really be about where the strategy takes place. So for example, integrated care is a concept that’s now been around 25 or 30 years. It’s not so much about integrated care being innovative. It’s about, can you do integrated care in a small, rural community? And that’s where the innovation in some of these strategies takes place. It’s, can it be done here? Can it be done in the type of communities that we have? Which can be very different than the type of communities that are traditionally funded on the east and west coast. And when we talk to our partners in the federal government, that’s a lot, those are things that we stress to them is that, you know, when you look at who you’re funding, let’s not, let’s not make everybody have to touch an ocean. Let’s make sure that those federal dollars can touch down in the Midwest. And what do you need from our organizations to make them more competitive? And that helps us then partner with these organizations to say, here are some things that we can help build together, so that these dollars can be pulled in and put to use in our small communities, and in a predominantly rural agriculture state like Kansas.

Wyatt Beckman 49:53
We’ve talked a lot about some of the work that you all have been doing. We started talking about the history of this place and some of the history of of the foundation. I want to, I want to end with sort of looking, looking forward. And you’re, the Foundation’s coming up on 25 years, but you both are in new roles. When you think about this coming year, when you think about your new positions, and think about the Sunflower Foundation, what are some of the things you’re feeling? And what are some of the hopes and the goals that you’re looking towards as you in some ways, start, start a latest, newest chapter of the Sunflower Foundation?

Elizabeth Burger 50:49
$25,000 question. I’ll take a first step so that Brandon can have the last word. I can genuinely say I’m more excited than I have ever been. One of the things that really excites me is, and it’s, you’ve probably heard the term, you know, nationally, trust-based philanthropy. Which is actually something to Sunflower’s previous Boards and founding CEO, we have always practiced trust-based philanthropy. But I feel like now we, they’re sort of building that evidence base that, hey, listening to your grantees, actually works with a better product. There’s now a maybe, new legitimacy to it, which didn’t exist before, which I think just gives us even more confidence, motivation, and encouragement to continue to practice trust-based philanthropy, if that makes sense, and be willing to take these risks and fail forward. The other thing I’ll add about what is very exciting is, not only integrating our own portfolios more and working, you making sure that each program area is touching and intersecting with another, and not disparate program areas. And also our relate our growing relationships with other Kansas funders, whether they be foundations, state, corporate, and I think there’s a growing acknowledgement among all types of funders that if we want nonprofits and communities to better collaborate together, we need to do the same. And I’m really happy to say that that is happening, and it’s a great place to be.

Brandon Skidmore 52:45
Yeah, I agree with all of Elizabeth’s points. I think that, you know, it’s, it’s a really exciting time for us to think about, you know, what the future looks like. But we also, you know, we don’t want to think too long. There is a need to be reactive, but there’s also a need to kind of like, get in and think about what needs to be done for the future, but get to work doing it. And I think that the infrastructure that we have here now really positions us to be a convener in that space. We talked about nonprofits and bringing them together. I think that this, this facility lends itself to doing that kind of work. It’s a place that people feel good coming. It’s a place that allows you to kind of unplug a little bit and really think about what it is that we’re trying to achieve as an organization. How are we connecting to our mission? What do we need to do to be the best version of our organization that we want to be? I think we’re really you know, systems change gets tossed around in a lot of conversations, and it’s been a term that has been banted around for decades now, but I think at the heart of it, we really are talking about systems change. We want to dig into that a little deeper and figure out, like, what does that mean for us? What, what can we do to support systems change? Going back to you know, your point earlier, Wyatt, about looking at the infrastructure that we do have and figuring out, how do we optimize that? If we never got any, another penny into Kansas, is our infrastructure set up, to optimize everything that it can be and that it can do? And if it’s not, then that’s work that we can be doing now. That’s not work that we have to wait on permission from Topeka, or D.C. to be doing. That’s work that we can dig into right now. Are we optimizing the infrastructure that we have in place in our communities, large or small, to do the best that it can do? And I think that those are the kind of conversations that we want to spark, that we want to catalyze. And then I think sometimes by looking at that question, are we making the most use of what we have? It really can lead you to then, what are our true gaps? A lot of times, when we hear from, if I, if I get a call from a county commissioner, a lot of times, the conversation always turns back to it seems like this, this, this fear of duplication. That somehow we have this limited pot of resources that we can spend, and there’s this fear that we’re spending on things that we’re duplicating. And I think better understanding our systems maybe would shine some light of clarity on that question, which is, you know what exactly is going on? Elizabeth mentioned this earlier. We talk a lot about who’s the air traffic control tower of your county, or your community? Who’s sitting up in the tower, and watching all of the moving parts, and making sure that they don’t bump into one another? And seeing the gaps, and then advocating for how we need to truly fill those gaps. When we don’t have the air traffic control tower, and we don’t have those individuals whose job it is to look at those things, then we do run the risk of duplication. We do run the risk of not optimizing the infrastructure that we do have. And I think that that, in some ways, then provides a lot of support to the 1000s of folks across the state who pour every ounce of their soul into the work that they do. The folks that when you come into their community, they say, “I wish it was going a little better, but I don’t have another hour to devote to this, because I’m already putting all of myself into it.” When you hear those conversations, then it really motivates you to figure out like so, so what can we do? If, if, if this structure isn’t working, how can we make it work better? And those, I think, are the questions that we want to explore, and we can’t explore those questions by ourselves. And I think, you know, as Elizabeth said, we are really vested now in connecting with the community-based organizations, our funding partners, all of these players, the state government, local government, because there is a lot going on. Part of it is figuring out how we harness all of that, how we connect it, how we build out a complete puzzle when you don’t really know what the picture is that you’re supposed to be building in the first place. And I think that’s sometimes the trick is like, what’s the picture that we’re trying to develop here? And then how do we fit the pieces of the puzzle together in a way that gets us there?

Wyatt Beckman 57:55
Well, it’s, it’s complicated work. It’s challenging work at times, I imagine, and really meaningful work, and I’ve really appreciated getting to hear about it. You both talked about learning as individuals and as a, as a organization. I’ve certainly learned in our time together and in this conversation. And I really look forward to what that future brings for Sunflower Foundation, and more importantly, what it means for our state as we all try to continue to work together to make Kansas an even better place to call home. And thanks again for having having me out here, and taking time out to talk with us about your work. Really appreciate it.

Elizabeth Burger 58:44
Thank you so much.

Brandon Skidmore 58:45
Thank you.

Voice over 58:47
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Transcribed by https://otter.ai