We’ve been talking about engaging the next generation of donors for years and yet, for many foundations, the work still feels hard to move forward.   

Healthcare philanthropy has long been built on strong, relationship‑driven major gift work, and that foundation remains essential. Those relationships sustain organizations and will continue to do so for years to come. At the same time, many leaders are beginning to acknowledge something else: the way we’ve been doing things, on their own, may not be enough to support what’s ahead. 

Most agree that the future of giving will look different from the past. Still, for many organizations, this work is harder to move forward than expected. Not because there’s disagreement about its importance, but because it’s difficult to place within the day‑to‑day realities of the foundation. 

• Where does this work live?
• Who is responsible for it?
• What does progress look like before a gift is made?
• How long are we willing to invest before expecting visible results?

These questions don’t have easy answers, and that’s exactly why they’re so often set aside. But avoiding them has consequences. Awareness isn’t the issue; structure is.  

The Work Exists Everywhere — and Nowhere 

One of the quieter challenges in this work is that next‑generation engagement touches nearly every part of a foundation, communications, marketing, events, stewardship, data, and frontline fundraising , yet, it rarely has a home where accountability truly sits.  

As a result, responsibility often remains implied rather than defined. Pieces move forward in different areas, but no one person is charged with moving the work forward. When priorities shift or capacity gets thin, this work is often the first to pause. 

Over time, that lack of ownership has a cost. The work doesn’t disappear, but it restarts more often than it should. Relationships begin, stall, and begin again. Momentum feels short‑lived, even when there is genuine interest and effort across the organization. And for donors experiencing those touchpoints, an organization can feel less intentional than it is.  

Early Progress Doesn’t Look Like Revenue 

Another challenge many teams face is the pressure to justify early work before it’s ready to be measured financially. Relationship‑building rarely follows neat timelines. Early signs of progress tend to be subtle: people returning, asking better questions, spending more time learning, staying engaged without being asked to give. These signals matter, but they don’t always register as “results” in traditional ways. When they aren’t recognized as meaningful, teams can feel stuck and hesitant to invest further. 

At the same time, this is often when some of the most important decisions are quietly being made. Younger donors are forming impressions about what healthcare organizations feel like through early interactions, consistency, and whether they feel invited to understand how care is delivered and where their involvement fits in. For many, the first questions aren’t about giving at all. They are about trust, understanding, and belonging. Those impressions develop gradually, whether organizations are paying attention to them or not.  

By the time giving enters the picture, much of that groundwork has already been laid. 

A Different Way to Think About What Comes Next 

What this moment invites is a closer look at how this work is taking shape inside our organizations.  

Healthcare philanthropy has always been rooted in relationships, and engaging the next generation of donors is simply an extension of the work foundations already know well. When someone stays with the work and pays attention to how trust and understanding form long before a gift is made, it can shape future decisions and can help foundations approach this work with greater intention and confidence. Simply noticing that shift and making room for it can change how this work moves forward.