Decades of focus: grant making at the John A. Hartford Foundation.

Foundation grant making can play an important role in advancing the U.S. health agenda. However, given the scale of the health care system and the intractability of many of its problems, philanthropy must be guided by strategic thinking in pursuit of realistically achievable goals. This essay describes the grant-making process at one nationally oriented foundation as an example of how these challenges might be approached. We believe that greater clarity about this process can improve collaboration among foundations, help the public appreciate foundations' work, facilitate partnerships with grantees, and, most importantly, yield sustainable improvement in the problem being addressed.