By Natalie Johnson
Many nonprofit leaders draw a strict boundary between community-level support and major gift philanthropy. For Bettina Alonso, separating the two overlooks the real mechanics of how meaningful donor relationships are built over time. She views grassroots initiatives and transformational gifts not as competing priorities, but as interconnected stages of a single donor journey. By tracking engagement early and focusing on authentic connections, organizations can turn everyday support into lasting institutional partnerships.
Reading the Signals in Community Giving
At healthcare organizations, initial contributions often begin with simple personal experiences rather than large financial commitments. Bettina notes that someone might give a modest sum because a nurse provided exceptional care to a family member or because they attended a neighborhood event. “I actually don’t think there should be a hard line between the two,” Bettina explains. “In healthcare, someone may start by giving $100 because a nurse cared for their mother or by supporting a community event. The amount matters less initially than the motivation behind the gift.”
Rather than viewing community gifts solely as immediate operational revenue, development leaders should treat them as vital institutional intelligence. Tracking repeated contributions, event attendance, and specific connections to physicians helps teams spot where genuine interest is taking root. “A major gift pipeline is not created by suddenly asking someone for a much larger gift or check,” Bettina says. “It is created by progressively deepening the connection to the mission. And you need a staff that is willing to meet in person, talk on the phone, and build relationships in person or face-to-face.”
Protecting Trust Through Relationship Continuity
As donors increase their contributions over time, the biggest operational risk is treating them differently simply because their financial capacity has grown. Donors quickly notice when institutional attention feels transactional or tied strictly to dollar figures. “A donor who gave $250 should receive the same authenticity and respect when they’re considering $250,000,” Bettina emphasizes. “That means listening before asking, being transparent about institutional priorities, and never making the donor feel that the early gifts were somehow less meaningful.”
To maintain that trust, Bettina often pushes back against the standard industry practice of moving donors to entirely new gift officers once they cross specific giving thresholds. Many institutions automatically reassign individuals when a contribution jumps from $1,000 to $5,000, which can sever the very personal bond that inspired the gift in the first place. “I like to take a very close look at why they gave $5,000, because sometimes the reason they gave $5,000 is that personal investment by my staff who either called, connected, or did something for them,” Bettina points out. Keeping that continuity intact ensures the donor feels valued as a partner rather than an account number.
Cultivating a Clinical Culture of Gratitude
In healthcare philanthropy, clinical teams play an essential role in bridging the gap between care delivery and philanthropic giving. While medical professionals often feel uneasy asking for donations directly, development teams can guide them to view giving as an extension of patient gratitude. Bettina regularly leads departmental workshops to demystify fundraising and role-play constructive donor conversations with healthcare staff. “The goal is to build a culture where clinicians understand that philanthropy can be an extension of gratitude while maintaining very clear ethical and privacy boundaries,” Bettina shares.
Importantly, this cultural shift extends well beyond senior physicians to include nurses, technicians, and front desk staff who interact with patients daily. Patients often ask support staff how to express their appreciation, creating a direct opportunity to steer gratitude toward departmental initiatives. “My experience is that, very often, the donor will not ask the doctor, ‘How can I show my gratitude?’ They will ask the front desk associate,” Bettina explains. “So there’s a change in culture there to say, ‘We have a website that supports the vision and mission of Dr. So-and-so, and that will help the whole department to advance research, services to underserved communities, or a specific project.’”
Building a Resilient, Diversified Ecosystem
To ensure fundraising programs remain stable in changing economic conditions, institutional leaders must balance broad participation with targeted major gifts. Bettina highlights three core operational priorities for executive teams: data, relationships, and diversification. “We need better data to understand donor behavior and identify potential earlier,” Bettina states. “We need stronger relationships between development, clinical leadership, and the community. And we cannot become overly dependent on a handful of major donors or one fundraising channel.”
This balanced philosophy proved highly effective during Bettina’s tenure at Oceana when the organization was an early-stage company navigating a crowded field. Instead of focusing solely on seven-figure donors, the organization launched a multi-channel campaign to engage 1,000 contributors at the $1,000 level. “We created a whole seven-step campaign, which was about initiating emails, sending postcards, leaving voicemails, and sending texts,” Bettina recalls. “And it took us about three years, but I’m happy to report that we were successful. We reached 1,000 donors who gave $1,000 each.”
By creating pathways for donors at every level to participate meaningfully, organizations build a broader base of long-term support. Grassroots programs and major gift strategies work best when they function as unified elements of a shared institutional vision. “Healthcare fundraising is ultimately about building a broad community of people who believe in the institution and then giving some of those people the opportunity to make an extraordinary impact,” Bettina concludes. “If we build that ecosystem well, grassroots fundraising and major gifts don’t compete with each other; they strengthen each other.”
Follow Bettina Alonso on LinkedIn for more insights on healthcare philanthropy, donor engagement, and building a culture of gratitude in healthcare fundraising.
