The Aligning Forces for Quality initiative: background and evolution from 2005 to 2015

Area of Science:

• Healthcare Quality Improvement
• Community-Based Interventions
• Health Systems Research

Background:

• The Robert Wood Johnson Foundation's (RWJF) Aligning Forces for Quality (AF4Q) program was a significant, privately funded initiative.
• It supported 16 multi-stakeholder alliances across the U.S. to improve healthcare quality.
• The program provided funding and technical assistance (TA) to these alliances.

Purpose of the Study:

• To describe the AF4Q initiative's theory of change.
• To outline the program's evolution and key activities.
• To analyze the implementation of quality improvement strategies by alliances.

Main Methods:

• A descriptive overview of a multi-site, community-based quality improvement initiative.
• Information was synthesized from program documents, meetings, observations, and interviews.
• Key stakeholders, including RWJF staff, TA providers, and alliance members, were consulted.

Main Results:

• The AF4Q program evolved dynamically, based on the principle that aligned, multi-stakeholder efforts outperform siloed actions.
• Alliances focused on five core areas: quality measurement/reporting, consumer engagement, care delivery improvement, healthcare equity, and payment reform integration.
• Participating alliances showed varying degrees of development in these programmatic areas.

Conclusions:

• The AF4Q initiative was an ambitious program targeting multiple healthcare system leverage points.
• Alliances received consistent expectations, funding, and substantial TA.
• Significant variation existed in alliance approaches due to differences in composition, market structure, and history.