AF4Q Background

Aligning Forces for Quality (AF4Q) was the Robert Wood Johnson Foundation’s (RWJF) core initiative in its longstanding commitment to improving the quality of health care Americans receive. With this initiative, 16 grantees across the country worked through multi-stakeholder Alliances to lift the overall quality and value of health care, reduce racial and ethnic disparities in care, and provide models for national reform. These Alliances—each a voluntary collaboration among local hospitals, provider organizations, health plans, employers, and consumers— engaged in a wide range of activities, including producing public reports of comparative performance information, implementing quality improvement strategies, and experimenting with different approaches to paying for care that support these innovations. The program began in 2007, though many of the grantees were actively working in this space prior to AF4Q, and continue to do so following the program’s conclusion in May, 2015.

Each of the 16 Alliances was led by a neutral, not-for-profit organization. The structure, governance, and authority of each organization varied by Alliance. Common across all Alliances, however, was a commitment to bring together stakeholders who give care, get care, and pay for care to implement local reforms that will result in higher-quality, lower-cost health care.

Cross-sector collaborative efforts can vary in their formality and structure. Within AF4Q, terms of stakeholders were defined in the following constituent models:

• Stakeholder: Anyone who can impact, or is impacted by, a deliberate, coordinated effort aimed at solving social problems.
• Partnership: Organization-to-organization or individual-to-individual joint effort around a shared purpose, ranging from informal to formal.
• Collaborative: Multiple stakeholders who come together with shared ownership, accountability, and decision-making authority to reach a shared goal broader than their own organizational efforts. Collective impact is one form of collaboration.
• Alliance: In the context of this document, the term Alliance refers to the 16 specific AF4Q member communities working together in an effort to lift the overall quality of health care, reduce racial and ethnic disparities, and provide models for national reform.