The U.S. health care system is large and complex, with multiple stakeholders—patients and families, employers, providers, payers, government—each holding a vested interest in how dollars and resources are allocated, and each having a pivotal role to play in implementing changes to transform care delivery. However, in many markets these entities are competitors and are not accustomed to working together toward collective goals. In fact, considerable distrust may exist between stakeholder groups. And some groups, such as consumers, are traditionally excluded from discussions of health care quality improvement.
In order to create transformative change in how health care is delivered and paid for, these stakeholders need to coordinate their efforts and work toward collective goals, as no single organization can create large-scale, lasting change alone. Further, local market dynamics have a huge impact on how these stakeholders interact and their willingness to partner and share resources. For this reason, Aligning Forces for Quality (AF4Q) was designed around regional multi-stakeholder Alliances, charged with building local partnerships and aligning all those who give care, get care, and pay for care around a common agenda. Alignment of stakeholders maximizes the impact of individual system efforts in payment and delivery reform, and is necessary to achieve population-level improvements to health care costs, quality, and outcomes.
 See http://www.fsg.org/OurApproach/WhatIsCollectiveImpact.aspx and Kania, J. and Kramer, M. (2011). Collective Impact. Stanford Social Innovation Review, Winter 2011. Accessed at http://www.ssireview.org/articles/entry/collective_impact