Deploying Technical Assistance for Success
Aligning Forces for Quality (AF4Q) was a multi-year, multi-stakeholder effort funded by the Robert Wood Johnson Foundation (RWJF) to improve the quality and lower the cost of care in 16 diverse communities across the country. Collectively, these communities represented 37 million people and 31,000 primary care physicians. There were eight funding opportunities, with approximately $50 million in funding awarded to grantees. The breadth and depth of the program necessitated substantial investment in technical assistance (TA) to support the communities in achieving their goals. The AF4Q TA program evolved substantially over the almost nine years the program was active.
Providing technical assistance to multi-stakeholder collaborative efforts is a powerful lever that funders can maximize to drive the pace of change and attain programmatic goals; however, as learned during AF4Q, technical assistance is not a silver bullet nor a quick fix when the sought after goal is complex and adaptive. Charged with implementing and managing the project, the AF4Q National Program Office (NPO) learned a number of TA-related lessons:
Clearly defining the program expectations, the operational implications, and the performance thresholds that denote success are important when structuring TA. Without clear definitions, the relevance and usefulness of the TA is difficult to measure or assess. A unified vision with common definitions allowed the NPO to differentiate roles and responsibilities, e.g., which TA providers were responsible for working with communities in different capacities and toward different goals.
Political will, knowledge, and skills
The type of TA needed by multi-stakeholder collaboratives can relate to issues around: 1) building political will; 2) obtaining knowledge; or 3) learning skills. The AF4Q NPO found that assessing the root causes of the challenges faced by the participating Alliances was important when implementing TA. The Alliances were key in determining the type of TA that would be the most helpful, but the NPO played a critical role in assessing if that TA would be an appropriate response to a challenge that the Alliance was facing. For example, knowledge-based TA may not help the Alliance meet program expectations if political will is the primary issue. Political will, meaning the desire (or not) of a major stakeholder to implement a change (or not), could possibly derail an Alliances’ efforts. By assessing the political will, knowledge, and skills of a grantee, NPOs and Foundations can seek the right balance and composition of TA to achieve programmatic goals.