National Program Office Infrastructure
The NPO consisted of approximately 20 staff. Fifty percent of the annual budget was allocated for technical assistance via 15-20 external contractors. From an organizational standpoint, the NPO was composed of three teams: regional support, administrative, and communications.
Investment in Staff
One line item that was particularly key was for professional development. NPO staff has the opportunity to advance their professional skills through meeting attendance, seminars, and a variety of other venues. This investment in professional development greatly contributed to the NPO’s organizational capacity by helping attract and retain staff, expanding skill sets, gaining new expertise in substantive areas, and improving the function, processes, and system needed to implement the Foundation’s vision.
Regional Support Team
The NPO realized that in order to successfully carry out the Foundation’s vision, it needed to develop a comprehensive understanding of each of the 16 markets in which the Alliances operated. The multi-stakeholder aspect of AF4Q, a cornerstone of the program, necessitated a thorough grasp of existing community relationships and thoughtful strategies for engaging many parties around common goals. In addition to serving as colleagues and coaches, the NPO had to simultaneously ensure that Alliances were advancing in their efforts while informing the Foundation of progress and challenges. This was the role of the regional support team.
The regional support team worked with the 16 AF4Q Alliances both individually and collectively, with NPO staff assigned to individual Alliances. Their primary responsibilities were:
- Assessing and monitoring progress of the Alliances in meeting the AF4Q expectations
- Translating that knowledge to identify needed technical assistance
- Working closely with TA providers to develop a shared understanding of the Alliances
- Guiding TA priorities, and helping develop TA products and deliverables
- Capturing highlights and stories from the Alliances’ experiences identifying accomplishments through both quantifiable change and anecdotes that illustrated the work of the Alliances.
Information-gathering and sharing among the Alliances and regional support was accomplished through site visits, semi-annual National Meetings, tri-annual Alliance reports, periodic phone conversations, and ongoing email exchanges. Regional support’s understanding of the individual Alliances was one way by which the NPO facilitated shared learning, e.g., by referring Alliances to their peers.
The high-touch nature of the regional support team was critical in understanding Alliance environments and regional support played a role in the NPO’s revamp of the TA process over the course of AF4Q. The evolution of TA resulted in a more demand-driven, holistic approach. TA providers collaborated and communicated with one another to better support work in Alliances and across the program.
Regional support monitored progress of the Alliances in meeting the dashboard measures, quality/equality indicators, and quality and cost goals. More information about these metrics can found in the “Measuring Progress: Metrics” section below. As part of this role, regional support provided periodic updates to the Foundation and TA providers. Updates included individualized reports on the status of each Alliance and a summary of activities and challenges in each of the major program areas (consumer engagement, quality improvement, performance measurement, public reporting, payment reform, cost, sustainability, and equity).
Over time, the NPO’s focus on content expanded to include leadership development and capacity building. At the beginning of the program, regional support committed substantial time and resources to building Alliances’ content portfolios, focusing on the main pillars of AF4Q (i.e. quality improvement, consumer engagement, measurement, and reporting). The goals of AF4Q drove the general direction that each site took toward increasing the quality and lowering the cost of care in their communities. During the second half of the program, the NPO increasingly focused resources and support to help bolster Alliances’ organizational capacity. The NPO recognized the need to build Alliance staff capacity for leadership and organizational sustainability given the grant timeline.
The Administrative team handled financing, contracts, office management, and human resources, among other responsibilities. Most of these tasks were not unique to the AF4Q NPO and the day-to-day operations were typical of many offices.
One area distinct from standard office operations was the NPO’s comprehensive approach to handling contract flow. A variety of NPO staff were involved in the contracting process for several reasons. First, the NPO managed a substantial number of contracts. Second, there was a requirement to re-contract every year because the Foundation contract for the NPO was an annual lifecycle. There were two main aspects of contracting: programmatic and financial. Programmatic considerations were closely tied to the work underway in the Alliances, thus required regional support’s input and involvement in both establishing new contracts and overseeing existing ones. Regional support staff participated in the contracting process by reviewing scopes of work for their assigned communities and their content areas. The financial element of the contracting process required coordination between regional support and the financial staff for obtaining approval. The process for joint decision-making was a component of the strategic decisions around the NPO’s team structure made at the beginning of the program.
The communications team directed and managed both internal and external communications and had responsibility for meeting planning, website and social media management, publications, and writing. Although staff typically worked primarily in one of these areas, there was frequent overlap in job responsibilities, extending as well to the regional support and administrative teams. Detailed information about the modes and methods of communication can be found in the “Communication Mechanisms” section below.
Interface with the Foundation
The NPO’s role of making the Foundations’ vision operational encompassed not only support to the Alliances, but also frequent dialogue with the Foundation about Alliance progress. Communication between the NPO and the Foundation was an important consideration at the beginning of AF4Q. In the case of AF4Q, the relationship was a blend of the NPO reporting out regarding implementation and creating opportunities for a dialogue about strategy, operations, tactics, and problem-solving. Developing the relationship between NPO and funder led to increased flexibility and trust that was critical for the project’s success. The NPO and Foundation coordinated a variety of mechanisms for achieving this relationship, including monthly calls between both teams, dyads of Foundation and NPO staff around specific content areas, and bi-weekly newsletters. The interface also involved strategic collaboration around developing goals and criteria, with partnerships between NPO and Foundation staff allowing for a balance between Foundation vision and NPO on-the-ground perspective regarding feasibility.