Currently Viewing:
Supplements The Aligning Forces for Quality Initiative: Early Lessons From Efforts to Improve Healthcare Quality
Creating and Sustaining Change: Early Insights From Aligning Forces
Claire B. Gibbons, PhD, MPH; and Anne F. Weiss, MPP
Getting the Structure Right for Communitywide Healthcare Improvement
Gordon Mosser, MD
Lessons for Reducing Disparities in Regional Quality Improvement Efforts
Scott C. Cook, PhD; Anna P. Goddu, MSc; Amanda R. Clarke, MPH; Robert S. Nocon, MHS; Kevin W. McCullough, MJ; and Marshall H. Chin, MD, MPH
The Imperative to Promote Collaborative Consumer Engagement: Lessons From the Aligning Forces for Quality Initiative
Debra L. Ness, MS
That Was Then, This Is Now
Lisa A. Simpson, MB, BCh, MPH, FAAP
Regional Health Improvement Collaboratives Needed Now More Than Ever: Program Directors' Perspectives
Randall D. Cebul, MD; Susanne E. Dade, MPA; Lisa M. Letourneau, MD, MPH; and Alan Glaseroff, MD, ABFM
The Aligning Forces for Quality Initiative: Background and Evolution From 2005 to 2012
Dennis P. Scanlon, PhD; Jeff Beich, PhD; Jeffrey A. Alexander, PhD; Jon B. Christianson, PhD; Romana Hasnain-Wynia, PhD; Megan C. McHugh, PhD; and Jessica N. Mittler, PhD
Barriers and Strategies to Align Stakeholders in Healthcare Alliances
Larry R. Hearld, PhD; Jeffrey A. Alexander, PhD; Jeff Beich, PhD; Jessica N. Mittler, PhD; and Jennifer L. O’Hora, BA
The Aligning Forces for Quality Initiative: Background and Evolution From 2005 to 2012 - eAppendix
Midterm Observations and Recommendations From the Evaluation of the AF4Q Initiative
Jeffrey A. Alexander, PhD; Dennis P. Scanlon, PhD; Megan C. McHugh, PhD; Jon B. Christianson, PhD; Jessica N. Mittler, PhD; Romana Hasnain-Wynia, PhD; and Jeff Beich, PhD
Producing Public Reports of Physician Quality at the Community Level: The Aligning Forces for Quality Initiative Experience
Jon B. Christianson, PhD; Karen M. Volmar, JD, MPH; Bethany W. Shaw, MHA; and Dennis P. Scanlon, PhD
Community-Level Interventions to Collect Race/Ethnicity and Language Data to Reduce Disparities
Romana Hasnain-Wynia, PhD; Deidre M. Weber, BA; Julie C. Yonek, MPH; Javiera Pumarino, BA; and Jessica N. Mittler, PhD
Currently Reading
Approaches to Improving Healthcare Delivery by Multi-stakeholder Alliances
Megan C. McHugh, PhD; Jillian B. Harvey, MPH; Dasha Aseyev, BS; Jeffrey A. Alexander, PhD; Jeff Beich, PhD; and Dennis P. Scanlon, PhD
Using Websites to Engage Consumers in Managing Their Health and Healthcare
Jessica N. Mittler, PhD; Karen M. Volmar, JD, MPH; Bethany W. Shaw, MHA; Jon B. Christianson, PhD; and Dennis P. Scanlon, PhD
Participating Faculty: The Aligning Forces for Quality Initiative: Early Lessons From Efforts to Improve Healthcare Quality at the Community Level
Letter From the Guest Editor
David Blumenthal, MD, MPP
Samuel O. Thier Professor of Medicine and Professor of Health Care Policy Massachusetts General Hospital/Partners HealthCare System and Harvard Medical School, Boston

Approaches to Improving Healthcare Delivery by Multi-stakeholder Alliances

Megan C. McHugh, PhD; Jillian B. Harvey, MPH; Dasha Aseyev, BS; Jeffrey A. Alexander, PhD; Jeff Beich, PhD; and Dennis P. Scanlon, PhD
Fourth, our results demonstrate the important role of performance measurement in the selection and ongoing management of QI activities. Notably, several of our respondents suggested that the relationship between measurement and QI was sequential. It is not clear from our analysis whether communities with greater capacities for performance measurement and public reporting are more successful in their QI efforts than others, but this could be an area for future research. In addition to QI, program planners might find it beneficial to support performance measurement and public reporting, through funding and TA.

Finally, our results point to the critical role of partners in conducting QI activities and obtaining additional grant funding to support those activities. Collectively, alliances were just as likely to support the QI efforts of their local partners as they were to lead their own efforts. Again, our results do not suggest whether alliance-led strategies are more successful than other strategies or whether alliances with more partner-led activities are able to conduct QI activities more efficiently. However, the results do suggest that there are many models that alliances may use to approach QI—as a leader, partner, or some combination of the 2.  

Despite the inherent challenges associated with establishing communitywide QI, it appears to be gaining favor in the public and private sectors. The early experiences of the AF4Q initiative suggest that communitywide QI is possible; however, alliances are primarily focused on collectively improving quality within organizations, rather than in initiating cross-organizational interventions. More research is needed to determine whether these approaches are sufficient to address clear gaps in quality.   

Author affiliations: Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI (JAA); Center for Health Care and Policy Research, Penn State University, University Park, PA (DA, DPS); Jeff Beich Consulting, Grand Island, NY, and Penn State University, University Park, PA (JB); Department of Health Policy and Administration, Penn State University, University Park, PA (JBH, DPS); Institute for Healthcare Studies and Department of Emergency Medicine, Northwestern University, Feinberg school of medicine, Chicago, IL (MCM).
Funding source: This supplement was supported by the Robert Wood Johnson Foundation (RWJF). The Aligning Forces for Quality Evaluation is funded by a grant from the RWJF.
Author disclosures: Drs Alexander, Beich, McHugh, and Scanlon, Ms Aseyev, and Ms Harvey report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.  
Authorship information: Concept and design (JAA, JB, MCM, DPS); acquisition of data (JAA, JBH, DPS); analysis and interpretation of data (JAA, DA, JB, JBH, MCM, DPS); drafting of the manuscript (JAA, MCM, DPS); critical revision of the manuscript for important intellectual content (DA, JB, JBH, MCM, DPS); obtaining funding (DPS); and administrative, technical, or logistic support (DA).
Address correspondence to: Megan C. McHugh, PhD, 750 N Lake Shore Dr, 10th Fl, Chicago, IL 60611. E-mail: megan-mchugh@northwestern.edu.
  1. Committee on Quality of Health Care in America, Institute of Medicine. To Err is Human: Building a Safer Health System. Kohn LT, Corrigan JM, Donaldson MS, eds. Washington, DC: National Academies Press; 2000.  
  2. Mangione-Smith R, DeCristofaro AH, Setodji CM, et al. The quality of ambulatory care delivered to children in the United States. N Engl J Med. 2007;357(15):1515-1523.  
  3. McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003; 348(26):2635-2645.  
  4. Chassin MR, Loeb JM. The ongoing quality improvement journey: next stop, high reliability. Health Aff (Millwood). 2011;30(4): 559-568.  
  5. Baker G, Delbanco S. Pay for performance: national perspective. 2006 longitudinal survey results with 2007 market updates. http://www.ehcca.com/presentations/pfpsummit3/linscott_1.pdf. Published December 2007. Accessed June 20, 2012.  
  6. Kuhmerker K, Hartman T. Pay-for-performance in state Medicaid programs: a survey of state Medicaid directors and programs. http://www.commonwealthfund.org/usr_doc/Kuhmerker_ P4PstateMedicaidprogs_1018.pdf?section=4039. Published April 2007. Accessed June 20, 2012.  
  7. Vos L, Dückers ML, Wagner C, van Merode GG. Applying the quality improvement collaborative method to process redesign: a multiple case study. Implement Sci. 2010;5:19.  
  8. Wilson MJ, Nguyen K. Bursting at the seams: improving patient flow to help America’s emergency departments. http://urgentmatters.org/media/file/reports_UM_WhitePaper_Bursting AtTheSeams.pdf. Published September 2004. Accessed June 20, 2012.  
  9. Pronovost PJ. Interventions to decrease catheter-related bloodstream infections in the ICU: the Keystone Intensive Care Unit Project. Am J Infect Control. 2008;36(10):S171.e1-5.  
  10. Agency for Healthcare Research and Quality. 2010 National Healthcare Quality Report. http://www.ahrq.gov/qual/nhqr10/ nhqr10.pdf. Published March 2011. Accessed June 20, 2012.  
  11. Landrigan CP, Parry GJ, Bones CB, Hackbarth AD, Goldmann DA, Sharek PJ. Temporal trends in rates of patient harm resulting from medical care. New Engl J Med. 2010;363(22):2124-2134.  
  12. Dentzer S. Still crossing the quality chasm—or suspended over it? Health Aff (Millwood). 2011;30(4):554-555.  
  13. Ferlie EB, Shortell SM. Improving the quality of health care in the United Kingdom and the United States: a framework for change. Milbank Q. 2001;79:281-  
  14. Leatherman S, Sutherland K. Designing national quality reforms: a framework for action. Int J Qual Health Care. 2007;19(6): 334-340.  
  15. Margolis PA, Stevens R, Bordley WC, et al. From concept to application: the impact of a community-wide intervention to improve the delivery of preventive services to children. Pediatrics. 2001;108(3):E42.  
  16. Donabedian A. The quality of care: how can it be assessed? JAMA. 1988;260(12):1743-1748.  
  17. Regional Health Improvement Collaboratives. Essential Elements for Successful Healthcare Reform. ROOTS. 2nd ed. http://www.iha.org/pdfs_documents/resource_library/Regional HealthImprovementCollaboratives.pdf. Accessed June 20, 2012.  
  18. About Aligning Forces for Quality. Robert Wood Johnson Foundation website. http://www.rwjf.org/qualityequality/af4q/about.jsp. Accessed June 20, 2012.  
  19. Harvey JB, Beich J, Alexander JA, Scanlon D. Building the scaffold to improve health care quality in Western New York. Health Aff (Millwood). 2012;31:636-641.  
  20. Scanlon DP, Beich J, Alexander JA, et al. The Aligning Forces for Quality initiative: background and evolution from 2005 to 2012. Am J Manag Care. 2012;18(6):S115-S125.  
  21. Scanlon DP, Alexander JA, Beich J, et al. Evaluating a community-based program to improve healthcare quality: research design for the Aligning Forces for Quality initiative. Am J Manag Care. 2012;18(6):eS165-eS176.  
  22. Glaser BG, Strauss AL. The Discovery of Grounded Theory: Strategies for Qualitative Research. Piscataway, NJ: Aldine Transaction; 1967.  
  23. Bradley EH, Curry LA, Devers KJ. Qualitative data analysis for health services research: developing taxonomy, themes, and theory. Health Serv Res. 2007;42(4):1758-1772.   
PDF
 
Copyright AJMC 2006-2020 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
x
Welcome the the new and improved AJMC.com, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up