Alexander Jeffrey A, Hearld Larry R, Wolf Laura J, Vanderbrink Jocelyn M
Am J Manag Care. 2016 Aug;22(12 Suppl):s423-36.
Multi-stakeholder healthcare alliances in the Robert Wood Johnson Foundation's Aligning Forces for Quality (AF4Q) program brought together diverse stakeholders to work collaboratively to improve healthcare in their local communities. This article evaluates how well the AF4Q alliances were collectively positioned to sustain themselves as AF4Q program support ended.
This analysis relied on a mixed-methods design using data from a survey of more than 700 participants in 15 of the 16 AF4Q alliances (1 alliance was unable to participate because it was in the process of closing down operations at the time of survey implementation), qualitative interviews with leaders in all 16 of the alliances, and secondary sources. Qualitative analysis of interview data and secondary sources were used to develop a classification of alliance strategic directions after the AF4Q program relative to their strategies during the AF4Q initiative. Descriptive analyses of survey data were conducted in the following areas: (1) alliance priorities for sustainability, (2) alliance positioning for sustainability, and (3) alliance challenges to sustainability.
The likelihood of sustainability and the strategic direction of the former AF4Q alliances are both decidedly mixed. A substantial number of alliances are at risk because of an unclear strategic direction following the AF4Q program, poor financial support, and a lack of relevant community leadership. Some have a clear plan to continue on the path they set during the program. Others appear likely to continue to operate, but they plan to do so in a form that differs from the neutral convener multi-stakeholder model emphasized during the AF4Q program as they specialize, make a major shift in focus, develop fee-for-service products, or focus on particular stakeholder groups (ie, employers and providers). In most cases, preserving the organization itself, rather than its programmatic activities from the AF4Q program era, appeared to receive the greatest emphasis in sustainability efforts.
As their core strategy, most alliances will not perpetuate the original AF4Q program vision of diverse local stakeholders coming together to implement a prescribed set of aligned interventions centered on healthcare improvement.
罗伯特·伍德·约翰逊基金会的“质量对齐力量”（AF4Q）项目中的多利益相关方医疗联盟将不同的利益相关方聚集在一起，共同努力改善当地社区的医疗保健。本文评估了在AF4Q项目支持结束后，AF4Q联盟在集体维持自身方面的状况。
本分析采用混合方法设计，使用了对16个AF4Q联盟中15个联盟的700多名参与者进行的调查数据、对所有16个联盟的领导者进行的定性访谈以及二手资料。对访谈数据和二手资料进行定性分析，以根据AF4Q联盟在AF4Q倡议期间的战略，对AF4Q项目结束后的联盟战略方向进行分类。对调查数据进行了以下方面的描述性分析：（1）联盟可持续性的优先事项，（2）联盟在可持续性方面的定位，（3）联盟在可持续性方面面临的挑战。
前AF4Q联盟的可持续性可能性和战略方向都明显参差不齐。由于AF4Q项目结束后战略方向不明确以及财务支持不足和缺乏相关社区领导力，大量联盟面临风险。一些联盟有明确的计划，继续沿着项目期间设定的道路前进。其他联盟似乎可能会继续运营，但它们计划以不同于AF4Q项目期间强调的中立召集者多利益相关方模式的形式运营，因为它们进行专业化、重点发生重大转变、开发收费服务产品或专注于特定利益相关方群体（即雇主和提供者）。在大多数情况下，在可持续性努力中，似乎最强调的是保留组织本身，而不是AF4Q项目时代的项目活动。
作为其核心战略，大多数联盟不会延续AF4Q项目最初的愿景，即不同的当地利益相关方聚集在一起，实施一套以改善医疗保健为中心的规定的对齐干预措施。
