Aligning Forces for Quality: The Regional Market Project

Quality health care. It's a local issue. It's a national issue. It's everyone's issue.

When it comes to health care, patients have more power than they think. At the Robert Wood Johnson Foundation (RWJF), we not only believe in the power of patients, but also in the power of health care professionals to deliver far better care than patients receive now. We need an end to miscommunication, mistakes and inequity. And we need it now. The Aligning Forces for Quality (AF4Q) initiative--the Foundation's core strategy in its longstanding commitment to improve the quality of health care that Americans receive--brings an unprecedented commitment of resources, expertise and training to turn proven practices into real results on the ground. By teaming up those who get care, give care and pay for care, we can deliver lasting change across entire communities.

The premise of Aligning Forces is that no single person, group or profession can improve health and health care throughout a community without support of others. AF4Q asks these critical stakeholders to work toward common, fundamental objectives that RWJF and others believe will lead to better care. For example, we believe that measuring and reporting on health care, if done right, can 1) help providers improve their own ability to deliver quality care; 2) help providers measure and publicly report their performance; and 3) help patients and consumers understand their vital role in recognizing and demanding high-quality care.

The program is operating in 14 communities across the country: Cincinnati, Cleveland, Detroit, Humboldt County (Calif.), Kansas City (Mo.), Maine, Memphis, Minnesota, Puget Sound, South Central Pennsylvania, West Michigan, Western New York, Willamette Valley (Ore.), and Wisconsin. The Foundation may add communities to the initiative in late 2008 or 2009, although we will not exceed 20 communities in this phase. A new national program office, located at The George Washington University Medical Center School of Public Health and Health Services, is helping the Foundation manage the activities of this far-reaching initiative. 

RWJF launched the first phase of Aligning Forces for Quality in 2006 as an effort to help communities build health care systems where none existed. Right now, while pockets of excellent health care exist across the country, most health care markets function as fragmented sectors, with different entities often working within their own silos. The first phase of AF4Q provided community leadership teams with grants and substantial expert assistance to help them work with physicians to improve quality of care, to measure and publicly report on the quality of ambulatory care, and to engage consumers to make informed choices about their own health and health care. The program expanded in June 2008 to include inpatient care, as well as a focus on reducing racial and ethnic gaps in care and enhancing the central role that nursing plays in good health care.

For years, RWJF has supported a variety of projects and programs that developed strategies and tools to improve health care quality. These efforts include funding for the development of quality measures, early pay-for-performance experiments, a new model for providing chronic care, and efforts targeted at specific diseases such as asthma, diabetes and depression. Many of the promising practices from these investments have spread beyond the initial phase of RWJF support, but too often, initiatives to improve the quality of care operate as disparate efforts. By aligning these efforts within targeted communities, the Foundation believes that the different Aligning Forces for Quality initiatives will result in community-wide transformation of health care.

For more information, visit www.rwjf.org/qualityequality.