title: Midterm observations and recommendations from the evaluation of the AF4Q initiative.
abstract: To offer midterm observations and recommendations based on how Aligning Forces for Quality (AF4Q) alliances are faring in their journey toward improving healthcare quality at the community level.
  
  
  
  This study used a mixed method design.
  
  
  
  Longitudinal evaluation data to date were analyzed, including results from multiple surveys, qualitative analysis of key informant interviews, review of secondary documents and analysis of secondary data, and ongoing tracking of the activities of the 16 participating alliances. The observations and recommendations are based on consensus achieved by the AF4Q evaluation team investigators after in-depth iterative discussions.
  
  
  
  Six formative observations are identified and discussed: (1) stakeholder support and participation has been maintained despite changes in economic and political environments; (2) progress on program goals has been slow; (3) the "alignment" in the AF4Q initiative has been slow to materialize; (4) the AF4Q initiative has established a productive network of peer communities; (5) the impact of the AF4Q initiative, and the time to observe impact, vary by community, based on history and context; and (6) sustainability is the major future challenge for the AF4Q initiative.
  
  
  
  Multi-stakeholder alliances' efforts to improve quality should be viewed as "pieces of the health reform puzzle" rather than stand-alone solutions. As healthcare reform is challenged politically, alliances can practice the bipartisanship that focuses conversation on what is good for the community and how best to achieve community goals amid a potential sea of change in both federal and state policy and funding.
authors.affiliation: School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA. jalexand@umich.edu
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Alexander
authors.forename: Dennis P
authors.initials: DP
authors.lastname: Scanlon
authors.forename: Megan C
authors.initials: MC
authors.lastname: McHugh
authors.forename: Jon B
authors.initials: JB
authors.lastname: Christianson
authors.forename: Jessica N
authors.initials: JN
authors.lastname: Mittler
authors.forename: Romana
authors.initials: R
authors.lastname: Hasnain-Wynia
authors.forename: Jeff
authors.initials: J
authors.lastname: Beich
mesh_terms: D003153:Community Health Services / Q000458:organization & administration*; D003256:Community Participation; D004059:Diffusion of Innovation; D005582:Foundations; D054625:Healthcare Disparities; D006801:Humans; D007857:Leadership; D011057:Politics; D058996:Quality Improvement; D011787:Quality of Health Care / Q000458:organization & administration*; D013997:Time Factors