Recent efforts to provide technical assistance to local organizations working on the front lines of health care innovation have shown me that grantees—like patients—want help that is timely, personalized, and “fits” with the way they live and work.
Back in 2007, when the Robert Wood Johnson Foundation (RWJF) launched Aligning Forces for Quality (AF4Q), we had an audacious goal: bringing together the key players—those people who give, get, and pay for care—in sixteen communities nationwide to improve the quality, equality, and value of health care in each region.
Each multistakeholder alliance worked on ways to publicly report information on the cost and quality of health care; improve the clinical quality of care; transform how care is paid for; and engage consumers in efforts to increase the value of the care they receive. By the time the program wound down in 2014, our communities had worked with nearly 600 hospitals and 31,000 primary care physicians that touched the lives of 37 million Americans.
Along the way, our sixteen alliances discovered new ways to do everything from standardizing diabetes care to reducing unnecessary visits to the emergency department. They also uncovered meaningful insights on what it takes to, regionally, move the needle on quality of care. For instance, when physicians can see their own results next to those of their peers, performance tends to improve, and when patients feel they have a true voice in their care “journey,” they tend to take better care of themselves.
Over the years, the RWJF supported these efforts through our national program office at the George Washington University, which in turn allocated roughly $25 million in technical assistance (TA) to the sixteen communities.
I’ve realized recently that what our alliances learned about improving care in their region runs parallel to what we learned about providing useful technical assistance.
We quickly learned that each alliance—located from coast to coast, in entire states or metropolitan areas, and in urban or rural settings—had unique, evolving needs. Some communities wanted regular hands-on site visits, or help sifting through data; others wanted regular conference calls and webinars to connect with their peers. At the RWJF, the level of customization the alliances needed was often more expensive than what we were accustomed to and could frustrate consultants and experts used to more “one-size-fits-all,” template-driven solutions.
By surveying each community extensively, we were able to determine what they actually needed and budget appropriately before we brought in the experts. As the program entered its later stages, we offered each community mini-grants—initially $40,000 annually and later $200,000 per year, to design and procure their own technical assistance, giving them increasing autonomy. We also asked for feedback on the specific TA providers that we recommended to help ensure the assistance offered was truly helpful.
As the nation’s largest philanthropy devoted exclusively to health and health care, we were excited at the outset simply to share the wealth of our institutional knowledge and connections—for example, by offering up leading experts in niche areas like health care measurement, quality improvement, or payment reform.
An unexpected consequence of all of this expertise: our alliances often found themselves repeating the same “elevator speech” to each new consultant. Our national program office came up with the solution of having each alliance employ a single staffer to brief their TA providers, as a group, in “huddles,” which in turn gave our providers a chance to get to know each other and figure out how to work together.
And while we didn’t set out to have our expert consultants work together, we found over time that not doing so led to duplication of effort and undermined our alliances’ ability to work strategically. Our national program office began assigning individual staff members to take the lead on understanding and responding to the unique needs of each community. And as our experts “huddled” with each other, they got better at helping the alliances meet their goals. We also supported a spirit of collaboration through newsletters, large twice-yearly meetings, and other communications vehicles that were available to all parties.
We also learned that our alliances weren’t always ready for everything we wanted to offer. For instance, we thought our grantees would benefit from early advice about sustaining their work over the long haul. At the outset, though, they were simply trying to hang their shingles and meet AF4Q’s basic expectations, which were demanding. They included getting health care providers and their stakeholders to agree on public reporting of quality reports about physicians’ offices. It wasn’t until much later that the alliances started to show interest in long-term business planning.
Over time, our alliances became increasingly more interested in learning from each other than from the experts. Even at the beginning, they asked us to scrap traditional plenary-and-panel meetings in favor of interactive, peer-driven convenings where they could openly share challenges and successes.
Eventually, they started asking us for less expert advice altogether, in lieu of funding for in-depth site visits to their peer alliances. However, when a few of the communities began asking for compensation to provide peer support, we demurred, figuring that open knowledge-sharing is a basic expectation of all of RWJF’s grantees.
As we at the RWJF look back on the grass-roots quality improvements and big-picture insights gleaned through AF4Q, we’re tremendously proud of how our communities rose to the challenge we gave them, but we’re also grateful for what we learned along the way about how communities can improve the quality and value of health care as we work to build a Culture of Health.
Along the road to regional quality improvement, we unexpectedly learned that our alliances wanted the same focused, individual attention that they have worked so hard to provide for residents of their communities.
Related reading:
“The Aligning Forces for Quality Experience: Lessons on Getting Consumers Involved in Health Care Improvements,” by Susan Mende and Deborah Roseman, Health Affairs, June 2013.
“Building the Scaffold to Improve Health Care Quality in Western New York,” by Jillian B. Harvey, Jeff Beich, Jeffrey A. Alexander, and Dennis Scanlon, Health Affairs, GrantWatch section, March 2012.
from Health Affairs Blog http://ift.tt/1L3ufQU
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