The Challenges of Capacity Building in the Aligning Forces for Quality Alliances Introduction

A central component of the Robert Wood Johnson Foundation’s Aligning Forces for Quality (AF4Q) initiative is the use of multi-stakeholder alliances to oversee and coordinate regional health care improvement activities. While alliances hold the prospect of accomplishing together what one sector could not do if working alone, the inherent characteristics of alliances present a multitude of challenges related to developing a foundation for ongoing, sustainable effort. Alliances rely on voluntary collaboration rather than hierarchical control. Their authority is derived from the consent of its members rather than from equity ownership or contractual authority. Other challenges include lack of barriers to member exit; organizational culture, differences in time horizons, risk orientation and decision-making styles among member organizations; and, potential conflict between the alliance’s goals and those of the members’ home organizations (Swain, Bennett, Etkind, & Ransom, 2001). In light of such differences and the ambitious goals of AF4Q programs, the AF4Q alliances must devote effort to developing the capacity of the alliance to sustain its efforts over the long term. Capacity building is more than acquiring a sustainable source of financial resources. It is defined as the activities and structures that leverage existing resources in pursuit of common objective(s) and which are sustainable over the long term. As part of our evaluation activities, the AF4Q Research and Evaluation Team is investigating capacity building within the AF4Q alliances. The purpose of this research summary is to present our preliminary findings on this topic based on qualitative data collected from interviews conducted with key