membership or board that reflects other disciplines, as well as federal agencies such as AHRQ, CMS, or NQF, to provide some level of transparency, consistency, and connectedness. Financial support of each alliance varies, but for most, ongoing sustainability becomes a challenge to the mission of the stakeholders.
Nursing Alliance for Quality Care
Nursing through the NAQC (https://www.nursingworld.org/practice‐policy/naqc) has created its own alliance of national nursing stakeholder organizations in partnership with patient care advocacy organizations representing consumers. NAQC’s membership continues to shift over time, yet remains viable, finding that space where nursing can collectively make the largest contribution to the quality arena. Formed in 2010 from a Robert Wood Johnson Foundation–funded planning grant, NAQC is committed to advancing the highest quality, safety, and value of consumer‐centered health care for patients, their families, and their communities. Governed by an independent board of directors, NAQC first sought long‐range expected outcomes that include the following:
Patients receiving the right care at the right time by the right professional.
Nurses actively advocating and being accountable for consumer‐centered, high‐quality health care.
Policy‐makers recognizing the contributions of nurses in advancing consumer‐centered, high‐quality health care.
NAQC focused on four goals to accomplish these three outcomes: (a) support consumer‐centered health care quality and safety goals to achieve care that is safe, effective, patient‐centered, timely, efficient, and equitable; (b) performance measurement and public reporting that strengthen the role of nursing in transparency and accountability activities; (c) advocacy, by serving as a resource to partners and stimulating policy reform that reflects evidence‐based nursing practice and advances consumer‐centered, high‐quality health care; and (d) building nursing’s capacity to serve in leadership roles that advance consumer‐centered, high‐quality health care. NAQC provided national‐level conferences that supported important policy changes, including nurse‐led medical homes, nurses’ roles in ACOs, and nurses’ roles in fostering patient and family engagement.
In 2013, NAQC determined that its long‐term strategy for sustainability as an alliance required a more permanent home within one of the existing member organizations. It now resides within ANA, maintaining memberships from among the leading national nursing associations. NAQC retains a seat as an alliance at various national tables.
Since 2013, NAQC has continued to embrace work in several areas of quality improvement. It has continued to pursue the transition of QSEN competencies and principles from education to practice. NAQC believes that its various constituencies are knowledgeable regarding the QSEN competencies, but have less comfort in translating them into practice. It also has noted that there is an evident gap with new graduates, who are educated regarding the competencies but are unable to employ them to their satisfaction when they arrive at their first place of employment. After multiple NAQC leadership discussions regarding the education to practice gap, dialogue began among QSEN leadership and NAQC Advisory Board members. From 2017 significant discussion resulted in a new partnership between the two entities. At this time QSEN has incorporated into its nationally searchable database educational exemplars, the first of what is hoped will be many practice exemplars, seeking to reduce the gap between education and practice in a variety of settings from ambulatory, to obstetrics, to acute care, and to the operating room. NAQC believes that it can work with its constituencies to engage them in populating this database.
NAQC’s second enduring initiative continues to be focused on patient and family engagement (patient‐centered care). Given the length of time since its initial White Paper on Nurses' Critical Role in Fostering Patient and Family Engagement in 2013, NAQC has witnessed the explosion of interest in patient involvement, shared decision‐making, and patient advocacy (Sofaer and Schumann, 2013). It is currently engaged in an updated review of literature and the drafting of an updated version of this work, more heavily focused on interdisciplinary efforts.
NAQC is also at the table participating in the National Quality Partnership Leadership Consortium and in both financially supporting and participating in an Action Team to Co‐Design Patient‐Centered Health Systems.
Alliance for Home Health Quality Innovation
The Alliance for Home Health Quality Innovation (https://www.ahhqi.org/about/history) is a nonprofit dedicated to improving the nation’s health care system by supporting research and education to demonstrate the value of home‐based care. Membership includes both nonprofit and proprietary home health care providers, academic experts, and all three major trade associations for home health care (the Visiting Nurse Associations of America, the National Association for Home Care and Hospice, and the Partnership for Quality Home Healthcare). This alliance’s guiding principles—integrity, innovation, transparency, and respect—reflect its commitment to evidence‐based research and education on home health that will further efforts to improve lives for patients, reduce costs throughout the US healthcare system, and define the future of health care at home. Innovations in care delivery that appropriately leverage home health care have the potential to contribute lasting, positive change to the health care system. The Alliance's programs and initiatives are aimed at contributing to the national dialogue about improving health care.
Historically there have been similar alliances that included nursing as partners in efforts to improve quality. These alliances have either dissolved in lieu of other broad‐based partnerships to impact the quality and safety of patients, or have been absorbed into other existing entities. These groups included Hospital Quality Alliance, Ambulatory Care Quality Alliance, Alliance for Pediatric Quality, Long‐Term Quality Alliance, Kidney Care Quality Alliance, Quality Alliance Steering Committee, and Institute of Pediatric Nursing.
Federal Agencies Engage with Alliances
It becomes clear from studying the configuration of most of these alliances that allegiance to and partnerships with federal agencies such as AHRQ and CMS are critical to any strategy driving health care system change that is focused on higher quality. CMS, at the behest of Congress, controls decisions determining reimbursement for services, how to reward for higher‐quality care, and how to make deductions in reimbursement due to preventable negative outcomes of care. NQF has been made the arbiter of measure endorsement and of which measures’ data, gathered by institutions and providers, point to the outcomes that either get rewarded or penalized. And AHRQ has played a major role from a federal perspective in the creation and validation of standards, offering guidelines for best practice, and being a clearinghouse of national quality measures and research related to quality, safety, and best practice. Any professional alliance looking to develop measures or to suggest that given measures are or are not appropriate for considerations of payment would do well to bring these entities along to the discussion, keep them informed of challenges and lessons learned, and either heed or shape the future they want to see. Some of the alliances that have developed and achieved endorsement of their measures from NQF ensured their measures continued through AHRQ representation.
Centers for Medicare and Medicaid Services
CMS is a federal agency that administers Medicare, Medicaid, and CHIP. CMS utilizes other entities to survey health care institutions and programs for maintenance of minimum standards of quality, yet retains ultimate authority. CMS reports to HHS. Even though Medicaid services are provided by each state, CMS provides guidance for administering services and can audit the services provided to Medicaid recipients. CMS has several newly created
