At the midpoint of the Aligning Forces for Quality (AF4Q) initiative, the authors report on the learnings and challenges experienced in the initiative thus far.

The Aligning Forces for Quality (AF4Q) initiative arose from insights that health care quality issues are local issues, and that no individual, profession or group can improve a community's health care without others’ support. AF4Q grew from giving grants in 2006 to alliances (community stakeholder partnerships) to study the quality of ambulatory care and to help consumers make informed health care choices, to emphasizing community development goals in 2011.

Key learnings from and challenges of the initiative to date include:

• The AF4Q team’s development of a communitywide quality improvement infrastructure to provide a consistent source for quality improvement resources for providers: challenging to implement in the diverse participating communities, but beginning to show progress.
• Concerns about the sustainability of the initiative if funding ends in 2015 as planned.
• The challenge of collecting patient-reported race and ethnicity data, and the resultant challenge of determining the initiative’s success in reducing race-and-ethnicity-based health disparities.

The authors believe that the 2010 Affordable Care Act, and other reforms, may help strengthen the work of AF4Q alliances in the future.