Phase 3: Align

Watch the Align Phase Video


What is the Align Phase?

The third phase of the Pathway focuses on aligning multiple efforts across the region under a common vision. In this phase, collaborative relationships among a whole array of stakeholders are well established, and the collaboration has logged experience with multiple cooperative projects and accomplishments. The Align Phase is different from earlier phases because:

  1. sturdy bridges have been built between health and health care;
  2. there is a well-established system orientation among many key leaders; and
  3. clearly articulated shared values are guiding serious efforts to pool resources, connect related innovations to each other, and hold key groups and organizations accountable to a set of shared measures.

In a successful Align Phase of regional health system transformation, leaders recognize that the impact of their efforts will be magnified if they are connected in meaningful ways. A well-established multi-stakeholder leadership team, carefully composed for adequate diversity and system perspective, organizes to link an array of health and healthcare improvement efforts. If a backbone organization was not launched in Phase 2, then Phase 3 typically is the time when significant investment in collaborative infrastructure—especially the information technology to support shared measurement—becomes critical. Align Phase efforts also are characterized by growing recognition of the importance of involving local residents in devising shared aims and helping to bridge relationships with different groups.

As a consequence, community forums and convenings become more common. In addition, the array of funding sources for community-based efforts broadens and there is more creative thinking about the deployment of things like hospital community benefit funding to deepen the impact of community-provider partnerships. The Atlanta Regional Collaborative for Health Improvement (ARCHI), representative of more than 90 organizations, is an example of a stewardship group in Phase 3. Together, its members were able to publish a regional Playbook outlining the group’s priorities, which include encouraging healthy behaviors, increasing pathways to advantage for families and students, increasing care coordination, and expanding health insurance coverage.

The ability to transition from the Align Phase to the Redesign Phase on the Pathway depends on whether the stakeholders involved can weather some failures in their shared tasks, are making investments in collaborative infrastructure that keeps pace with the scope of their efforts, and have the patience and attention to persist over time.

Transition from Phase 3 to 4 also depends on whether collaborations can take on more difficult topics and accept that there will be winners and losers moving forward. Because Phase 4 involves significant redesign of the system—including addressing competitive relations among organizations how providers are paid and resources distributed—the activities of Phase 3 must foster trusting relationships anchored in genuinely shared values to enable the next leap forward.


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Common Pitfalls in the Align Phase

  • “Early wins” have already succeeded. Safe topics, easy funding streams, and low-hanging fruit are nearly exhausted; momentum and excitement are therefore much more difficult to trigger and sustain.
  • The “backbone” is sagging. As the scope of a group’s efforts broaden, the infrastructure can’t keep up.
  • Unexpected departures erode shared purpose. As safe topics are exhausted, initial champions leave, undermining the effort’s clarity of long-term vision.

Consequences: Early members drift away, funding gets tighter, and members give in to the temptation to redefine the effort and narrow it.

Read the full descriptions of the Phase 3 Pitfalls.

Momentum Builders for the Align Phase

  • Up the ante. Use moral authority to call for more audacious and transformative goals for the whole system; focus on learning from prior successes and challenges.
  • Invest and experiment. Explore sources of funding, non-financial resources, and new ideas that may not yet have been considered; expand commitments to infrastructure.
  • Recruit new stewards. Revisit shared values and norms, and recruit leaders for whom the focus is on gains for the whole region.

Consequences: Renewal of energy, enhancement of resources, and important learning that can feed a sharper, more systemic approach to moving the whole system.

Read the full descriptions of the Phase 3 Momentum Builders.