Appendix D. Sample Prework Checklist

Community quality collaboratives are community-based organizations of multiple stakeholders, including health care providers, purchasers (employers, employer coalitions, Medicaid and others), health plans, and consumer advocacy organizations, that are working together to transform health care at the local level. The Agency for Healthcare Research and Quality offers these organizations many tools to assist in their efforts.

Appendix D: Sustainability Planning Prework Checklist

Instructions

To get started in your sustainability planning, gather and organize relevant information about the current state and recent history of the collaborative.

This information will provide the facilitator with an up-to-date view of the current state. You should also consider how recently the participants in your planning process, such as a steering group, working committee, or your board, have reviewed this information. If it has been more than a few months, you may want to begin by refreshing and level-setting all participants' understanding of the current state.

√	ID	Item
	1	Strategic plan, including goals and objectives*
	2	Financial plan, including budget, sources of funds, and future financial forecasts*
	3	Structure of contracts, dues, fees, and other sources of income*
	4	Summary of accomplishments*
	5	Annual report*
	6	Tools used for measuring performance, such as dashboards, scorecards, evaluation of objectives *
	7	Market or stakeholder research, if available, such as opinion surveys, evaluations of products or events, etc. *
	8	Summary description of each program *
	9	Governance structure, including staff and board/committee organizations *
	10	List of board members and other key stakeholders, with roles, organizations, and titles
	11	Community Quality Collaborative application; other applications and/or reports, such as funding applications and evaluations
	12	Major deliverables: Actual products, sample views, and/or links
	13	Recent board meeting minutes or notes
	14	Strategic or sustainability planning session minutes or notes
	15	Prior consulting recommendations, if any
	16	Financial history and trends: such as IRS 990 reports for prior years, back to 2000 if available
	17	Recent grant proposals
	18	Other relevant information, such as strategic planning and financial information; and information about programs, stakeholders, or deliverables

* Indicates priority items.

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Page last reviewed January 2009

Internet Citation: D. Sample Prework Checklist: Appendix D: Sustainability Planning Prework Checklist. January 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://archive.ahrq.gov/professionals/quality-patient-safety/quality-resources/value/suscqcollab/suscqcollappd.html