Effecting timely publication of the results of Fund-supported work involves working partnerships between grantees and Fund program and communications staff. As the volume of publications has increased, the Fund has implemented improved systems for setting priorities and organizing resources to achieve timely publication of commissioned papers and other research. As a result, there has been progress in reducing the time between acceptance of articles by the Fund's publications review committee and their posting on the Web site.

The Fund's strategy of harvesting the results of grants and intramural research to ensure a strong flow of accessible information for change agents sets it apart from most other foundations, which more often leave dissemination of results to their grantees. The Fund's communications product line has greatly expanded with the introduction of the Quality Improvement and Efficiency program and with the continuous upgrading of the foundation's Web site —rising from 215 products in 2003 to 515 in 2006.

As already noted, the absence of the market, political, constituency, and media reality tests to which most other organizations are subject make private foundations particularly susceptible to losing momentum and strategic direction. Therefore, using strategic new initiatives to "stretch" the institution and maintain continued vitality is even more important than in business, government, and other nonprofits.

The Fund's goal of effecting at least four institution-stretching product developments annually spurs the foundation to take on even more ambitious goals and strategies and make investments for accomplishing them. Stretch initiatives for 2005-06 were as follows: development of the "Medicare Extra" option for a comprehensive Medicare benefit;⁽¹⁸⁾ expansion of the Harkness Fellows in Health Care Policy program to Germany; partnership with the Netherlands to extend the International Health Policy Survey to that country; redesign of the Fund Web site and initiation of E-Forums on it; and establishment of a strong voice on the implications of the policy trend toward relying on health savings accounts to control health care costs.

Initiatives completed or under way for 2006-07 include the following: publication of the National Scorecard on U.S. Health System Performance; enrichment of the Frail Elders program to further promote culture change and resident-centered care in nursing homes; partnership with Modern Healthcare magazine on the Fund's Health Care Opinion Leaders Survey; introduction of a congressional health care legislative policy watch (analysis and modeling of the leading health care bills in Congress); partnership with the Bosch Foundation in the funding of German Harkness Fellows in Health Policy; and development of the Chart Cart feature on the Fund's Web site, which will eventually make available, at no charge, virtually all data produced by the Fund and its grantees, and in a format designed to speed the translation of research into policy action.