Final answer:
None of the options provided in the question - A) payment incentives, B) public reporting, C) regulatory penalties, D) quality improvement initiatives - are considered 'not a lever' for aligning organizations with the National Quality Strategy, as they all contribute to healthcare quality improvement and adherence to NQS goals.
Step-by-step explanation:
The National Quality Strategy (NQS) is a nationwide initiative to align health care organizations towards common goals of improved quality of care. When considering the levers that help align organizations with the NQS, quality improvement initiatives are actually one of the primary tools used by organizations to align with NQS objectives. The other options listed - payment incentives, public reporting, and regulatory penalties - also serve as mechanisms to promote quality improvement and drive alignment with the NQS. Thus, none of the options listed in the question would be considered as 'not a lever' in the context of the NQS, as they all play a role in promoting healthcare quality and alignment with the strategy's objectives.