First the QAT can include tools that we choose to add to it. You just Right Click on a tool and the option to Add to Quick Access Toolbar appears. You can also remove a tool in a similar fashion. Careful, add tools in the order you want them to appear because you can't shuffle them around....yet anyway. There is always hope.
One negative of the current implementation of the Ribbon approach with Revit is that users can't see what the Active Workset is. Granted they could turn off the Workset toolbar in previous versions but if they were actually using Worksets they usually do not. With the Ribbon, if you choose to change to another tab you no longer see the Active Workset. Problem solved, in a fashion, add it to the QAT.
The Align tool is trapped on the Modify ribbon tab. Why it doesn't appear on others, like many of the contextual ribbons...I understand. Align is a Prima Don, it wants you to "pick me, pick me" before letting you use it. Other tools like Copy or Move have less ego because they are content to react to you selecting elements first, they wait patiently for you to do something to provoke them. Align sits stubbornly on its own throne (ribbon) because it doesn't care that you are sketching walls or placing doors. The reality is that I quite often to decide to use Align precisely because I AM doing something else. The something else inspires me to use the Align tool. Switching to the Modify ribbon tab...well...irks me. Problem solved, in a fashion, added it to the QAT.
And now the finished product! After first putting the Active Workset on the QAT and wishing it was after the Align tool...Remove, Remove...Add...Add...all better, aah.