NewPublicHealth is speaking with directors of several health departments who recently were accredited by the Public Health Accreditation Board. Eleven health departments received the credential so far. We recently spoke with Mary Selecky, director of the Washington State health department, one of the first two state health agencies receive national accreditation status. Ms. Selecky recently announced her plans to retire from the health department.

>>Also read our interview with Terry Cline, health commissioner of Oklahoma, which also was recently accredited by PHAB.

NPH: How do you think accreditation will improve delivery of public health services and care in Washington State? Now that the health department is accredited, do you feel as though you are leaving the department in even better shape than it was?

Mary Selecky: Accreditation is really a quality improvement tool, and the standards that have been set by the Public Health Accreditation Board force you to examine whether you have the right processes in place for continuous, sustained quality improvement. And if you have found that you are not quite up to par in an area, then the processes help you ask what you will do to improve your performance in that area? The process helps you increase your performance, your effectiveness, and your accountability.

Public health touches people every single day—everybody in the state, from the moment they get up until they go to bed at night and even while they’re sleeping. This credential shows us that we have effective programs and measures in place to meet the needs of our communities. Drinking water systems are a good example. We regulate 16,000 drinking water systems, and I have a lot of drinking water engineers who are out in communities checking on water systems. I have to know that they’ve got a common set of operating procedures to assure the public that we’re looking out for their interests and when they turn on their tap from a municipal water system, that the water’s safe to drink. You can only do that when you have some procedures in place and that goes for the engineers, for laboratories or programs to make sure they are operating well in the community. Accreditation touches every part of the department.

NPH: How will you be promoting and explaining accreditation to policymakers?  

During opening remarks at this year’s Keeneland Conference, hosted by the National Coordinating Center for Public Health Systems and Services Research (PHSSR) based at the University of Kentucky in Lexington, Professor Douglas Scutchfield, director of the Center, proudly announced that three of the first health departments to be accredited by the Public Health Accreditation Board (PHAB) earlier this year were in Kentucky. Accreditation had its own track during the conference scientific sessions, including a presentation from Jessica Kronstadt, MPP, PHAB’s director of research and evaluation.

NewPublicHealth caught up with Kronstadt to talk about her presentation on some very early findings from an internal evaluation of the accreditation process.

>>Read more on national public health department accreditation.

NewPublicHealth: What information is PHAB seeking to gain from an evaluation of the accreditation process?

Jessica Kronstadt: Just as we’re asking health departments to engage in quality improvement, PHAB is very much committed to engaging in quality improvement of the accreditation program. So these evaluation efforts will really help us understand what is working well in our accreditation program, and what the experience was like from the perspective of the health departments and the site visitors. This evaluation will allow us to continue to improve the accreditation process.

Yesterday, New York State Health Commissioner Nirav R. Shah, MD, MPH, released the 2013-17 Prevention Agenda: New York State’s Health Improvement Plan—a statewide, five-year plan to improve the health and quality of life for everyone who lives in New York State. The plan is a blueprint for local community action to improve health and address health disparities.

Dr. Shah was joined by New York City Health Commissioner Thomas Farley, MD, MPH, and representatives from leading health care and community organizations at the Charles B. Wang Community Health Center in Manhattan. Among the other speakers were Jo Ivey Boufford, MD, president of The New York Academy of Medicine, and Daniel Sisto, president of the Healthcare Association of New York State.

 >>Read a related Q&A with Commissioner Nirav Shah.

“We’ve all heard the adage—an ounce of prevention is worth a pound of cure,” said Commissioner Shah. “We need to fundamentally change the way we think about achieving better health in our society.”

That fundamental shift toward prevention, said Dr. Shah, requires setting clear goals, promoting active collaborations, and identifying policies and strategies that create opportunities for everyone to live a healthy life.

The Prevention Agenda identifies five priority areas:

• Prevent chronic disease
• Promote healthy and safe environments
• Promote healthy women, infants and children
• Promote mental health and prevent substance abuse
• Prevent HIV, STDs, vaccine-preventable diseases, and healthcare-associated infections

A health improvement plan like the one released by the New York Department of Health is a critical prerequisite for public health department accreditation. Recently, the Public Health Accreditation Board awarded five-year accreditation to 11 public health departments. Those 11 are the first of hundreds currently preparing to become accredited, including New York state.

"Completing the accreditation application, which includes our Prevention Agenda 2013-17, provides the Department of Health a valuable opportunity to engage partners and community stakeholders in our ongoing efforts to improve public health, evaluate the effectiveness of our services and showcase our successes," Commissioner Shah said.

State legislatures recently got underway across the country and many will be considering some critical public health law measures, according to a recent blog post from the Network for Public Health Law.

Critical issues include:

• A smoking ban in Kentucky which could stall in committee
• A bill in Kentucky which could restrict the work of local boards of health.
• A law in Ohio that would require health departments to enter into agreements for shared services and to become accredited.  

>>Bonus Links:

• Read the Network blog post.
• Use the state legislative tracking page from the Association of State and Territorial Health Officials to follow state public health agendas for 2013.

Today the Public Health Accreditation Board (PHAB) granted 5-year accreditation to 11 public health departments. The national program is jointly supported by the Robert Wood Johnson Foundation and the Centers for Disease Control and Prevention and aims to improve and protect the health of the public by advancing the quality and performance of the nation’s state, tribal, local and territorial public health departments.

The accreditation program sets standards for the nation’s more than 3,000 public health agencies to improve the quality of their services and performance. Since the program’s launch in September 2011, more than 125 health departments have applied to PHAB for accreditation, and hundreds of public health practitioners from across the nation have been trained to serve as volunteer peer site visitors for the program.

NewPublicHealth spoke with Terry Cline, PhD, health commissioner of Oklahoma, about how his department engaged in the accreditation process and what it means for public health in the state.

NPH: Explain the significance of public health accreditation.

Cline: This is that external validation that tells [the public and policymakers] that this isn’t just what we think of ourselves as an organization. This is accreditation from an organization that was developed through a consensus project that developed the standards that are critical to the advancement of public health across our country. Policymakers don’t have the time, and the public typically isn’t able, to evaluate the performance capabilities for health departments, so they rely on other reputable organizations to do that type of assessment. And now the Public Health Accreditation Board is providing that external validation. It’s a peer process, just as we use for peer reviewed journals. Who’s going to be more critical than the actual experts in the field?

Eleven Public Health Departments First to Achieve National Accreditation Status
The Public Health Accreditation Board (PHAB) has awarded 5-year accreditation to eleven public health departments. The national program, which is jointly supported by the Robert Wood Johnson Foundation and the Centers for Disease Control and Prevention, aims to improve and protect the health of the public by advancing the quality and performance of the nation’s state, tribal, local and territorial public health departments. The newly accredited agencies are the first of hundreds currently preparing to seek national accreditation through PHAB, an independent organization that administers the national accreditation program. “With accreditation, we now have national standards that promote continuous quality improvement for public health and a mechanism for recognizing high performing public health departments,” said PHAB President and CEO Kaye Bender, PhD, RN, FAAN. “These are the first of many health departments that we look forward to being able to recognize for achieving national standards that foster efficiency and effectiveness, and promote continuous quality improvement.”Read more on accreditation.

Report: HIV Cured in Baby
Researchers from the Johns Hopkins Children’s Center will report today that a baby in rural Mississippi has been cured of HIV through aggressive use of anti-retroviral drugs following birth. The finding will be presented at the Conference on Retroviruses and Opportunistic Infections in Atlanta. The findings have not been yet been published in a peer review journal and the researchers say the findings may not apply to adults. Read more on HIV/AIDS.

Public Health and Sequestration
Several public health organizations has issued statements  on the potential impact of sequestration, across the board budget cuts to the federal budget, including the Association of State and Territorial Health Officers (ASTHO), the National Association of County and City Health Officials  (NACCHO) and the American Public Health Association (APHA). Read more on budgets.

First Grade Math Skills Set Foundation for Critical Skills Needed Later in Life
Children who failed to acquire basic math skills in first grade scored far behind their peers by seventh grade on a test of the mathematical abilities needed to function in adult life, according to new research supported by the National Institutes of Health. The basic skills tested include the ability to relate a quantity to the numerical symbol that represents it, to manipulate quantities and to make calculations. The researchers say these skills, called numeracy, are the foundation of all other mathematics abilities, including those necessary for functioning as an adult member of society. Starting with poor number knowledge can put children so far behind that they never catch up, according to the researchers, who also reported that more than 20 percent of U.S. adults do not have the eighth grade math skills needed to function in the workplace. Read more on education.

About One in Five U.S. Adult Cigarette Smokers Have Tried an Electronic Cigarette
In 2011, about 21 percent of adults who smoke traditional cigarettes had used electronic cigarettes, also known as e-cigarettes, up from about 10 percent in 2010, according to a study by the U.S. Centers for Disease Control and Prevention (CDC). Overall, about six percent of all adults have tried e-cigarettes, with estimates nearly doubling from 2010. During 2010-2011, adults who have used e-cigarettes increased among both sexes, non-Hispanic Whites, those aged 45–54 years, and those living in the South, according to the CDC. In both 2010 and 2011, e-cigarette use was significantly higher among current smokers compared to both former and never smokers. Awareness of e-cigarettes rose from about four in 10 adults in 2010 to six in 10 adults in 2011. Read more on tobacco.

The Public Health Quality Improvement Exchange (PHQIX) is a brand new online community designed to be a communication hub for public health professionals interested in learning and sharing information about quality improvement (QI) in public health. PHQIX was created by RTI International and funded by  the Robert Wood Johnson Foundation. The key goal of the site is to share national QI efforts by health departments of all sizes so that public health experts can learn from the experience of their colleagues across the country. NewPublicHealth recently spoke with Jamie Pina, PhD, MSPH, PHQIX project director, and Pamela Russo, senior program director at the Robert Wood Johnson Foundation about the new resource and its promise for helping health departments continuously improve their performance and achieve the national standards set forth by the Public Health Accreditation Board.

NewPublicHealth: What’s the vision of PHQIX, and how did it come about?

Pamela Russo: Public health departments are looking for ways to be more and more efficient and to eliminate waste and to make their limited budgets have the maximum possible impact. That’s the major value of QI, to show what works and where you can improve.

The new issue of Frontiers in Public Health Services and Systems Research (PHSSR), an online journal that looks at early research on issues related to public health services and delivery, focuses on quality improvement in practice-based research networks.

This issue’s commentary, from the journal’s editor, Glen Mays, PhD, MPH, is about a series of studies sponsored by the Robert Wood Johnson Foundation that  look at how public health decision-makers are responding to accreditation, quality improvement, and public reporting initiatives during  ongoing fiscal problems. Mays is co-principal Investigator of the National Coordinating Center on PHSSR, Director of the Public Health Practice-Based Research Networks and the F. Douglas Scutchfield Endowed Professor at the University of Kentucky College of Public Health. Mays says that, overall, the current evidence shows that “these initiatives represent promising strategies for strengthening evidence-based decision-making and expanding the delivery of evidence-tested programs and policies in local public health settings.” 

Mays  adds that continued comparative research and evaluation activities are needed to provide more definitive evidence about which combination of strategies work best, for which population groups, in which community and organizational settings, and why.

The Public Health Accreditation Board (PHAB) recently celebrated the one year anniversary of the launch of national public health accreditation.

Over 100 health departments have engaged with the Public Health Accreditation Board on their accreditation journey, according to PHAB CEO Kaye Bender in an email exchange with NewPublicHealth, and more health departments enter the system each week. “One year post launch of voluntary national public health department accreditation, PHAB is excited about the progression of health departments through the process,” Bender wrote. “The first site visits began last month, and more are scheduled. We expect to announce the first accredited health departments in early 2013!”

At the recent APHA 2012 conference, representatives from California’s state and local health departments led a session offering their peers a first look at the accreditation process underway in California. As PHAB states, “the goal of national public health accreditation program is to improve and protect the health of the public by advancing the quality and performance of all health departments in the country – state, local, territorial and tribal.” All of the California representatives made a case for why accreditation is a priority for their respective departments.

“Accreditation equals opportunity,” said Dr. Ron Chapman, California Department of Public Health director. “Quality improvement is about problem solving. Infuse quality into what you do every day and you will see transformation.”

>>Watch a VIDEO with Ron Chapman about new opportunities to transform public health by making quality improvement a way of life.

Dr. Alonzo Plough, Emergency Preparedness and Response Program director for the Los Angeles County Public Health Department, said accreditation’s quality improvement standards align well with the “triple aim” goals of: improving patients’ experience of care, improving the health of populations and reducing the cost of health care.

Plumas County Public Health Agency director, Mimi Hall, talked about how building relationships with local hospitals and community and business leaders can help meet public health goals.

“We have to redefine the role of public health and work with outside organizations to get the best benefit for the community,” said Hall. “Accreditation pulls it all together.”