The Three Rivers district health department in Owenton, Kentucky was one of three health departments in that state and eleven in the country to receive national public health accreditation from the Public Health Accreditation Board. NewPublicHealth has been speaking with directors from accredited health departments about the value of the credential; how it can change their operations and outcomes; and what they’d like to share with departments considering applying for the credential. We recently spoke with Georgia Heise, DrPH, Three Rivers’ health director and a vice president of the National Association of County and City Health Officials, about the benefits she sees from both the application process and the new status accreditation confers.

NewPublicHealth: What has the reaction been from community members and policymakers to the news that you’re now accredited?

Georgia Heise: It has been wonderful. Our health department has talked about accreditation from the day we started working on it, so people have been waiting to see what the decision was going to be. We’ve gotten flowers, cards, letters, and emails and there have been celebrations hosted by us and by others. And we did get some attention from policymakers, which was wonderful.

We have, for the past three years now, introduced into the Kentucky legislative process a bill that would require health departments in Kentucky to be accredited by 2020. We haven’t got that bill approved yet, but we continue to work on it and we think we will eventually. But that effort means that the legislators are familiar with the concept of accreditation. While maybe they haven’t paid that much attention to it before, they’re paying more attention now because Kentucky had three health departments receive accreditation in the first round and that’s gotten some attention statewide.

NPH: In terms of the process, what has been harder than you thought and what was easier

In February, the Robert Wood Johnson Foundation honored six communities with the inaugural RWJF Roadmaps to Health Prize, which recognizes outstanding community partnerships that are helping people live healthier lives.

Recently, NewPublicHealth spoke with Claude-Alix Jacob, chief public health officer at the Cambridge, Mass., department of health, one of the six prize-winning communities to be recognized by the Foundation. Mr. Jacob spoke to NPH about how collaborating around and winning the Prize has impacted the community, including resilience in the face of tragedy.

>>Apply to become a winner of the 2013-2014 RWJF Roadmaps to Health Prize. This year's application deadline is May 23, 2013.

NewPublicHealth: What did winning the RWJF Roadmaps to Health Prize mean to your community?

Claude Jacob: It has been great and exiting news for our community. Over the course of the last few months and through National Public Health Week last month we’ve had a chance to celebrate. We’ve been able to share our public health plans and community partnerships, but also under the aegis of the Robert Wood Johnson Foundation, we now have more credibility for all of our efforts. The Foundation is associated with promoting important health improvement efforts nationwide and just to be linked to the Foundation will open doors, especially now that we’re one of the six inaugural prize winning communities.

During National Public Health Week we invited our community stakeholders to celebrate to thank them for their hard work in helping us to prepare for the site visit that was required of prize finalists. So it’s been a phenomenal few weeks.

NPH: How has winning the prize impacted the health improvements of your community?

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.

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.”

Several sessions at this year’s American Public Health Association meeting include brass-tacks guidelines for initiating and furthering partnerships between public health and hospitals to improve community health. In a session yesterday, Michael Bilton, who co-founded and leads the Association for Community Health Improvement of the American Hospital Association, spoke about the value of partnerships between public health and hospitals, since both have requirements to complete similar community needs assessments.

Health departments seeking public health accreditation must complete a community needs assessment, and non-profit hospitals must complete community benefits reports every three years under the Affordable Care Act.

Bilton pointed out that for many communities, the collaboration won’t be one that starts from scratch. San Francisco has had a community benefit requirement for non-profit hospitals since 1994, “which promoted a sense of collaboration in many communities,” Bilton told the audience at the APHA session.

Bilton says the collaboration also aligns with the National Prevention Strategy, released by the Surgeon General last year, which is promoting partnerships across federal agencies to improve community health.

>>Read an interview series on the National Prevention Strategy on NewPublicHealth.

Bilton says the Strategy specifically points to community needs assessments as a way to identify and begin working on many of the priorities in the Strategy. “And those priorities have already been identified by many hospitals,” says Bilton. The joined forces of hospitals and public health departments also help achieve the “triple aim” of additional goals stressed in the Affordable Care Act including improving improving care, improving health care quality and reducing costs. These collaborations underscore the notion that helping to manage population health is the role of hospitals as well, said Bilton.

Bilton advised public health officials anxious to collaborate with hospitals on community benefit requirements to do several things including:

• Become acquainted with hospital regulations
• Approach hospitals as early as possible in your process
• Find out who is leading the assessment
• Ask hospitals about their assessment  process and goals
• Offer to help hospitals with with data, communications,  facilitation or staff expertise, as appropriate  
• Balance short term needs such as fulfilling IRS or accreditation requirements with longer term opportunities—sustained health improvement collaboration.

>>Bonus Link: Read a NewPublicHealth interview with Laurie Cammisa from Children's Hospital Boston on community benefit collaboration. 

The Office for State, Tribal, Local and Territorial Support (OSTLTS) at the Centers for Disease Control and Prevention (CDC), was launched in 2009 as a central office dedicated to advancing public health at the state and local levels and identifying both gaps and opportunities for collaboration. Judith Monroe, the office's director, spoke to us last year about challenges facing health departments in a tough time. Recently, at the ASTHO Annual Meeting, we had a chance to catch up with Dr. Monroe to hear what she and her office have been up to since we last spoke in the summer of 2011.

>>Read our earlier Q&A with Dr. Monroe.

NewPublicHealth: The focus of the ASTHO annual meeting this year is on the intersection of health care and public health. What efforts is CDC engaged in right now in that intersection?

Dr. Monroe: We’ve been involved in a number of areas. The IOM report on the integration of primary care and public health, was co-funded by the Health Resources and Services Administration and CDC. And CDC had a seat at the table when ASTHO and the IOM came together to develop the strategic map for the integration. We’re excited about that and we continue to be on those calls.

We have an office here at CDC recently created called the Office of Prevention Through Healthcare that is looking at this intersection and where the gains might be, working with the Centers for Medicare and Medicaid Services very closely. And, in addition, our office—the Office of State, Tribal, Local and Territorial Support—has forged a relationship with all of the primary care residency programs across the nation. That’s dear to my heart because I was a residency program director in family medicine for a number of years. We’ve had a number of educational venues taking the science from CDC and packaging it in a way that the residency programs can use. We’re looking toward some quality improvement projects with the residency programs as well as “playing matchmaker” in many ways, between health departments and residency programs. And, I am the point person here at CDC for our relationships between the American Academy of Family Physicians and the American College of Physicians so we have a lot going on. Those are the biggies, but there are many daily activities taking place as well.

NPH: Thank you for that overview. Since you’ve been at OSTLTS, what are some successes that you’d point to?

This summer, Paul Kuehnert, MS, RN, joined the Robert Wood Johnson Foundation (RWJF) as senior program officer and director of the Foundation’s Public Health Team. For nearly 20 years, Kuehnert has provided executive leadership to private and governmental organizations to build and improve systems to address complex health and human services needs. As the county health officer and executive director for health for Kane County, Ill, he led public-private partnerships, integrated planning with transportation, land use, parks and recreation and other diverse sectors, and a comprehensive wellness program for government workers that resulted in demonstrable improvements to the health of employees – as well as marked cost savings [watch an RWJF Public Health in Action video profile of Kuehnert].

NewPublicHealth caught up with Paul Kuehnert during the National Association of County and City Health Officials Annual Meeting this week to talk about the future of public health, and what his decades of leadership in government and private organizations to improve health has taught him.

NewPublicHealth: You were a health director at a time of great change in public health, and that includes massive budget cuts and incredibly rising rates of chronic disease, all creating a very challenging environment. How did that shape your approach to leadership at Kane County and how do you think it will inform what you’ll now be doing in your position?

Paul Kuehnert: I think we’re living through a time that there’s this incredible convergence of the recession, the epidemic of chronic diseases and other situations that all present challenges for public health. As a local public health leader, the key thing was to really develop a strategic focus and to find ways to engage policymakers and other community leaders and partners. That was and is so critical because I think what we have to do in these times is really sort out what it is that public health, and in particular, governmental public health really has to do in order to meet these challenges. And, what is it that other partners can do or, in fact, may do better than governmental public health, which has to be an excellent steward of the public resources. Governmental public health has to be really well versed in what the evidence is for the kinds of things that we’re doing, and be mindful of being very accountable and very transparent in the community as relatively scarce dollars are used to provide services to the community.

Those are the issues that were key for me when I was a local health director, and I think what that does for me in my new position at the Robert Wood Johnson Foundation is that it has really grounded me in the reality that these are very different and very difficult times for public health. So, I would say the same things that were true for me as a local health director really have to be true for Robert Wood Johnson Foundation as well. We need to be strategic, we need to be focused, we need to engage policymakers and stakeholders in our work and we need to be very transparent about what we’re doing. So, I feel like my recent experience, in the trenches really provides a grounding for me in this new position.

NPH: Partnerships are critical to the future of public health and health departments. What partnerships did you develop or advance that were most critical to the success of public health endeavors in Kane County?