Public Health Department Accreditation Begins: NewPublicHealth Q&A with Terry Cline
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?
NPH: Why did you want your state to apply for accreditation so soon after the credential became available?
Cline: When I started at the Oklahoma State Department of Health about four years ago, the department’s governing body began asking how we know that the department would be doing all its work optimally and how we could assess that. How could we ensure that we were actually being as efficient, as focused and effective as possible?
Accreditation was being talked about very actively at that time and I had been part of other systems that had been accredited, such as hospitals. From my own experience I saw the value of accreditation, and I had seen other organizations rally to ensure that they were meeting those standards. So, I was sold on the value of accreditation and saw it as being very good for the field and the discipline of public health. I was a believer from the beginning.
NPH: What did you learn about your community and your health department during the process of applying for accreditation?
Cline: Well, it was interesting. In part, it was validation of the excellent work that was already taking place within the health department, and we seldom take time to stop and recognize accomplishments and to celebrate those things that we’re doing well. We’re always focused on the next objective, so in some ways accreditation really forced us to stop and take stock of what we were doing well, as well as those areas where we needed to see improvement.
NPH: In what ways will being accredited by the Public Health Accreditation Board benefit your community and health department?
Cline: The underlying premise behind accreditation is really embracing and putting into practice quality improvement, a performance-improvement culture. That will transfer across every single program and every activity that we engage in. We have pockets of quality improvement programs and performance improvement, but it has not been pervasive enough. Accreditation will help us make that more widespread so that it becomes really part of our culture.
Concretely, accreditation has forced us to actually do some things that we knew that we should have done but they always seem to take a second step down in terms of priorities. A good example is our senior leadership team, which is made up of about seven people. We reviewed every single policy for the department—hundreds and hundreds and hundreds of pages. We carved out part of our agenda every week to read, review and discuss policies. Some of those policies have been on the books for a very long time; some were outdated. It’s a very labor-intensive process and not very glamorous and not very glitzy, but something that really needed to be done. If it hadn’t been for accreditation, we probably would not have prioritized that because there were so many other pressures of the day and so many other things that we need to be focused on.
NPH: Was the accreditation process harder or easier than you expected?
Cline: I think the hardest part probably was the paperwork review, the documentation. That’s very important, but in the pressure of the day in public health moves down the priority list. We added documentation to the existing work that we were doing, which was a challenge. It was really critical to have good leadership and someone organizationally who took primary responsibility to make sure we stayed on track and that things didn’t move down the priority list.
The easier part for us was the demonstration of community partnerships, because we have a good track record. I think it would be a challenge to develop that just as you’re applying for accreditation, but it’s one of those things that if you’re not doing, you absolutely need to do it. We can’t do it alone in public health. The only way we’ll really be successful is through active engagement with other stakeholders and other partners. When we asked people to participate in part of the accreditation process, our community partners stepped forward and were able to accurately describe their work with us. That’s just the way we did business.
NPH: What advice do you have for health departments about to embark on the accreditation process?
Cline: I would definitely encourage them to look at the PHAB guidelines and to map out the process. It can feel a bit overwhelming at times. So, I’d say take it in chunks. Recognize that the only deadline that you have is the one that you impose on yourself, because no one else is requiring us to do this. And really look at it as not add-on work that you’re doing, but work that needs to be done.
In terms of stakeholders you’re engaged with, one of the accreditation requirements asks what I can do as a public health department to help other stakeholders be successful. A concrete example would be working with the business community. We are able to actually increase their productivity, deliver a healthier workforce, reduce their bottom line costs and increase their profit margin. We might not typically think that public health has much to offer in terms of economic development or improvement, but we need to really think about how we can help other entities achieve their goals, and I think public health is very well suited to do that on multiple fronts.
Examples of how to engage with business include creating worksite wellness programs that can reduce healthcare costs and decrease workers’ compensation costs, as well as decrease absenteeism and increase productivity.
Usually when we think of partnerships we think of we’re asking somebody to join us. I think that we need to turn that around and think about what public health has to contribute to other sectors such as business, education, housing and transportation, because we have a lot to offer and we need to align our goals with the goals of these other sectors.
The way you turn that around is to ask, how can I help that sector be more successful?