NewPublicHealth Q&A: Kaye Bender

Aug 9, 2011, 5:22 PM, Posted by NewPublicHealth


The Public Health Accreditation Board (PHAB) is developing a national voluntary accreditation program for state, local, territorial and tribal public health departments, to launch in September 2011. The goal is to improve and protect the health of every community by advancing the quality and performance of public health departments.

Ahead of the launch, NewPublicHealth spoke with Kaye Bender, Ph.D., R.N., F.A.A.N., president and C.E.O. of the Public Health Accreditation Board (PHAB). She provides an update on the progress on accreditation, and what she’s hearing about it from local health departments. Accreditation is grounded in standards and measures – standards are the required level of achievement that a health department is expected to meet, and accreditation is a process to measure performance against those standards, and provide recognition for those departments that measure up.

NPH: You’re gearing up to accept applications for public health department accreditation. Why is accreditation important now?

Kaye Bender: Two Institute of Medicine studies in the past said that public health in this country was in disarray. Accreditation will drive public health departments to continuously improve the quality of the services they deliver to the community, and ultimately improve the health of all Americans. Local health departments participating in state accreditation programs have already seen the benefits – valuable, measurable feedback on strengths and areas of improvement to help them better serve their communities; accountability and credibility; and better staff morale and increased visibility in the community. We expect to see all of these benefits in national accreditation as well.

NPH: Some health departments may not have started thinking about applying for accreditation. Some may say it seems like quite a large task. What would you say to a health department that’s just beginning to think about applying?

Kaye Bender: I would tell them that accreditation is about making us all better at what we do. In terms of process, local health departments will need to submit three prerequisites as part of the application process: 1) a community health assessment, 2) a community health improvement plan, and 3) an agency strategic plan. A good place to start is the NACCHO accreditation toolkit and the PHAB website for Version 1.0 of the Standards and Measures.

NPH: As you’re getting near the launch, what are the kinds of questions that you’re getting from public health departments who are close to being ready to apply?

Kaye Bender: Well, the ones who are close to applying have of course been working at this for a little while. Some of them were our beta test sites as well. So the kinds of questions they’re asking are: what are the differences in the standards and measures now that they’ve been revised for the launch from the draft ones that were available before? Because they really did most of their preparation last year, based on the drafts of those materials. So, on our website is a summary of the standards and measures as well as a summary of the process for applying, and those include notices of what has changed from drafts that we used for the beta tests. And understandably, health departments are curious about the fees.

NPH: Can you tell us about the fees?

Kaye Bender: We recently published the fee structure. We’ve tried to be very frugal with the needed expenses. We’ve also tried to be very basic in the costs we’re passing on. And we have several ways that health departments can negotiate to pay it: one lump sum with a discount or paid over five years or paid in two-year increments – whatever works for their budget team. That flexibility, I think, has really helped a lot. For the fees they pay, the health department gets the time and attention of the PHAB staffer who is their liaison from the day they first apply through the whole process. They also get access to the peer review team reviewing their application. The departments will be able to consult with those who can say “you’re doing well at this” or “you need to improve on that.” Then of course PHAB will promote the fact that we’ve accredited these health departments. This is a big deal in public health and it’s been a long time coming and so we want the health departments to use it as a good marketing opportunity. It’s something that they should be proud of, so we’ll help them with the tools to do that.

NPH: And what are those numbers? What are the fees?

Kaye Bender: There are eight categories and they’re based on the size of the jurisdiction that the health department serves. We use the size of the jurisdiction as a proxy for the complications associated with the review. Of course, the larger the jurisdiction, the more complicated the review and the more complex. So the annual fees for the smallest jurisdictions are in the range of $3,000 and the annual fee for the largest is in the $20,000 range.

Some good news associated with fees is that we just found out that the federal government has designated the payment of accreditation fees as a legally allowable expense under federal grants. So if you had a health department and you have five or six grants, for example, you could spread the fees among those grants. The caveat is, the local health department has to ask their respective grants officer about that because this is new, but it’s legal and it’s allowable, so if they have end-of-the-year money and they want to go ahead and pay the whole thing upfront, then we give them a discount for doing that [as we’re doing with all upfront payment]. We’re trying to find creative ways to help.

NPH: In addition to the discounts and being able to use grants, are there any other sources of financial assistance if health departments are looking for them?

Kaye Bender: We heard from someone who said that a foundation in his state likes to support public health and one of our panelists [in a session at NACCHO 2011] told him they could help offset the fees as well as perhaps assist with some of the accreditation. This is worth some solicitation, if you will, on the part of health departments, to be able to get those fees taken care of.

NPH: Of the health departments that will be the first out of the gate to apply for accreditation, do you have the full mix there? Local, state, big, small, tribal, territorial?

Kaye Bender: From a survey we did, we know we have large, small, centralized, decentralized, state, and tribal health departments applying in the early stages. The mix appears to be all over the place, which is great. It’s a major priority for PHAB to make the process work for small departments. The really, really small health departments in many cases are working now on partnering with other local jurisdictions that are contiguous to their areas and are working towards submitting a multi-jurisdictional application and so they’ve got to figure out what those shared services look like before they are ready to apply.

NewPublicHealth: At this point, do you know how many public health departments will be at the starting gate, ready to apply?

Kaye Bender: Between one hundred fifty and two hundred health departments have told us that they’re getting ready to apply. That sounds good to us and we’ll be ready to accept their applications.


This commentary originally appeared on the RWJF New Public Health blog.