The Public Health Accreditation Board (PHAB) has selected 30 public health departments to participate in a test of the national public health accreditation program. From the fall of 2009 through the end of 2010, the selected sites will evaluate the accreditation standards and processes that, in 2011, will become the basis of the national voluntary accreditation program for public health departments.
The beta test sites will use the draft standards, developed by PHAB with input from over 4,000 public health professionals across the country, to undergo the accreditation process and provide feedback to PHAB to help inform the final accreditation program. The selected sites include 19 local, eight state and three tribal health departments that represent a diverse cross-section of departments, varying in size, structure, population served, governance, location, and degree of preparedness for accreditation (i.e., previous experience with other accreditation efforts).
Accreditation: A New Benchmark for Public Health Departments
Public health departments play a critical, but often unrecognized, role in promoting and preserving the health of people in communities across the country. Despite the important role health departments play in our communities, there has not been a national system that encourages departments to measure their performance against national standards. Other community services and organizations have seen the value of accreditation, such as schools, day care centers, police departments, and hospitals and now with PHAB’s guidance, health departments will be able to, as well.
The Public Health Accreditation Board (PHAB), funded by the Robert Wood Johnson Foundation (RWJF) and the Centers for Disease Control and Prevention (CDC), was created in 2007 to serve as the national public health accrediting body and to drive improvements in the quality and performance of public health departments. PHAB is developing the national public health accreditation program, testing it during 2009 and 2010 and working with public health departments across the country to implement the program. The national public health accreditation program will launch in 2011 and efforts are already under way to help public health departments start preparing.
The Goal of the National Public Health Accreditation Program
The goal of the 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 United States—state, local, territorial and tribal. Accreditation will drive public health departments to measure themselves against national standards and continuously improve the quality of the services they deliver to the community. As public health departments face increasing challenges with emerging epidemics, such as H1N1, and as accountability and cost-efficiency become more important than ever in this tough economy, accreditation is a critical part of the future of public health. The Robert Wood Johnson Foundation and PHAB share the goal of having 60 percent of the U.S. population served by an accredited health department by 2015.
For public health departments, accreditation means demonstrated accountability and improved quality. Nationally, public health accreditation means that people across the country can expect the same quality of public health programs and services no matter where they live.
Given the significant differences in public health agencies across the country, the accreditation standards were designed to work for all health departments, regardless of size, governance, organizational structure and community health needs.
“Accreditation marks a significant and important change in the future of public health,” said James S. Marks, M.D., M.P.H., senior vice president and director of the Health Group at the Robert Wood Johnson Foundation. “Our vision is that a national, voluntary public health accreditation program will help health departments assess their strengths and gaps so they can continuously improve the health of the nation—community by community.”
Local health departments that are participating in state accreditation programs have reported a variety of benefits including:
Performance assessment and quality improvement: The accreditation assessment process provides valuable, measurable feedback to health departments on their strengths and areas for improvement, so they can better protect, promote and preserve the community’s health.
Accountability and credibility: Gaining accreditation status demonstrates accountability to elected officials and communities, resulting in increased credibility public health departments.
Visibility: The recognition of excellence brought on by meeting accreditation standards enhanced the visibility of the health departments in their communities.
Work Toward Accreditation
The Robert Wood Johnson Foundation, in partnership with local, state, tribal and national public health leaders, is working to improve the quality and performance of public health departments by investing in programs and research that are advancing public health accreditation and quality improvement. These programs include:
1. The Public Health Accreditation Board. The Robert Wood Johnson Foundation, in collaboration with the Centers for Disease Control and Prevention, is supporting the Public Health Accreditation Board and their efforts to launch the national public health accreditation program in 2011. Working directly with the Association of State and Territorial Health Officials (ASTHO), the National Association of City and County Health Officials (NACCHO), the National Association of Local Boards of Health (NALBOH) and the National Indian Health Board (NIHB), RWJF is providing support to PHAB and participating health departments to undergo an 18-month beta test of the accreditation program. Thirty state, local and tribal health departments will participate in the beta test, managed by PHAB, and provide valuable feedback that will inform the final accreditation program before the national launch in 2011.
2. The Multi-State Learning Collaborative : Lead States in Public Health Quality Improvement (MLC). The MLC: Leads States program brings state and local health departments together with other stakeholders, including public health institutes and universities, to improve public health services and the health of their communities by implementing quality improvement practices and preparing for national public health accreditation.
Led by the National Network of Public Health Institutes (NNPHI), the 16 RWJF-funded MLC states have helped build the momentum for national public health accreditation and are leading the way in developing innovative tools and resources to help health departments implement quality improvement and prepare for public health accreditation. The North Carolina Roadmap to Accreditation and the Michigan Quality Improvement Handbook are among the many resources developed by the MLC states. For additional resources, visit NNPHI’s E-Catalog.
North Carolina Roadmap to Accreditation. As part of their participation in the MLC: Lead States program, the North Carolina Accreditation Learning Collaborative created this comprehensive checklist of issues public health agencies should consider to create and implement a successful accreditation program.
Michigan Quality Improvement Handbook. Four local health departments in Michigan created this guidebook as part of their participation in the MLC: Lead States program. The guidebook is intended to provide resources to all local health departments in the state to begin or advance the use of a quality improvement model.
3. NACCHO Accreditation Preparation and QI Demonstration Sites With funding from the Robert Wood Johnson Foundation and the Centers for Disease Control and Prevention, NACCHO coordinated the Accreditation Preparation and Quality Improvement (QI) Demonstration Site Project to give local health departments from across the country the opportunity to engage in quality improvement activities and start preparing for accreditation. As part of the initiative, over 60 local health departments conducted self-assessments using the to identify areas for improvement and then implemented QI projects to address priority areas identified by the self-assessment. The sites completed detailing the outcomes of their assessments and QI work.
4. Accreditation Coalition. In 2007, shortly after the inception of the Public Health Accreditation Board, RWJF and CDC funded a series of meetings for public health organizations working towards public health accreditation. Known as the Accreditation Coalition, the group meets periodically to discuss the development of the accreditation movement and ensure that the various organizations’ efforts to promote accreditation are consistent, strategic and supportive of PHAB’s efforts. The Accreditation Coalition adopted the following purpose statement in 2008:
The Accreditation Coalition will work collaboratively and strategically to promote the success of a national voluntary accreditation system in order to improve the performance of public health departments and improve the health of the population.
5. Building the Evidence for Quality Improvement (QI) Initiatives in Public Health Practice. In preparation for national public health accreditation, many health departments are implementing QI as a means of improving performance to meet accreditation standards. Currently, however, there is little published evidence on the impact of QI in public health, and only preliminary evidence exists about the factors that promote the successful implementation and spread of QI efforts in health departments. The Foundation is currently funding 13 local, state and tribal health departments who will evaluate the impact of a range of QI approaches on key public health processes.
The goal of the national public health accreditation program is to improve and protect the health of the public by advancing the quality and performance of all public health departments across the country. With broad input and support from public health practitioners, the accreditation program has developed standards that state, local, tribal and teritorial health departments can implement to ensure they are providing the best services possible to keep their communities safe and healthy and to demonstrate accountability to their communities.
The Public Health Accreditation Board (PHAB) is a non-profit organization that was created specifically to develop and implement the national public health accreditation program. PHAB was incorporated in 2007, after public health leaders explored the feasibility of a national accreditation program. They saw the need for, and value of, accreditation, and advocated for the implementation of a national program. With funding from the Robert Wood Johnson Foundation and the Centers for Disease Control and Prevention, PHAB was created and the public health accreditation program was underway. Public health accreditation is currently supported by the nation’s leading public health organizations, including the American Public Health Association (APHA), Association of State and Territorial Health Officials (ASTHO), National Association of County and City Health Officials (NACCHO), National Association of Local Boards of Health (NALBOH), National Indian Health Board (NIHB), National Network of Public Health Institutes (NNPHI), and Public Health Foundation (PHF), as well as several state health departments.
Accreditation signifies that the best possible services are being offered to keep a community healthy, and drives health departments to continuously improve the quality of their services. With accreditation status, health departments are able to demonstrate increased accountability and credibility to the public, funders, elected officials and other stakeholders. Also, the accreditation assessment process provides valuable, measureable feedback to health departments about their strengths and areas for improvement, so they can better protect, promote and preserve the community’s health. National public health accreditation means that people across the country can expect the same quality of public health programs and services no matter where they live.
The expectation is that accreditation will strengthen public health departments and the services they provide, which contributes to improved health outcomes in communities. Accreditation will allow all public health departments to demonstrate the value and importance of their work, and the critical impact that public health departments have on the public’s health and quality of life.
The Exploring Accreditation Report is the foundational document for the development of a voluntary national accreditation program and its standards. The draft standards were developed by a nation-wide Workgroup through review of 15 sets of state and national standards, including NACCHO’s Operational Definition (including metrics), NPHPSP state and local, Project Public Health Ready, and results of ASTHO’s State Public Health Survey. The first version of the proposed PHAB standards was reviewed through an alpha test with two state agencies and six local health departments. The revised proposed standards were reviewed through an extensive, formal vetting process that resulted in more than 3,700 comments from all parts of public health throughout the U.S.
After reviewing every one of these comments, the Workgroup revised the materials and made revisions for use in the beta test, now under way.
Quality improvement in public health is the use of a deliberate and defined improvement process, such as Plan-Do-Check-Act, which is focused on activities that are responsive to community needs and improving population health. It refers to a continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality in services or processes which achieve equity and improve the health of the community. 1 Accreditation, as a strategy to improve the performance of public health departments, catalyzes the implementation of quality improvement activities. In fact, the PHAB accreditation program includes standards on the implementation of quality improvement. Additionally, the quality improvement activities public health agencies are already doing will be critical to meeting standards that address evaluation and continuous improvement of processes, programs and interventions. In essence, accreditation drives QI, and by implementing QI activities, health departments can improve their performance and the public health programs and services they deliver to the community. Because accreditation identifies where the gaps in performance are, it drives QI and vice versa.
1 Accreditation Coalition Workgroup, Bialek R, Beitsch LM, Cofsky A, Corso L, Moran JW, Riley W, and Russo, P. “Quality Improvement in Public Health”. Submitted to the Accreditation Coalition for consideration on June 18, 2009.