The 2003 Institute of Medicine (IOM) report, The Future of the Public’s Health, called for the establishment of a national Steering Committee to examine the benefits of accrediting governmental public health departments.
Within its 2004 Futures Initiative, the Centers for Disease Control and Prevention identified accreditation as a key strategy for strengthening public health infrastructure. Several states manage statewide accreditation or related initiatives for local health departments. Within this context, the Robert Wood Johnson Foundation in 2004 convened public health stakeholders to determine whether a voluntary national accreditation program for state and local public health departments should be explored further. The consensus was to proceed, and the Exploring Accreditation project was launched in 2005.
The goal of the Exploring Accreditation project was to develop recommendations regarding the feasibility and desirability to implement a national public health accreditation program or some other method for achieving a systematic approach for public health improvement. To achieve that goal, the Exploring Accreditation Steering Committee and its workgroups designed a proposed model program and vetted it through public health officials. Based on the feedback, changes were made to the proposed model in winter 2006. At that time, the Steering Committee concluded that it was both desirable and feasible to move forward with establishing a voluntary national accreditation program that:
- Promotes high performance and continuous quality improvement;
- Recognizes high performers that meet nationally accepted standards of quality and improvement;
- Illustrates health department accountability to the public and policymakers;
- Increases the visibility and public awareness of governmental public health, leading to greater public trust and increased health department credibility, and ultimately a stronger constituency for public health funding and infrastructure; and
- Clarifies the public’s expectations of health departments.
PHAB was formed as the non-profit entity to implement and oversee national public health department accreditation, and program development began in May 2007 with the incorporation of PHAB. The accreditation process was developed by the PHAB Assessment Process Workgroup, which included state and local public health professionals, representatives from state-based accreditation programs, representatives from other national accreditation programs, and other technical experts. The standards and measures were the products of months of development by the PHAB Standards Development Workgroup, which included state and local public health professionals, national and federal public health experts, public health researchers, and other technical experts. The initial standards and measures were subject to an “alpha” field test with a small group of local and state health agencies, resulting in multiple revisions.
In February 2009, PHAB released the initial accreditation process and a set of draft standards and measures for public comment for a period of three months. During that time, PHAB received over 4,000 individual comments, as well as other comments through online surveys and group feedback forms. The PHAB Standards Development Workgroup carefully reviewed each comment, and proposed changes to the documents based on the feedback. The next set of standards and measures was released in July 2009 for use in the beta test.
The PHAB beta test took place from fall 2009 through the end of 2010, at which time 30 public health departments (19 local, eight state, and three Tribal) throughout the United States participated in a test of the national public health department accreditation process. The 30 beta test sites were selected from a pool of 148 applications. To ensure that the test sites represented a diverse cross-section of health departments, PHAB carefully selected health departments that varied in size, structure, population served, governance, geographic region, and degree of preparedness for accreditation. Throughout the beta test, the sites worked through the accreditation process and provided valuable feedback on the process, materials, and tools.
PHAB recognized the unique and critical role of Tribal governments in informing the development of national public health department accreditation. The Tribal Standards Workgroup was created to make adaptions as needed to ensure the standards and measures, required documentation, and guidance were relevant to Tribal health departments. After a public vetting period, the Tribal Standards Workgroup developed an eligibility definition and a set of Tribal standards, measures, and interpretation guidance that is relevant, contextually appropriate, and culturally sensitive to Tribes and Tribal health departments. The workgroup also made recommendations and identified references in the PHAB state and local health department measures where there could be collaboration between all health departments.
In spring 2011, the Assessment Process Workgroup and Standards Development Workgroup came together one last time to review all of the comments received and to finalize the official standards and measures and process for the launch of national public health department accreditation. Upon approval of the PHAB Board of Directors, Version 1.0 of the PHAB Accreditation Standards and Measures and the Guide to National Public Health Department Accreditation were released to the public in July 2011. National public health department accreditation launched on September 14, 2011.
For more information on the background of accreditation, please see the Journal of Public Health Management and Practice, January/February 2014, Volume 20, Number 1. Other background publications and reports that helped inform the development of PHAB are available here.