Public Health Department Accreditation Background
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 Futures Initiative (2004), the Centers for Disease Control and Prevention (CDC) 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, in 2004, the Robert Wood Johnson Foundation (RWJF) 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. In order to achieve the goal, the Exploring Accreditation Steering Committee and its workgroups designed a proposed model program and vetted it through public health officials. In the winter of 2006, changes to the proposed model were made based on the feedback received and the Steering Committee concluded that it is 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
- 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 based on the feedback, proposed changes to the documents. The next set of standards and measures were released in July 2009 for use in the beta test.
The PHAB beta test took place from fall 2009 through the end of 2010, where 30 public health departments (nineteen local, eight state, and three Tribal) throughout the US 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.
Simultaneously with the beta test, PHAB held various think tanks to engage thought leaders in particular areas on over-arching issues related to public health department accreditation. Some think tanks have completed their work in one meeting, with some email and conference call follow-up, while others have worked over several months and multiple meetings. Specifically, PHAB has identified the following think tank topics:
- To engage major public health program areas in accreditation and to avoid duplication of effort.
- Environmental Public Health
- Public Health Laboratories
- Emergency Preparedness
- Chronic Disease
- Maternal and Child Health
- To consider various organizational configurations affecting accreditation implementation.
- Centralized States
- Large City/Metropolitan Public Health Departments
- Multi-jurisdictional/Shared Services Models
- To engage with special populations affected by accreditation.
- Tribal Public Health
- Texas Public Health
- California Public Health
After each think tank is completed, reports are generated that include recommendations to the PHAB Board of Directors, which may lead to additional work plans. All think tank recommendations are considered to further strengthen the accreditation process and standards and measures for future versions.
PHAB recognized the unique and critical role that Tribal governments have in informing the development of national public health department accreditation, and 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 for a final meeting to review all of the comments received to finalize the official standards and measures and process for the launch of national public health department accreditation. After PHAB Board of Directors approval, 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 will launch in September 2011.
Background publications and reports that helped inform the development of PHAB are available here.