Public Health Department Accreditation:

An OverviewRobin WilcoxChief Program OfficerPublic Health Accreditation BoardAugust 1, 2012

County Health Executives Association of California

Public Health Accreditation

National Public Health Department Accreditation

• The measurement of health department performance against a set of nationally recognized, practice-focused, and evidenced-based standards.

• The issuance of recognition of achievement of accreditation within a specified time frame by a nationally recognized entity.

• A platform for continuous quality improvement.

• The continual development, refinement, and distribution of standards and measures.

PHAB’s Vision

4

High Performing Health

Departments Leading to a

Healthier Nation

Goal of Public Health Department Accreditation

The goal of the national public health department accreditation is to improve and protect the health of the public by advancing the continuous quality and performance improvement of state, local, tribal and territorial public health departments.

Public Health Accreditation Board

(PHAB)

Public Health Accreditation Board(PHAB)

• PHAB is the non-profit public health department accreditation organization founded in 2007.

• PHAB is funded by the Robert Wood Johnson Foundation (RWJF) and by the Centers for Disease Control and Prevention (CDC) but also has accreditation fees associated with the application..

• PHAB’s governance structure is a board of directors composed of public health leaders from Tribal, state and local health departments and academia.

PHAB Accreditation Themes

• Quality Improvement • Planning• Partnerships• Community Engagement• Leadership and Governance• Customer / Community Focus

Standardsand Measures Version 1.0

Principles of Standards and Measures

• Advance the collective public health practice

• Moderate level: not minimum, not maximum

• Be simple, reduce redundancy, minimize burden

• Apply to all sizes of HDs and all forms of governance structure

• Establish same standards for Tribal, state and local health departments

• Build quality improvement into standards

PHAB Domains of StandardsStandards Grouped by the Core Functions of Public Health &

Ten Essential Public Health Services

Twelve Domains1. Conduct assessments focused on population health status

and health issues facing the community 2. Investigate health problems and environmental public health

hazards to protect the community 3. Inform and educate about public health issues and functions 4. Engage with the community to identify and solve health

problems5. Develop public health policies and plans6. Enforce public health laws and regulations7. Promote strategies to improve access to healthcare services8. Maintain a competent public health workforce9. Evaluate and continuously improve processes, programs,

and interventions10. Contribute to and apply the evidence base of public health11. Maintain administrative and management capacity12. Build a strong and effective relationship with governing entity

Domains Cross All Programs

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STD Programs

Environmental PH Program

MCH Program

Immunization Program

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Structural Framework

 Domain

  Standard

Measure  

Documentation

Guidance

The PHABAccreditationProcess

.

PHAB’s Electronic Information System

Multiple users, different viewso Tracks transactions in processoHD SOI and applicationsoHealth departments upload documentationo Site visitors review documentationo Site visitors develop Site Visit Reporto Accreditation Committee reviews SVRo Accreditation Committee records decision

Health Department

• Appoint an Accreditation Coordinator• Establish an Accreditation Team• Establish a process to select the best

documentation for each of PHAB’s measures and requirements for documentation

• Outreach and involve staff department-wide and partners

Seven Steps1. Pre-application

Applicant prepares and assesses readiness, informs PHAB of its intent to apply (SOI)

2. ApplicationApplicant submits application

and pre-requisites and receives training

3. Documentation Selection and SubmissionApplicant gathers and submits

documentation

4. Site VisitDocumentation review, site visit and site visit report

5. Accreditation DecisionsPHAB Accreditation Committee determines accreditation status:

Accredited (5 years)

or Not Accredited

6. ReportsAnnual progress reports

7. Reaccreditation

1. Pre-app: Statement of Intent

• Submit prior to application • Online • Designate Accreditation Coordinator• Does not commit the health department

to applying• Submit anytime after

online orientation is

completed

2. Application• Completed online • Three prerequisites• Letter of support• Electronic signature• Eligibility to apply• Completeness review• Forward invoice• Applicant training

Three Prerequisites

Community Health Assessment

Community Health Improvement Plan

Health Department Strategic Plan

2. Applicant Training• Required for each applicant health

department Accreditation Coordinator

• Another representative at the health department’s cost

• Must be completed prior to

upload of documentation

Accreditation SpecialistsEach health department is assigned a PHAB Accreditation Specialist

– Support HD as they upload documentation– Completeness Review– Communication link between HDs and SVs

prior to site visit• Questions on documentation• Agenda

– Attend site visit – Receives the Site Visit Report

3. Documentation Selection and Submission

• 12 months to complete the upload• When finished, PHAB will conduct a

completeness review• Checks that documentation is complete• Does not check for conformity with the

Standards and Measures

• PHAB staff will follow-up for missing documentation

3. Documentation SelectionConsider variety of options and programs:

• Best reflects health department operation

• Meets specifics of the Required Documentation

• Demonstrates conformity with measure (Context and intent of M & S)

• Changes may be made until final submission

4. Site Visit• After pre-site visit review of

documentation• Usually 2 day visit• Interview staff; verify documentation

implementation• Meet with community partners and

governance• May ask for additional documentation• Visual observations

4. Site Visitors

• Peer reviewers• Matched to HD• Trained by PHAB• 3 or 4 team members• Conflicts of interest determined

4. Site Visit Report

• Submitted online• Due 2 weeks after completion

of site visit• Health department will review

and may submit any information to correct a factual error

Final Process Steps5. Accreditation Decision is by the

Board’s Accreditation Committee

6. Annual Reports must be provided each year during your accreditation

7. Reaccreditation will occur after 5 years and advanced notice will be sent by PHAB

Multijurisdictional Applications

• Apply as a single entityo Two or more HDso PHAB will accredit each HDo All HDs or none accreditedo PHAB can limit number of HDs

• One lead HD• One lead AC• Geographically contiguous preferred• Shared documentation assessed once

Multijurisdictional Applications

• Established & defined working relationship– MOU – Deliver services/perform functions over

combined jurisdiction

• High degree of interdependence– Each HD could not fulfill role – Half of Domains, majority of Measures

What can you do NOW

to begin to prepare?

Readiness Checklists

• Assists with health department preparation for accreditation

• Optional, but recommended prior to submitting a Statement of Intent

• The checklists are not submitted to PHAB

Three Prerequisites Community Health Assessment

Standard 1.1 Community Health Improvement Plan

Standard 5.2 Health Department Strategic Plan

Standard 5.3• Submitted with the application for accreditation• Criteria included in Domains 1 and 5• One page “tip sheet” on prerequisites available

Health Department• Appoint an Accreditation Coordinator

• Establish an Accreditation Team

• Review your documentation for each of PHAB’s measures and requirements for documentation

• Outreach and involve staff department-wide and partners

Dates and Signatures

Review your HD’s:• Policies• Procedures• Plans• Directives• Public

Information• Etc.

Dates: Created dateRevised dateReviewed dateAmended dateEffective period

Signatures:(Evidence of “authenticity”)

HD logoHD Director signatureHD Abbreviation

For -

Online Orientation• 4 Modules

– Introduction– Process– Accreditation Coordinator – Standards and Measures

• 2 hours– About 30 minutes each

Fees

Fees: 2011-2013Health Department Category

Population Size of the Jurisdiction Served Total Fee

Category 1 Less than 50,000 $12,720

Category 2 50,000 to 100,000 $20,672

Category 3 >100,000 to 200,000 $27,030

Category 4 >200,000 to 1 million $31,802

Category 5 >1 million to 3 million $47,701

Category 6 >3 million to 5 million $63,600

Category 7 >5 million to 15 million $79,499

Category 8 Greater than 15 million $95,402

Fees: 2011-2013Health Department Category

Population Size of the Jurisdiction Served

Year 1 Payment

Year 2 Payment

Year 3 Payment

Year 4 Payment

Year 5 Payment

Category 1 Less than 50,000 $ 3,180 $ 2,385 $ 2,385 $ 2,385 $ 2,385

Category 2 50,000 to 100,000 $ 5,168 $ 3,876 $ 3,876 $ 3,876 $ 3,876

Category 3 >100,000 to 200,000 $ 6,758 $ 5,068 $ 5,068 $ 5,068 $ 5,068

Category 4 >200,000 to 1 million $ 7,950 $ 5,963 $ 5,963 $ 5,963 $ 5,963

Category 5 >1 million to 3 million $ 11,925 $ 8,944 $ 8,944 $ 8,944 $ 8,944

Category 6 >3 million to 5 million $ 15,900 $ 11,925 $ 11,925 $ 11,925 $ 11,925

Category 7 >5 million to 15 million $ 19,875 $ 14,906 $ 14,906 $ 14,906 $ 14,906

Category 8 Greater than 15 million $ 23,850 $ 17,888 $ 17,888 $ 17,888 $ 17,888

Fees Support• Assigned Accreditation Specialist• In-person training for the HD’s AC• Subscription to e-PHAB

• Easier & cost effective to participate• Peer review and Site Visit• Site Visit Report with identified

opportunities for improvement and areas of excellence

• Annual QI guidance

Costs of Seeking Accreditation• The cost of doing business• The cost of CQI – doing better things better• The cost of planning and prioritizing• The cost of team building and strategic

alignment of staff• The cost of building partnerships and sharing

responsibilities with others in the public health system & community

• The cost of maintaining a good working relationship with governing entity.

Benefits of Accreditation• Recognition and credibility• Identifies successes and opportunities for improvement• Access to public health experts• Platform for culture of continuous quality improvement• Means for accountability• Energizes the staff• Increases the understanding of public health• Improves communication with governance• Initiates and advances partnerships and community

involvement• Encourages linkages among levels of health departments

Beta Test Feedback

“ . . .had a positive effect on those staff involved by providing opportunities to learn about the department in-depth and how much we do for the people who live and visit our state.”

Beta Test Health Department

Beta Test Feedback“The standards and measures can be viewed as an operating manual on how to run a good health department. The basics and fundamentals in management are there, so as new leaders come in they don’t have to reinvent the wheel—the standards and measures can provide a consistent roadmap.”

Beta Test Health Department

Technical Assistance• PHAB

Accreditation Process, Standards and Measures Interpretation, e-PHAB, fees, and accreditation requirements

• NACCHO, PHF, PH Institutes, each other Preparation of processes, programs,

interventions, materials, and documents

PHAB Accreditation Support Materials

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Alexandria VA 22314

703.778.4549

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