Public Health Department Accreditation: An Overview

1. County Health Executives Association of California Public Health Department Accreditation: An Overview Robin Wilcox Chief Program Officer Public Health Accreditation Board August 1, 2012

2. Public Health Accreditation

3. 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.

4. PHAB’s Vision High Performing Health Departments Leading to a Healthier Nation

5. 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.

6. Public Health Accreditation Board (PHAB)

7. 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.

8. PHAB Accreditation Themes • Quality Improvement • Planning • Partnerships • Community Engagement • Leadership and Governance • Customer / Community Focus

9. Standardsand Measures Version 1.0

10. 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

11. PHAB Domains of StandardsStandards Grouped by the Core Functions of Public Health & Ten Essential Public Health Services

12. Twelve Domains • Conduct assessments focused on population health status and health issues facing the community • Investigate health problems and environmental public health hazards to protect the community • Inform and educate about public health issues and functions • Engage with the community to identify and solve health problems • Develop public health policies and plans • Enforce public health laws and regulations • Promote strategies to improve access to healthcare services • Maintain a competent public health workforce • Evaluate and continuously improve processes, programs, and interventions • Contribute to and apply the evidence base of public health • Maintain administrative and management capacity • Build a strong and effective relationship with governing entity

13. Domains Cross All Programs Sample Domains Family Planning Program # 8 Public Health Workforce Programs Immunization Program MCH Program # 3 Educate the Public # 9 Quality Improvement # 4 Community Engagement # 5 Policy & Plans Environmental PH Program STD Programs

14. Structural Framework  Domain   Standard Measure Documentation Guidance

16. The PHABAccreditationProcess

17. . PHAB’s Electronic Information System Multiple users, different views • Tracks transactions in process • HD SOI and applications • Health departments upload documentation • Site visitors review documentation • Site visitors develop Site Visit Report • Accreditation Committee reviews SVR • Accreditation Committee records decision

18. 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

19. Seven Steps 1. Pre-application Applicant prepares and assesses readiness, informs PHAB of its intent to apply(SOI) 2. Application Applicant submits application and pre-requisites and receives training 3. Documentation Selection and Submission Applicant gathers and submits documentation 4. Site Visit Documentation review, site visit and site visit report 5. Accreditation Decisions PHAB Accreditation Committee determines accreditation status: Accredited (5 years) or Not Accredited 6. Reports Annual progress reports 7. Reaccreditation

20. 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

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

22. Three Prerequisites • Community Health Assessment • Community Health Improvement Plan • Health Department Strategic Plan

23. 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

24. Accreditation Specialists Each 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

25. 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

26. 3. Documentation Selection Consider 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

27. 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

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

29. 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

30. Final Process Steps • Accreditation Decision is by the Board’s Accreditation Committee • Annual Reports must be provided each year during your accreditation • Reaccreditation will occur after 5 years and advanced notice will be sent by PHAB

31. Multijurisdictional Applications • Apply as a single entity • Two or more HDs • PHAB will accredit each HD • All HDs or none accredited • PHAB can limit number of HDs • One lead HD • One lead AC • Geographically contiguous preferred • Shared documentation assessed once

32. 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

33. What can you do NOW to begin to prepare?

34. 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

35. 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

36. 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

37. Dates and Signatures Review your HD’s: • Policies • Procedures • Plans • Directives • Public Information • Etc. Dates: Created date Revised date Reviewed date Amended date Effective period Signatures: (Evidence of “authenticity”) HD logo HD Director signature HD Abbreviation For -

38. Online Orientation • 4 Modules • Introduction • Process • Accreditation Coordinator • Standards and Measures • 2 hours • About 30 minutes each

40. Fees

41. Fees: 2011-2013

42. Fees: 2011-2013

43. 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

44. 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.

45. 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

46. 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

47. 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

48. 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

49. PHAB Accreditation Support Materials x

50. Public Health Accreditation Board 1600 Duke St Suite 440 Alexandria VA 22314 703.778.4549 www.phaboard.org SIGN UP TO RECEIVE THE PHAB NEWSLETTER!!