This case report provides insights and perspectives from one state that was among the first accredited health departments in the nation.
Office of Performance Management, Oklahoma State Department of Health, Oklahoma City.
Correspondence: Joyce Marshall, MPH, Office of Performance Management, Oklahoma State Department of Health, 1000 NE 10th St, Oklahoma City, OK 73117 (email@example.com).
The author thanks Dr Terry Cline, Julie Cox-Kain, Stephen Ronck, Neil Hann, and the Core Accreditation Team for their leadership. The author also thanks the OSDH employees whose dedication and commitment to accreditation and quality improvement made it all possible.
This work was supported by Centers for Disease Control and Prevention's National Public Health Improvement Initiative Cooperative Agreement 5U58CD001296.
The author declares no conflicts of interest.
Our accreditation journey was one filled with many challenges, yet completely worthwhile and ultimately successful. It began in 2007 and 2008 with discussions with Missouri's and North Carolina's state accreditation systems and continued through the Robert Wood Johnson Foundation's Multi-State Learning Collaborative. In 2009, we began preparation for national accreditation by reviewing both the local and state draft standards from the Public Health Accreditation Board (PHAB). We were accepted in late 2009 as 1 of 8 state PHAB beta-test sites. Because of the beta test, the Centers for Disease Control and Prevention's National Public Health Improvement Initiative, and continuous efforts toward accreditation, we filed our statement of intent and application to go through the PHAB accreditation process as soon as it became available in September 2011. Following this, we had our site visit in November 2012 and we achieved accreditation in February 2013. The focus of this case report is to provide insights and perspectives from one state that was among the first accredited health departments in the nation.
When the request for proposals for the application to be PHAB beta-test sites came out, the timing was not optimal for the Oklahoma State Department of Health (OSDH) (Table). Not only were we going through transition of our highest OSDH office and impending reorganization of the health department, but we were also enduring serious budget cuts, with more expected to come in the ensuing months. However, although the timing seemed to not be the best, we felt the opportunity was too important to let go by. Therefore, 2 of our deputy commissioners and the director for the Office of Performance Management approached our new commissioner within his first 2 weeks on the job to let him know the request for proposals was out and that we thought it was critical that the OSDH apply. We discussed the restraining forces along with the fact that the grant funds being offered would not come close to covering the actual costs of being a PHAB beta-test site. However, we stated that despite these factors, we felt that we should seize the opportunity and that the benefits would be greater than the costs. We felt this was an opportunity to have a voice in the shaping of the national public health accreditation standards, to test how the standards worked in a centralized/mixed structure such as ours, and to be on the cutting edge of public health accreditation for our state. In addition to serving as a frontrunner in the important area of public health accreditation, we knew that the process would improve the health of the citizens of our state by ensuring an organization that operated at a national standard of excellence. We were very fortunate that our new commissioner, Dr Terry Cline, saw things similarly and was a believer from the beginning. He stated that he fully understood the current situation, but he was a huge proponent for quality improvement and accreditation and believed that this was an opportunity we needed to pursue. He then offered us his full support and backing. With leadership support, including that of our commissioner and our Board of Health, we moved fully ahead and never looked back—through the beta test and full accreditation when it became available, until we finally reached our goal.
Our journey to accreditation provided our department with many achievements. However, 3 of these stand out. First, it has assisted us in strengthening our bond with our local health departments, the many tribal nations in our state, and our partners as we worked together toward the unified goal of providing the best services in the most effective manner possible to provide all Oklahomans the opportunity to lead long and healthy lives. Oklahoma was very fortunate to have beta-test sites awarded in all 3 venues: state, local, and tribal. We worked in partnership—providing each other data, resources, and support in meeting the PHAB standards. Working toward accreditation together, each at its own pace, also provided us the venue to learn where we may have gaps in services and allowed us to address these gaps together. Second, the accreditation process was a significant factor in contributing to the development of a quality improvement culture within our organization—one in which we are continually improving and always striving to do better in serving all Oklahomans. Accreditation was significant in developing this culture by setting national standards of excellence we could strive toward and meet across our organization using proven improvement approaches and methods. Third, our performance management model1 assisted us in efforts to achieve our goals by providing a framework of how all the pieces work together from national, through state, agency, local, community, and individual employee levels using the Step UP system,2 the PHAB accreditation standards and prerequisites, and quality improvement tools and practices (Figure).
Our journey was full of challenges. Accreditation is not easy—in fact, at times it can be downright tough and very frustrating as you are trying to pull all the pieces together with competing priorities; limited and shifting personnel, time, and resources; and public health emergencies and crises. We also had to figure out how to meet the standards within our governance and organizational structure, keep staff motivated through a very lengthy process, and put organizational systems into place to keep track of hundreds of documents in varying stages of completion.
However, having gone through it all, it is worth it. In the beginning, you may wonder whether this will really be the quality improvement journey it is intended to be, and I can tell you from our viewpoint, it definitely has been. The standards and measures have been very well written, and the guidance greatly improved since the beta test so that it serves as a true guide as to what you must do to meet the specified measure requirements. We had definite gaps in several items, from our beginning to the beta test and from the beta test to full accreditation. However, we addressed these gaps and, in doing so, not only did it help us to become accredited but it also helped us to become a better, more improved organization to fulfill our vision of “creating a state of health.”
Advice for Other Health Departments
Our recommendations for other health departments seeking accreditation would be as follows:
1. Ensure leadership and governance support from the beginning. This support is essential to streamline the process, reinforce that we are all in this together, and demonstrate that efforts toward accreditation (which will be many and extensive) are important and valued.
2. Do an honest assessment. Don't be afraid to take a good honest look at your department and how it measures up to the current PHAB standards. It's okay to not be there yet, you can work to get there, and know that while you are in the process, you are becoming a better organization with enhanced ability to serve your community in the best manner possible. Also, understand that one of your greatest takeaways will not be the piece of paper, the beautiful plaque, or even accreditation itself—it is the opportunity the process provides to continually improve to be the best organization possible and serve our communities at the highest level.
3. Establish collaborative systems. It is critical that state, tribal, and local systems, along with their communities, strive together for success. It is important from a logistical point of view, as no one operates within a vacuum, and all must work together for true lasting achievement. In addition, to have the greatest impact and benefit to our communities, many of which overlap and interrelate with each other, it is essential that we be in alignment—working toward the same ultimate goals and in support of one another.
4. Celebrate. Celebrate the small and large successes. It can be a long, hard journey, so while putting the emphasis on pulling together documentation demonstrating the good work we do, we need to be sure to take time to appreciate and celebrate the milestone accomplishments along the way.