In the fall of 2009, the Tooele County Health Department (TCHD) was selected as 1 of 30 health departments in the country to participate in the Public Health Accreditation Board's (PHAB) national beta test for voluntary accreditation. The process since 2009 has been one of continuous quality improvement—identifying areas in the department, such as processes, programs, protocols, procedures, or policies that are lacking, and making the necessary changes to increase output and/or desired results.
As a result of the accreditation process, our department has developed several plans with accompanying goals and objectives to improve its capacity to provide the best possible services and improve the overall health of the community we serve. Three milestones have been achieved including the completion of the department's community health assessment, community health improvement plan, and strategic plan. Collaboration with community partners has become a central component of the TCHD's efforts to continuously improve its services since the accreditation journey began in 2009. Efforts to meet the PHAB standards and measures for accreditation have allowed our department to evaluate areas of strengths and identify areas for improvement.
The focus of this case report is to examine the Tooele County Health Department's experience with the beta test and where we are now (see the Table).
Prior to the TCHD's participation in the PHAB beta test, the general consensus in Utah among local health departments was against national accreditation. The TCHD was of the opinion that accreditation would assist us in evaluating the needs of our community and the effectiveness of the services our agency provides. We believed that if our department was a beta test site, it would help us meet our objectives, as well as serve as a demonstration site for the entire state of Utah. Our intentions were to share our experiences with the state health department as well as the other 11 local health departments. We believed by seeing the accreditation process in action other local health departments in the state would see the benefits of accreditation and would be swayed in their opinions.
To prepare for national accreditation, an accreditation core team was organized to facilitate the PHAB beta test self-assessment. This self-assessment was submitted to PHAB to show where the department was already in alignment with the PHAB standards, and to identify where gaps existed. The accreditation core team was composed of 8 people representing the executive management team, the division coordinators, and administrative support. The executive management team was composed of the health officer, the deputy director, the family and school health supervisor, and the community services supervisor. The deputy director functioned as the accreditation coordinator and project lead. Management believed that top-level staff must set the tone to encourage staff to buy into and support the accreditation and quality improvement process.
The team was organized in November of 2009; training was conducted for the core team in December of 2009. The accreditation coordinator in consultation with the executive management team assigned standards and measures to each core team member according to who could adequately address the measure. One to 2 domains were reviewed and assigned every 2 weeks. The core team met at least once every 2 weeks to review progress and to receive new assignments for standards and measures. As standards and measures were completed, the accreditation coordinator would score the measure, and the whole core team would then review the score and discuss different perspectives. The self-assessment portion of the beta test took 2½ months and about 500 staff hours to complete. When the core team met to review progress on standards and measures, it was common for someone to express difficulty in documenting the measure and often other members would recognize documentation they could use that might meet the standard. Having regular scheduled core team meetings helped to keep team members on task and accountability for deadlines was more readily achieved. On a number of occasions, the team would recognize that a standard and measure was met by the department, but they could not provide adequate documentation to demonstrate the measure. We realized that we would need to develop new documentation to demonstrate conformity with the measures.
Before applying for national accreditation, our department completed the 3 prerequisites (community health assessment, community health improvement plan [CHIP], and strategic plan) and developed other plans such as the quality improvement plan and the workforce development plan. As a result of these new plans, our department has seen an increase in collaboration with community partners, increased trust and support from the governing board of health, and improved staff understanding and resolve to develop and implement quality improvement projects in their respective divisions and programs.
Perhaps the most notable achievement is an increased measure of accountability on the part of the health department to provide the highest quality service to its population. Through the accreditation process, the department has been able to recognize areas for improvement and apply quality improvement tools and techniques to improve in these areas.
The biggest challenges for the health department in the accreditation process have been at times gaining support from other agencies and community partners, such as getting community partners to attend meetings. Our department discovered that it helps to provide an incentive for partners to attend meetings, such as providing a meal. Another challenge the department has encountered is having the time and resources to follow through with implementation of strategies that have been developed in plans like the CHIP and strategic plan. This is a challenge that the department is still working on. Some of the PHAB standards and measures have been difficult for a small rural health department, such as Tooele, to meet. For example, one measure asked for 2 incident reports of disease outbreaks in the last 5 years; however, there has been only 1 disease outbreak in the county in the last 5 years that required an incident report. Locating certain documents and signed contracts and updating old policies and procedures have also proven to be a lot of work.
Advice for Other Health Departments
Our experience suggests that total staff buy in and support of the process are essential for success. It takes more than just a few management staff to meet all of the PHAB standards and measures for accreditation. For departments thinking about accreditation, it may be worthwhile to do the following:
- Hold frequent meetings with an accreditation core team to discuss progress and make assignments
- Complete a self-assessment of the department to evaluate readiness to apply
- Be organized and consistent in saving of electronic document files
- Become well acquainted with the PHAB Accreditation Coordinator Handbook
- Use Adobe Pro XI for help with documentation development and editing