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Piloting a State Health Department Accreditation Model: The North Carolina Experience

Reed, Joy EdD, RN, FAAN; Pavletic, Denise MPH; Devlin, Leah DDS, MPH; Davis, Mary V. DrPH, MSPH; Beitsch, Leslie M. MD, JD; Baker, Edward L. MD, MPH, MSc

Journal of Public Health Management and Practice: March-April 2009 - Volume 15 - Issue 2 - p 85–95
doi: 10.1097/01.PHH.0000346003.13533.67

Accreditation of state and local public health agencies is a major national priority. North Carolina, a national leader in the accreditation of local public health agencies, undertook a pilot project to evaluate a process for accreditation of the state health agency, the North Carolina divisions of public and environmental health. This pilot project evaluated the instrument and process of a state public health agency accreditation effort and provided information on agency performance. The pilot project used a modified national public health performance standards state instrument to assess state health agency capacity and performance. A site visit followed a self-assessment process conducted internally within the state health department. The pilot project revealed that public health performance standards are a useful framework for state-level standards, but that measurement should focus on stem questions to ensure measurement at an appropriate, not overly detailed, level and reduce the level of work needed to complete the self-assessment process. The project also identified major strengths within the North Carolina Division of Public Health and laid the foundation for ongoing performance improvement under the leadership of the state health director and senior staff. As a result of this experience, accreditation of state health agencies is feasible and provides immediate benefit to state health agency leadership with respect to performance and quality improvement.

This article provides an overview of the state health department pilot accreditation process, evaluation results from that process, and recommendations to advance state health department accreditation efforts.

Joy Reed, EdD, RN, FAAN, is the Branch Head for the Local Technical Assistance and Training Branch and Head of Public Health Nursing at the Division of Public Health, North Carolina Department of Health and Human Services. She has been involved with the local health department accreditation in North Carolina since its inception and serves as a member of the Public Health Accreditation Board Standards Workgroup.

Denise Pavletic, MPH, is Head of the Performance Improvement and Accountability Unit at the Division of Public Health, North Carolina Department of Health and Human Services. She spent 4 years in the US Army as an active duty officer and then went on to spend the next 12 years in various healthcare leadership roles. She was the lead for the state accreditation pilot process.

Leah Devlin, DDS, MPH, is State Health Director for North Carolina and Division Director for the Division of Public Health, North Carolina Department of Health and Human Services. She has served in a number of national leadership roles including president of the Association of State and Territorial Health Officials and member of the Exploring Accreditation Steering Committee and Public Health Accreditation Board.

Mary V. Davis, DrPH, MSPH, is Director of Evaluation Services at the North Carolina Institute for Public Health. She has conducted evaluations of the North Carolina Local Health Department Accreditation program from pilot through implementation phases. She currently serves on the Public Health Accreditation Board Research and Evaluation Workgroup.

Leslie M. Beitsch, MD, JD, is Professor of Family Medicine and Director of the Center for Medicine and Public Health at Florida State University College of Medicine. His current public health interests relate to quality improvement and accreditation, as well as public health systems research. Dr Beitsch is a longtime public health practitioner, having worked in state and local public health agencies for nearly 20 years.

Edward L. Baker, MD, MPH, MSc, is Director of the North Carolina Institute for Public Health, the service and outreach arm of the University of North Carolina at Chapel Hill School of Public Health. Previously, he served as Director of the Public Health Practice Program Office at the Centers for Disease Control and Prevention, where he directed the development of the National Public Health Leadership Institute and the National Public Health Performance Standards Program.

Corresponding Author: Joy Reed, EdD, RN, FAAN, 1916 Mail Service Center, Raleigh, NC 27699 (

This work was funded by the North Carolina Division of Public Health and a grant from the Robert Wood Johnson Foundation.

We acknowledge the devotion to the process of public health accreditation in North Carolina of our highly valued colleague, Craig Michalak, who passed away in August 2007. Michalak's commitment to the highest standards of quality service and rigorous attention to detail helped immeasurably in making the North Carolina public health accreditation system a model for the nation. Michalak was also a pleasure to work with. He will be greatly missed.

© 2009 Lippincott Williams & Wilkins, Inc.