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Legal Frameworks Supporting Public Health Department Accreditation: Lessons Learned From 10 States

Matthews, Gene W. JD; Markiewicz, Milissa MPH, MIA; Beitsch, Leslie M. MD, JD

Journal of Public Health Management and Practice: January/February 2012 - Volume 18 - Issue 1 - p E8–E16
doi: 10.1097/PHH.0b013e31822f62b0
Research Articles

Context: The existence of different types of accreditation legal frameworks, embedded in complex and varying state legal infrastructures and political environments, raises important legal implications for the national voluntary accreditation program.

Objective: To increase an understanding of accreditation-enabling laws nationwide.

Design: In 2010 to 2011, the North Carolina Institute for Public Health conducted a study of state legal frameworks supporting public health department accreditation or related programs (ie, certification/assessment, performance management, and quality improvement). First, a mapping study was conducted to identify current programs and their legal frameworks. Ten states were then selected for in-depth qualitative case study. Data were gathered through semistructured interviews with public health practitioners and key stakeholders.

Results: The findings from the mapping study delineate the accreditation, certification/assessment, performance management, or quality improvement program currently in place and the type of legal framework supporting it. The citations for statutes and regulations are also included. Among the 18 states in the sample, 4 have accreditation programs, 6 have certification/assessment programs, and 8 have performance management/quality improvement programs. Accreditation programs were most likely to have a statutory basis, while performance management and quality improvement programs were most often supported via health department policy. The findings from the case study provide greater detail about each state, reflecting public health structures, programs, legal frameworks, approaches to Public Health Accreditation Board (PHAB) accreditation, and legal strategies for achieving accreditation.

Conclusions: Early adopter states have pursued a variety of legal frameworks to develop their accreditation, certification/assessment, performance management, and quality improvement programs. With the voluntary national accreditation program scheduled to go live in late 2011, these 10 states have also carefully considered options for aligning their activities with PHAB accreditation. Lessons derived from this examination can inform public health practitioners, advocates, and elected officials about how to best structure legal frameworks to support accreditation and related activities.

This article focuses on mapping and describes case studies to increase an understanding of accreditation-enabling laws nationwide.

North Carolina Institute for Public Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (Mr Matthews and Ms Markiewicz); and Center for Medicine and Public Health, Florida State University College of Medicine, Tallahassee (Dr Beitsch).

Correspondence: Gene W. Matthews, JD, North Carolina Institute for Public Health, CB 8165, University of North Carolina, Chapel Hill, NC 27599 (

This research was funded by the Robert Wood Johnson Foundation's Public Health Law Research program.

Disclosure: The authors report no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.