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Quality Improvement and Accreditation Readiness in State Public Health Agencies

Madamala, Kusuma PhD, MPH; Sellers, Katie DrPH, CPH; Beitsch, Leslie M. MD, JD; Pearsol, Jim MEd; Jarris, Paul MD, MBA

Journal of Public Health Management and Practice: January/February 2012 - Volume 18 - Issue 1 - p 9–18
doi: 10.1097/PHH.0b013e3182367d91

Objective: There were 3 specific objectives of this study. The first objective was to examine the progress of state/territorial health assessment, health improvement planning, performance management, and quality improvement (QI) activities at state/territorial health agencies and compare findings to the 2007 findings when available. A second objective was to examine respondent interest and readiness for national voluntary accreditation. A final objective was to explore organizational factors (eg, leadership and capacity) that may influence QI or accreditation readiness.

Design: Cross-sectional study.

Setting: State and Territorial Public Health Agencies.

Participants: Survey respondents were organizational leaders at State and Territorial Public Health Agencies.

Results: Sixty-seven percent of respondents reported having a formal performance management process in place. Approximately 77% of respondents reported a QI process in place. Seventy-three percent of respondents agreed or strongly agreed that they would seek accreditation and 36% agreed or strongly agreed that they would seek accreditation in the first 2 years of the program. In terms of accreditation prerequisites, a strategic plan was most frequently developed, followed by a state/territorial health assessment and health improvement plan, respectively.

Conclusions: Advancements in the practice and applied research of QI in state public health agencies are necessary steps for improving performance. In particular, strengthening the measurement of the QI construct is essential for meaningfully assessing current practice patterns and informing future programming and policy decisions. Continued QI training and technical assistance to agency staff and leadership is also critical. Accreditation may be the pivotal factor to strengthen both QI practice and research. Respondent interest in seeking accreditation may indicate the perceived value of accreditation to the agency.

This study aimed to explore organizational factors (eg, leadership and capacity) that may influence quality improvement or accreditation readiness.

Association of State and Territorial Health Officials, Arlington, Virginia (Drs Madamala, Sellers, and Jarris and Mr Pearsol); and Center for Medicine and Public Health, Florida State University College of Medicine, Tallahassee (Dr Beitsch).

Correspondence: Katie Sellers, DrPH, CPH, Association of State and Territorial Health Officials, 2231 Crystal Dr, Ste 450, Arlington, VA 22202 (

Funding for this work was provided by the Robert Wood Johnson Foundation and the Centers for Disease Control and Prevention.

The authors thank Nikki Lawhorn and Katherine Barbacci for their invaluable support in follow-up, data cleaning, and analysis of the 2010 ASTHO Profile data.

Disclosure: The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.