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Accreditation: Time to Get Ready

Gorenflo, Grace MPH, RN

Journal of Public Health Management and Practice: July-August 2007 - Volume 13 - Issue 4 - p 432–434
doi: 10.1097/01.PHH.0000278041.92259.87
News From NACCHO

The National Association of County and City Health Officials (NACCHO) is the national organization representing local health departments. NACCHO supports efforts that protect and improve the health of all people and all communities by promoting national policy, developing resources and programs, seeking health equity, and supporting effective local public health practice and systems.

This column emphasizes enhancing capacity, engaging in effective performance activities, and cultivating governing bodies that are supportive of accreditation applications.

Grace Gorenflo, MPH, RN, is Senior Advisor, NACCHO, Washington, District of Columbia.

Corresponding author: Grace Gorenflo, MPH, RN, NACCHO, 1100 17th St, NW Second Floor, Washington, DC 20036 (

The articles in this journal demonstrate that the time for accreditation has come for governmental public health. State health departments and local health departments (LHDs) will soon have the opportunity to join the ranks of many others in health disciplines that demonstrate their accountability and meet defined standards through accreditation programs. NACCHO is a major player in the establishment of the new voluntary national accreditation program, the Public Health Accreditation Board (PHAB). Borne from the recommendations of the Exploring Accreditation project, the PHAB is being incorporated by the leadership of NACCHO, the American Public Health Association, the Association of State and Territorial Health Officials, and the National Association of Local Boards of Health. NACCHO is working to ensure that the program includes features that will increase LHDs' participation and is also providing resources for LHDs to engage in quality improvement efforts and otherwise position themselves to become accredited. The time to become prepared for accreditation is now.

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NACCHO's Position on Accreditation

NACCHO has been on record since 2004 in support of voluntary accreditation, provided that several provisions are addressed. NACCHO's representatives on the Exploring Accreditation Steering Committee* worked to ensure that the design of the national program included features to encourage LHD buy-in and participation. The resultant program recommendations addressed nearly all of NACCHO's issues, paving the way for NACCHO's leadership to endorse the recommendations and resolve to “lead, in cooperation with appropriate partners, in the development and implementation of such a national voluntary accreditation program that will drive continuous quality improvement.” The American Public Health Association, the Association of State and Territorial Health Officials, and the National Association of Local Boards of Health also support the program's recommendations.

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Attracting LHD Applicants

NACCHO believes that the voluntary national accreditation program must be affordable, designed as a part of a system that supports participation, and generated through significant input from local public health practitioners.

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A primary theme in NACCHO's resolution revolves around the need for a national accreditation program to be within financial reach for all interested LHD applicants. New funds must be available to support the costs, and cost-shifts must not occur to participate. The steering committee strived to design a program that would attract a maximum number of participants, fully recognizing the need to make not only the application fees, but also the related costs for undergoing the process, reasonable and affordable for public-sector entities. The program recommendations outline a robust set of strategies to this end, with an emphasis on significant program subsidies and a variety of mechanisms to support budget requests for accreditation and have them treated as allowable costs.

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Systems approach

NACCHO also cited a systems approach as key to the program's success. Such an approach would require the availability of tools and resources to help LHDs succeed with accreditation, a parallel effort to accredit state health departments in a mutually supportive and philosophically consistent manner, and partnerships with those who train and educate the public health workforce. The PHAB will offer assistance on the application process and also will advocate for the availability of technical assistance for LHDs working to align themselves with program standards. The PHAB has been designed to accredit both state and local health departments, and the same 11 domains will be the framework for both state- and local-level standards. Although the program recommendations do not specify a role for public health trainers and educators other than participation on the governing board, these groups have been identified as key collaborators for the program's development.

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LHD input

NACCHO and its members must play a significant role in developing the accreditation program and tools and in determining who should do the accrediting. The Operational Definition of a Functional Health Department (Operational Definition), developed through an extensive vetting process with local health officials and public health partners, has been identified as the framework for local standards for the PHAB. NACCHO's executive director is on the Board of Incorporators for the PHAB. In addition to establishing internal operations, this group will appoint the first governing board that will assume full responsibility for the new entity. In accordance with the program recommendations, the PHAB's governing board will have a majority of members with state and local public health practice experience, providing yet another venue for significant input from local public health practice. In addition, the developmental phase of the PHAB includes the formation of several committees to establish standards and assessment processes; these groups will primarily comprise current state and local public health practitioners. The developmental phase is designed to allow for sufficient time and effective methods for vetting program standards and measures through potential applicants. Finally, NACCHO staff will assist in the development of standards and assessment processes and in research and evaluation activities.

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Preparing LHDs for Accreditation

Now is the time for LHDs to take advantage of resources to position themselves for accreditation. Enhancing capacity, engaging in effective performance activities, and cultivating governing bodies that are informed and supportive of accreditation applications will not happen overnight. The following resources and additional information about them are available at

  • An interactive map, populated on an ongoing basis with resources from states that have accreditation or related programs for LHDs,* including the standards and measures in use, best practices in meeting the standards, crosswalks between the standards and the Operational Definition, and other state-specific resources.
  • A prototype set of measures for the Operational Definition standards. Drawn from measures in use from the National Public Health Performance Standards local instrument and state-based accreditation programs, these metrics provide a sense of what some PHAB standards and measures may look like.
  • A series of workshops on quality improvement to be offered through seven states, as well as other quality improvement resources.
  • A series of Web casts that cover such topics as quality improvement, lessons learned from state-based accreditation programs, and how to engage governing boards.
  • Tools developed through NACCHO's efforts to support states working to “functionally regionalize” local governmental public health. Over time, these will include resources such as lessons learned about the process, checklists to assist others in undertaking a similar effort, sample mutual aid agreements, state legislation enabling cross-jurisdictional sharing of resources, governance agreements, and economic analyses of cost efficiencies gained through regionalization.
  • A peer assistance network that connects those with experience in using the Operational Definition or similar standards with those looking for assistance in applying standards or otherwise aligning themselves with the Operational Definition.

NACCHO is committed to continue developing tools and resources that will assist LHDs in operating within a culture of quality improvement and otherwise preparing for accreditation. Contact Jessica Solomon at NACCHO at (202) 783–5550 for more information. Additional information about the PHAB can be found at

*NACCHO's representatives on the Exploring Accreditation Steering Committee were Stephanie Bailey, MD, MSHSA, then Director of Health, Metro Nashville/Davidson County, Tennessee, and currently Chief of Public Health Practice for Centers for Disease Control and Prevention; Harold Cox, MS, MPH, then Chief Public Health Officer, Cambridge, Massachusetts, and now the Associate Dean for public Health Practice at Boston University; Bobby Pestronk, MPH, Health Officer, Genesee County, Michigan, and current President-Elect of NACCHO; and Bruce Pomer, MPA, Executive Director, Health Officers Association of California. Dr Bailey also chaired the Standards Development Workgroup, and Mr Pomer chaired the Finance and Incentives Workgroup.
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*The majority of information is from states involved in the second round of the Robert Wood Johnson Foundation's Multi-state Learning Collaborative (MLC-2). More information on this initiative can be found at
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© 2007 Lippincott Williams & Wilkins, Inc.