Open for Business
The Public Health Accreditation Board (PHAB) launched the first national, voluntary accreditation program for state, local, Tribal, and territorial health departments this fall. This program was sparked from the Institute of Medicine's 2003 report,1The Future of the Public's Health, and culminated from a series of performance improvement milestones along a road to accreditation in public health. Local health departments (LHDs) nationwide are vying for the title of first nationally accredited health department while others remain skeptical regarding the value and feasibility of earning accreditation during these challenging economic times. With budget cuts in full force, how can an agency afford the fees and costs associated with accreditation? With limited staff capacity, who has the time to prepare for accreditation? What is the value of being an accredited health department? Even after the September launch of the program, these daunting questions remain on the minds of many LHDs. However, as many health officials note, the use of certain business principles often used in the private sector in combination with existing resources available in the public health practice community can help alleviate some of the concerns related to pursuing accreditation.
Accreditation: Not Just a Cost But an Investment
In the wake of the current economic and political environment, public health programs and services have taken severe funding cuts. According to the National Association of County and City Health Officials’ (NACCHO's) 2010 Economic Surveillance Survey, between 2008 and 2010 an estimated 29 000 LHD jobs were lost and 40% of all LHDs made cuts to at least one program area. On the surface, statistics such as these might be seen by some as reason to avoid additional costs of accreditation, but the fundamental purpose of accreditation would suggest otherwise. Public health accreditation is a multidimensional concept, which goes beyond demonstrating compliance with national standards. Accreditation is about understanding an agency's capacity, ensuring that standards are demonstrated, and continuously improving performance through quality improvement (QI). Measurable improvements cannot occur without identifying a starting point and accreditation provides a structured platform to identify where efficiencies can be created. Investment in accreditation allows an LHD to demonstrate accountability and accomplish more with less through the use of QI.
Because LHDs are serving as the backbone of the local public health system and working with shrinking resources as need grows, “business as usual” will no longer suffice. LHDs must adopt a new model for doing business, explore innovative strategies, and optimize use of existing resources. Private corporations have achieved multimillion dollar profits partly because they have analyzed their internal process and mastered the art of creating efficiencies to maximize profits. Because LHDs are being forced to do more with less, LHDs can achieve efficiencies to improve quality of services delivered and ultimately, health outcomes through accreditation. In addition, LHDs must be increasingly more strategic about securing funding as public and private funders are increasingly demanding to see demonstrated results for their investments. Accreditation serves not only as a new framework to demonstrate quality but also as a marketing tool to attract dollars, sending a message that the agency is using investments wisely and is accountable to funders, governing bodies, and constituents alike. Philosophically, accreditation must be thought of as an investment in the future of public health rather than an added cost.
Friendly Competition: Accreditation as a Motivational Tool
Through a for-profit business lens, competition is important to a free-market economy, driving corporations to offer quality products and services while making a profit. Although competition does not drive the work of governmental public health departments in this same way, meeting a set of nationally recognized standards can demonstrate the high quality of services an agency provides to its community while instilling a sense of accomplishment. At national public health conferences and meetings, several public health leaders have been vocal about their agencies’ intention to become the first accredited health department, spurring a sense of friendly competition among those LHDs already preparing. Because PHAB accreditation is on a five-year cycle and requires agencies to demonstrate how they have improved within each five-year period, it also pushes an agency to compete against itself, serving as an effective motivational tool for LHD staff.
A National System of Support
Amidst this new era of performance improvement in public health, LHDs today are in a very unique position as they are the first to be faced with the decision to apply for accreditation, weighing the costs against the benefits. With competing priorities and shrinking resources, it may be difficult for some to see the feasibility of taking on the lofty endeavor of the accreditation process, while others have been waiting for years for a mechanism to prove their worth and value. In either case, the public health community has come together to develop a national system of support. No one LHD must embark upon the accreditation process on its own and an incredible amount of resources and expertise already exist. For instance, NACCHO will collect materials and lessons learned generated from early adopters and make them available to the larger public health practice community. In addition, NACCHO provides live technical assistance along with a robust web site housing how-to guides, stories from the field, examples of documentation, and a webinar series, to name just a few of the many resources available. Taking advantage of these technical assistance offerings will save a great deal of LHD staff time, promote best practices, and streamline accreditation preparation efforts.
The Robert Wood Johnson Foundation (RWJF) has gone on record with an ambitious goal of having 60% of the US population served by an accredited health agency by the year 2015.2 As noteworthy partners to PHAB, both the Centers for Disease Control and Prevention (CDC) and RWJF are committed to the success of the program and have worked with PHAB, and others, to maximize the feasibility of accreditation for all health departments.
A Historical Milestone
The launch of the PHAB program has truly been a historical milestone in working toward a stronger public health infrastructure. For a long time, public health was one of the few public service providers without an accreditation process. CDC Director Thomas R. Frieden states, “Just as the public expects hospitals, law enforcement agencies, and schools to be accredited, so should they come to expect public health departments.”3 After the recent launch of the PHAB program, the field is anxiously awaiting to see how many will apply, the success rate of the first round of applicants, and the experiences and lessons learned during the process. National partners have every reason to believe that these “early adopters” will serve as excellent role models and mentors for the rest of the field as we all move in lockstep toward an ever higher performing public health system.
For more information on NACCHO's Accreditation Preparation and Quality Improvement program, visit www.naccho.org/accreditation. For more information on PHAB, visit www.phaboard.org.