The Chicago Department of Public Health's (CDPH's) journey toward accreditation began when it participated in a Large City/Metro Think Tank with the Public Health Accreditation Board (PHAB) in May 2011. CDPH's first step was to assess accreditation readiness. After the readiness assessment revealed that the department was ready to proceed, the most important step was the selection of the accreditation team (team) in August 2011. Nearly 10 months after selecting the team, CDPH identified all of the evidence needed and conducted 2 internal mock reviews and 1 external review that provided invaluable feedback and certainly improved the documents that CDPH ultimately submitted in late 2012 (Table). The purpose of this case report is to share CDPH's accreditation journey and to highlight the role that leadership and communication strategies played throughout the journey.
CDPH strives to be a leader in public health. By committing to pursue accreditation, CDPH leadership not only wanted to ensure that the department meets or exceeds national standards but also wanted to send a clear message about the importance of accountability and quality improvement to the workforce. In addition, when a big city health department leads the way towards accreditation, this will have an impact on other local health departments especially those in large urban settings. Developing a team at CDPH was the first step to raise awareness across the department about our accreditation journey. CDPH gave every staff member the opportunity to apply to be part of the team. It offered training and leadership development as a way to further encourage the staff to be part of this process. There were more applicants than available slots.
The importance of communicating with the staff was identified as a key strategy for success. The team developed regular progress updates to be included in the Commissioner's Weekly Update that goes to all staff. The team also created a monthly newsletter, developed a logo and slogan (“We're going on a PHAbulous Journey”) to better provide a lasting image for the staff, designed posters for the workplace as visual reminders of the journey, and ensured accreditation is a major focus at annual all-staff meetings. In addition, the team met with subject matter experts at CDPH, by domain, to review all relevant standards and measures and brainstorm work products that could be used as evidence. CDPH hosted these meetings throughout the year to ensure the staff was reminded how their work was reflected in the PHAB standards.
When the decision was made to start the accreditation process, CDPH was in the midst of reforming the delivery of its primary care services. The partnership with federally qualified health centers to enhance services provided to Chicagoans led to significant staff changes in the department. The accreditation process helped focus many of the department's efforts on quality improvement and workforce development.
This meant CDPH leadership had to message accreditation in a way that was positive and supportive to the staff by stressing quality improvement and workforce development. Since PHAB requires that a system for both be in place, this was the perfect opportunity to invest resources into both. Through the accreditation process CDPH launched an employee satisfaction survey in April 2013 to better understand job satisfaction and developed a plan to address common themes that arised. The staff expressed a need to do a “morale survey” in early 2011, but we were never able to launch it; our accreditation pursuit placed added value in administering an employee satisfaction survey.
The accreditation process's greatest accomplishment so far has been the qualitative feedback from the staff that accreditation efforts are making positive changes in communications, accountability, and standardization and, most importantly, providing training opportunities to the staff. CDPH's work environment is changing by providing opportunities for staff growth. In addition, going through the accreditation process ensured that CDPH is not only meeting the national standards but also has the right documentation and protocols in place to prove it.
Leadership and communication were CDPH's greatest asset in achieving accreditation. At the same time, staff engagement at different levels was not optimal. As in most government agencies, staff are being asked to do more with less. Requesting more from already stretched staff posed a challenge. Also, many accreditation team members were not located at CDPH “headquarters” and had not previously met colleagues with whom they would need to collaborate in order to obtain successful evidence for accreditation. In light of this, the team prioritized face-to-face interactions to accomplishing tasks. Regular in-person meetings were scheduled throughout the process. From this, the team learned two important lessons: (1) the importance of face-to-face interaction and meetings to accomplish tasks, and (2) the need for the executive staff to be responsive to the team member's requests.
Advice for Other Health Departments
Here is a list of recommendations that will result in other local health departments succeeding in obtaining accreditation:
- Ensure the commissioner (health director) is totally supportive and understands both the reasons for pursuing accreditation and the significant commitments of time and resources needed throughout the process.
- Select/identify a dedicated team and a strong team leader who has the full support of the commissioner so that the process is not halted because of lack of commitment.
- Recognize that pursuing accreditation needs to be a top priority.
- Engage in frequent communication from the accreditation coordinator to the executive team on the progress, challenges, and lessons learned while preparing for accreditation.
Quality is not a destination that's achieved when a health department receives accreditation. Quality is a target that must be always pursued. This accreditation process requires a significant amount of dedication and attention to detail and cannot be a “one and done” process.