Contemporary Public Health: Principles, Practice, and Policy

7. National Accreditation of Public Health Departments

7 National Accreditation of Public Health Departments Kaye Bender In September 2011 the first national public health department accreditation program opened its doors for business. The Public Health Accreditation Board (PHAB), chartered in May 2007, officially accomplished something first suggested in 1850. That year, Report of the Sanitary Commission of Massachusetts (the Shattuck Report) described an early framework of the determinants of health and set forth the duties of councils of health in assessing the public’s health status and promoting interventions aimed at improving it.1 In essence, these were early standards of public health and a call to action for implementation. In 1914 the Journal of the American Medical Association (JAMA)published several articles that called on public health agencies to support standardization , efficiency, and a planned approach to delivering public health services.2 Joseph Mountin, founder of the Centers for Disease Control and Prevention (CDC), described the importance of local health departments in carrying out governmental public health activities in an organized manner. A December 1945 paper entitled “A Twenty-five Year Review of the Work of the Committee on Administrative Practice”advocatedregular reviews and reports on the performance of public health agencies, which “might be set up as a norm or as a general guide to be used by any community which aspires to provide adequate health protection for its citizens.”3 For the next several decades, most of the literature describing the work of health departments was based on profile and observation, with no real attention given to performance measurement.4 In 1988 the Institute of Medicine (IOM) report The Future of Public Health described the importance of a governmental presence in local communities, but it characterized the public 156   Kaye Bender health infrastructure as being in disarray.5 Almost fifteen years later, another IOM report entitled The Future of the Public’s Health in the 21st Century repeated that observation, citing the need for a public health “backbone” in every community—the local public health department.6 That same study noted the important work initiated by the National Public Health Performance Standards Program (NPHPSP) in tracking trends in public health practice at the systems level, providing accountability to stakeholders and constituencies, benchmarking performance for improvement efforts, and increasing the scientific basis for public health practice. A recommendation for a national dialogue on the accreditation of public health departments was included in the 2003 IOM report. The Robert Wood Johnson Foundation and the CDC cofunded a feasibility study on accreditation in 2005. The study was conducted by a twentyfive -member steering committee composed of representatives from public health departments, academia, and advocacy organizations. Two questions guided the study: Is it desirable to develop a national, voluntary public health accreditation program for the country? Is it feasible to initiate such a program ? A report was issued in 2006, not only responding affirmatively to these questions but also suggesting a model for the development of national public health accreditation.7 Simultaneous with this study, the Robert Wood Johnson Foundation funded another initiative, the Multistate Learning Collaborative (MLC); its aim was to both foster interest in accreditation and institute a culture of quality improvement in public health.8 The Public Health Accreditation Board (PHAB) grew out of this study and was supported by the work of the MLC. Although accreditation is not a new concept to many governmental businesses (e.g., public education, hospitals and health systems, fire departments , police departments), it is a new concept to public health. After many decades spent identifying the need and almost two decades of definitive preparatory work, PHAB’s creation constitutes a historic moment in public health. The goal of PHAB’s accreditation activities is to improve the performance and quality of state, local, tribal, and territorial public health departments in order to impact the health outcomes of the communities they serve. It is important to recognize the difference between standards and accreditation . Standards can be defined as qualitative statements that reflect researchbased best practices for a health department and function as the minimum requirements to achieve accreditation. Accreditation is the process by which an identified set of standards is utilized to evaluate an organization’s performance and determine whether those standards have been met. National Accreditation of Public Health Departments   157 Development of the Public Health Accreditation Board The initial recommendations from the 2006 Exploring Accreditation Project Report were realized when the Public Health Accreditation Board was incorporated...