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NALBOH Members Share the Importance of Accreditation through Q&A & Essay

Friday, June 9, 2017  
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The Honorable Henry W. Bertram, Pendleton County Judge/Executive, Retired

“For every dollar spent on accreditation, a higher level of service is provided”

What are some of the greatest benefits national accreditation brings to your communities?

Accreditation greatly improves the health department services provided by our employees due to asking them to obligate themselves to a higher standard of performance. Thus, our constituents are able to benefit from the health department’s commitment to accreditation.

As a board of health member, you are held accountable to the tax-paying citizens who support your local health department. In what ways to do you feel accreditation supports accountability?

By becoming accredited, board members can demonstrate their willingness to excel their health department to a national standard, thus showing taxpayers they are getting the best service possible for their tax dollars.

Some health departments are concerned with the expenses related to accreditation.  What would you say to those that are not pursuing accreditation due to costs?

Employee production is extremely enhanced through achieving accreditation. Thus, for every dollar spent on accreditation, a higher level of service is provided. Employee production can recoup accreditation expenses in a short amount of time. Salaries are always the most expensive part of operating any type of business, thus production must be at its best in order to get the most bang for the buck. We must, as public servants, spend every taxpayer dollar provided us as wisely as possible.

What does a board of health member or elected official get out of working with their health department on accreditation?

Board of health members of an accredited health department can be assured they are part of a team that is providing the best possible health services to the constituents of their community. They can be confident that they have set a standard for excellence in the health community in which they provide services.

A Pendleton County business owner for 30 years, Judge Henry Bertram is president of the Kentucky Association of Local Boards of Health and the Pendleton County (Kentucky) Board of Health. A Pendleton County Judge/Executive for 16 years, he is former chair of the Pendleton County Health Department Board and former chair of the Three Rivers Health District Board. A decorated Vietnam infantry combat veteran, he holds the Purple Heart and the Bronze Star.

PHAB Feature with Judith Sartucci

“Accreditation is a great accomplishment. Board members take away the satisfaction of knowing that they are serving their community well.”

What are some of the greatest benefits national accreditation brings to communities?

When an agency decides to seek voluntary public health department accreditation it sends a strong message to the public that it serves that it’s committed to both providing the best service it can and to making a difference in the health and well-being of that community. 

One need only to look at some of the principles behind public health accreditation to see the benefits an accredited agency can offer. I am thinking of agency leadership that brings stakeholders in the community together to identify public health problems and do solid planning to address them; community engagement of individuals and groups to make decisions together about how best to address issues and move solutions forward; a customer focus with improved agency responsiveness to requests for service, new service needs and community concerns, to name a few. And best of all, improvements in the health of the community.

 As a board of health member, you are held accountable to the tax-paying citizens who support your local health department. In what ways to do you feel accreditation supports accountability?

Whether governing or advisory or policy-making, public or quasi-official, our boards of health have a civic responsibility to the communities they represent and serve.  Accountability is high on the list of demands for most boards. We carry a public trust that we must honor. 

Whether the source of funds is local or county, state or federal, it’s taxpayer dollars that largely support our agencies and it is to the taxpayers that we are accountable.  As money gets tight, the demand for accountability becomes greater. More and more, taxpayers are demanding quality and positive outcomes for their dollars.

However, accountability is not just about the handling of public funds – it’s about the decisions that a board makes and its ownership of the results of those decisions.

There are several important functions of board governance that the National Association of Local Boards of Health (NALBOH) has identified and promotes and that mesh well with accreditation. These include: development of policy to promote, protect and improve the public’s health; stewardship of resources including good fiscal planning and advocating for necessary funding; exercise of legal authoritypartnership engagementcontinuous quality improvement; as well as oversight of agency performance and achieving measurable outcomes.

In many ways, a board of health could not ask for a better process to meet these obligations of governance.

As demonstrated by our agencies, accreditation can significantly improve a department’s overall management, operations, coordination of services and efficiency. An accredited agency has a clear focus with programs and activities that support its vision and mission and that lead to tangible results.

A common complaint of public health people is that the public doesn’t really understand what public health is and its value.  By meeting nationally accepted standards, accredited agencies are effectively demonstrating to their communities what public health is all about.

Lastly, what better way to demonstrate accountability than an agency’s efforts to continuously improve the quality of its operations and service to the public, and to be able to demonstrate that it is making a difference in the health of the jurisdiction it serves.

Some health departments are concerned with the expenses related to accreditation. What would you say to those that are not pursuing accreditation due to costs?

This is a tough choice for many boards of health given their fiscal circumstances.  For too long our public health agencies and infrastructure have been underfunded for their breadth of responsibility and collectively we are feeling the brunt of it. Voluntary accreditation is not for every agency, for any number of reasons. The cost and lack of funding can be major barriers and are most often cited. Capacity is another issue, especially with the smaller health departments. Leadership turnover has been underway for some time. The right circumstances just might not be there.

Boards of health need to weigh the costs versus the benefits of seeking accreditation, not just in the immediate future, but long term. However, it is important to recognize that what public health accreditation asks of an agency is not exotic. It does not contain unusual standards or measures that are out of the ordinary.  It does not go into foreign territory.  Rather it addresses processes and tools that have long been part of public health. It’s about good management and good public health practice. Some of the early findings from accredited agencies report more opportunities for funding opening for these agencies.

I think that it is the journey towards accreditation, not just the final designation, that is important.  I am impressed with the remarkable changes in public health agencies - their functioning, focus, staff enthusiasm, problem-solving -- that occurs over time as they commit to and begin down this road. A transformation happens over time and can lead to better efficiencies in management and service delivery; better health outcomes for their communities; and better problem-solving in using the resources they have, including seeking new revenue streams and funding.

What does a board of health member or elected official get out of working with their health department on accreditation?

Whether elected or appointed, board of health members are based in the communities they represent and serve. Most take this obligation very seriously and look for ways where their service can make a difference.  Accreditation is a great accomplishment.  Board members take away the satisfaction of knowing that they are serving their community well through an agency that is serving its community well and making a difference.

Judith Sartucci is chair of the Board of Health of the Central Connecticut Health District, a regional health department based in Wethersfield, CT. She is also a member of the Board of Directors of the National Association of Local Boards of Health (NALBOH). She is retired from the Connecticut Department of Public Health, where she served as Chief of the Community Health Nursing Section and Director of the Office of Local Health Administration. Judy holds a Bachelor of Science degree in nursing from St. Anselm College in Manchester, NH, and a Masters in Nursing from the University of Washington.

Harvey Wallace: Public Health Department Accreditation: What’s In it For a Board of Health Member?

I am often asked what a board of health member or elected official gets out of working with their health department on accreditation. There is no short, direct answer to this question. The best answer requires knowledge of the process or “road” to accreditation through the Public Health Accreditation Board (PHAB), and that knowledge is best left to the local health department’s leadership team. However, the initial application process requires a letter of support from the governing entity. Which brings us back to the original question: Why support a process that takes time and money and is voluntary?

I have been a proud member of my local board of health for a very long time, having been appointed by my county commission. I am also a proud member of the National Association of Local Boards of Health (NALBOH), as well as a proud member of PHAB’s Board of Directors. Though each role is separate and distinct, the common thread that weaves this trio of responsibilities together is the importance of national accreditation through PHAB. Working with local health departments, NALBOH, and PHAB gives me a unique perspective and affirms our shared roles in the performance of NALBOH’s six Functions of Public Health Governance: policy development, resource stewardship, legal authority, partner engagement, continuous improvement, and oversight.

PHAB accreditation strengthens a local health department (LHD) and helps it better serve its community. Boards of health participate in the community health assessment and the community health improvement plan, bringing them together with not only other health care providers but also with a wide range of community members interested in working toward a common goal. Working toward PHAB accreditation helps the LHD better identify the strengths and weaknesses in the public health system, which leads to a strategic plan directed toward achieving their mission and vision. This plan can be used to assess a LHD’s progress toward meeting its program goals.

When a health department achieves PHAB accreditation there is a community-wide celebration. The local newspaper and media stations broadcast the news and help explain what it all means. Accreditation, the community is told, means that their LHD is among a growing number of health departments around the country that meet PHAB’s nationally approved standards and measures that advance quality and performance in LHDs. 

Around the nation, LHD employees, after working so hard to achieve PHAB accreditation, are looking forward to working on the goals identified in their community health improvement plans. A question many have is “Does accreditation make it easier to get state and/or federal funding for local programs?” The answer is a definite maybe. More than half of PHAB’s accredited health departments report that they used information they developed during the accreditation process to acquire additional funding. There is growing evidence that PHAB-accredited health departments are contributing to positive health outcomes. That should encourage funding agencies to provide accredited health departments with additional opportunities.

Meanwhile, local boards of health around the nation will continue their oversight functions and will continue to move toward their goals, which for my own board of health is a vision of “a community where people achieve the highest quality of life through healthy living by caring for themselves, one another, and the environment.”

This essay first appeared on JPHMP Direct, the online forum for the Journal of Public Health Management & Practice. Visit the site at https://jphmpdirect.com/.

About the author: Harvey Wallace, PhD, serves as Dean Emeritus in the College of Health Sciences and Professional Studies at Northern Michigan University in Marquette, Michigan. He also serves on the Board of Directors of the Public Health Accreditation Board. In 1987, Dr. Wallace was appointed to the Marquette County Board of Health and continues to serve in that position. In 1995, Dr. Wallace was elected to the Board of Directors of the National Association of Local Boards of Health (NALBOH), serving as NALBOH’s president in 2001. He also served as County Commissioner on the Marquette County Board of Commissioners from 1999 to 2011; and as a board member and president of the Public Health Foundation from 2006 to 2013.