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Governing Well: Using Accreditation as a Mechanism for Health Department Performance Assessment

Friday, April 3, 2015  
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Governing Well: Using Accreditation as a Mechanism for Health Department Performance Assessment

Kaye Bender, President/CEO, Public Health Accreditation Board, 1600 Duke Street, Suite 200, Alexandria, VA 22314,,

There seems to be a growing amount of public distrust in the government these days. It isn’t as rare as it used to be to hear members of the public muse aloud about what benefit they are actually deriving from their tax dollars (federal or local). Board of health members may feel an increasing pressure to assure their constituents that the health department is performing its role well; has the organizational capacity to administer the services it provides; and has adopted a culture where measurement of performance is the norm. There are many ways that a board member can consider to provide this assurance. There are fiscal audits, program evaluations, and customer satisfaction surveys, to name a few. The Public Health Accreditation Board (PHAB) was organized to develop and administer a national accreditation program for health departments in the United States so that health department performance can be measured against national standards.

This concept is not new. Hospitals, education systems (K-12 and higher education), child care centers, ambulatory care clinics, fire departments, police departments and many more governmental and private entities use an accreditation process to validate that services are being provided in an accountable manner. The first thing a new board of health member could ask, in the quest for assuring a well-run health department is “Is our health department accredited? If not, are they planning to be?” Then, the board member engages with the health department along that journey, both to provide support and to ensure continuity once the accreditation has been achieved.

A common myth about health department accreditation is that it promotes a model where the federal government is deciding what local health departments should do. That is simply not the case. PHAB is a non-profit organization, and the accreditation standards and measures were either developed or selected by public health practitioners in the field. The health department selects examples from their programs and services that they want to use to document conformity with the accreditation standards and measures. The reviews are done by peers from other public health departments. The whole process was developed based on a commitment to principles of performance management and quality improvement. And, it’s all in one package, reducing the need to separate and costly reviews.

How does PHAB know that the accreditation process makes any difference in the health departments’ approach to doing business PHAB conducts ongoing internal evaluation activities with health departments in the e-PHAB system (PHAB’s electronic information system) and also manages an external evaluation contract with NORC at the University of Chicago in order to systematically gather some insights into these questions. Based on data from seventeen health departments accredited for one year, key benefits of accreditation were identified as:


  • Better able to identify strengths and weaknesses of health department;
  • Document capacity of health department to deliver the core functions and ten Essential Public Health Services;
  • Stimulate transparency;

·         Improve management processes used by the health department;

·         Stimulate quality improvement and performance management;

·         Improve accountability to community, stakeholders, and policy makers;

·         Improve communication with the governing entity/board of health;

·         Improve competitiveness for funding.

PHAB’s internal evaluation (September 2014) indicated that, in addition to improvements in the health outcomes identified in their community health improvement plans (CHIP), accredited health departments describe a variety of quality improvement (QI) and other initiatives to better serve their communities.

  • Improving compliance with mandated frequencies of inspections;
  • Improving a program with schools that works to implement environmental/policy changes;
  • Improving communications with governing entity;
  • Procuring an electronic medical records (EMR) system to gather better data for evaluation & performance management;
  • Improving new employee orientation;
  • Streamlining & strengthening process for responding to grant requests for proposals;
  • Incorporating Essential Public Health Services and PHAB domains into all job descriptions and annual employee evaluations;
  • Coordinating with a local hospital for the IRS requirements for the community health assessment (CHA);
  • Engaging all health department divisions in at least one QI project;
  • Providing data to community partners as part of efforts to address social determinants of health (e.g., high school graduation rates);
  • Expanding opportunities for community and partner involvement in CHA and CHIP, including better engaging diverse populations.

Fidelity to the original accreditation principles upon which PHAB was organized

remains a value for the PHAB board and staff. Those promises kept include:

·         Adhering to the voluntary nature of the process;

·         Anchoring the accreditation process in principles of performance management and quality improvement;

·         Developing and changing accreditation based on a consensus model;

·         Fostering and strengthening the peer review process;

·         Being respectful of the environment as we manage an electronic submission and review process;

·         Keeping administrative costs under twenty percent of the total budget;

·         Building efficiencies into PHAB’s procedures and requirements;

·         Maintaining a governance model composed of public health practitioners,

academicians, and researchers.

If a board of health is interested in supporting its health department to assure the citizens of tis jurisdiction that the work of the health department has been opened for peer review against national standards and has been found to value performance management and quality improvement, then the accreditation process is a good process to support that work. A board of health can also strengthen its relationship with the health department by looking closely at the standards and measures in Domain 12, which is specifically focused on the role of the governing entity in improving the health status of the public they serve.

PHAB appreciates its partnership with NALBOH and is available to provide education and information to its members on the accreditation process as a means to assure good governance.

PHAB wishes to acknowledge the work of Jessica Kronstadt, Director of Research and Evaluation, of NORC at the University of Chicago, and the support of the Robert Wood Johnson Foundation and the Centers for Disease Control and Prevention, Office of State, Tribal, Local and Territorial Support.