Public Health Department Accreditation: Connections with Quality Improvement May 1, 2012

1. Public Health Department Accreditation: Connections with Quality ImprovementMay 1, 2012 Alonzo Plough, PhD, MPHDirector, Emergency Preparedness and Response Program, LA County Department of Public Health Member, Board of Directors, Public Health Accreditation Board

2. What is Public Health Accreditation? Who is PHAB?

3. What is Public Health Accreditation? • The measurement of health department performance against a set of nationally recognized, practice-focused and evidenced-based standards. • The issuance of recognition of achievement of accreditation within a specified time frame by a nationally recognized entity. • The continual development, revision, and distribution of public health standards.

4. The Public Health Accreditation Board (PHAB) PHAB is a non-profit, voluntary accreditation organization founded in 2007 whose goal is to advance public health performance by providing a national framework of accreditation standards for local, state, territorial and Tribal health departments. PHAB is the national organization charged with administering the public health accreditation program. PHAB is located in Alexandria, VA

5. Voluntary Accreditation Goal • The goal of a voluntary national accreditation program is to improve and protect the health of the public by advancing the quality and performance of state ,local, tribal and territorial public health departments.

6. PHAB’s Timeline 2003Institute of Medicine (IOM) report calls for an examination of public health accreditation 2004CDC identifies accreditation as a key strategy forstrengthening public health infrastructure 2005Exploring Accreditation Project (EAP) develops a model of national accreditation 2006 ASTHO, APHA, NACCHO, and NALBOH become BOI 2007 PHAB is incorporated in May 2008 Workgroups and committee begin development 2009-2010 PHAB conducts beta test 2011 PHAB launches in September

8. Materials PHAB Has To Assist Health Departments in Understanding the Process

9. Accreditation Support Materials x

10. www.phaboard.org

11. The PHABAccreditationProcess

12. Seven Steps 1. Pre-application Applicant prepares and assesses readiness, informs PHAB of its intent to apply(SOI) 2. Application Applicant submits application and pre-requisites and receives training 3. Documentation Selection and Submission Applicant gathers and submits documentation 4. Site Visit Site visit and site visit report 5. Accreditation Decisions PHAB Accreditation Committee determines accreditation status Accredited (5 years) or Not Accredited 6. Reports Annual progress reports 7. Reaccreditation

13. Application:Three Prerequisites • Community health assessment • Community health improvement plan • Health department strategic plan • Submitted with the application • Reviewed by PHAB staff for completeness but not quality and content • Reviewed for quality and content by site reviewers • Criteria included in Standards Domains 1 and 5

14. Standards and Measures Version 1.0

16. PHAB 12 Domains Based on Core Functions of Public Health & Ten Essential Public Health Services

17. Twelve Domains • Conduct assessments focused on population health status and health issues facing the community • Investigate health problems and environmental public health hazards to protect the community • Inform and educate about public health issues and functions • Engage with the community to identify and solve health problems • Develop public health policies and plans • Enforce public health laws and regulations • Promote strategies to improve access to healthcare services • Maintain a competent public health workforce • Evaluate and continuously improve processes, programs, and interventions • Contribute to and apply the evidence base of public health • Maintain administrative and management capacity • Build a strong and effective relationship with governing entity

18. Structural Framework  Domain   Standard Measure Documentation Guidance

19. Sample Standards and Measures

21. Accreditation Information System

23. Accreditation Fees

24. 2011-2012 Applicant Fee Schedule

25. What Do the Fees Cover? • An assigned accreditation specialist to guide your department through the application process • Site visit, including a comprehensive review of your health department’s operations against the national accreditation standards by a team of peer review experts • In-person training for your department’s accreditation coordinator • Subscription to PHAB’s online accreditation information system, making it easier and more cost-efficient for departments to participate in accreditation • Annual quality improvement support and guidance for 5 years • Contribution to a growing network of accredited local health departments contributing to the evidence base for public health

26. Why Would A Health Department Want to be Accredited?

27. Benefits of Accreditation(individually and collectively) • Increased credibility • Increased visibility and accountability • Potential access to new funds • Potential streamlined reporting • Access to knowledgeable peers for review and comment on performance • Opportunity to leave the health department better than you found it!

28. Beta Test Feedback “ . . .had a positive effect on those staff involved by providing opportunities to learn about the department in-depth and how much we do for the people who live and visit our state.” “helped jumpstart the process to create a QI culture for the agency as a whole.” We've got a very clear roadmap to guide us in the months ahead….It's been such a wonderful journey, with greater awards than I imagined.”

29. Thank you, CDC…. Endorsement of Accreditation “Accreditation is a major accomplishment for a health department. It means that it is addressing key community health problems" Thomas R. Frieden, M.D., M.P.H. CDC Director Read the full March 24, 2011 press release: http://www.cdc.gov/media/releases/2011/p0324_publichealthdeptaccreditation.html

30. From the RWJF… With shrinking budgets and a growing number of health challenges to address, there has never been a more important time for public health departments to focus on the best and most efficient ways to keep people healthy…” • Jim Marks, MD, MPH, Senior Vice President and Director of the Robert Wood Johnson Foundation’s Health Group

31. Top 10 Accreditation Myths • Federal government telling us what to do • No clear benefit to health departments • Will require a lot of money to prepare • Will require a lot of extra work • Don’t have the staff to do it • Might as well be mandated • Our health department is different • We are already doing a good job • My board (Governor, HHS Director) won’t agree • Don’t have the funds for the fees

32. The Connection Between QI and Accreditation

33. Quality Improvement Defined for Public Health The use of a deliberate and defined improvement process…which is focused on activities that are responsive to community needs and improving population health.

34. Quality Improvement Defined for Public Health A continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes and other indicators of quality of services or processes that achieve equity and improve the health of the community. Riley, Moran, Corso, Beitsch, Bialek, Cofsky. ”Defining Quality Improvement in Public Health”. Journal of Public Health Management and Practice, January/February 2010

35. Characteristics of QI “Small QI” Program or activity level Great way to learn a specific model “Large QI” Organization-wide System focused

36. Realizing Public Health Transformation Through QI • Set focus on a vital few priorities • Create a sense of urgency for measurable results and a culture of quality • Engage every employee • Build QI time into daily workload • Adopt fact-based decision making • Reward and celebrate progress

37. Results of Accreditation Leads to QI Focus The process of preparing for and achieving accreditation yields information about the agency that can be used to identify areas of improvement. These are areas that exist at the “Large QI” level.

38. Success Stories: Beta Test SitLLLocal Health Department QI Projects During the Beta Test • 30% increase in community engagement for CHA • 40% reduction in time it takes to complete a septic and well inspection • 13% reduction in client wait time in Family Planning clinic • 45% decrease in no-show rates in HIV clinic • 49% increase in # of department policies and procedures reviewed and updated in last 3 years

39. Beta Test QI Projects: State Health Departments (ASTHO, 2010) FL used Beta test results to improve website OK targeted state, local, and tribal accreditation readiness MI assessed LHD engagement with MI accreditation QI module WY used QI process to reduce data errors in newborn screening WA improved verification of qualifications for final job applicants MS improved evidence-based tobacco cessation referral process OH improved cycle time for reporting data on out-of-state births IA Assessed use of a checklist to improve press releases

40. Public Health Accreditation Board www.phaboard.org 1600 Duke Street, Suite 440 Alexandria, VA 22314 703.778.4549 SIGN UP TO RECEIVE THE PHAB NEWSLETTER