What’s New at the Public Health Accreditation Board?

1. What’s New at the Public Health Accreditation Board? Kaye Bender, PhD, RN, FAAN MLC Grantee Meeting –Charlotte, NC March 19, 2009

2. Presentation Overview • Description of PHAB’s Current Work • PHAB Board of Directors Strategic Plan • Program Development and Timeline • Introduction to the Standards

3. A Rising Tide… • CDC’s Future Initiatives • “Future of the Public’s Health” in the 21st Century (IOM) • Statewide Accreditation Programs • Exploring Accreditation

4. Accreditation “Fits” in 2008 Accreditation, as envisioned by the Public Health Accreditation Board, is in tune with heightened national movement • The Healthiest Nation • Trust for America’s Health – Blueprint for a Healthier America

5. Commitment of the PHAB Board of Directors and Staff • Create demand and successfully deliver PHAB accreditation • Develop and establish PHAB accreditation • Market and manage the PHAB brand • Promote strategic partnerships *** • Establish sufficient funding • Strengthen PHAB organizational effectiveness

6. Robert Wood Johnson Foundation Goal 60% of the population will be covered by accredited health departments by 2015.

7. Credentialing and Accreditation • Credentialing is a concept that applies to individuals who seek public health certification. • Accreditation is a concept of validating performance improvement that applies to state, local, tribal, and territorial health departments.

8. 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, territorial and tribal public health departments.

9. Public Health Accreditation Board • Established May 2007 in Alexandria, VA • Governed by state, tribal and local public health officials and board of health members • Health department involvement: • Board of Directors representation • Workgroups oversee development • Volunteer opportunities

10. Executive Committee • Chair: Paul K. Halverson • Vice Chair: unfilled • Secretary/Treasurer: Ed Harrison • Immediate Past President: Marie Fallon

11. PHAB Board of Directors • Kenneth Kerik (OH) • Carol Moehrle (ID) • Judy Monroe (IN) • Bud Nicola (WA) • Alonzo Plough (CA) • William Riley (MN) • F. Douglas Scutchfield (KY) • H. Sally Smith (AK) Kaye Bender, President and CEO Rex Archer (MO) Shepard Cohen (MA) Leah Devlin (NC) Marie Fallon (OH) Fernando A. Guerra TX) Paul K. Halverson (AR) Edward Harrison (IL)

12. Funding Partners

13. Eligible Applicants All variations of state, local, tribal and territorial health departments can apply for national accreditation

14. Developmental Work • Standards Workgroup • Assessment Process Workgroup • Beta test • Equivalency Recognition Workgroup • Research and Evaluation Committee • Fees & Incentives Workgroup • Marketing and Communication

15. PHAB Timeline Internal Operations Standards and Measures Assessment Process 18 Month Beta Test Applications

16. Standards Development Workgroup • Workgroup comprises state and local health department leaders and BOH members • Collaborative, consensus, iterative process • Facilitated by consultant with standards development expertise • MCPP Healthcare Consulting, Inc

17. Leah Devlin (NC): Co-Chair Carol Moehrle (ID): Co-Chair Terry Allan (OH) Rex Archer (MO) Tim Callahan (CT) Rick Danko (TX) Robert Fulton (MN) John Gwinn (OH) Mary Kushion (MI) Richard Morrissey( KS) Rita Parris (NE) Sylvia Pirani (NY) Joy Reed (NC) Stephen Ronck (OK) Jane Smilie (MT) Torney Smith (WA) Bonita Sorenson (CA) Jeffrey Stoll (CO) Susan Turner (FL) Harvey Wallace (MI) Christina Welter (IL) Kathy Vincent (AL) Barbara Worgess (AZ) Standards Development Workgroup

18. Standards and Measures Development • Develop standards for all health departments • Measures specific to local and state health departments • Guidance for documentation and demonstration of department performance on meeting standards and measures • Scoring and weighting methodology

19. Standards and Measures: Principles • Advance the collective practice • Be simple, reduce redundancy • Minimize burden • Reinforce local and state health departments’ roles, demonstrate shared accountability • Apply to all sizes and all forms of governance structure • Based on American National Standards Institute principles

20. Principles continued • Based on a body of existing work • Essential PH Services • NACCHO Operational Definition • National Public Health Performance Standards Program • State Experiences • ASTHO Survey Data • Essentially all of the concepts in the Operational Definition and NPHPSP have been addressed

21. Draft standards and measures developed by workgroups Alpha test/desk review Public vetting Revised based on feedback PHAB Board approval Beta testing Feb 08-Feb 09 Oct 08-Nov 08 Feb 09-April 09 May 09-June 09 July 09 Late summer 09-Nov 10 Standards Development Timeline

22. Standards Vetting Why? Improve standards and measures What? Standards, measures and documentation guidance How? Through a variety of online and in-person opportunities When? February-April 2009 We need to hear from YOU! And, we will, in just a few moments!

23. Bud Nicola (WA): Chair Rex Archer (MO) Janet Canavese (MO) Shepard Cohen (MA) Kathleen MacVarish (MA) Joan Brewster (WA) Pamela Butler (OH) Martha Gelhaus (IA) Joe Kyle (SC) Edd Rhoades (OK) Rachel Stevens (NC) Debra Tews (MI) Lee Thielen (CO) Equivalency Recognition Workgroup

24. Equivalency Recognition Work Group • To acknowledge states with existing programs that advised the national process • Not a grandfathering process • Recognize programs that conform to the national program • Not “PHAB accreditation,” but eligible for same benefits

25. Application Process (and Fees) PHAB SER Review Process Scoring Methodology Glossary Equivalency Workgroup Products • Definition • Guiding Principles • Eligibility Criteria • Recognition Criteria

26. Accreditation System A public health accreditation system is a network of public health agency accrediting bodies, led by PHAB and including state-based and regional accrediting programs that work together to improve the infrastructure of public health in the nation. This will be accomplished through PHAB leadership, a commitment to collaboration, innovation at the state and national levels, and by sharing common goals and objectives.

27. More Recent Work on State-Based Accreditation Think Tank to further the discussion More work to come…..

28. Assessment Process Workgroup • Determine how to evaluate whether a health department has achieved accreditation status • Determine how health departments can appeal decisions • Professional Accreditation Consultant • Michael Hamm and Associates

29. Assessment Process Workgroup • Bud Nicola (WA): Chair • Christine Abarca (FL) • Joan Ascheim (NH) • Janet Canavese (MO) • Alan Kalos (KY) • Jerald King (IN) • Laura Rasar King (DC) • Richard Matheny (CT) • Bruce Pomer (CA) • Rita Schmidt (WA) • David Stone (NC) • Jeffrey J. Zayach (CO)

30. Assessment Process Process to include: • Readiness Review • Application Form • Self-assessment • Site Visit • Findings and Recommendations Report • Final Determination • Appeals Process • Maintenance of Performance • Re-accreditation

31. Assessment Process: Principles • The assessment process should reduce anxiety and increase comfort for the applicant • PHAB will offer training, technical assistance, and informational materials on the accreditation process • All applicants will be required to participate in PHAB training on the application process 31

32. Research and Evaluation Committee • Develop a plan for evaluating the assessment processes and identifying research that would improve the standards-setting and accreditation program. • Review standards and measures for validity and reliability. • Provide consultation on data collection and interface with accreditation tracking and application online system.

33. William Riley (MN): Chair Christine Bean (NH) Mary Davis (NC) Seth Foldy (WI) Les Beitsch (FL) Paul Erwin (TN) Kerry Gateley (VA) Brenda Joly (ME) Laura Landrum (IL) Glen Mays (AR) Research and Evaluation Committee

34. Financing • Workgroup on fees and incentives • Affordability of fees critical to success • Accreditation process should be designed with cost controls in mind

35. Tool for improvement Benefits of Accreditation Accountability & credibility Highlights HD strengths Greater collaboration Accreditation Team building Recognition & validation Better understanding of public health

36. Incentives • Uniformly positive • Participate in learning community • Informed by UNC research • Possible tangible incentives • Improved access to funding • Grants application requirements • Grants reporting requirements

37. Incentives Research • What matters to State HDs? • Financial incentives • Accredited agencies – 60% • Agencies applying for accreditation – 32% • Infrastructure/quality improvement – 36% • Grants application and administration – 20%

38. Incentives Research • What matters to Local HDs? • Financial incentives • Agencies considering accreditation – 51% • Accredited agencies – 37% • Infrastructure/quality improvement – 33% • Technical assistance and training – 27%

39. Incentives Underway

40. Areas for Further Exploration • Incentives thresholds • Incentives from States to Locals • Providing incentives • Menu • Sequencing • Incentives for Tribal Health Departments

41. Now, To The Standards

42. Draft Standards Framework • 11 Domains • 31 Standards • >100 Measures • Documentation

43. Eleven Domains Part A Administrative Capacity and Governance Part B Conduct assessment activities 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

44. 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 Eleven Domains (cont.)

45. Domain 1: Conduct assessment activities focused on population health status and health issues facing the community

46. As you review the standards… • Consider the following questions: • Will this standard improve public health department performance? • Are the important components of this standard captured in its associated measures for the standard? • Can this standard be documented? • Can health departments meet this standard now?

47. Standards for Discussion Which standards do you think are particularly strong? You would recommend that PHAB keep these standards. Which standards do you think are Problematic? You think PHAB should modify or possibly delete these standards.

48. Opportunities to Provide Feedback There are multiple ways to offer feedback on the standards and measures before April 30, 2009: • Complete the online survey at www.phaboard.org • Complete and submit the online or hard copy vetting forms • Invite PHAB to lead a standards vetting discussion at your group meeting • Lead a vetting session with your group

49. Your Feedback on the Standards Why did this standard catch your attention? If you think the standard is strong, why did you like it? If you think the standard is problematic, why? How would you modify it?

50. For more information… www.phaboard.org Contact Kaye Bender or any Board Member 703.778.4549