Eleven health departments first to attain public health accreditation: Measuring capacity
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* Kim Krisberg

In 2003, an Institute of Medicine report on the future of public health called on health officials to take a closer look at creating uniform standards for evaluating public health agencies. A decade later, the first class of health departments to meet such standards is being celebrated.

Announced in February, the 11 health departments awarded five-year accreditation by the Public Health Accreditation Board are at the forefront of a movement toward continuous quality improvement within the public health system. Public health department accreditation, which employs universal standards to measure a health department’s capacity to deliver core and essential public health services, originally launched in 2011 after years of collecting input from hundreds of public health practitioners nationwide. APHA member Kaye Bender, PhD, RN, FAAN, president and CEO of the Public Health Accreditation Board, called the initial class of accredited health departments a “huge milestone” for public health.

“I can’t say enough about how brave these health departments were,” Bender said. “It’s tough to be the first of anything. But to have health departments say ‘we believe in this so strongly that we’re going to put our work out there’…that’s a very brave thing to do.”

The 11 departments to achieve accreditation were:

*   ♦ Comanche County Health Department, Oklahoma;

*   ♦ Franklin County Health Department, Kentucky;

*   ♦ Livingston County Department of Health, New York;

*   ♦ Northern Kentucky Independent District Health Department, Kentucky;

*   ♦ Oklahoma City-County Health Department;

*   ♦ Oklahoma State Department of Health;

*   ♦ Spokane Regional Health District, Washington;

*   ♦ Cabarrus Health Alliance, North Carolina;

*   ♦ Three Rivers District Health Department, Kentucky;

*   ♦ Washington State Department of Health; and

*   ♦ West Allis Health Department, Wisconsin.

As of mid-March, nearly 130 health departments were working toward voluntary accreditation, and the board is receiving new applications every week, Bender told *The Nation’s Health*. Applicants range from small health departments serving communities of just 9,000 to those serving metropolitan areas of millions, Bender said. She noted that before accreditation, “we never really had anything by which to measure how an individual health department was doing against the best and most promising practices in public health.”

“Accreditation does require a health department to commit to changing its culture to one of continuous quality improvement and learning,” Bender said. “(Accreditation) allows health department staff the freedom to actually call into question when they feel they need to start over or to stop doing something or to do something differently. That, to me, is the most transformational part.”

In Oklahoma City, the accreditation process helped the local health department pave a new path toward better health. In conducting a community health assessment — one of the prerequisites for applying for accreditation — staff with the Oklahoma City-County Health Department found that residents in northeast Oklahoma City face chronic disease rates up to 10 times higher than the healthiest ZIP codes in the city. The assessment data and resulting community health improvement plan — another accreditation prerequisite — brought all the pieces and partners together to help launch a citywide health initiative known as Wellness Now, said Gary Cox, JD, executive director of the Oklahoma City-County Health Department.

![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/43/4/1.1/F1.medium.gif)

[Figure1](http://www.thenationshealth.org/content/43/4/1.1/F1)

Oklahoma State Department of Health employees celebrate the agency's accreditation status March 8. The department was one of 11 to achieve accreditation through a program administered by the Public Health Accreditation Board.

Photo by Marylee Wright, courtesy Oklahoma State Department of Health

Cox noted that the accreditation process helped his health department redirect its limited resources to areas of greatest need — areas more likely to return significant improvements in health outcomes. For example, under the Wellness Now umbrella is My Heart, My Health, My Family, a community-based cardiovascular disease prevention project that screens residents at high risk for heart disease, connects them with a medical home and provides services such as smoking cessation and case management. As of mid-March, the project had reached nearly 200 people living in neighborhoods home to the highest rates of cardiovascular disease.

“Our goal is to become a cutting-edge health department and we thought accreditation was a key way to demonstrate to our community that we’re striving for a more proactive approach to protecting and improving the health of our citizens,” said Cox. “It’s a lot of work, it’s a substantial investment of time. But it’s a valuable exercise that will help you refocus your agency in areas that will pay dividends very quickly. It’s a great source of pride for our employees to have gone through this very strenuous exercise and be successful at it.”

Georgia Heise, DrPH, district director for Kentucky’s Three Rivers District Health Department, said her health department began aligning its activities with accreditation standards long before accreditation officially debuted. When the opportunity to apply finally arrived in 2011, “We were ready to go,” said Heise, an APHA member and current vice president of the National Association of County and City Health Officials. Within the four counties the health department serves, Heise said accreditation has helped Three Rivers define its identity for residents and rally its resources “to do true public health work.” In fact, because the provision of clinical services is not considered a core public health service, such services are not included within the accreditation framework.

“We wanted to distinguish ourselves from clinical care, from primary care…we wanted to build our identity within our community,” Heise told *The Nation’s Health*. “We wanted the community to know that we’re not just another clinical source; we are a convener of services, a watchman of the health status, we’re here to make broad changes that will help the overall health of our citizens. We’ve wanted that identity for a long time.”

In terms of building a more effective, more efficient health department, Heise said accreditation gave her a vehicle to deliver quality improvement education to the entire staff. The accreditation process leads health departments through a process to pinpoint areas in need of quality improvement. Heise said most employees jumped on the chance to improve the quality of their work and “take more control over their jobs.”

Heise noted that state legislation to require accreditation at all Kentucky health departments has been introduced on three occasions, though it has yet to make it to the governor’s desk.

“(Accreditation has) been tremendous for our health department,” she said. “The standards and measures are a playbook of how to run a health department. We don’t look at this as a program; we look at this as how you run an effective public health department.”

In Washington state, work to improve the quality of public health services had been under way for more than a decade, so when the opportunity to become nationally accredited arrived, “it made sense for us,” said APHA member Mary Selecky, who recently served as secretary of health at the Washington State Department of Health, one of the first two state-level health departments to achieve accreditation. Noting that achieving accreditation requires a considerable amount of work and dedication, Selecky said it is important to first build a culture of quality improvement within the health department.

“When you think about quality improvement and performance management, for some folks it can feel like an add-on, so you have to make sure you have a culture that supports and understands quality improvement work,” Selecky told *The Nation’s Health*. “Quality improvement is not something you make people do, it’s something that needs to be embraced.”

For a health department anxious to prove its efficiency, accreditation sends the message that “we’re committed to quality and transparency…that we’re trying to improve the effectiveness of the resources being made available to us,” said F. Douglas Scutchfield, MD, a member of the Public Health Accreditation Board’s Board of Directors. Scutchfield noted that the accreditation board has created avenues for even the tiniest health departments with the most limited resources to be able to achieve accreditation.

“I don’t think there’s a health department out there that’s satisfied with the status quo,” he said.

For more information about public health accreditation, visit [www.phaboard.org](http://www.phaboard.org).

*   Copyright The Nation’s Health, American Public Health Association