Public Health Department Accreditation: Answering the “So What?” Question CDC’s Role in Advancing Accreditation November 18, 2014, 10:30 am–12:00 pm American Public Health Association Annual Meeting New Orleans, Louisiana Session # Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support

CDC’s Role in Accreditation Support  PHAB—partner and funder  National partner organizations  Technical assistance, educational resources, and trainings  Accreditation Support Initiatives  National Public Health Improvement Initiative (NPHII) and Performance Improvement Managers Network  Establishing incentives—for preparing and for accreditation status  Building connections to CDC-supported areas and funding streams

NPHII: The Program at a Glance  Key objectives:  Accelerate public health accreditation readiness  Improve organizational efficiency and effectiveness through quality improvement activities  Increase performance management capacity  Establish a national network of Performance Improvement Managers (PIM Network) Supported through the Prevention and Public Health Fund of the Affordable Care ActAffordable Care Act FY2010: $42.5M to 76 awardees FY2011: $33.6M to 74 awardees FY2012: $33.5M to 73 awardees FY2013: $32.5M to 73 awardees

NPHII Awardees

Completion of PHAB Prerequisites (as of May 2014)  81% of NPHII awardees completed one or more prerequisites (n=59/73)  48% of awardees completed all three prerequisites (n=35/73) Accreditation Prerequisite % of Grantees That Have Completed % of Grantees Currently Developing Total % Health Assessment71.2% (n=52)16.4% (n=12)87.6% (n=64) Organizational Strategic Plan 68.5% (n=50)26.0% (n=19)94.5% (n=69) Health Improvement Plan 53.4% (n=39)30.1% (n=22)83.5% (n=61)

Completion of Self-Assessment Against PHAB Standards (as of August 2014) N=60

Standardized Public Health QI Outcomes Time saved Reduced steps in a process Revenue generated due to billable services Costs saved Costs avoided Efficiency Increased customer/staff satisfaction Increased reach to a target population Quality enhancement of services and programs Quality enhancement of data systems Dissemination of information, products and evidence-based practices Organizational design improvements Increased preventive behaviors Decreased prevalence/incidence Effectiveness

Initial Findings: Increased Efficiencies (as of May 2014)  By midpoint of Year 4, 63% (n=39/62) of awardees that completed at least one QI initiative increased efficiencies Percent of awardees

Initial Findings: Increased Effectiveness (as of May 2014)  By midpoint of Year 4, 89% (n=55/62) of awardees that completed at least one QI initiative increased effectiveness Percent of awardees

NPHII Impact—Voices from the Field “Our map, our strategic plan, it is everywhere in our department. All of this started with the NPHII funding and the drive toward accreditation, performance improvement, and just transparency in what we do.” (from a state HD) “I think our funding sparked, along with our leadership support, the entire movement in changing the way we do things at our health department. Putting accreditation and performance improvement and now continuous quality improvement on the map, our agency is actually invested now in three additional full-time positions in these areas. Aside from the PIM and the performance management specialist that are supported by the NPHII grant funding, our agency has invested in three other positions to help support this entire unit.” (territorial HD) “spark(ing)... a movement in changing the way we do things at our health department.... The whole process and the journey of getting through our strategic plan, our state health assessment, looking at our domain, teams across our entire agency. It has changed the awareness of what we do, how we provide our ten essential services. I just can’t say enough; it really has changed the entire way we do things and the way we think.” (state HD) - From NPHII focus groups with Performance Improvement Managers, 2013

Accreditation Support Initiatives  Small amounts of funding to advance accreditation readiness  Short period of time  Funding from CDC’s Office for State, Tribal, Local and Territorial Support through national partners:  NACCHO—focusing on local health departments  APHA—affiliate organizations  NIHB—tribal health departments (upcoming)

CDC/NACCHO Accreditation Support Initiative (ASI)  Started in 2011; provided $3.7 million ($2.3 million in ACA funding) through 78 awards—to advance accreditation readiness  Funding to health departments and to organizations supporting health departments  Of 64 awardees eligible for accreditation, 59% (n=38) are in the process of being accredited, and 16% (n=10) have achieved accreditation status  Approximately one quarter of awardees used funds to pay up to 50% of PHAB fees  ASI primary contribution to accreditation readiness was the initiation of activities and acceleration of the pace of accreditation preparation  Quality improvement  Community health improvement plan  Agency strategic plan  Workforce development  Performance management system More information at

ASI Sites 2011– –2014 ASI Sites2013–2014 and 2012–2013 Sites 2012–2013 ASI Sites2012–2013 and 2011–2012 Sites 2011–2012 ASI Sites

CDC/APHA Accreditation Support Initiative  Started in 2012; provides funding to APHA affiliates partnering with health departments to advance national accreditation readiness  Year 1 and 2 grantees:  Alabama, Arizona, Georgia, Illinois, Indiana, Iowa, Michigan, Mississippi, Missouri, Montana, Nevada, Ohio, Oklahoma, Oregon, Texas, Utah  Sample activities:  Webinar series and educational sessions  Gap analysis against PHAB standards and training  Focus on tribal partnerships  Toolkit development

Accreditation—Making Strategic and Programmatic Connections  How are programs and services reflected in PHAB standards?  How can funded programmatic activities aid in meeting PHAB standards?  How can PHAB standards provide the right foundation for strong programmatic work? Programs and Activities PHAB Standards and Measures

PHAB Accreditation Language Within CDC FOAs  Standard templates and guidance for Funding Opportunity Announcements (FOAs)  Fact sheet available at  Included in 58 FOAs to date (FY13 and FY14)  Organizational capacity statement and Budget Narrative Guidance  “…applicants may describe their current status in applying for public health department accreditation or evidence of accreditation…”  “(Applicants) may, if consistent with statutory authority, use funds for activities, as they relate to the intent of this FOA, to meet national standards and/or seek health department accreditation through the Public Health Accreditation Board.”

Examples of Programmatic and Strategic Connections  PHHS Block Grant  Healthy People 2020  Preparedness*  Chronic disease programs  Maternal and child health  Environmental public health*  Laboratories  Infectious disease  Immunizations*  Occupational safety and health* *Crosswalk developed or in progress  Informatics  Community health assessment/planning  Healthcare-associated infections*  Food safety*  Health literacy  Guide to Community Preventive Services*  National Prevention Strategy  HHS quality aims and characteristics*