EXCELLENCE IN PUBLIC HEALTH AND THE ROLE OF ACCREDITATION BUD NICOLA, MD, MHSA, FACPM, VICE CHAIR PUBLIC HEALTH ACCREDITATION BOARD NAPHSIS ANNUAL MEETING JUNE 11, 2014 SEATTLE, WA

Session Objectives Describe the current status of the national public health accreditation program Discuss accreditation changes for 2014 Discuss an exciting potential opportunity for PHAB and NAPHSIS for

Current Status

Public Health Accreditation Board PHAB is national accrediting organization for public health departments: State health departments Local (city, county, regional) health departments Tribal health departments Territorial health departments

Public Health Accreditation Board (PHAB) The goal of the 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.

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.

Current Accreditation Activity

Population Summary All HDs in the system269,356,490 All HDs in the system (unduplicated)193,251,423 Accredited HDs23,623,173 Accredited HDs (unduplicated)21,712,137 Smallest Population of Applicant725 Largest Population of Applicant37,691,912

Accredited Health Departments in 2013

Accredited Health Departments in 2014 Columbus Public Health, Columbus, OH Cook County Department of Public Health, Oak Forest, IL Delaware General Health District, Delaware, OH Hennepin County Human Services and Public Health Department, Minneapolis, MN Loudon Health District, Leesburg, VA Marion County Health Department, Salem, OR Missoula City-County Health Department, Missoula, MT Oneida County Health Department, Rhinelander, WI Tooele County Health Department, Tooele, UT

Why Were These Health Departments Interested in Accreditation? Transparency and Accountability Most other governmental and health related services are accredited: hospitals, schools, child care centers, police departments, fire departments, etc. Provides a priority setting framework Commitment to improving their services Increased public engagement and support Increased staff morale Risk Management Potential for increased funding in the future; already using their accreditation certificate in grant proposals

Early Evaluation Results 97% of health departments that have had their PHAB site visit strongly agree that “Going through the accreditation process has improved the performance of our health department.”^ According to HDs that have had their site visit, accreditation: –Identifies strengths and areas for improvement –Strengthens internal and external partnerships –Encourages HDs to prioritize and address long-standing concerns –Acts as a “stimulus…for continuous quality improvement and performance management in our daily practice” ^ From PHAB evaluation of 33 health departments.

Early Evaluation Results Among health departments applying for accreditation, 95% or more believe that accreditation will:* –Stimulate quality and performance improvement opportunities –Allow HD to better identify strengths and weaknesses –Improve management processes –Stimulate greater accountability and transparency within HD * From NORC at the University of Chicago evaluation survey of 62 health departments that have applied for accreditation.

Early Evaluation Results Health departments also reported the following motivators for applying for accreditation^ –Accountability to external stakeholders –Documentation of HD’s capacity to deliver the 3 core functions and 10 Essential Public Health Services –Credibility of HD within community –Relationships with community stakeholders –Competiveness for funding opportunities –Communication with governing entity ^From NORC at the University of Chicago evaluation survey of 62 health departments that have applied for accreditation.

PHAB 2014 Update

Evidence Base Growing Journal of Public Health Management and Practice, January/February 2014 Issue totally dedicated to accreditation. It’s free online at

ACCREDITED HEALTH DEPARTMENTS ANNUAL REPORTS NEW IN 2014 “ The submission of annual reports is required of all accredited health departments, in an on-line format provided by PHAB. Reports must: Include a statement that the health department continues to be in conformity with all the standards and measures of the version under which accreditation was received. Include leadership changes and other changes that may affect the health department’s ability to be in conformity with the standards and measures. Describe how the health department has addressed areas of improvement noted in the site visit report. Describe how the health department will continue to address areas of improvement identified in the site visit report and/or by the health department in their accreditation action plan. Describe work on emerging public health issues and innovations

Standards and Measures Version 1.5 (07/01/14) Edits and rewording for increased clarity Recommendations from the PH Community Questions Received from HDs and SVs Think Tanks and Expert Panels Health Equity Public Health Ethics Public Health Communication Science Public Health Workforce Public Health Informatics Other Resources – Meetings and readings

Decision Points About Version 1.5 The current version of PHAB's Standards and Measures is Version 1.0. PHAB will release Version 1.5 of the PHAB Standards and Measures on the PHAB website in January They will become effective for health departments' accreditation on July 1, Hard copies of the standards and measures will be available July 1, Health department directors must submit their application in e-PHAB by 11:59 PM Eastern Time on June 2, 2014 to be assessed under Version 1.0 of the Standards and Measures. Health departments that submit their applications on June 3, 2014 or after will be reviewed and assessed using Version 1.5 of the Standards and Measures. Also to be available on July 1, 2014 will be a revised PHAB Acronyms and Glossary of Terms. It will be Version 1.5 of the Acronyms and Glossary of Terms.

The PHAB Accreditation Process: To Be Reviewed In

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 Documentation review, 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

Think Tanks in Accreditation and Quality Improvement Public Health and Health Care Intersection Vital Records/Statistics Army Public Health Large City/Metro Rural Health Departments

PHAB’s Partnership with NAPHSIS

Working Together in 2013 Provided excellent input into the edits to Version 1.5 of the standards and measures. More explicitly noted where vital statistics/vital records units could be a resource for health departments preparing for accreditation. Participated in planning and implementing an Expert Panel to consider future work together

Expert Panel Meeting September 9-10, 2013

Purpose of the Expert Panel Discuss relationship between accreditation standards/measures and best practices in VR/PHS Explore the feasibility of developing and integrating accreditation measures for VR/PHS programs into the existing accreditation standards/measures Discuss the development of a work plan to identify concepts, activities and tools that could strengthen accreditation and VR/PHS

What PHAB Learned While there is a Model State Vital Statistics Act and there are NAPHSIS developed standards for those units, there is no accreditation process for these core public health functions. NAPHSIS has a history of supporting quality improvement and accreditation. NAPHSIS and PHAB intend to partner to develop a work plan for accreditation in order to pair the experience of PHAB in accreditation with the content expertise of NAPHSIS to develop a strong, credible accreditation program. There are good working definitions of vital statistics and vital records that PHAB can use in its accreditation language.

Working Definitions Vital records means reports of live birth, death, fetal death, marriage, (divorce, dissolution of marriage, or annulment) and data related thereto which have been accepted for registration and incorporated into the official records of the Office of Vital Statistics. Vital statistics means the aggregated data derived from the records and reports of live birth, death, fetal death, induced termination of pregnancy, marriage, (divorce, dissolution of marriage, or annulment) and supporting documentation and related reports.

PHAB’s Commitment to NAPHSIS To request funds to further explore what accreditation of the State Health Department’s Office of Vital Statistics which is statutorily authorized to maintain, operate and advance the only system of vital statistics throughout a given state might look like.

Feedback, Words of Wisdom, Concerns and Cautions

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