PHAB E-Newsletter header

   ISSUE #27: 

September 2010

Beta Test Site Visits
PHAB Board of Directors Meeting
Tribal Public Health Standards
MLC Open Forum Meeting
Social Media
PHAB Word on the Street
1600 Duke Street
Suite 440
 Alexandria, VA 22314

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It's a wrap! The Beta Test site visits are finished and PHAB could not be more pleased with how successful they were. We have heard from the health departments and site visitors that the site visits were positive learning experiences for all involved. PHAB shares this feeling of accomplishment with all those who worked with us on the Beta Test.
It has been a "PHABulous" summer and an historic one for public health. After thirty site visits from Maine to Arizona, from Washington to Florida, we have learned so much about our public health system. We have noted what makes each health department unique and most importantly we have found common characteristics and enthusiasm for providing the best public health services possible to the communities we serve. 
PHAB appreciates the work of the staff at the sites (especially the Accreditation Coordinators), the site visit teams who reviewed documents and traveled to health departments, and the partners who served as observers. This was collaboration at its finest. Now, it's time for the National Opinion Research Center (NORC) to carefully analyze all of the data we've gathered. As PHAB has planned, all of the information will be used to revise the standards, measures, documentation guidance, glossary, self-assessment, and other tools and documents of the process so that the best possible accreditation program can be launched in 2011. PHAB expects that it will take about six months to complete this important body of work.
For health departments who are anticipating applying for accreditation once it is launched in 2011, PHAB recommends working diligently on the pre-requisites. These are required to apply for accreditation and will not change. They are a community/state health assessment, a community/state health improvement plan, and an agency strategic plan. PHAB will continue to share the latest wisdom in meeting these pre-requisites. Read more about this in the "Word on the Street" section.
Also in this e-newsletter you'll find highlights of the PHAB Board of Directors quarterly meeting and an update on the development of Tribal specific standards. PHAB will keep you informed of our progress on all aspects of accreditation and we are committed to answering your questions and sharing best practices. Let us know how we can improve on this commitment.


Kaye Bender, PhD, RN, FAAN
PHAB President & CEO

Final Beta Test Site Visit
The last of thirty site visits took place on August 26-27, 2010, at the Township of Bloomfield Department of Health and Human Services in Bloomfield, NJ. 

Members of the Township of Bloomfield Department of Health and Human Services and the PHAB site visit team at the final Beta Test site visit.

PHAB Board of Directors Quarterly Meeting
The PHAB Board of Directors held their quarterly meeting August 18-20, 2010. Highlights from the meeting include the following:
  • A report of the Beta Test site visits to date. As of the Board meeting dates, all of the Beta Test site visits had been completed except for one. The Board acknowledged the hard work of the Beta Test sites, the site visit teams, the partner observers, and the PHAB staff in ensuring that the visits were conducted according to PHAB protocol and completed on time.
  • A report of the Beta Test evaluation being conducted by NORC. The information being received by NORC is on track, and final analysis will begin as soon as the site visit reports have all been received. NORC expects to provide its final report to the Board of Directors at its December 2010 meeting. Results of that report, along with other feedback received, will inform changes in the standards, measures, documentation guidance, and accreditation process.
  • A report from the website and focus group feedback analysis conducted by the North Carolina Institute for Public Health. This information will be used to inform the Board about potential changes in all of the tools used in the Beta Test as the final accreditation documents are developed.
  • Discussions about other issues potentially affecting health departments as they prepare for accreditation. These issues included health reform implementation; the impact of the economic downturn on health department staffing and services; and the status of health department readiness for accreditation through the development of the pre-requisites (community/state health assessment, community/state health improvement plan, and agency strategic plan).
  • The Information Systems Development Committee met for the first time to begin their work on developing the information system to support accreditation and research related to accreditation.
  • The Fee Development Committee met for the first time to begin their work on the development of the fee structure for accreditation.
  • The Beta Test Accreditation Review Committee met and provided initial recommendations for Board consideration regarding the future policies and procedures for determining the accreditation status of health departments, including the potential makeup of the Accreditation Committee in the long-term, categories of accreditation, the process for the review of site visit reports, and other similar issues related to the accreditation decisions. This committee will continue to meet regularly over the next several months as they finalize this part of the accreditation process.
  • A report from the Public Health Laboratory Think Tank and an interim report from the Texas Think Tanks.
  • The Board held discussions with two of its national partner Executive Directors, Georges Benjamin from the American Public Health Association (APHA) and Bobby Pestronk from the National Association of County and City Health Officials (NACCHO), about current issues in public health and their potential effect on health departments getting ready for accreditation.
Georges Benjamin (Executive Director, APHA) and
 Bobby Pestronk (Executive Director, NACCHO).

Tribal Public Health Standards

PHAB has established a Tribal Standards Workgroup to assist in the development of a tribal specific set of documents, based on PHAB's current standards, measures, documentation, and interpretation for state and local health departments. The Workgroup will consider the unique characteristics of tribal health departments, and recommend revisions to the PHAB documents to ensure their applicability and relevance to tribal health systems with sensitivity to linguistic and cultural appropriateness.
The first meeting of the Tribal Standards Workgroup will be held on September 19-20, 2010, in Sioux Falls, SD. The meeting is being held in cooperation with the National Indian Health Board (NIHB) and coincides with their 27th Annual Consumer Conference. Aleena Hernandez is serving as PHAB's tribal consultant to this process. 

Aleena Hernandez, Red Star Innovations
If you have questions about this work, please contact Robin Wilcox (
[email protected]) and continue to watch for updates in upcoming e-newsletters.

MLC Open Forum Meeting
PHAB staff recently attended the Multi-State Learning Collaborative (MLC) Open Forum: A National Conference of Leaders in Quality Improvement held in Washington, DC, on September 15-17, 2010. The conference featured several sessions on accreditation, highlighting the experiences of those who participated in the Beta Test and discussing the links between accreditation and quality improvement. Dr. Kaye Bender, PHAB CEO, Dr. Bill Riley, Chair of the PHAB Board of Directors, and Dr. Les Beitsch, member of the Board, gave presentations. Beta Test participants who shared their experiences included: Gina Frack, Norton County Health Department; Shannon Jones, Austin-Travis County Health and Human Services Department; Joyce Marshall, Oklahoma State Department of Health; Joy Harris, Iowa Department of Public Health; Sara Wagner, Coconino County Department of Health; and Rene Ynestroza, Miami-Dade County Department of Health.  See "Word on the Street" below for some questions heard at the conference.

Gina Frack, Shannon Jones, and Joyce Marshall share their Beta Test experiences and discuss the relationship between accreditation and quality improvement.
Rene Ynestroza, Sara Wagner, and Joy Harris share their Beta Test experiences and
 provide advice to others interested in preparing for accreditation.

Twitter, Tweeting, and PHAB

PHAB encourages the use of social media to share information among constituents. Tweets about the MLC Open Forum raised the subject of a designated hashtag. Tom Briggs, ASTHO Senior Analyst for Accreditation, tweeted about the event using the #PHAB hashtag. According to Twitter, "Hashtags are a community-driven convention for adding additional context and metadata to your tweets. They're like tags on Flickr, only added inline to your post. You create a hashtag simply by prefixing a word with a hash symbol: #hashtag. Hashtags were developed as a means to create "groupings" on Twitter without having to change the basic service."
For those of you who tweet, adding the #PHAB hashtag to tweets related to accreditation will help the rest of us keep track of all the PHAB twitter. Tweet on!

Word on the Street

1. Now that the Beta Test is over, what should health departments considering accreditation be doing while PHAB is working on making changes in the documents and tools?


We have learned from the Beta Test that health departments can do this! There is a set of processes and activities that health departments can get organized to achieve. For health departments who are anticipating applying for accreditation in the future, PHAB recommends working diligently on the following, at a minimum:


a. Appoint an Accreditation Coordinator and department-wide team for review of the standards, measures and documentation guidance, and the identification of documents.


b. Review the documentation requirements for the measures and note the areas where the health department needs to be sure that documentation potentially used in accreditation is "up to speed". That means dating agendas, communications, and policies as they are developed; signing and dating contracts; keeping sign-in sheets for various trainings; and creating an electronic filing system to store information so that it can be easily found for future reference during the self- assessment.


c. Begin/refine work on the pre-requisites. PHAB has learned from the Beta Test that completing these pre-requisites lays wonderful groundwork for completing the rest of the self-assessment. So, getting these done properly will get a health department off to a good start. Remember to contact one of our national partners for technical assistance with these processes. As a reminder the components are:


i. Community (or state) health assessment involves a process of collecting, analyzing and using data to educate and mobilize communities, develop priorities, garner resources, and plan actions to improve the public's health. It is one of the core functions of public health, which is why it's in the accreditation standards. It involves the systematic collection and analysis of data in order to provide the health department and the community it serves with a sound basis for decision-making. It should be conducted in partnership with other organizations in the community and include collecting data on health status, health needs, community assets, resources, and other community or state determinants of health status. A community (or state) health assessment links directly to the standards and measures in PHAB's Domain 1 and Domain 4. The intention here is that, for accreditation purposes, the health department can demonstrate that it systematically assesses its jurisdiction's health status and can describe it. Most health departments should have access to much of the data needed. Partnerships with hospitals, academic institutions, other governmental agencies (such as schools or police), and non-profit health promotion organizations will help to access additional data needed to assess the health of the community or state. Putting it altogether in an organized way to describe the health status or health profile of the community it serves might be a little different way to use the information available. 


ii. Community (or state) health improvement plan is a long-term systematic effort to address issues identified by the assessment and community health improvement process. It is broader than the health department agency and its development, and should include participation of a broad set of community partners. A solid community health improvement plan can be used by partners to prioritize activities and set priorities. The health improvement plan links directly to Standard 5.3 and its measures. For accreditation purposes, the community health improvement plan should be updated at least every five years.


iii. The agency strategic plan is internal to the health department, although may have been developed with input from partners. It shapes and guides what the health department does and why it does it; it sets forth the department's vision, mission, guiding principles and values, and strategic priorities; and describes measurable and time-framed goals and objectives. The strategic plan should include steps to implement portions of the community health improvement plan as well as other strategic issues for the department. The strategic plan links directly to Standard 5.2 and its measures.


d. Prepare documentation according to the concepts imbedded in the current measures and guidance, but not according to the specific measure number. All of the elements of the PHAB accreditation documents are subject to change once the comments from the Beta Test, the website feedback, and the Think Tanks have been considered. PHAB does not recommend that future applicants gather their documentation specifically according to the existing measures (e.g., 1.1.2). However, PHAB does not expect changes in the following:


i. The framework for the domains and the link to the Essential Public Health Services;


ii. The public health concepts and processes the documentation represents; and


iii. The underlying philosophy that accreditation is based on performance and quality improvement.


2. You have said that PHAB will take about six months to consider all of the feedback and the Beta Test evaluation as it makes changes to the documents. That seems like a long time. How should we keep up with the latest information as that process moves along?
When you are anxiously awaiting information, it does seem like a long time. But, PHAB intends to consider all feedback and evaluation material as it revises the materials. So, it really isn't a long time from that standpoint. While we know the final products won't be perfect for the launch, we want them to be as good as we possibly can get them. In the meantime, stay tuned into our website (which we will be updating regularly) and the e-newsletter so you can stay abreast of the latest information over this adjustment period.

3. How long does accreditation last? What is the planned frequency of the process?
PHAB has adopted a 5-year accreditation cycle. Once a health department has achieved accreditation, the renewal will be due in five years. How that process will work has not yet been developed and approved. That will be done over the next year.

4. We are still wondering about the costs associated with accreditation. Is there anything you can tell us?
PHAB is also learning about the full costs associated with accreditation, so we are working hard to capture as much of that information from the Beta Test and other places as possible. Right now, we have identified three basic areas of costs to be considered: one is the cost of completing the pre-requisites; second is the cost of preparing the information for the application and self-assessment; and third is the cost of the site visit. The cost of the pre-requisites is not totally limited to preparation for accreditation since those are the basic elements of planning, implementing, and evaluating public health services. However, we do know that some health departments have not historically done that work, so those costs might be new to them. PHAB will share the analysis of the time involved in the Beta Test and the costs associated with the site visits just as soon as we have those analyses to share. And, of course, we will also share the accreditation fee structure as soon as it has been developed. 
5. Messages to support public health accreditation are often vague. How can we make a stronger argument in favor of accreditation?
If a health department has experienced some noteworthy change due to work on accreditation and/or quality improvement, tell others about it. If you are a health department that operates in a state with a state-based accreditation program, and having standards improved how your health department functions, talk about it. If you are a health department that participated in the MLC projects and you know that your work changed the face of public health in your area, talk about it. Write about it. Be specific. If your health department was a PHAB Beta Test site and something changed for the better because of preparing for that experience, tell that story. It's the health department's specific work that will keep the messages pertinent and valuable and therefore, not vague. Be proud of working to make public health better. Share your story!

6. How can we promote public health accreditation as a path to performance improvement?
PHAB's approach to accreditation will only continue to be based on the principles of improving the quality of public health if we keep the focus there. While we are all developing the key components to accreditation and learning about how to implement those components, it will look as though that is all we are about. But, the reason to work on accreditation is to improve health department performance. High performing public health departments will run better programs and services for their jurisdictions; they will more readily translate best and promising practices into every day work; they will have closer ties with their communities; and they will not be afraid to have peers look at their work on a regular basis so that they can continue to improve their services. We can promote public health accreditation as a path to performance and quality improvement if we keep our collective focus on why we are being accredited -- not just on being accredited. 

7. What is the latest news on possible incentives for accreditation?
Dr. Mary Davis conducted some valuable research on incentives for accreditation and published her findings. Using that paper as a resource, PHAB's Fees and Incentives Workgroup developed a description of proposed incentives for accreditation and presented them to the Board of Directors in January 2010. They were passed and are being shared and discussed at all policy levels. Dr. Davis' article can be found in the September 2009 issue of the American Journal of Public Health

If you have a suggestion for future segments of "Word on the Street," please send them to Donna Davis, PHAB's Director of Public and Constituent Relations, at [email protected].