PHAB E-Newsletter: November/December 2010

1. We have contracts and agreements with others who perform some public health functions and produce some of the policies, procedures, and documents that the health department uses. Some of the documentation that is required by the PHAB standards was not produced by my health department but has been developed by other governmental agencies and partners. Will this documentation be accepted by PHAB?

It is not necessary that your documentation was created by the health department, as long as it is currently in use by the health department. Many health departments do not conduct all public health functions directly but have formal agreements, contracts, or partnerships with others to perform selected functions. The health department must provide documentation that demonstrates that the function is being performed, though it may be performed by another entity. The focus of the PHAB standards, measures, and documentation guidance is on "what" is provided, not "how" it is provided.

The accountability for providing documentation that demonstrates conformity with the measures rests with the health department being reviewed for accreditation. PHAB will not only need to see the documentation, but will need to see evidence of a formal working relationship when the measure is met by another organization. Departments will need to submit to PHAB formal documentation of the partnership or assignment of responsibility to others (MOA, MOU, letter of agreement, contract, legislative action, executive order, ordinance, or rules/regulations).

Some examples are:

Health departments may have formal agreements or partnerships with non-governmental organizations to provide particular functions or activities. For example, a health department might contract with an academic institution to collect primary data (Measure 1.1.3: "Collect additional primary and secondary data on population health status.") The health department is accountable and responsible for ensuring the high quality, accuracy, and utility of those data, but they do not have to collect the data themselves.
Health departments may share functions or services with other governmental agencies. For example, environmental public health is a function that is sometimes provided by another state or local agency. A health department's documentation may be documents that were produced by that other agency.
Health departments, as agencies that are a part of a larger governmental unit, may utilize the policies, procedures, or functions of that governmental unit. For example, a health department may utilize the human resources system of the local or state government (Measure A1.4: "Maintain a Human Resources system.") In this case, the documentation for human resource policies and procedures would be the policies and procedure of that other level of government. The health department need not have its own policies and procedures, but those that it does have and use, must meet the PHAB measures.
Local, state, and Tribal health departments may have agreements with each other about the responsibility for and provision of public health functions. For example, the state may provide the epidemiology function at the state and local levels (Measure 2.1.2: "Demonstrate expertise and capacity to conduct an investigation.") If the state did not serve this function, the local or Tribal health department would need to provide it some other way. Even when the state has the primary responsibility to perform a function that is specified in a measure, the local or Tribal health must still provide documentation that it is being performed.

2. What is the relationship between accreditation and quality improvement (QI) in public health?

PHAB is using the definition of quality improvement in public health that was developed by the Accreditation Coalition and published in the Journal of Public Health Management and Practice (January/February, 2010). Specifically, that definition states that quality improvement in public health is:

A continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes and other indicators of quality of services or processes that achieve equity and improve the health of the community.

In that same article, the differences between "small QI" and "large QI" are described. "Small" quality improvement efforts are often focused at the program or activity level, and are a great way to learn a specific model. "Large" quality improvement efforts are conducted organization-wide and are system focused. Public health can be transformed through the adoption of a comprehensive approach to QI where it becomes incorporated into everything the health department does rather than a separate set of activities. Adopting a quality improvement culture allows a health department to:

Set focus on a vital few priorities;
Create a sense of urgency for measurable results and a culture of quality;
Engage every employee;
Build QI time into daily workload;
Adopt fact-based decision making; and
Reward and celebrate progress.

PHAB recognizes that learning about quality improvement models and language is new for many health departments. And yet, it is the cornerstone upon which accreditation is based. It's not about the accreditation certificate; it's about the focus on learning to do what we do better and sharing that knowledge with others.

3. We are working on our Community Health Improvement Plan (CHIP) and we want to make sure that the process we choose to get this work done is acceptable to PHAB. Is there one model that PHAB endorses?

No. The model that you choose should be the one that works for your health department to engage partners and the community as a whole in reviewing the health assessment information and determining the best course of action to work collaboratively to improve the health of the community you serve. Some health departments have used the MAPP process (Mobilizing for Action through Planning and Partnerships) while others have found other equally useful models. The required elements in linking the community health assessment and the community health improvement planning process to the agency strategic plan are what PHAB will be looking for in our reviews. MAPP and other similar models should all have those elements. Select the one that does mobilize the community to work on the issue.

4. How much will it cost to apply for PHAB accreditation?

PHAB understands that the field would like to know the accreditation fees in order to plan their budget cycle. However, this is totally new territory for PHAB to develop. We have no history or track record for determining these fees. PHAB's Fee Development Committee has met twice in the last two months and has developed a work plan approved at the December Board of Directors meeting. The committee is actively developing the model and criteria that will be used in determining the fee structure for the accreditation program. The committee requested that a market survey be developed, distributed, and analyzed over the next 60 days. The information from the survey, being distributed in early January, will help better inform the fee development process. The committee hopes to conclude their work in the spring of 2011 and publish the fees soon thereafter.