Rolling Right Along: The Status the PHAB Accreditation Program

PHAB Addresses Challenges of Unique Organizational Structures 

PHAB has worked hard to develop policies and procedures to protect the integrity of the accreditation process while at the same time administering the program in such a way to address the unique organizational characteristics of health departments across the country. At its December 2011 meeting, the Board of Directors approved specific policies and procedures by which PHAB will implement the accreditation process for centralized states. Centralized states, for purposes of PHAB accreditation, are those states that directly operate some or all of their local health departments. If you are working in a centralized state at the state or local level and would like a copy of the policies and procedures that guide accreditation implementation in that setting, please contact us.

Multi-Jurisdictional Setting

PHAB is working to put in place policies and procedures for multi-jurisdictional applications for accreditation. Entities that meet the definition of a Tribal or local health department may apply jointly, as multi-jurisdictions, if some essential services are provided by formally sharing resources and the sharing of resources can be clearly demonstrated. PHAB established an Expert Panel that developed a set of recommendations that consider the unique characteristics and circumstances of various multi-jurisdictional models. The PHAB Board of Directors appointed an ad hoc Board committee to further review the issues and the implications of the recommendations of the Expert Panel. The board committee is considering issues such as:

• Should there be a threshold for the number of services shared in order to be eligible to apply as a multi-jurisdictional health department?
• Should there be a threshold for the number of PHAB standards and measures met jointly in order to be eligible to apply as a multi-jurisdictional health department?
• Must the jurisdictions in a multi-jurisdictional application be contiguous?
• How should the number or selection of jurisdictions that will be visited by a site visit team be determined?

These and other related issues lie at the heart of PHAB's commitment to ensuring that our reviews are equitable regardless of the organizational setting. To that end, the Board's ad hoc committee is conducting additional fact finding and is arranging for presentations to be made at the April Board meeting so that multi-jurisdictional models can be fully understood. When the Board of Directors has considered all of the contextual issues and implications, they will adopt policies and procedures for multi-jurisdictional applications. At that time, PHAB will prepare to implement the policies and procedures and be ready to accept multi-jurisdictional applications by the summer of 2012. 

PHAB Accreditation Fee Schedule 2013

For health departments planning to apply for accreditation in 2013, we know that you need to plan your budgets accordingly. The PHAB Board of Directors has determined that the 2013 accreditation fee schedule will remain the same as the 2011-2012 fee schedule. The reason is that we don't yet have enough information to inform any adjustment in the fees. Given that PHAB costs are likely to rise in the future, however, we don't expect to be able to hold the fees constant for very long. And, remember that you get a discount if you pay your fees in one lump sum. If you have questions related to our fees or fee payments, please contact Mark Paepcke, Chief Administrative Officer, at mpaepcke@phaboard.org.

New Positions Open for Recruitment at PHAB

As PHAB grows, we have two new positions open for recruitment at the PHAB office in Alexandria, VA. The first is the Director of Research and Evaluation, a full-time position that will guide PHAB's reporting processes for evaluation, as well as our support of public health systems research. The second position is an Office Manager for PHAB, also a full-time position that will be responsible for ensuring that PHAB's daily office operations are well coordinated and that our various activities are supported internally. For more information on each of these positions, including the position descriptions and process for submitting an application, please visit the PHAB website.

Word on the Street

1. Health departments are required to submit three prerequisites with their application for accreditation: a community health assessment, a community health improvement plan, and a health department strategic plan.  Can these three documents be revised for submission with the department's documentation?

The National Public Health Department Documentation Guidance Version 1.0, which can be accessed on the PHAB website, states that: "When the (three prerequisite) documents are submitted with the application, PHAB staff will review them to ensure that they conform to the PHAB definitions of the documents. PHAB staff will not assess them against the standards and measures. The health department may revise and update them for the final documentation submission. Site visitors should have the most recent version to assess against the measures and required documentation. The health department can change any documentation until they hit the final 'submit' button to submit the materials to PHAB." Health departments should submit their most recent version of documents when they submit their documentation to PHAB, including their community health assessment, their community health improvement plan, and the health department's strategic plan.

PHAB is not recommending any particular process for health departments to identify, organize, or store their electronic documentation. PHAB neither requires nor endorses any product for use in accreditation preparation, and the use of a software product or the PHAB Standards and Measures Documentation Selection Spreadsheet Version 1.0 will not guarantee "accredited" status. It is our understanding that many health departments are setting up shared file folders (by domain, standard, measure, and required documentation) that members of the department's accreditation team can access. It is most important that your department uses a system that makes sense for your team and department's organizational structure. Your department will want a system that will allow the user to know what is in a file and to what it relates. The PHAB Standards and Measures Documentation Selection Spreadsheet Version 1.0, developed for health department's optional use, is in Excel format and accompanies the PHAB Standards and Measures Version 1.0. This tool is designed to assist health departments track the status of documentation selection. The spreadsheet and other PHAB documents and tools are available on the PHAB website. 

The e-PHAB documentation upload system follows the format of the PHAB Standards and Measures Version 1.0. The domain, standard, measure, required documentation, and guidance for each piece of required documentation will be listed in e-PHAB. There is an upload button for each piece of required documentation. The button functions much like choosing a document for an e-mail attachment, with the added features of allowing the user to enter a title of the document and a short description of what the document is and how it relates to the requirement. In short, the process is a series of uploads that follow the structure of the PHAB Standards and Measures Version 1.0. 

PHAB staff will conduct a completeness review of the documentation submitted to determine that there is a sufficient type and volume of documentation to proceed to the next step of the accreditation process, that is, the review by a site visit team. PHAB's completeness review is a staff review, and therefore does not include the review of the documentation for conformity with the standards and measures; the review will be for only completeness of information and documentation. The completeness review will include confirmation that documents are dated and signed as required, but will not assess if they are in conformity with the time frames required by the PHAB Standards and Measures Version 1.0. The site visit team will make the final determination as to whether any given measure is demonstrated based on the submitted documentation.

You may contact: 

Mark Paepcke, Chief Administrative Officer, to talk about fees and contractual information. He may be reached at mpaepcke@phaboard.org or 703-778-4549 ext. 104.

Robin Wilcox, Chief Program Officer, to talk about interpretation and meaning of the PHAB Standards and Measures as well as the accreditation process. She may be reached at rwilcox@phaboard.org or 703-778-4549 ext. 106.

Rachel Margolis or Marita Chilton, Accreditation Specialists, to talk about the accreditation process for health departments. Rachel may be reached at rmargolis@phaboard.org or 703-778-4549 ext. 108, and Marita may be reached at mchilton@phaboard.org or 703-778-4549 ext. 114.

David Stone, Accreditation Education Specialist, to talk about PHAB's education services, including orientations and trainings. He may be reached at dstone@phaboard.org or 703-778-4549 ext. 105.

Travis Parker Lee, Program Specialist, to talk about meetings, events, and requests for speakers.  He may be reached at tlee@phaboard.org or 703-778-4549 ext. 102.

Kaye Bender, President/CEO, to talk about accreditation related strategies, partnerships, long-range planning at PHAB, PHAB Board of Directors, committees, and think tanks. She may be reached at kbender@phaboard.org or 703-778-4549, ext. 103.

If you have a suggestion for future segments of Word on the Street, please send them to Travis Parker Lee, PHAB Program Specialist, at tlee@phaboard.org.