To advance understanding of public health accreditation, we analyzed data on the North Carolina Local Health Department Accreditation program. We surveyed accredited health departments on barriers to and supports of accreditation preparation, performance on accreditation standards, and benefits and improvements after accreditation. All 48 accredited agencies responded to the survey. All agencies improved policies to prepare for accreditation and met most accreditation standards. Forty-six percent received local funds for accreditation preparation. The most common barrier to accreditation preparation was time and schedule limitations (79%). Fifty percent of agencies acted on suggestions for improvement, and 67% conducted quality improvement activities. Benefits of accreditation included improvements in local partnerships. Agencies of all sizes conducted accreditation activities, were successfully accredited, and experienced benefits resulting from accreditation.
Accreditation of state and local public health agencies is a major national priority. North Carolina, a national leader in the accreditation of local public health agencies, undertook a pilot project to evaluate a process for accreditation of the state health agency, the North Carolina divisions of public and environmental health. This pilot project evaluated the instrument and process of a state public health agency accreditation effort and provided information on agency performance. The pilot project used a modified national public health performance standards state instrument to assess state health agency capacity and performance. A site visit followed a self-assessment process conducted internally within the state health department. The pilot project revealed that public health performance standards are a useful framework for state-level standards, but that measurement should focus on stem questions to ensure measurement at an appropriate, not overly detailed, level and reduce the level of work needed to complete the self-assessment process. The project also identified major strengths within the North Carolina Division of Public Health and laid the foundation for ongoing performance improvement under the leadership of the state health director and senior staff. As a result of this experience, accreditation of state health agencies is feasible and provides immediate benefit to state health agency leadership with respect to performance and quality improvement.
North Carolina (NC) is one of several states that have developed an accreditation system for local public health agencies. The NC Collaborative, composed of the NC Association of Local Health Directors, the NC Division of Public Health, and the NC Institute of Public Health, conducted several initiatives to enhance the NC accreditation system and contribute to the Multi-state Learning Collaborative. Two of these projects, benefits of accreditation and the Accreditation Road Map, are of potential national interest and can inform the proposed national, voluntary accreditation model. Benefits of accreditation from the perspectives of various system participants were explored through the ongoing evaluation of the NC accreditation system. The development of the Accreditation Road Map and its intended uses are described. Implications for the proposed national model and public health systems research are discussed.
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