Local Boards of Health Characteristics Influencing Support for Health Department Accreditation

Abstract

Background Local boards of health (LBoHs) serve as the governance body for 71% of local health departments (LHDs). Purpose To assess the impact of LBoH governance functions and other characteristics on the level of LBoH support of LHD accreditation. Methods Data from 394 LHDs that participated in the 2015 Local Boards of Health Survey were used for computing summative scores for LBoHs for domains of taxonomy and performing logistic regression analyses in 2016. Results Increased odds of an LBoH directing, encouraging, or supporting LHD accreditation activities were significantly associated with (a) a higher overall combined score measuring performance of governance functions and presence of other LBoH characteristics (adjusted odds ratio [AOR] = 1.05; P < .001); (b) a higher combined score for the Governance Functions subscale (AOR = 1.06; P < .01); (c) the “continuous improvement” governance function (AOR = 1.15; P < .001); and (d) characteristics and strengths such as board composition (eg, LBoH size, type of training, elected vs nonelected members), community engagement and input, and the absence of an elected official on the board (AOR = 1.14; P = .02). Conclusions LBoHs are evenly split by thirds in their attention to Public Health Accreditation Board accreditation among the following categories: (a) encouraged or supported, (b) discussed but made no recommendations, and (c) did not discuss. This split might indicate that they are depending on the professional leadership of the LHD to make the decision or that there is a lack of awareness. The study findings have policy implications for both LBoHs and initiatives aimed at strengthening efforts to promote LHD accreditation.

Patterns and trends in local health departments’ efforts to promote access to care in local communities throughout the United States: The contributions of governance structures

“…35,36 For example, one study found that LHDs with larger boards and greater community input were more likely to be accredited. 37 Other studies, however, found that most members of local boards of health were White (96%) and male (60%) 18 and tended to be appointed rather than elected, 38 suggesting these board members may not be entirely representative of the communities they serve. To the extent these differences result in incomplete or inaccurate awareness of local health needs, it may explain why the presence of a local board of health was not correlated with greater access to health services.…”

Local Health Departments' Characteristics and Their Performance Scores in PHAB Accreditation Standards

“…These characteristics have been shown to be associated with whether LHDs were involved in accreditation or not. 20,[25][26][27]36 For example, LBoH authority, LHDs' governance structure, and LHDs' jurisdiction population have been associated with LHDs' decisions to participate in accreditation. 20,25,26 Therefore, these characteristics may be similarly important for understanding factors that could affect performance scores of LHDs that have completed accreditation assessments in each of the standards.…”

“…20,[25][26][27]36 For example, LBoH authority, LHDs' governance structure, and LHDs' jurisdiction population have been associated with LHDs' decisions to participate in accreditation. 20,25,26 Therefore, these characteristics may be similarly important for understanding factors that could affect performance scores of LHDs that have completed accreditation assessments in each of the standards. However, many of these characteristics examined did not show significant variation between the clusters except in their jurisdictionsʼ population size.…”

“…Our analyses also described the organizational and jurisdiction characteristics of the LHDs in each of the clusters in the sample. These characteristics have been shown to be associated with whether LHDs were involved in accreditation or not 20,25–27,36. For example, LBoH authority, LHDs' governance structure, and LHDs' jurisdiction population have been associated with LHDs' decisions to participate in accreditation 20,25,26.…”

“…21 In all of the approximately 2400 LHDs in the United States, only about 12% of LHDs have been accredited at the time when data for this study were obtained in 2020 and accreditation has occurred disproportionately among large LHDs. 21,22 Many studies of PHAB accreditation have revealed variation in aspects of the accreditation process, such as decisions regarding pursuing accreditation and preparation for accreditation, leading to variability in LHDs pursuing and participating in accreditation 14,[23][24][25][26] because of factors such as organizational and jurisdiction characteristics, 27 LHD size, 22 resources and time needed for the process, 22,28 type of governing structure, 25,28 perception of inadequacy to tackle accreditation demands and fear of underperforming, 28,29 and lack of will to invest in the process because of perceptions that the effort exceeds the benefits. 26,28 However, among accredited LHDs, data show there is also variation in accreditation assessment performance scores.…”