Public Health Agencies' Level of Engagement in and Perceived Barriers to PHAB National Voluntary Accreditation

Abstract

Accreditation is expected to provide pathways to accountability, consistency, and better fit between community needs and public health services. National strategies targeting rapid diffusion of accreditation among public health agencies should include elements that address the needs of LHDs with varying degrees of intent to pursue accreditation.

Drivers and Barriers for Adopting Accreditation at Local Health Departments for Their Performance Improvement Effort

“…In 2011 the Public Health Accreditation Board (PHAB) initiated a national voluntary accreditation process. 6,7 As of November of 2016, 142 local health departments have been accredited by PHAB. 8 The accreditation process requires that each LHD complete a series of tasks from several accreditation domains.…”

“…For example, existing studies have found that LHD accreditation pursuit has been associated with formal quality improvement programming, and that the implementation of accreditation can be facilitated by financial and legal incentives, population size, degree of top executive, governance structure, state health department accreditation pursuit, and the existence of formal quality improvement initiatives. 9,10,11,12 …”

Local Boards of Health Characteristics Influencing Support for Health Department Accreditation

“…One of those factors is the role of the governing entity, which for many LHDs is a local board of health (LBoH). 3 …”

“…3 The PHAB accreditation standards and measures directly address the important role of governing bodies; they include standards dedicated to “engagement with the governing entity” and requirements for the governing body to indicate approval for the initial accreditation application and to participate in the site visit. 4 Therefore, LBoHs are potentially important allies in motivating LHDs to pursue PHAB accreditation, 3 but the extent to which LBoHs play this role has been unclear.…”

“…15 As LHDs usually have competing priorities and limited resources, they might need encouragement from governing bodies such as the LBoH to decide to engage in the accreditation process. 3 Encouragement and support by the LBoH may also be critical, given that limited evidence exists about the return on investments and the negative impact of not seeking accreditation. In addition, LHDs are mandated to provide certain public health programs and services, 16 so unmandated activities (such as accreditation preparation) may receive a lower priority.…”