Accreditation Position Statement

I. ASTHO Supports Voluntary National Accreditation in Public Health

The Association of State and Territorial Health Officials endorses the Public Health Accreditation Board’s final set of state and territorial health agency standards and processes for accreditation as the sole voluntary national accreditation program for public health agencies.

ASTHO recommends state and territorial health agencies attain voluntary national accreditation through their efforts in continuous quality improvement.

II. Within This Context ASTHO Recommends:

• The establishment of the attainment of national accreditation status as an agency strategic goal or priority.
• Identification of leadership through a position, such as a performance improvement manager, to build, institutionalize, and implement performance management capacity within the agency.
• Designation of staff and quality improvement experts dedicated to performance management and continuous quality improvement that routinely evaluate and improve the effectiveness of the organization, practices, partnerships, programs, use of resources, and the impact the improvements have on the public’s health.
• Establishment of an organizational capacity that utilizes a health information technology system to integrate data and information used in an accreditation process.
• Routine staff trainings and core competencies of quality improvement and performance methods and policies within the state and territorial health agency.
• The development and continuous update of a state health assessment¹; using reliable, comparable, and valid data to provide a complete picture of the health status of the population and conditions of public health importance, a state health improvement plan; using data from the state health assessment to establish programmatic resource allocation and improvement targets, and a strategic plan; linking to the state health assessment and the state health improvement plan to establish organization goals, strategies, and objectives to strengthen the organization to better serve the state’s population.
• The education of governing entities (governor, state legislature, board of health) on the national public health standards and accreditation program.

III. Background

Accreditation is a means for advancing the overall quality and accountability of state public health practice. By setting benchmarks though performance standards and measures, accreditation programs in other industries have evolved to advance quality in services and improve organizational performance.

The 2003 release of The Future of the Public’s Health by the Institute of Medicine (IOM) called for the exploration of the benefits of accrediting governmental public health departments.

To this end, and after a two-year exploratory phase, the Public Health Accreditation Board was incorporated in 2007 and began work on the development of the first set of national agency level accreditation standards in public health. The Public Health Accreditation Board’s mission is to advance the continuous quality improvement of state, local, tribal, and territorial public health departments.

The national trend towards accountability and quality in state health agencies reinforces the increasing importance of quality improvement initiatives and voluntary national accreditation in public health. Leveraging resources through quality improvement tools and techniques, such as self evaluation through a set of standards and measures, improvement cycles like plan -do-study-act, data-driven performance management, balanced scorecard approaches and performance standards, may contribute to improved health agency performance, and ultimately improved health outcomes.

Given the economic and public health challenges facing states, health agencies are increasing efficiency and providing more services with smaller budgets. According to the ASTHO Budget Cuts Survey, most state and territorial health agencies (43 of 54 responding) experienced budget cuts between 2008 and 2011, many experiencing multiple successive cuts resulting in continually shrinking budgets.  According to the ASTHO Profile of State Public Health, 78 percent of state health agencies had a quality improvement process in place in 2010. Among them, only 8 percent (4 out of 39) have it fully implemented department-wide.

There are many things health agencies can do to prepare for PHAB’s accreditation program. With the flexibility to use existing and new federal funding streams to support quality improvement and accreditation readiness efforts, state health agencies will be able to consistently improve the quality of services, prepare for accreditation, and increase the effectiveness of the work they do to protect and improve the health of the population.  ASTHO supports federal and nonfederal funding opportunities such as the CDC’s National Public Health Improvement Initiative, to provide support for building infrastructure to improve performance of public health practice and to support voluntary national public health accreditation in state and territorial health agencies.

Preparing for and seeking national accreditation is an ongoing process that will require state health agencies to institutionalize a culture of accountability and awareness of agency performance.

Approval History:

ASTHO Position Statements relate to specific issues that are time sensitive, narrowly defined, or are a further development or interpretation of ASTHO policy. Statements are developed and reviewed by appropriate Policy Committees and approved by the ASTHO Board of Directors. Position Statements are not voted on by the full ASTHO membership.

Performance Policy Committee Review and Approval: July 8, 2011
Board of Directors Review and Approval: July 20, 2011.
Policy Expires: July 20, 2014.

Notes

1. ASTHO recognizes that the Public Health Accreditation Board uses the wording “community health assessment” to apply to all health assessments – state, local and tribal; however, for the purposes of this position statement, ASTHO wishes to emphasize the importance of the state health assessment as a prerequisite for voluntary accreditation for state health agencies.