The Meaning of Accreditation

www.phaboard.org

Ron Chapman, MD, MPHHealth Strategist

What is Accreditation?

• Public Health Accreditation Board (PHAB)– Launched in 2011– National accrediting body– Composed of peer Public Health Professionals

• Public Health Accreditation is:– Set of standards developed by peers– Process to assess performance; identify strengths

and areas for improvement– Recognizes Departments that meet the standards

What does Accreditationmean to department staff?

• High performance & Quality Improvement• Recognition, Validation, and Accountability• Potential increased access to resources• Busting silos and building bridges

• CDPH Employees say Accreditation will:– Provide introspection– Expand knowledgebase– Improve our visibility– Increase collaboration– Improve morale

Leadership + Vision + Hard Work=

Accreditation

• Drive organizational change.• Create a quality improvement

infrastructure. • Improve business operations.• Improve accountability and monitoring.• Increase credibility.

The Value of Accreditation

Build Bridges

CDPH Accreditation Accomplishments

• Quality improvement plan.• Workforce development and succession plan.• Established quality performance council.• Launched California Performance

Improvement Management Network (CalPIM).• First annual strategic map progress report.• Improved communication and collaboration.

Accreditation = Culture of Quality

California Accreditation December 2014

Site visitor report:“The California Department of Public Health demonstrates exemplary performance across the entire framework of the PHAB standards. As cited throughout the report, many of the department’s programs and strategies serve as national models. Department leaders have created a culture of quality, professionalism, and service that is visible throughout the agency.”

Why Culture of Quality?

• Government– Accountability– Transparency– Improvement– Frugality

• Accreditation• Quality Improvement• Performance Management

The Roadmap

• NACCHO– Phase I No knowledge of QI– Phase 2 Not involved with QI activities– Phase 3 Informal of Ad Hoc QI activities– Phase 4 Formal QI activities in specific areas– Phase 5 Formal agency-wide QI – Phase 6 Culture of quality

• Evaluate and continuously improve health department processes, programs, and interventions.

• Standard 9.1: Use a performance management system to monitor achievement of organizational objectives.

• Measure: Engage staff at all organizational levels in establishing or updating a performance management system.

Domain 9

Standard 9.2: Develop and implement quality improvement processes

integrated into organizational practice, programs, processes, and interventions.

• Written quality improvement plan.• Describe a culture of quality and the

desired future state of quality in the department.

• QI communication plan.• QI training plan.

What is Quality Improvement?

Quality improvement (QI) is a continuous process that involves:– Identifying an opportunity to improve upon the

current process– Brainstorming the underlying problems (“root

causes”)– Finding possible solutions– Implementing or putting in place a solution– Testing and collecting data to see whether the

solution addressed the improvement opportunity

QI empowers each and every employee to improve efficiencies and effectiveness of a system or process.

Summary Of Benefits

1. Involves all employees2. Continuous and ongoing3. Data-driven4. Team-based5. Focuses on improving processes and systems

• People will learn and use the tools to analyze and transform systems.

• People will be empowered to use these tools and to make the systems changes.

• The system will be changed to provide better and faster services for our customers.

QI Expectations

• Not a replacement for:– Leadership skills– Functional teams (team building)– Governance

What Performance Management and QI Are Not

Ingredients For Success

• Leadership• Vision• Commitment• Employee empowerment• Communication

How To Start

• Small bites

• Expect failures and learn

• Thomas Edison-”I have not failed. I’ve just found 10,000 ways that won’t work.”

Achieve Targeted Improvements in Health Outcomes

Strengthen CDPH as an Innovative, High Performing

Organization

Strengthen Statewide

Infrastructure to Improve Health

Secure and Deploy Resources

for Sustainable Impact

Strengthen Deeper Understanding of

Public Health

Strengthen/Streamline Resource

Acquisition, Management &

Deployment

Integrate Data Systems to Monitor &

Investigate Health Problems

Use Determinants of Health in Policy and

Decision Making

Use Cost-Benefit and Health Outcome Analyses

Retain and Recruit a Skilled, Diverse and Empowered

Workforce

Leverage Opportunities to Secure Revenue

Enhance State and Local Public Health

Services

Develop Communication

Strategies for Unified Messaging

Foster a Cohesive,

Values-Driven Culture

Develop and Use Results-Oriented

Public Health Interventions

Optimize CDPH Organizational

Structure & Processes

Enforce Laws and Regulations to

Ensure Safety and Protect Health

Publish Reports and Outcome Measures

Strengthen Statewide Public Health Workforce

Development

Use Performance Management

Systems to Monitor Outcomes

Maximize Technology to Support CDPH

Priorities

Expand and Strengthen Collaborations and Partnerships

Make Continuous Quality Improvement a Way of Life in the Department

Leverage Key Opportunities to Define and Shape the Future of

Public Health in a Changing Environment

California Department of Public Health Strategic Map:2012-2014

Vision: Healthy individuals and families in healthful communities

Mission: The California Department of Public Health is dedicated to optimizing the health and well-being of the people in California

Prepare for and Respond to Public

Health Threats

Improve Alignment of Resources with

Departmental Priorities

Achieve National

Public Health Accreditation

Draft04/24/12

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Achieve Health Equity Through Public Health ProgramsH

All About The People

We are ready…

PHAB Video

• “Reaping the Benefits of Accreditation Across the Nation”

• http://www.phaboard.org/featured-videos/

Current Status of Small Health Departments

• NACCHO Profile 2013– 1567 health departments < 50,000– 55% of 2845 total

• PHAB Data as of September 2015– 39 in the system (11% of PHAB’s 338)

NACCHO Profile 2013

• Barriers to accreditation, as expressed by small health departments:– Fees– Standards and measures– Resources (staff and other) to prepare– Board of health said “no”

Town Hall at COPPHI Open Forum

• Invitational session• NNPHI sent out info and offered 10

scholarships – received 80 inquiries• Session held on Friday am, March 20, 2015• 87 attendees• Those who couldn’t attend requested an

interactive webinar

Think Tank Held

• PHAB held a Think Tank in June 2015• Held an interactive webinar as part of the

Think Tank• PHAB continues to receive input and

information• A second Think Tank will be held in early 2016

Observations/Input

• Many had 5-10 non-clinical staff• General welcoming of PHAB’s request for

input• Fairly good knowledge of accreditation• Would like to have something that they can

achieve that recognizes their achievement of performance standards

Board of Health Issues

• Many from home rule states• Accreditation requirements seem to be “more

government” which is not politically palatable at the moment

• Not sure of the ROI – boards need to see specific case studies with what accreditation “changed”

Standards and Measures

• Concerns about Domains 2 and 6 especially– Outbreaks, surveillance– Enforcement

• Some expressed difficulty in getting info from the state for accreditation

• Number of examples required might not be achievable

Time and Resources• Not enough staff for an AC – might have to be the

director• All staff would need to work on it, but all staff are

working on everything, so time is an issue• Development of documentation seems daunting• Grant funds are perceived to be restrictive

PHAB’s Work Plan

Ultimately create an accreditation related product for small health departments that meets their needs; supports QI and PM; and provides natural “stepping stone” to regular accreditation if/when a small health department wants to move to the next level.

PHAB’s Work Plan

• To accomplish that goal, PHAB will:– Look into other accrediting organizations’

approach to this issue– Consider what small health departments have in

common and also what is aligned already with the PHAB standards and measures

– Reconvene the Small Think Tank group (spring 2016) to design next steps

Ron Chapman, MD, MPHronchapmanmd@gmail.com

707-580-7622