Accreditation: Why are we Accreditation: Why are we swimming in it—and, is a swimming in it—and, is a

life raft on the way??life raft on the way??Matt Richardson, MPHMatt Richardson, MPH

Lee LaneLee LaneApril 22, 2010April 22, 2010

In the Beginning, there was In the Beginning, there was Snow…Snow… • Broad Street pumpBroad Street pump

• Report of the Sanitary Report of the Sanitary Commission of Commission of Massachusetts: Massachusetts: Lemuel Lemuel Shattuck and “markers” Shattuck and “markers” of community healthof community health

• Discussion of LOCAL Discussion of LOCAL Public Health and the Public Health and the need for communities need for communities to protect itto protect it

Early 1900s…Early 1900s…• Charles Chapin, a Charles Chapin, a

physician, with the first physician, with the first survey!survey!

• 1914 American Medical 1914 American Medical Association and the Association and the Council of Health and Council of Health and Public Instruction Public Instruction

• Surveyed activities for Surveyed activities for local health local health departments to define departments to define roles more clearlyroles more clearly

Evolution is always Evolution is always controversial, even for “public controversial, even for “public health standards”…health standards”…• Haven Emerson and the Committee on Haven Emerson and the Committee on

Administrative Practice Report on Local Administrative Practice Report on Local Public Health UnitsPublic Health Units

• Six core public health activities in 1945:Six core public health activities in 1945:– Vital statisticsVital statistics– SanitationSanitation– Communicable Disease ControlCommunicable Disease Control– Maternal and child healthMaternal and child health– Health EducationHealth Education– Laboratory ServicesLaboratory Services

1988: Game Changer1988: Game Changer• AssessmentAssessment• Policy DevelopmentPolicy Development• AssuranceAssurance• Barriers to Effective Action Barriers to Effective Action

listed:listed:– Lack of consensus on missionLack of consensus on mission– Inadequate capacityInadequate capacity– Disjointed decision-making Disjointed decision-making

without datawithout data– InequityInequity– Organizational FragmentationOrganizational Fragmentation– Inadequate knowledgeInadequate knowledge

““Turning Points” to MAPP, and Turning Points” to MAPP, and another Report? 2003—Now another Report? 2003—Now • Turning Point effortTurning Point effort• MAPP frameworkMAPP framework• 10 Essential Services 10 Essential Services

for Public Healthfor Public Health• NPHPSNPHPS• Future of Public Health Future of Public Health

in the 21in the 21stst Century Century– First call for national First call for national

accreditation!accreditation!• State efforts begin in State efforts begin in

earnest…earnest…

Let’s go Let’s go “Exploring…”“Exploring…”

• Final Final recommendations on recommendations on a voluntary system a voluntary system

• National effort with National effort with many partners: many partners: NACCHO, ASTHO, NACCHO, ASTHO, NALBOH, CDC, RWJFNALBOH, CDC, RWJF

• The true genesis of The true genesis of national PH national PH accreditationaccreditation

Texas Accreditation Texas Accreditation DiscussionsDiscussions• 2007 - Texas Association of Local Health Officials (TALHO) 2007 - Texas Association of Local Health Officials (TALHO)

agreed to convene an “Accreditation Committee” to agreed to convene an “Accreditation Committee” to examine the feasibility and interest in pursuing local public examine the feasibility and interest in pursuing local public health accreditationhealth accreditation

• The Texas Association of Local Health Officials accreditation The Texas Association of Local Health Officials accreditation committee determined that there was a need for a neutral committee determined that there was a need for a neutral party and developed the Public Health Accreditation Council party and developed the Public Health Accreditation Council of Texas (PHACT) to carry out their plan. of Texas (PHACT) to carry out their plan.

Public Health Accreditation Council of Texas Public Health Accreditation Council of Texas (PHACT)(PHACT)

• Developed in June of 2007 Developed in June of 2007 • Voting Members include: Voting Members include:

– School of Public HealthSchool of Public Health– 6 LHDs (2 small, 2 medium, 2 large)6 LHDs (2 small, 2 medium, 2 large)– State Association of County/City Health Officials State Association of County/City Health Officials

(SACCHO)(SACCHO)– 2 DSHS (1 Central office, 1 HSR)2 DSHS (1 Central office, 1 HSR)– TPHATPHA– THI THI – TMATMA

• Ex- Officio MembersEx- Officio Members

PHACT MissionPHACT Mission• ““To assure and enhance the quality To assure and enhance the quality

of public health in Texas by of public health in Texas by identifying and promoting the identifying and promoting the voluntary implementation of public voluntary implementation of public health standards and evaluation of health standards and evaluation of voluntary accreditation of local voluntary accreditation of local health departments on their ability to health departments on their ability to meet these standards.”meet these standards.”

Activities of the PHACTActivities of the PHACT• 2008 – Standards Development 2008 – Standards Development

Workgroup - Reviewed and commented Workgroup - Reviewed and commented on the National Public Health Performance on the National Public Health Performance Standards Program, NACCHO Operational Standards Program, NACCHO Operational Definition and ASTHO’s State Public Definition and ASTHO’s State Public Health SurveyHealth Survey

• Recommended standards best suited for Recommended standards best suited for assessing compliance with Domain assessing compliance with Domain measurementsmeasurements

Activities of the PHACTActivities of the PHACT• 2009 - PHAB made recommended changes to 2009 - PHAB made recommended changes to

national standards. national standards. – PHACT agreed to and adopted the PHAB PHACT agreed to and adopted the PHAB

standards for Texasstandards for Texas– PHAB called for national Beta site applicationsPHAB called for national Beta site applications– 1 Texas site awarded (ATCHHS)1 Texas site awarded (ATCHHS)

• 2010 – PHAB contracts with TALHO on behalf of 2010 – PHAB contracts with TALHO on behalf of PHACT to conduct Think Tank Meetings to PHACT to conduct Think Tank Meetings to review Beta accreditation materialsreview Beta accreditation materials

Role of PHACT in National Role of PHACT in National Accreditation ProcessAccreditation Process• Responsible for assisting LHDs in Responsible for assisting LHDs in

preparation for accreditation by: preparation for accreditation by: – Providing technical assistanceProviding technical assistance– Recruiting reviewersRecruiting reviewers– Advocating for capacity buildingAdvocating for capacity building– Using the PHAB standards and Using the PHAB standards and

processes to review and recommend processes to review and recommend accreditation (outside reviewers)accreditation (outside reviewers)

Initial Steps by PHACTInitial Steps by PHACT• Review leadership and membership for Review leadership and membership for

revised rolerevised role• Research and produce document of Research and produce document of

minimal LPH capacity levels for a well-minimal LPH capacity levels for a well-functioning public health systemfunctioning public health system

• Assess current state of LPH systemAssess current state of LPH system• Collect resources to assist LHDs in Collect resources to assist LHDs in

meeting accreditation standardsmeeting accreditation standards

DSHS Regions? What exactly DSHS Regions? What exactly are they in this process?are they in this process?• State Health Department State Health Department

accreditation assumed to be similar, accreditation assumed to be similar, yet distinctyet distinct

• Not sure of PHACT role for RegionsNot sure of PHACT role for Regions

Questions or comments?Questions or comments?• Thanks for listening!Thanks for listening!