It's Not Just a Yes or No Answer: Expressions of Local Health Department Accreditation.

Beth E Meyerson,Jerry King,Laura Miller,Sandra S Liu,Karen Comer

doi:10.3389/fpubh.2016.00021

Abstract

The identification and exploration of moderators of health department accreditation remain limited by current dichotomous conceptualizations of pursuit. A 2015 survey measured Indiana local health department (LHD) accreditation pursuit and progress, classifying respondents by progress evidence. Covariates included attitudes about the future impact of accreditation on funding and performance, health department size, geography, health outcome ranking, and quality improvement (QI) programing. Four classifications of accreditation pursuit emerged and were found to have greater association with covariates than standard dichotomous measures. "Active Pursuit" was associated with formal QI programing and a belief that accreditation will impact future funding and performance. "Intent Only" was associated with no QI programing and no completion of accreditation prerequisites. "Discontinued" was associated with the belief that accreditation will not impact future performance. "Not Pursuing" was associated with no interest or plan to complete prerequisites and reported belief that accreditation will not impact future health department funding or performance. More granular characterizations of accreditation pursuit may improve understanding of influential factors. This measurement framework should be validated in studies of LHDs in other states.

Highlights

U.S health department pursuit of voluntary accreditation is a natural experiment allowing the observation, identification, and definition of influential environmental, organizational, policy, and structural factors
A majority of local health department (LHD) reported some form of quality improvement (QI) programing, as 42% reported implementing informal or ad hoc QI activities, 13% reporting formal, program-specific QI programing, and 11.6% reporting formal, agency-wide-specific QI programing
As our findings indicated, when observing accreditation pursuit only in dichotomous terms “yes/no,” there was little association between accreditation pursuit and LHD characteristics

Summary

Introduction

U.S health department pursuit of voluntary accreditation is a natural experiment allowing the observation, identification, and definition of influential environmental, organizational, policy, and structural factors. The national research agenda set by the Public Health Accreditation Board’s (PHAB) Research Advisory Council called for improved measures to help understand this pursuit and progress [1]. While local health department (LHD) accreditation is recognized as a QI initiative. Local Health Department Accreditation Pursuit that could help standardize the delivery of 10 essential public health services in each community [2,3,4], it is a fairly new innovation, launched nationally in 2011. It has become clear that financial and legal incentives facilitate accreditation, as do population size, degree of top executive, governance structure, state health department accreditation pursuit, and the existence of formal QI initiatives [5,6,7,8]. The influence of prerequisite completion continues to be investigated [5, 9, 10], and frameworks guiding the study of accreditation are at formative stage; two have used the PHAB framework for accreditation to help conceptualize progress [5, 11]

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Conclusion