A Local Health Department’s Journey in Pursuing National Voluntary Accreditation by the Public Health Accreditation Board

Lindsay Menard, MPH

La Crosse, WI

I started the fellowship program a little over a year and a half ago at the La Crosse County Health Department (LCHD).  As a student of health policy and administration in graduate school I was eager to learn the inner-workings of a local health department as I hope to be a Health Officer/Director one day.  Before I started work at my placement site, I knew much of my work would be dedicated towards helping the LCHD become a national (voluntary) Public Health Accreditation Board (PHAB) accredited health department.  This knowledge was exciting as I knew the accreditation process would allow me to see the daily operations of a health department.  Before I became immersed in the journey I thought I knew the complexity of this task, but I had dramatically underestimated the effort and resources needed to become an accredited health department.  With that, I do believe all of the work, effort, planning, and collaboration was and continues to be worth it. 

What is the purpose of PHAB accreditation you may ask? The purpose is to, “advance quality and performance within public health departments.  Accreditation standards define the expectations for all public health departments that seek to become accredited.  National public health department accreditation has been developed because of the desire to improve service, value, and accountability to stakeholders”.[i]

We, the LCHD, have met all of our established deadlines up to this point.  After submitting the accreditation application in March 2013, the accreditation coordinator and I traveled to PHAB headquarters in Virginia to attend accreditation coordinator training.  Upon our return to the LCHD we established domain teams and a system for uploading documentation.  Currently we are finalizing documentation collection and uploading documents into e-PHAB (the electronic database used by health departments, PHAB staff, and site visitors throughout the final stages of the process).   We hope to have all documentation uploaded into e-PHAB by March 2014 and a site visit during the summer of 2014.

The process of becoming accredited is often described as an enormous quality improvement project.  The process initiates with a self-assessment to determine the accreditation readiness of a given health department.  In 2010, the LCHD completed their self-assessment and determined the gaps in their accreditation readiness to be Domain 7:  promote strategies to improve access to healthcare services; Domain 8: maintain a competent public health workforce; Domain 9: evaluate and continuously improve processes, programs, and interventions; and Domain 10: contribute to and apply the evidence-base of public health.  The past three and a half years have been dedicated to addressing these gaps, building capacity on existing strengths, and developing sustainable systems to ensure mechanisms are in place to continuously meet standards and measures established by PHAB for years to come.  

The majority of my time at the LCHD has been spent addressing the gaps identified in the accreditation readiness self-assessment.  I have helped the LCHD develop and implement a performance management system.  We are embarking on our second year of implementing this system and are continually striving to improve the method in place for selecting standards, establishing measures, and reporting on the progress of the standards.  We have established a quality improvement (QI) committee charged with facilitating and implementing the quality improvement plan and P & P (policy & procedure).  The QI process has resulted in over eight QI project proposals being submitted to the QI Committee  and  three of those have been initiated throughout the department.  We revised and updated the department’s strategic plan to ensure we are compliant with PHAB’s standards and measures (The NationalAssociation of County and City Health Officials (NACCHO) developed an invaluable guide  to help us maneuver this process).  We also created a workforce development team consisting of division managers to create, implement, and revise a new department-wide workforce development plan.

The accreditation process allowed the LCHD to identify areas of improvement from an established and vetted set of standards and measures.  Without these universal principles established by PHAB we would not know what systems, operations, or processes need improving or what goal(s) we should be working towards. Throughout the entire journey many lessons were learned by the health department and me.   Not only has the La Crosse County Health Department grown in its capacity to provide effective, efficient, culturally competent, and equitable services but the professional journey and skills I have developed and fostered along the way are invaluable and will guide me throughout my career. 

Lessons learned by the La Crosse County Health Department in their accreditation journey:
· It is necessary to engage staff at all levels whether it be by developing documentation, creating new systems, collecting documents, or ensuring they know their role in implementing the various department-wide plans.
· Following a work-plan/timeline for key milestones throughout the process is helpful; allowing for flexibility with deadlines is also important.
· Engage stakeholders, partners, and board members at the onset of the process as it is critical in obtaining the necessary resources (staff, fees, etc.).

Lessons learned by me in the accreditation journey:
· The process of becoming accredited ensures health departments are delivering public health services that meet the needs of community members, targeting the use of limited resources, and are accountable to the residents served.
·The work involved in operating, directing, and overseeing a health department is vast and intricate.
·Developing systems from scratch is complicated, always evolving, and fun.
· Facilitating the creation of a strategic plan is the easy part; implementing and evaluating it is more difficult.

In my final months at the La Crosse County Health Department I am excited to complete the accreditation journey and hopefully participate in a site-visit by PHAB site visitors.  I hope I can update you with the great news that the La Crosse County Health Department earned accreditation by the end of 2014. 

P.S.  As of this poisting, 22 health departments have been accredited nation-wide with 4 of them being from Wisconsin.  GO WISCONSIN!!!!

[i] Public Health Accreditation Board. (2013). What is Accreditation? Retrieved from