Preparing for PHAB:An Overview

Jessie Jones

Overview

What is the Public Health Accreditation BoardWhat is its purpose?

Benefits of AccreditationOverview of PHAB ProcessBrief Overview of DomainsFeesLGE’s Role in Accreditation

The Public Health Accreditation Board

The Public Health Accreditation Board, or PHAB, is a nonprofit organization dedicated to advancing the quality and performance of state, local, tribal, and territorial public health departments by providing a national framework of standards. PHAB has a vision of improving the quality and performance of all health departments in the U.S. through voluntary accreditation.

The Public Health Accreditation BoardPHAB Purpose: Accreditation looks at leadership, strategic planning, community engagement, customer focus, workforce development, evaluation, and quality improvement

Goal: To improve and protect the health of every community by advancing the quality and performance of LHD’s

Vision: High-performing governmental public health system that will make us a healthier nation

Benefits of AccreditationHigh performance and Quality ImprovementRecognition, Validation, and AccountabilityPotential increased access to resourcesImproved communication and collaboration

Encourages better communication and collaboration among staff, governing entities, partners, community members, and other external stakeholders

Overview of PHAB ProcessStep 1: Pre-application

Assess readiness: Prepare and complete optional PHAB readiness checklists

TrainingView online orientation to accreditation

Overview of PHAB Process – The Seven Steps of Public Health Accreditation

Step 1 continued: Submit Statement of Intent Online form that collects contact and other basic information about LHD

Valid for 12 months

Non-binding and does not commit LHD to submit an application

Step 2: ApplicationFormal notification of LHD’s official intent to proceed with the accreditation processDone completely onlineFee due at time of applicationAccreditation Coordinator TrainingSubmit prerequisites along with applicationPHAB will conduct a completeness review of application and pre-requisites and grant access to e-PHAB

Overview of PHAB Process – The Seven Steps of Public Health Accreditation

Step 3: Documentation Selection and SubmissionAgency-wide effort to collect documentationMust be completed within 12 months of e-PHAB accessUse Guidance in the Standards and Measures documentUpload documentation to e-PHABPHAB staff conduct Completeness Review of submitted documentation

Overview of PHAB Process – The Seven Steps of Public Health Accreditation

Step 4: Site Visit2-3 day visit by 3-4 reviewersSite Visit Purpose: Verify the accuracy of documentation submitted by the health department, seek answers to questions regarding conformity with the standards and measures, and provide opportunity for discussion and further explanationSite visitors report developed and provided to PHAB

Overview of PHAB Process – The Seven Steps of Public Health Accreditation

Step 5: Accreditation DecisionPHAB Accreditation Committee will determine status

Decision based on site visit report, LHD self-assessment, and documentation

Two status options: Accredited or Not AccreditedAccredited status lasts for 5 years

Committee will provide all applicants with list of opportunities for improvement

*NOTE: Accreditation status will be public, even if not accredited.

Overview of PHAB Process – The Seven Steps of Public Health Accreditation

Step 6: ReportsLHD must submit annual reports while accreditedReports address areas for improvement and activities taken

Overview of PHAB Process – The Seven Steps of Public Health Accreditation

Step 7: ReaccreditationRestart application process at Step 1

Overview of PHAB Process – The Seven Steps of Public Health Accreditation

PHAB Domains

12 DomainsModeled after the 10 Essential Public Health Services, plus one domain focusing on health department administration and one focusing on the local governing entity

Brief Overview of PHAB Domains

• Conduct and disseminate assessments focused on population health status and

public health issues facing the community

Domain 1

• Investigate health problems and environmental public health hazards to protect the community

Domain 2

Brief Overview of PHAB Domains

• Inform and educate about public health issues and functions

Domain 3

• Engage with the community to identify and address health problems

Domain 4

Brief Overview of PHAB Domains

• Develop public health policies and plans

Domain 5

• Enforce public health laws and regulations

Domain 6

Brief Overview of PHAB Domains

• Promote strategies to improve access to healthcare services

Domain 7

• Maintain a competent public health workforceDomain 8

Brief Overview of PHAB Domains

• Evaluate and continuously improve processes, programs, and interventions

Domain 9

• Contribute to and apply the evidence base of public health

Domain 10

Brief Overview of PHAB Domains

• Maintain administrative and management capacity

Domain 11

• Maintain capacity to engage the public health governing entity

Domain 12

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Fees

Population Based

Payment options: lump sum, 3 years, 5 yearsFor payment schedules, 40% is due the first year and the remaining 60% is paid over the remaining years

Health departments can receive a discount by paying in one lump sum

Health Department Category

Population Size of the Jurisdiction Served

2013 Total Fee

Category 1 Less than 50,000 $12,720

Category 2 50,000 to 100,000 $20.670

Category 3 > 100,000 to 200,000 $27,030

Category 4 > 200,000 to 1 million $31,800

Category 5 >1 million to 3 million $47,700

Category 6 > 3 million to 5 million $63,600

Category 7 > 5 million to 15 million $79,500

Category 8 Greater than 15 million $95,000

LGE’s Role in AccreditationSign a letter of support

Place public health programs and services high on LGE priority list

Support LHD in its efforts to become or remain accredited

Participate in LHD’s on-site review visit

Read the on-site review report describing the results of the accreditation process

Celebrate the successes of LHD’s accomplishment when it receives accreditation

Questions?

Thank You!

Preparing for PHAB:An Overview for Livingston County Health Department Staff

Overview

• PHAB Prerequisites• Overview of Standards• Staff Preparation for Participation in PHAB• Resources for more information• Questions

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PHAB Prerequisites• Community Health Assessment

– Standard 1.1: Participate in or lead a collaborative process resulting in a comprehensive community health assessment

• Community Health Improvement Plan– Standard 5.2: Conduct a comprehensive planning

process resulting in a Community Health Improvement Plan

• Agency Strategic Plan– Standard 5.3: Develop and implement a health

department organizational strategic plan

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PHAB Prerequisites

Image Source: NNPHI Webinar- Drawing Connections- Linking the Tools in Your Toolbox, 8/7/2012nnphi.org/CMSuploads/WebinarSummary8.7.12.pdf

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PHAB’s Definition of CHA• Systematic and comprehensive examination of health and the

determinants of health in jurisdiction served by health department.

• Conducted in collaboration with community partners.• Data used to identify priority health issues and assets in a

community. • Goal is to develop strategies to address the community's

health needs and identified issues. • A variety of tools and processes may be used.

The essential ingredients are community engagement and collaborative participation.

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More about these “essential ingredients”

• Community engagement & collaborative participation– Collective discussion, decision making, & action– Mutually beneficial & defined relationships– Commitment to work together toward shared

goals– Shared responsibility, authority, and accountability– Sharing resources and rewards

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Community Health Assessment(Standard 1.1)

• A process by which a health department assesses the health status and the public health needs in the community

• Allows us to collect data and then analyze it and develop a plan to address the issues brought to light in the CHA

• Conducted in partnership with other organizations in the community

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Community Health Assessment(Standard 1.1)

• Purpose: Use data to educate and mobilize communities, develop priorities, garner resources, and plan actions to improve the public’s health

• Accreditation Purpose: Demonstrate that the health department can systematically assesses its jurisdiction’s health status and can describe it

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Community Health Improvement Plan (Standard 5.2)

• Maps out exactly what the health department is going to do as it works with partners to improve the health status of its jurisdiction

• Typically involves addressing community issues with our system partners and is a long-term and systematic effort that goes beyond the scope of just your agency

• Based on CHA results

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Community Health Improvement Plan (Standard 5.2)

• Includes strategies and measures to ultimately improve the health of a community

• Looks at how the activities of many community organizations can contribute to health improvement

• Used by the community, stakeholders, and partners to set priorities, direct the use of resources, and develop and implement projects, and programs, and policies

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Community Health Improvement Plan (Standard 5.2)

• Purpose: To describe how the health department and the community it serves will work together to improve the health of the population of the jurisdiction that the health department serves

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Strategic Plan (Standard 5.3)

• Sets forth the health department’s priorities and how it plans to accomplish its strategic goals

• Based on the CHA and CHIP• A strictly internal focus to guide what the

agency is, what you do and why you do what you do

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Strategic Plan (Standard 5.3)

• A leadership tool grounded in decisions the organization has made about strategic priorities for the near future- usually 3-5 years

• Similar to a road map, indicates an agency’s current position and the directions the agency can follow to achieve its goals

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Strategic Plan (Standard 5.3)

• NOT intended to be a stand-alone document• Should be aligned with other important

assessment, planning and evaluation work such as: – a local community health improvement process,– an agency quality improvement (QI) plan– operational/work plans or– an annual report

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CHIP vs. Strategic PlanCHIP Strategic Plan

Shared ownership- involves LHD, partners, and community members

Internal to LHD

Focused on achieving the shared vision of community health and goals of partners

Focused on achieving the vision for the agency and informed by the mission

Community focus; community driven Focused on health department; can be driven by LHD staff or outside entity (governing body)

Based on CHA Based on CHA and CHIP

Long-term, systematic plan (with short, mid-term, and long term objectives)

Limited to next 3- 5 years

Used by partners to prioritize and coordinated strategies for all local public health system partners toward a shared vision

Includes steps to implement portions of the CHIP as well as other strategic issues for the department as they relate to the fulfillment of the ten essential services

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41Image Source: NACCHO http://www.naccho.org/topics/infrastructure/CHAIP/chachip-online-resource-center.cfm

Overview of StandardsDomain 1: Conduct and disseminate assessments focused on population health status and public health issues facing the communityStandard 1.1: Participate in or lead a collaborative process resulting in a comprehensive community health assessment. Standard 1.2: Collect and maintain reliable, comparable, and valid data that provide information on conditions of public health importance and on the health status of the population. Standard 1.3: Analyze public health data to identify trends in health problems, environmental public health hazards, and social and economic factors that affect the public’s health. Standard 1.4: Provide and use the results of health data analysis to develop recommendations regarding public health policies, processes, programs, or interventions.

Overview of StandardsDomain 1: Conduct and disseminate assessments focused on population health status and public health issues facing the communityStandard

Standard

Standard

Domain 2: Investigate health problems and environmental public health hazards to protect the communityStandard 2.1: Conduct timely investigations of health problems and environmental public health hazards.Standard 2.2: Contain/mitigate health problems and environmental public health hazards.Standard 2.3: Ensure access to laboratory and epidemiological/environmental public health expertise and capacity to investigate and contain/mitigate public health problems and environmental public health hazards. Standard 2.4: Maintain a plan with policies and procedures for urgent and non-urgent communications.

Overview of StandardsDomain 3: Inform and educate about public health issues and functionsStandard 3.1: Provide health education and health promotion policies, programs, processes, and interventions to support prevention and wellness.Standard 3.2: Provide information on public health issues and public health functions through multiple methods to a variety of audiences.

Overview of StandardsDomain 4: Engage with the community to identify and address health problemsStandard 4.1: Engage with the public health system and the community in identifying and addressing health problems through collaborative processes.Standard 4.2: Promote the community’s understanding of and support for policies and strategies that will improve the public’s health.

Overview of StandardsDomain 5: Develop public health policies and plansStandard 5.1: Serve As a Primary and Expert Resource for Establishing and Maintaining Public Health Policies, Practices, and Capacity.Standard 5.2: Conduct a comprehensive planning process resulting in a community health improvement plan.Standard 5.3: Develop and implement a health department organizational strategic plan.Standard 5.4: Maintain an all hazards emergency operations plan.

Overview of StandardsDomain 6: Enforce public health laws and regulationsStandard 6.1: Review existing laws and work with governing entities and elected/appointed elected/appointed officials to update as needed.Standard 6.2: Educate individuals and organizations on the meaning, purpose, and benefit of public health laws and how to comply.Standard 6.3: Conduct and monitor public health enforcement activities and coordinate notification of violations among appropriate agencies.

Overview of StandardsDomain 7: Promote strategies to improve access to healthcare servicesStandard 7.1: Assess health care service capacity and access to health care services.Standard 7.2: Identify and implement strategies to improve access to health care services.

Overview of StandardsDomain 8: Maintain a competent public health workforceStandard 8.1: Encourage the development of a sufficient number of qualified public health workers.Standard 8.2: Ensure a competent workforce through the assessment of staff competencies, the provision of individual training and professional development, and the provision of a supportive work environment.

Overview of StandardsDomain 9: Evaluate and continuously improve processes, programs and interventionsStandard 9.1: Use a performance management system to monitor achievement of organizational objectives.Standard 9.2: Develop and implement quality improvement processes integrated into organizational practice, processes, and interventions.

Overview of StandardsDomain 10: Contribute to and apply the evidence base of public healthStandard 10.1: Identify and use the best available evidence for making informed public health practice decisions.Standard 10.2: Promote understanding and use of the current body of research results, evaluations, and evidence-based practices with appropriate audiences.

Overview of StandardsDomain 11: Maintain administrative and management capacity Standard 11.1: Develop and maintain an operational infrastructure to support the performance of public health functions.Standard 11.2: Establish effective financial management system.

Overview of StandardsDomain 12: Maintain capacity to engage the public health governing entity Standard 12.1: Maintain current operational definitions and statements of public health roles, responsibilities, and authorities.Standard 12.2: Provide information to the governing entity regarding public health and the official responsibilities of the health department and of the governing entity.Standard 12.3: Encourage the governing entity’s engagement in the public health department’s overall obligations and responsibilities.

Accreditation is the beginning

Improve Improve Improve

Accreditation Re-accreditation

Improve

Improving the public’s health through continuous quality improvement

Image Source: NACCHO Presentation “Accreditation for LHD Staff” 8/11/2011 http://www.naccho.org/topics/infrastructure/accreditation/upload/Accreditation-for-LHD-staff-8-11-11.pptx

Staff Preparation

• Appoint Accreditation Coordinator– Can be full or part time position– Can have other duties outside of accreditation

such as QI leadership and other special projects• Select Accreditation Team

– Should include those from all divisions of LHD– Establish meeting schedule

Staff Preparation

• Complete Readiness Checklist/ Initial Self-Assessment

• Develop a work plan/timeline for preparation• Software:

– Internal share drive– Mind Manager by MindJet ($350)– Google– Dropbox

Resources

• Association of State and Territorial Health Officials (ASTHO): www.astho.org

• National Association of County and City Health Officials (NACCHO): www.naccho.org

• National Association of Local Boards of Health (NALBOH): www.nalboh.org

• National Indian Health Board (NIHB): www.nihb.org• National Network of Public Health Institutes (NNPHI):

www.nnphi.org• Public Health Foundation (PHF): www.phf.org