1. The Meaning of Accreditation www.phaboard.org Ron Chapman, MD, MPH Health Strategist

2. 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

3. What does Accreditation mean 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

5. Drive organizational change. Create a quality improvement infrastructure. Improve business operations. Improve accountability and monitoring. Increase credibility. The Value of Accreditation

7. 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.

9. 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.”

10. Why Culture of Quality? Government – Accountability – Transparency – Improvement – Frugality Accreditation Quality Improvement Performance Management

11. 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

12. 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

13. 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.

14. 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

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

16. Summary Of Benefits 1.Involves all employees 2.Continuous and ongoing 3.Data-driven 4.Team-based 5.Focuses on improving processes and systems

17. 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

18. Not a replacement for: – Leadership skills – Functional teams (team building) – Governance What Performance Management and QI Are Not

19. Ingredients For Success Leadership Vision Commitment Employee empowerment Communication

20. 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.”

23. We are ready…

24. PHAB Video “Reaping the Benefits of Accreditation Across the Nation” http://www.phaboard.org/featured-videos/

25. 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)

26. 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”

27. 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

28. 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

29. 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

30. 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”

31. 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

32. 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

33. 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.

34. 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

35. Ron Chapman, MD, MPH ronchapmanmd@gmail.com 707-580-7622