Public Health Leadership Society 2005 Leadership Series

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Public Health Leadership Society2005 Leadership
Series

• Credentialing Accreditation The Right Choice
  for Public Health?
• Call 4 The Road Ahead
• July 25, 2005
• Presenters Mr. Robert Pestronk, Dr. F.E. (Ed)
  Baker,
• Dr. Bernard Turnock
• Moderator Dr. Leslie Beitsch

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Accreditation
of
Public Health Agencies


Are We Bragging, or Can We Do It?
Ed Thompson, MD, MPH Chief of
Public Health Practice Centers for Diseases
Control and Prevention

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It aint braggin if you can do it.

- Dizzy Dean
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The American Public Health System
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ANTHRAX
BIOTERRORISM
Flu
West Nile Virus
SMALLPOX
SARS
Monkeypox
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The Good News
The public now knows the importance of public
health, and values it.
The Bad News
The public now knows the importance of public
health, and values it.

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The Good News
The public now knows the importance of public
health, and values it.
The Bad News
The public now knows the importance of public
health, and values it and has expectations.

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Accountability

For public health agencies
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Accreditation of Public Health Agencies
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Accreditation of Public Health Agencies

Accreditation
Incentives for Participation
Implementation Questions
Building Broad Buy-in
State and Local Agency Standards
Partnership Development
NPHPSP
State PH Accred. Standards Program
Operational Definition of a LPHA
Growing Interest (IOM Recs., NACCHO Res.)
Other Accreditation Programs
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Accreditation of Public Health Agencies
Principles
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Accreditation of Public Health Agencies

Foundations Already Laid
IOM Report
10 Essential Services
NACCHO Functional Definition Of Local Health
Agency
National Public Health Performance Standards
Program
Existing State Programs
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Exploring Accreditation
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Exploring Accreditation
Time Frame 14 Months

Start August 1, 2005
Product Blueprint/Roadmap - July 31, 2006
Communicate August 1 - September 30, 2006
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?
Accountability
Accreditation
For public health agencies
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Accountability
Accreditation
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Accountability

Credentialling
Performance Measurement
Accreditation
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We aint braggin - we can do it.

- The Public Health System
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Accreditation and certification

• Robert M. Pestronk
• Health Officer
• Genesee County, MI
• pestronk_at_gchd.us

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• Accreditation and certification are different

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Processes presently exist for each

• There are advantages and disadvantages to each

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They are variations on a culture of federalism,
crafts, and guilds

• National, state, and local processes
• Often self-controlled
• Little consensus or science on what works well or
  poorly
• No certainty that new will be better
• Tenuous connection to health outcomes
• No catalog of what presently exists

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For professions or organizations not presently
covered, there are questions

• Why are accreditation and certification needed?
• Who will be in charge?
• Who will be accredited or certified?
• What process will be used?
• Who will develop the process?
• Who will bear the costs?
• Who will manage the process?
• Who will do the review and make decisions?
• Will it be voluntary or required?
• Is it quality improvement or contractual
  compliance?

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and more questions

• What is the return on investment?
• Have the entities responsible for accrediting
  been accredited themselves?
• How good are those programs currently designed to
  prepare the workforce?
• (Can, should, do) certification processes for
  individuals nest within accreditation processes
  for organizations?
• What is fair and will be a solid foundation for
  the future?

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Devils in the decisions and details

• Individuals
• Which professions?
• Which workers?
• New graduates
• Current Workers
• Academics
• What is measured?
• Knowledge
• Skill
• Ability
• Experience
• How is it measured?
• Who controls measurement?
• How evaluated?

• Organizations
• Which ones?
• Federal, state, local
• What is measured?
• Structure
• Process
• Outcome
• Knowledge
• Skill
• Ability
• Experience
• How is it measured?
• Who controls measurement?
• How evaluated?

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Is a systemic approach possible?

• NACCHO Resolution
• SPH include curriculum to support credentialing
  and accreditation
• PH Agencies given resources to succeed
• Explore accreditation of state/federal agencies
• Assure mutually supportive accreditation programs
• Purpose quality improvement
• Re-evaluate over time

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Accreditation and CredentialingThe Last Word?

• Barney Turnock
• UIC School of Public Health
• July 25, 2005

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What We Do Know

• Public Health standards date back nearly 100
  years (Chapin, Emerson) efforts to use standards
  to accredit LPHAs gt60 years history suggests
  focus has been more on measuring than improving
• In recent years, standards-based activities are
  flourishing (thousand flowers?)
• For public health organizations APEXPH, NPHPS,
  MAPP, CHAP, state initiatives (WA, MI, NC, MO,
  etc), Public Health Ready
• For public health workers competency
  assessments, certificates, discipline-based
  certification, leadership development, MPH, etc.

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What We Do Know

• Accreditation/Credentialing activities use
  standards for recognition and accountability
  applications
• Other applications (such as quality improvement
  or research/enhanced science base) may be
  organized around the same standard

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What We Do Know

• Multiple applications organized around the same
  set of standards establish an environment more
  likely to value and promote standards than stand
  alone applications
• For PH Organizations consistent standards for
  improvement (MAPP), state-local standards
  (NPHPS), federal funding streams, external
  accreditation
• For PH Workers consistent standards for job
  descriptions, performance appraisals, training
  plans, external credentialing

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What We Dont Know

• How to make this happen at the national level
  (lessons from Objective 8.14, Chapter 23)
• How to systematically build standards into public
  health systems through linked applications
• Impact/results dependent on scope and depth
  (deployment and penetration)
• How to get this done in enough places to make a
  difference (scope)
• How to build public health systems with multiple
  applications based on and valuing standards
  (depth)

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Where We Are

• Current Options
• Option A (Let it happen)
• Accreditation taking different form in different
  places limited penetration, cannot be
  aggregated
• Credentialing expanding but remains academic
  based limited penetration, exclusive rather
  than inclusive, misses majority of public health
  workers
• Option B (Make it happen)
• Accreditation and Credentialing national
  programs but linked to federal funding streams
  and/or state funding and regulatory requirements

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Let It Happen Example

• Credentialing of public health administrators
• certification by independent board based on
  public health practice and management
  competencies
• not required for state or local public agency
  hiring or promotion despite involvement of LPHAs,
  BOHs, and state health agency
• few public health administrators seeking
  certification juice not worth the squeeze
• Same results if required for specific positions?
  If higher salaries provided? If shorter path to
  career advancement?

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Make It Happen Example

• Core function-based standards for LPHAs
• certification by state health agency
• changed the public health practice landscape over
  the course of a decade
• requirement accepted by LPHAs through
  negotiation and significant resource commitment
  and collaboration by state (data, systems,
  training, patience)
• Same results if not required?

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Whats Next?

• Move ahead but with eyes wide open
• PH Organization Accreditation national voluntary
  program spearheaded by PHLS and NNPHI on behalf
  of national public health organizations
• Credentialing national credentialing for MPH
  graduates (7,000 per year) complemented by basic
  credentials available for those unable to secure
  MPH or discipline-based credential
• Success will depend on whether (and how well)
  linked to other public health system applications
  that promote these standards (systematic vs stand
  alone approach)!
• Making It Happen Leadership Challenge