Benefits and Impacts of Public Health Accreditation for Small Local Health Departments

Abstract

Objective: This study sought to identify accreditation benefits and impacts among local health departments (LHDs) stratifying by size of population served to determine differences between small, medium, and large LHDs. Background: The Public Health Accreditation Board operates the national accreditation program for public health departments, through which 306 LHDs have been accredited as of August 2022. Benefits of accreditation for LHDs are well documented, despite potential challenges and barriers to seeking accreditation. Research on the benefits of accreditation for small LHDs, specifically, is more limited. Methods: All health departments that completed the accreditation process between December 2013 and May 2022 were surveyed following receipt of the accreditation decision. The analytic sample included 266 LHDs (response rate of 93.7%). Data for LHDs were analyzed for specific variables related to experiences, challenges, and benefits, and stratified by size to compare small LHDs with medium and large LHDs. Bivariate analyses were conducted to identify statistical significance. Results: Generally, small LHDs reported similar outcomes of accreditation to medium and large LHDs. These included improvements in staff competencies, capacity to provide high-quality services, and relationships with partners. Small LHDs were significantly more likely than medium and large LHDs to report that accreditation increased their use of evidencebased practices. LHDs of all sizes reported an increase in quality improvement activities due to accreditation. Challenges for small LHDs included limited staff time or staff turnover and limited funding. Conclusions:The public health accreditation program has offered numerous benefits to LHDs of all sizes, including small LHDs. These accreditation benefits may be particularly important for small LHDs because of their critical role in the public health system and the ongoing need to support performance improvement, strengthen infrastructure, and increase resilience. KEY WORDS: local health departments, public health accreditation, public health capacityT he Public Health Accreditation Board (PHAB) operates the national accreditation program for public health departments, with the mission to "advance and transform public health practice by championing performance improvement, strong infrastructure, and innovation." 1 A strong public health infrastructure is necessary to ensure the capacity of the public health system to advance health equity, prepare for and respond to public health emergencies and threats, and improve population health. 2

Challenges and opportunities for improvement in the management and financing system of Health Promotion Offices in Hungary

“…These national organizations often provide professional support, monitor local providers' operations, and evaluate based on transparent indicators. The expected benefits of standardized service provision is the reduction of variation in service quality between geographical units and ensuring that evidence-based, effective services are provided to the population ( 48 – 50 , 52 , 53 , 55 , 56 ). It is important to note however that standardization is a sensitive topic in public health, and local needs have to be taken into account when developing or providing services.…”

“…In this context, it is proposed to establish a national health promotion fund to which HPOs can apply for funding. The range of services and programmes eligible for funding should be defined and evaluated by the national professional organization, based on international and local best practices, with mechanisms to review the program portfolio ( 50 ). The budget available for each HPO to submit proposals will be allocated based on a multi-component formula.…”

“…Based on promising international practices, it could be beneficial to improve the professional management system and the monitoring and performance assessment capacities ( 36 , 37 , 41 , 48 , 49 ). Several studies have also found that it would be beneficial to update and apply the service standards and guidelines and create a flexible operational structure adapted to the population coverage of HPOs ( 38 , 44 , 50 , 53 , 56 ).…”

“…Following the best international examples there are numerous examples of organizations at national or regional level responsible for formulating professional guidelines or standards for the provision of public health services (38,41,44,(47)(48)(49)(50)(51)(52)(53)(54). These national organizations often provide professional support, monitor local providers' operations, and evaluate based on transparent indicators.…”