1. Gorenflo, Grace MPH


The National Association footline of County and City Health Officials (NACCHO) is the national organization representing local health departments. NACCHO supports efforts that protect and improve the health of all people and all communities by promoting national policy, developing resources and programs, seeking health equity, and supporting effective local public health practice and systems.


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The 2002 Institute of Medicine report The Future of the Public's Health1 included a recommendation that called on the public health community to consider how accreditation ultimately could prompt improvements in the nation's health. Public health practice organizations, organizations dedicated to public health improvement, and federal partners were convened in December 2004 to determine whether or not to pursue this recommendation, and unanimously agreed on the importance of forging ahead. The Exploring Accreditation project emerged as a result, the purpose of which is to develop a model voluntary national accreditation system for state and local health departments and determine whether it is feasible and desirable to implement the model. The goal of a model system is to improve and protect the health of the public by enhancing the quality and performance of state and local health departments. The guiding philosophy of developing a model is to leave no stone unturned, considering all possible alternatives related to the issues at hand. Public health practitioners and other interested parties are urged to engage in this effort. Please see for additional information, and also read on to learn of opportunities for involvement.


A steering committee is overseeing the development of a model system. The steering committee is chaired by Kaye Bender, PhD, Dean, School of Nursing, University of Mississippi, and represents a wealth of experience in wide-ranging state and local government public health practice settings, as well as substantial involvement and interest in various public health agency improvement initiatives. The executives of the Association of County and City Health Officials (NACCHO), the Association of State and Territorial Health Officials (ASTHO), the National Association of Local Boards of Health, and the American Public Health Association form a planning committee that provides executive oversight to project activities. The members of this group, along with Dennis Lenaway, PhD, Office of Chief of Public Health Practice, Centers for Disease Control and Prevention (CDC), serve as ex-officio members of the steering committee. The steering committee's deliberations are being informed by four workgroups, the Multi-State Learning Collaborative (MLC), and public comment.


The steering committee established four workgroups to fully delve into topical areas: governance and implementation, principles to develop standards for state and local health departments, finance and incentives, and research and evaluation. Subject matter experts are consulted for various issues, and discussion papers with information on experience with accreditation in public health and in other sectors are developed to stimulate the workgroups' discussions. Workgroups' reports to the steering committee include not only consensus recommendations but also the nature of consensus achieved, rationales for the recommendations, other alternatives that were considered and not recommended, in addition to why the alternatives were not ultimately recommended. Workgroup members include state and local government public health practitioners and members of academia.


The lead article in this month's issue describes the Robert Wood Johnson Foundation's investment in enhancing current state-based performance assessment or accreditation efforts through the MLC. Representatives from MLC states serve on the steering committee and the workgroups. Site visits from Exploring Accreditation staff and MLC panel presentations to the steering committee have provided additional insights in the development of a national model.


The steering committee is committed to considering the perspectives of potential applicants and other stakeholders with respect to the design and implementation of a national model, and it has developed several mechanisms to that end. The project's Web site has provided a venue for submitting comments since the site was launched. Stakeholders will be invited to public forums across the country from May through July to respond to the draft model. In addition, an opinion survey will be sent to state health departments and a stratified, random sample of local health departments to solicit additional feedback. Moreover, an invitational meeting of local and state elected officials will be held to elicit their perspectives on the draft model. It would be especially helpful to hear from you on the following questions:


* there a major issue you think the Exploring Accreditation project has overlooked?


* Would you or your health department seek accreditation if it looked like this model? Why or why not? What factors might tip the balance for you?


* Are there "thought leaders" you recommend receive more information about this project in this formative stage that you do not see reflected in our plan?



All of the views and comments gathered will be shared with the steering committee when it meets to finalize a model and consider a business case for its implementation. The steering committee will issue a report of its final recommendations at the end of August, including the nature of consensus that was achieved, the rationale for the recommendations, and alternatives that were explored and the rationale for not pursuing them. The report will be distributed to all members of the organizations represented on the steering committee, and also will be available upon request.


NACCHO is supportive of a voluntary national accreditation program for local health departments, provided that it possesses certain characteristics. For example, a national program should


* be based on NACCHO's operational definition of a functional local health department;


* accommodate existing state and local accreditation and performance standards programs that share core, nationally agreed-upon characteristics (eg, the fundamental framework of the Operational Definition standards);


* include accreditation of state health departments so that state and local accreditation programs are mutually supportive and philosophically and operationally consistent;


* be carefully planned to prevent unintended consequences of accreditation;


* be developed with a systems approach, so that local health departments are provided with the tools and resources needed to succeed with accreditation, and schools of public health and others who train public health professionals include content that prepares the workforce to work in accredited agencies;


* strengthen the public health infrastructure and contribute to ongoing quality improvement;


* incorporate research-based processes that have been demonstrated to improve the public's health in communities;


* raise no economic barriers to local health departments wishing to participate;and


* include new sources of funding to bear the costs for local health departments.



For the complete NACCHO resolution in support of voluntary accreditation, visit the NACCHO Web site




1. Institute of Medicine, Committee on Assuring the Health of the Public in the 21st Century. The Future of the Public's Health in the 21st Century. Washington, DC: The National Academies Press; 2002. [Context Link]