Quality Improvement and Accreditation: Essential Aims for All Health Departments

Claude JacobBy Claude-Alix Jacob, MPH, NACCHO President and Chief Public Health Officer for the Cambridge Public Health Department (MA)

In 2011, the Public Health Accreditation Board (PHAB) launched its voluntary national accreditation program for public health departments with the goal of improving and protecting the public’s health by advancing performance improvement. PHAB accreditation seeks to continuously improve the quality of local health department (LHD) performance. To achieve accreditation through PHAB, LHDs must demonstrate conformity to PHAB’s Standards and Measures, a document that outlines the standards, measures, and documentation required to achieve accreditation, such as the completion of a community health assessment, community health improvement plan, and strategic plan. The program has improved local public health practice and strengthened a culture of quality improvement in LHDs. To date, 141 LHDs have achieved PHAB accreditation.

LHDs and the communities they serve benefit from accreditation in several ways. The extensive processes that precede accreditation help LHDs identify their strengths and weaknesses, fortify partnerships, and prioritize the most pressing public health issues facing their communities. According to a 2014 NACCHO survey of accredited LHDs about the benefits of PHAB accreditation, 81% significantly improved agency processes, 70% significantly increased staff understanding of public health, and 57% significantly increased data-driven decision-making in their LHDs.1 Additionally, more than four out of five LHDs reported that they experienced greater support from their governing entity while nearly nine out of ten LHDs reported that they experienced at least some increase in the number of community partners actively engaged with their health department.

My health department, which recently completed the first stage of our application for PHAB accreditation, has experienced these benefits first-hand. We have completed the community health assessment, community health improvement plan, and the strategic plan, which will guide our work going forward. Our community health assessment contains data on access to care, chronic disease, substance abuse, and many other topics. More than 1,600 people completed our Community Health Assessment Survey and over 90 people participated in focus groups to share their public health priorities. Our community health improvement plan describes our challenges and outlines goals, objectives, and strategies for improving health in the areas of mental health and substance abuse; violence; housing; and healthy eating and active living. More than 70 people from diverse sectors of the community provided input on the defined strategies while more than 30 subject matter experts helped fine-tune the content.

This monumental effort required support from health department staff at all levels, participation from our community partners, and buy-in from our elected officials. We expect to become one of the first accredited health departments in Massachusetts in the coming year. Through the accreditation process, we will continue building a high-performing health department that will meet our community’s needs now and in the future.

NACCHO supports LHD accreditation and quality improvements in a variety of ways. Its Accreditation Support Initiative, launched in 2011 in collaboration with the Centers for Disease Control and Prevention, is designed to stimulate quality improvement and promote the readiness of health departments to prepare and apply for accreditation. Awardees have used the funding to advance their accreditation readiness. In 2016–2017, NACCHO awarded nearly $387,000 to 28 LHDs in 20 states. In evaluations of the initiative, grantees reported that the initiative helped create momentum for and commitment to accreditation among health department leaders and staff.

NACCHO has developed numerous tools to help LHDs seeking accreditation form accreditation readiness teams; develop community health assessments, community health improvement plans, and strategic plans; conduct quality improvement activities; collect and organize supporting documentation; budget for costs and fees; and engage local governing entities. NACCHO has also created several complementary publications that describe how other areas of public health practice—such as environmental health and health impact assessment—can play a role in accreditation preparation. NACCHO’s Mobilizing for Action through Planning and Partnerships (MAPP) can also be instrumental in helping LHDs prepare for accreditation. MAPP is a community-wide strategic planning process for improving community health and strengthening the local public health system. Facilitated by public health leadership, MAPP provides a framework that helps communities prioritize public health issues; identify resources for addressing them; and develop, implement, and evaluate health improvement plans.

While accreditation requires significant investments of time and resources, its benefits are tremendous. I strongly encourage LHD leaders to learn more about the process and initiate the first steps toward achieving accreditation in their agencies. No matter where you are on your accreditation journey, NACCHO has the resources and expertise to help you create a culture of continuous performance improvement in your LHD.


NACCHO’s Accreditation Preparation Webpage

NACCHO Publications

NACCHO’s Roadmap to a Culture of Quality Improvement

Cambridge Public Health Department Publications

Public Health Accreditation Board


  1. (2014). Benefits of National Accreditation for Local Health Departments [research brief]. Washington, DC: NACCHO. Retrieved Dec. 19, 2016, from http://eweb.naccho.org/prd/?na363pdf


A Look Back: The Best of NACCHO Preparedness


By Anastasia Sonneman, NACCHO Communications Specialist

This story originally ran on NACCHO’s Preparedness Brief.

The year 2016 brought a whole new meaning to the importance of public health emergency preparedness. From the onset of Zika virus disease to international acts of violence related to terrorism, to the worst global migrant crisis since World War II, NACCHO has worked diligently in collaboration with many of its members and partners to enhance the capacity of local health departments (LHDs) to protect and increase the resiliency of their communities. As we enter the new year, many of NACCHO’s preparedness-related projects can still serve as a valuable resource to local preparedness staff. With this in mind, the NACCHO Preparedness team compiled the following list, highlighting a selection of the year’s featured programs, events, resources, and tools. Continue reading

Health and Disability Training: The Power to Transform Public Health

meredith-williamsBy Meredith Williams, MPH, 2015–2016 NACCHO Health and Disability Fellow

This story originally ran in NACCHO’s Healthy People, Healthy Places.

This October, I had the privilege of representing the National Association of County and City Health Officials (NACCHO) Health and Disability Team at the American Public Health Association (APHA) Conference in Denver. As a former NACCHO Health and Disability Fellow, I was thrilled to see so much interest in our poster on health and disability training. My time at the conference gave me the chance to share my experiences with training, learn from national disability leaders in public health, and encourage professionals, students, and educators to join us in advancing this crucial field. Continue reading

Using Disease Intervention Specialists to Improve Linkages and Access to Care

By Carolyn Campbell, Anne Arundel County (MD) Health Department

This story originally ran in NACCHO’s Stories from the Field.

Fifty-percent of people in the United States who are living with HIV and AIDS (PLWHA) reside in twelve of the nation’s cities. Frequently listed among the top six of these high-morbidity cities are Baltimore and Washington, DC. Anne Arundel County in Maryland is located immediately south of Baltimore, directly east of Washington, DC, and houses the state capital, Annapolis. Maryland ranked third in the United States for HIV diagnoses rates in 2013, and Anne Arundel County ranked fifth among Maryland jurisdictions for percentage of total newly diagnosed HIV cases. In addition, the county has the fourth highest rates of chlamydia, gonorrhea, and syphilis infections in Maryland. Anne Arundel is similar to many other counties in Maryland in its proximity to both Baltimore and Washington, DC and in its combination of residents– mixing rural, suburban, and urban populations and having a wide range of income levels. Continue reading

World AIDS Day 2016: Local Health Department Leadership, Commitment, and Impact

By Alyssa Kitlas, HIV, STI, & Viral Hepatitis Program Analyst, NACCHO 

This story originally ran in NACCHO’s Healthy People Healthy Places.

The U.S. Government theme for World AIDS Day 2016 is “Leadership. Commitment. Impact.” These themes resonate strongly with the work local health departments (LHDs) do every day to address HIV in their communities.

LHDs are key leaders in providing and assuring access to HIV prevention, care, and treatment for the communities they serve. As community health strategists, LHDs facilitate collaboration between public health, healthcare, social services, and other key stakeholders, such as community organizations and small businesses, to achieve more integrated and effective systems for HIV prevention and care. Over the past few years, this leadership and collaborative work with community partners has led to the successful development of local and state plans for ending the HIV epidemic, such as those for Fulton County (GA), San Francisco (CA), Houston (TX), and the State of New York. The value of health department leadership for reducing new HIV infections and improving outcomes across the HIV care continuum was highlighted in a recent study to generate hypotheses to explain declines in HIV incidence in Massachusetts, North Carolina, San Francisco, and Seattle. Researchers found that the most unifying observation was that leadership within health departments is critical to achieving success. Continue reading

Public Health 3.0: A Challenge for the Nation, a Charge for Public Health

By LaMar Hasbrouck, MD, MPH, Executive Director, NACCHO & Karen DeSalvo, MD, MPH, MSc, Acting Assistant Secretary for Health, U.S. Department of Health and Human Services

What will Public Health 3.0 — new model for building healthier communities across America — mean for the nation’s nearly 3,000 local public health departments (LHDs), as they face the ongoing challenge of tackling the full range of factors that influence each citizen’s overall health and well-being?  NACCHO and the HHS Office of the Assistant Secretary for Health (OASH) are working together to define what this means in practical terms trying to help LHDs refine their efforts to address the social determinants of health in the communities in which they serve. Continue reading

Removing Barriers to Breastfeeding in Niagara County

istock_000000346530_mediumBy Elaine Roman, MA, BSN, RN, IBCLC, ANLC Director, Division of Public Health Planning and Emergency Preparedness, Public Information Officer & Elise Pignatora, MS, CLC Public Health Resource & SNS Support Officer, Niagara County Department of Health

For the past three years, Niagara County (NY) Medical Reserve Corps (MRC) has received the MRC Challenge Award from the National Association of County and City Health Officials (NACCHO) for their breastfeeding initiative, “Energizing Partnerships to Advance Support Networks for Breastfeeding Mothers.” Director of the Division of Public Health Planning in the Niagara County Department of Health Elaine Roman, MA, BSN, RN, IBCLC, ANLC and Public Health Resource and SNS Support Officer Elise Pignatora, MS, CLC led the lactation initiative. The Niagara County Department of Health’s inspiration for this intervention to the 215,000 population community came from the 2011 Surgeon General’s Call to Action to Support Breastfeeding.  “We also looked at the Healthy People 2020 numbers and realized our county was not performing the way we would like it to be in regards to initiation, duration, and exclusivity of breastfeeding in our county,” Roman said. Continue reading