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