Issues in Public Health Accreditation: US and Illinois

1
Issues in Public Health Accreditation US and
Illinois

• Illinois Public Health Association
• April 24, 2006
• Laura B. Landrum
• Illinois Public Health Institute

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Exploring Accreditation for the NationWhy Are
We Doing This?

• The Future of the Publics Health in the 21st
  Century (IOM)
• CDCs Futures Initiative
• Quality Improvement Efforts in Public Health
• Key Stakeholder Meeting 2004
• Do the benefits outweigh the costs?

3
Exploring
Accreditation (EA) Project Goal
Design a model voluntary national accreditation
system for state and local (governmental) public
health departments and determine whether it is
feasible and desirable to implement.
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Draft EA Accreditation Model Under Construction

• Governance structure
• Process for implementing the governance structure
• Principles for establishing standards
• Principles for determining conformity with
  standards
• Financial principles
• Proposal for incentives to attract applicants for
  accreditation
• Proposal for evaluating success

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Purpose of IL Accreditation Development Project

• Design an accreditation framework that would
  transition the IL local public health
  certification program into a more
  performance-based program
• Contribute to the knowledge base and participate
  in national dialogue through the Multi-State
  Learning Collaborative

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Requirements for Certification of Illinois Local
Health Departments

• Before and After 1993

Before July 1993 To be recognized as a local
health department in Illinois, LHDs MUST DO
After July 1993 To be certified as a local health
department in Illinois, LHDs MUST

• Potable Water
• Food Sanitation
• Maternal Health/Family Planning
• Child Health
• Communicable Disease Control
• Private Sewage
• Solid Waste
• Nuisance Control
• Chronic Disease
• Administration

• Assess community health needs
• Investigate hazards within the community
• Analyze identified health needs for their
  determinants
• Advocate and build constituencies for public
  health
• Prioritize among identified community health
  needs
• Develop policies and plans to respond to priority
  needs
• Manage resources and organizational structures
• Implement programs and services to respond to
  priority needs
• Evaluate programs and services
• Inform and educate the community

7
IL Certification Process

• LHD conducts IPLAN process
• IDPH reviews IPLAN submission for substantial
  compliance with Code
• LHD submits Certification Application
• If Certification Application provides
  self-affirmation of compliance with all practice
  standards, then IDPH director grants a 5-year
  certification to the LHD

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Certifications Essential Element IPLAN

• Organizational capacity assessment
• Community health needs assessment
• Community health plan, focusing on a minimum
  of three priority health problems

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IPLAN Products Health Priority Comparison
Chronic Disease Substance Abuse Access to Care
MCH Violence Mental Health
Infectious Disease Unintentional
Injury Environmental
Source Illinois Department of Public Health,
Division of Health Policy, Preliminary Results,
6/16/00
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Percent of Illinois LHDs Performing Selected
Practice Performance Measures 1992-1999
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Forces of Change in IL

• Split of a single SACCHO into three
• Northern IL Consortium bill highlights
  disagreement on how best to fund public health
• IDPHs Enrich and Strengthen strategic planning
  process to revisit basic issues in governmental
  public health
• increased interest in use of standards
• increased interest in accountability,
  accreditation

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Evolution of IL Accreditation Components
1984 1993 1999 2005

• 1984 Roadmap Principles
• 1990 Project Health
• 1993 Standards established IPLAN begins
• 1994 Certifications granted
• 1999 2nd Round Certifications
• 2003 Enrich and Strengthen process
• 2004 3rd Round Certifications begin
• 2005 IL Accreditation Project through IL Public
  Health Institute

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IL Accreditation Development Project Milestones

• Convene IL Accreditation Task Force
• Adopt a set of performance standards
• Develop enhanced measurement instrument for
  adopted standards
• Develop a governance structure/process
• Design an evaluation/QI plan
• Develop IL Accreditation Resource Plan
• Develop an implementation plan

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Major Issues for IADP

• Building a new consensus among 3 local public
  health organizations and IDPH
• Increasing state capacity to shepherd and sustain
  new program
• Revitalizing local and state capacity-building
  activities
• Creating a new culture of performance improvement
  and rigor
• Balancing capacity, process and outcomes in
  performance measures

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IADP EnhancementsFrom Our Current System into
the Future

• Descriptive metrics
• Assessment focus
• State administration
• Pass/fail criteria
• Forgotten purpose

• Objective measures
• All core functions
• Possible third party
• Range/tiered criteria
• Improvement purpose

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Key IADP Decisions To Date

• Retain current Illinois local public health
  performance standards
• Use NACCHOs Operational Definition to develop
  performance measures
• Criteria for analyzing structure options
• Criteria for effective performance measures

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Structural Elements of Enhanced
Certification/Accreditation in IL

• New relationship between mandatory certification
  and voluntary accreditation?
• Fix certification and enable lhds to choose
  beyond minimum mandatory measures
• Administration of the program
• Fair and equitable process
• Peer learning
• Training
• Governance of the program
• Decision-making process
• Meaningful evaluation
• Redevelop standards and measures over time

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Comment Periods

• Exploring Accreditation
• Consensus report available May 2006
• www.exploringaccreditation.org
• IL Accreditation Development Project
• LHD/BOH commentary process July-August 2006