Public Health Accreditation

2014 Illinois Local Health Department Accreditation Survey Report Results 

The report below is a result of a collaboration between Illinois Public Health Association (IPHA) and Illinois Public Health Institute (IPHI) to assess capacity and barriers for voluntary public health PHAB accreditation among local health departments (LHDs) in Illinois. IPHI worked with an advisory committee of local health department representatives with two LHDs per region in Illinois and surveyed all Illinois LHDs with an 84% response rate.

Public Health Accreditation Final Report – Illinois Local Health Department Accreditation Survey

Evaluation Questions

  1. Identify the health department with whom your Affiliate is working, the PHAB standard(s) and domain(s) that your project addresses, and which of the seven steps of the accreditation process your health department is working to achieve.

This project was carried out as collaboration between the Illinois Public Health Association (IPHA) and Illinois Public Health Institute (IPHI) to assess capacity and barriers for voluntary public health PHAB accreditation among local health departments (LHDs) in Illinois. IPHI worked with an advisory committee of local health department representatives with two LHDs per region in Illinois and surveyed all Illinois LHDs with an 84% response rate.  This project was not focused on working with one health department related to a specific PHAB standard or measure or step in the accreditation process.

  1. Summarize the project’s completed objectives and major accomplishments.

The objectives for this project were to assess staff capacity and barriers related to voluntary public health accreditation readiness and work to develop policy recommendations to help build capacity and obtain resources need for local health department accreditation in Illinois. This was accomplished through forming a project advisory committee of local health departments, conducting an online survey of Illinois local health departments and conducting key information interviews with state and national technical assistance organizations. Survey and interview results were summarized and presented to the advisory committee to solicit ideas for potential policy recommendations.  Ideas generated were summarized and shared with IPHA and distilled into 4 major categories as follows:

  1. IDPH needs to further define how the IPLAN/Accreditation Policy will be implemented.
  2. Identify funding to support accreditation through:
    1. New funding streams
    2. Attaching or increasing a fee to build resource pool
    3. Identifying existing or new funding that allows support for accreditation

Identify and secure funding to support LHDs with:

  1. PHAB Accreditation Fees
  2. LHD staff time to compile and prepare documentation for PHAB
  3. Provision of identified TA and training priorities and needs.
  4. Encourage IDPH and DHS to integrate PHAB standards and measures into all IDPH funded training.
    1. Develop training to be in alignment with guidance in PHAB and the standards and measures.
    2. Include related PHAB guidance, standards and measures in the training content and materials.
    3. Regardless of accreditation plans, this helps increase familiarity with national standards for implementation of the 10 essential services.
  5. Integrate PHAB Standards and Measures into IDPH and DHS Funding Opportunities
    1. Proactively integrate PHAB standards and measures into IDPH/DHS RFP language
    2. Ask applicants to describe how the proposed activities align with PHAB standards and measures
  1. Describe activities undertaken and the lessons learned from your Affiliate’s experience in preparing your health department for national accreditation.

Note: This project did not focus on preparing a health department for national accreditation but did study and explore what is needed to support Illinois LHDs through this process.

Through a process of online surveys and key informant interviews, this project aimed to collect information on staff capacity and barriers to accreditation for LHDs. These outcomes will be used to inform policy recommendations to promote accreditation among LHDs in Illinois.

The 84% response rate provides a diverse variety of viewpoints from LHDs in Illinois.  Results of this survey provided key insights on challenges faced by LHDs and perceived benefits and barriers. By asking each LHD to identify their accreditation status, it was possible to determine those who were accredited, those who had applied or were in the process of applying, those who were uncertain about applying and those who decided not to apply for accreditation. This categorization of the departments based on accreditation status provided insight into the differences between their needs and priorities.

A variety of reasons were identified by accredited health departments as motivators for accreditation, however, the most common were to establish high standards of performance, act as leader among health departments, and to have more opportunities to apply for funding and improve the likelihood of receiving additional grants and funds.

The most common challenges and barriers to pursuing accreditation identified by LHDs were limited staff time and resources, lack of funding to dedicate to the accreditation process, and PHAB application fees. Other issues identified as contributing to uncertainty or the decision to not apply were associated with difficulty in understanding the value and advantages of accreditation and unknown benefits or return on investment compared to the cost of the applying. Those who were uncertain about applying felt the least knowledgeable about the process and felt they needed more information in areas such as preparation of documents, prerequisites of the application and the process of submission.  Furthermore, some departments felt that their current Illinois LHD certification and their own programmatic evaluation standards were sufficient.

In order to identify which areas of the accreditation process were most problematic, respondents were asked to identify the PHAB Domains that they found to be the most difficult to complete. The most challenging domains were Domain 9 (Evaluate and continuously improve health department process, programs, and interventions), Domain 10 (Contribute to and apply evidence-based public health), Domain 8 (Maintain a competent public health workforce), Domain 11 (Maintain administrative and management capacity), Domain 7 (Promote strategies to improve access to care) and Domain 12 (Maintain capacity to engage the public health governing entity). There was also substantial interest in learning more about preparing for PHAB accreditation. Respondents revealed they would like to participate in activities such as webinars, regional training and consultation and classroom-style trainings on a variety of topics related specifically to PHAB standards, measures and guidance.

LHDs also provided information regarding financial and non-financial benefits that would help to increase their interest and their governing body’s interest in accreditation. A majority of this feedback was focused around increased funding, staff training, collaboration with other LHDs, quality improvement and recognition. Respondents stressed the need for understanding the benefits of accreditation, particularly the Return on Investment (ROI) given the in-depth time commitment and overall resource commitment to obtain go through the accreditation process and become accredited.  Overall, it was found that funding and limited resources were the main obstacles to accreditation with the need for increased understanding of ROI.

  1. If some intended activities were not carried out, please note them and explain why they were not pursued.

Local health departments were not included in the key information interviews since they were included in the advisory committee. Their feedback was utilized to develop a survey tool that addressed all the necessary areas of capacity and needs in pursuing accreditation. Fourteen key informant interviews were conducted and summarized in the PowerPoint presentations during the advisory committee meetings.

  1. Describe any new activities or modifications and why they were added since the initial proposal and/or the Interim Report.

There were no other activities added or modifications to the initial proposal.

  1. Describe any factors or circumstances (positive and/or barriers) within your environment affecting progress toward achieving goals either generally or as they relate to specific activities.

The major factor affecting the goal of assessing all local health departments in Illinois was the survey response rate. A response rate of 84% was achieved rather than the initial goal of 100% responses. Efforts were made to achieve a higher rate through reminder emails and phone calls to local health department administrators. In addition, a limited time frame was an additional barrier. The deadline for deliverables was June 30 2014; however, the policy recommendation process was carried into July due to the availability of the advisory committee members. Even though data was gathered in June, it was necessary to hold a second meeting in July to discuss policy recommendations due to vacation schedules of committee members.

  1. Discuss how APHA and CDC partnership was communicated to local partners and stakeholders.

The project was defined as a subcontract with IPHI from IPHA, the affiliate of APHA.  APHA was defined as the original funded entity through CDC support.

Future Plans

  1. Discuss next steps and the project activities you intend to pursue following the end of the grant period (June 30, 2014). Include in your discussion any new partnerships you are working to pursue.

The Illinois Public Health Institute will be collaborating with the Illinois Public Health Association, the University of Illinois at Chicago, and the Illinois Department of Public Health to discuss the results of the survey and work to advance policy recommendations aimed at building capacity, reducing barriers and providing support to local health departments in Illinois to have the necessary resources to pursue accreditation.

  1. Discuss plans for sustaining the momentum of your health department towards national accreditation beyond the grant period.

Based on the nature of this project, this question does not apply.


  1. Discuss strategies for disseminating your project’s success beyond APHA.

The results of this project and the survey report will be shared with all local health departments in Illinois as well as the Illinois Department of Public Health.  In addition, national partners (NNPHI, CDC, ASTHO, NACCHO and PHAB) and other key interview informants will receive the survey results and information on policy recommendations.





Accreditation Mock Review Collaborative

For the past several months, IPHI has been meeting monthly with a representative from Cook, Kendall and Clay County to develop a mock accreditation review process and tool to apply for mock surveys in each of the three health departments to increase their readiness to apply to PHAB.